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It is unclear whether similar patterns exist for aversive interoceptive stimuli. We compared activation in the insular cortex and other brain regions during the anticipation and experience of aversive stimuli between adolescents with SUD and those without.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross\u2010sectional experimental study with two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Adolescents (ages 15\u201317\u2009years) with an alcohol or marijuana SUD (<jats:italic>n<\/jats:italic>\u2009=\u200918) and healthy comparison subjects (CON, <jats:italic>n<\/jats:italic>\u2009=\u200915).\u2009Participants were recruited by distributing flyers at local high schools.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Keck Imaging Center, University of California San Diego, CA, USA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Behavioral and neural responses to a continuous performance task with inspiratory breathing load recorded during an fMRI session. Questionnaires assessed life\u2010time drug use, anxiety, sensation\u2010seeking, impulsivity, affect and bodily awareness. Visual analog scales assessed drug craving and breathing load responses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Across subjects, experience of breathing load elicited greater bilateral anterior and posterior insula (AI and PI, respectively) activation than anticipation (<jats:italic>F<\/jats:italic><jats:sub>(1,31)<\/jats:sub>\u2009=\u20094.16, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). SUD exhibited greater left AI and bilateral PI activation during breathing load than anticipation, compared\u2009with\u2009CON (<jats:italic>F<\/jats:italic><jats:sub>(1,31)<\/jats:sub>\u2009=\u20094.16, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). In contrast, CON showed greater activation during anticipation than breathing load in left PI, compared\u2009with\u2009SUD (<jats:italic>F<\/jats:italic><jats:sub>(1,31)<\/jats:sub>\u2009=\u20094.16, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adolescents with alcohol and marijuana substance use disorders may be hypersensitive to aversive interoceptive stimuli.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.13090","type":"journal-article","created":{"date-parts":[[2015,8,1]],"date-time":"2015-08-01T16:00:18Z","timestamp":1438444818000},"page":"2025-2036","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Under pressure: adolescent substance users show exaggerated neural processing of aversive interoceptive stimuli"],"prefix":"10.1111","volume":"110","author":[{"given":"Lotte","family":"Berk","sequence":"first","affiliation":[{"name":"University of California San Diego Department of Psychiatry  La Jolla CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer L.","family":"Stewart","sequence":"additional","affiliation":[{"name":"City University of New York Queens College Department of Psychology  New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"April C.","family":"May","sequence":"additional","affiliation":[{"name":"University of California San Diego Department of Psychiatry  La Jolla CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinout W.","family":"Wiers","sequence":"additional","affiliation":[{"name":"University of Amsterdam Developmental Psychology  Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul W.","family":"Davenport","sequence":"additional","affiliation":[{"name":"University of Florida Department of Physiology  Gainesville FL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin P.","family":"Paulus","sequence":"additional","affiliation":[{"name":"University of California San Diego Department of Psychiatry  La Jolla CA USA"},{"name":"Laureate Institute for Brain Research  Tulsa OK USA"},{"name":"Veterans Affairs San Diego Healthcare System  San Diego CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan F.","family":"Tapert","sequence":"additional","affiliation":[{"name":"University of California San Diego Department of Psychiatry  La Jolla CA USA"},{"name":"Veterans Affairs San Diego Healthcare System  San Diego CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,9,28]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"JohnstonL. 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