reduced interoceptive awareness previously linked to alcohol addiction (Çöl et al., 2016). Hypoconnectivity within the insula has been previously reported and hypothesized as playing a role in alcohol relapse because of a diminished awareness of substance use (Camchong et al., 2012). Another possible explanation for the observed hypo-connectivity is the known damage to white matter caused by alcohol (Pfefferbaum et al., 2000) which disrupts the anatomical connection between left insula and lingual gyrus (Ghaziri et al., 2015).The insula and the putamen are regions that has been previously associated with the brain reward system and with different directions of effects including loss of connectivity (Kuceyeski et al., 2013) and increased connectivity (Zhu et al., 2015). However, we could not confirm a link between putamen or insula connectivity changes and the AUDIT score, which might be due to small sample size and small AUDIT range in the DRN population. Our data suggests that connectivity of the reward system may go in different directions of effects where putamen connectivity increases due to a neuroplasticity mechanism, but insular connectivity decreases due to microstructural disruption of white matter.
