The capacity for insight into our internal world (encompassing interoception but extending to higher-order emotional, motivational and cognitive self-awareness) is partly dependent on the PFC. Given the impairments in PFC function in people with addiction reviewed above, it is possible that a restricted awareness of the extent of the behavioural impairment or of the need for treatment may underlie what has traditionally been ascribed to ‘denial’ in drug addiction — that is, the assumption that the addicted patient is able to fully grasp his or her deficits but chooses to ignore them may be erroneous. Indeed, studies have recently suggested that addicted individuals are not fully aware of the severity of their illness (that is, their drug seeking and taking behaviour and its consequences) and this may be associated with deficits in the control network139.
