, Volume 228, Issue 1, pp 143–155 | Cite as

Insula’s functional connectivity with ventromedial prefrontal cortex mediates the impact of trait alexithymia on state tobacco craving

  • Matthew T. SutherlandEmail author
  • Allison J. Carroll
  • Betty Jo Salmeron
  • Thomas J. Ross
  • Elliot A. Stein
Original Investigation



Alexithymia is a personality trait characterized by difficulty indentifying and describing subjective emotional experiences. Decreased aptitude in the perception, evaluation, and communication of affectively laden mental states has been associated with reduced emotion regulation, more severe drug craving in addicts, and structural/functional alterations in insula and anterior cingulate cortex (ACC). The insula and ACC represent sites of convergence between the putative neural substrates of alexithymia and those perpetuating cigarette smoking.


We examined the interrelations between alexithymia, tobacco craving, and insula/ACC neurocircuitry using resting-state functional connectivity (rsFC).


Overnight-deprived smokers (n = 24) and nonsmokers (n = 20) completed six neuroimaging assessments on different days both in the absence of, and following, varenicline and/or nicotine administration. In this secondary analysis of data from a larger study, we assessed trait alexithymia and state tobacco craving using self-reports and examined the rsFC of bilateral insular subregions (anterior, middle, posterior) and dorsal ACC.


Higher alexithymia in smokers predicted reduced rsFC strength between the right anterior insula (aI) and ventromedial prefrontal cortex (vmPFC). Higher alexithymia also predicted more severe tobacco craving during nicotine withdrawal. Critically, the identified aI–vmPFC circuit fully mediated this alexithymia–craving relation. That is, elevated alexithymia predicted decreased aI–vmPFC rsFC and, in turn, decreased aI–vmPFC rsFC predicted increased craving during withdrawal. A moderated mediation analysis indicated that this aI–vmPFC mediational effect was not observed following drug administration.


These results suggest that a weakened right aI–vmPFC functional circuit confers increased liability for tobacco craving during smoking abstinence. Individual differences in alexithymia and/or aI–vmPFC functional coupling may be relevant factors for smoking cessation success.


Alexithymia Craving Nicotine Varenicline Resting-state functional connectivity Insula Ventromedial prefrontal cortex fMRI 



This work was sponsored by the National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Department of Health and Human Services (NIDA-IRP/NIH/DHHS). We thank Eliscia Smith, Angela Neal, Kimberly Slater, Loretta Spurgeon, Anita Signau and the NIDA-IRP nurses, pharmacy, and recruitment staff for assistance with data collection.

Conflicts of interest

The authors declare no conflicts of interest.

Supplementary material

213_2013_3018_MOESM1_ESM.pdf (812 kb)
ESM 1 (PDF 812 KB)


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Copyright information

© Springer-Verlag Berlin Heidelberg (outside the USA) 2013

Authors and Affiliations

  • Matthew T. Sutherland
    • 1
    • 2
    • 3
    Email author
  • Allison J. Carroll
    • 2
  • Betty Jo Salmeron
    • 2
  • Thomas J. Ross
    • 2
  • Elliot A. Stein
    • 2
  1. 1.Department of PsychologyFlorida International UniversityMiamiUSA
  2. 2.Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, NIH/DHHSBaltimoreUSA
  3. 3.Department of PsychologyFlorida International University, Deuxieme MaisonMiamiUSA

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