Bringing Interoception Into the Clinical Setting of Alcohol Use Disorder

Abstract Background. Interoception is increasingly implicated in alcohol use disorder (AUD), yet clinical translation remains limited by construct conflation, dependence on cardiac tasks, and uncertainty about whether atypical bodily processing reflects a stable deficit or a context-sensitive process. Methods. This critical narrative review integrates AUD-specific behavioral, psychophysiological, neuroimaging, alcohol-administration, and intervention evidence using an explicit hierarchy that separates direct interoceptive measures from mechanistic and translational support. Results. Direct studies indicate that lower cardiac-task performance can coexist with heightened subjective bodily attention, while recent validity work shows that heartbeat-counting scores cannot be treated as pure indices of bodily-signal detection. Acute alcohol, stress-cue, and ambulatory findings further indicate that the behavioral significance of bodily signals depends on how they are generated, attributed, and linked to alcohol-related action. Conclusions. The central clinical proposition is not to increase bodily awareness indiscriminately, but to improve the detection, differentiation, attribution, and appraisal of bodily states within context. This signal-context-action framework generates testable hypotheses for assessment, relapse monitoring, and treatment matching within established AUD care