ArticleLiterature Review

Addiction, a condition of compulsive behaviour? Neuroimaging and neuropsychological evidence of inhibitory dysregulation

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Abstract

Addiction has been conceptualized as a shift from controlled experimentation to uncontrolled, compulsive patterns of use. Current neurobiological models of addiction emphasize changes within the brain's reward system, such that drugs of abuse 'hijack' this system and bias behaviour towards further drug use. While this model explains the involuntary nature of craving and the motivational drive to continue drug use, it does not explain fully why some addicted individuals are unable to control their drug use when faced with potentially disastrous consequences. In this review, we argue that such maladaptive and uncontrolled behaviour is underpinned by a failure of the brain's inhibitory control mechanisms. Relevant neuroimaging, neuropsychological and clinical studies are reviewed, along with data from our own research. The current literature suggests that in addition to the brain's reward system, two frontal cortical regions (anterior cingulate and orbitofrontal cortices), critical in inhibitory control over reward-related behaviour, are dysfunctional in addicted individuals. These same regions have been implicated in other compulsive conditions characterized by deficits in inhibitory control over maladaptive behaviours, such as obsessive-compulsive disorder. We propose that in chronically addicted individuals, maladaptive behaviours and high relapse rates may be better conceptualized as being 'compulsive' in nature as a result of dysfunction within inhibitory brain circuitry, particularly during symptomatic states. This model may help to explain why some addicts lose control over their drug use, and engage in repetitive self-destructive patterns of drug-seeking and drug-taking that takes place at the expense of other important activities. This model may also have clinical utility, as it allows for the adoption of treatments effective in other disorders of inhibitory dysregulation.

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... Therefore, obsessive-compulsive disorder (OCD), impulse control disorders (ICD) and substance-related disorders (SUD) overlap on various levels, including neurochemistry and neurocognition, phenomenology as comorbidity, neurocircuitry, as well as family biography. Lubman, Yucel and Pantelis, [3] suggested that malfunctional behaviours and high relapse rates in individuals suffering from chronic addictions, may be viewed as 'compulsive' activities which are a result of dysfunction within inhibitory brain circuits. This explanation may provide a rationale for why addicts tend to lose control over their drug use and persistently revert to self-destructive behaviors of drug-seeking and drug use, while sacrificing other essential activities in their lives [3]. ...
... Lubman, Yucel and Pantelis, [3] suggested that malfunctional behaviours and high relapse rates in individuals suffering from chronic addictions, may be viewed as 'compulsive' activities which are a result of dysfunction within inhibitory brain circuits. This explanation may provide a rationale for why addicts tend to lose control over their drug use and persistently revert to self-destructive behaviors of drug-seeking and drug use, while sacrificing other essential activities in their lives [3]. ...
... Lubman, Yucel and Pantelis, [3] claimed that although controlrelated cognitions have often been implicated in discourse related to Obsessive Compulsive Disorder (OCD), scientific inquiries related to the relationship between 'need of control' constructs and OCD symptoms are still insufficient (Lubman, Yucel and Pantelis, 2004). Moulding and Kyrios [5] found that higher levels of the desire to control and low levels of sense of control were associated with high levels of OCD-related beliefs and symptoms. ...
Article
Full-text available
As clinicians specializing in the treatment of patients who suffer from Obsessive Compulsive Disorder (OCD) and those suffering from other anxiety disorders, the Covid 19 pandemic had revealed surprising features of these patients' coping mechanisms. We observed that while the general population reported an increase in anxiety levels and associated symptoms, patients suffering from OCD reported less anxiety and stress than before the pandemic. While the feeling of uncertainty in almost all life domains was the predominating experience of the general population, OCD patients surprisingly reported experiencing a reduction in stress. As psychotherapists, we were fascinated by this phenomenon and attempted to investigate the origin of this paradox. In this paper, in order to contain the complexity of OCD in both the theory and practice of it's treatment, we present a two-track approach to the disorder involving the structures and mechanisms of addiction. People who suffer from OCD experience recurring, intruding sensations, thoughts, and ideas (obsessions) that make them feel impelled to conduct repetitive actions (compulsions) [1]. These repetitive cycles significantly interfere with the person's daily functioning as well as their social interactions. A lot of people experience preoccupation with troublesome recurring thoughts, as well as behaviours which they regularly repeat. However, these may contribute structure to their daily lives and some necessary functions require repeated actions in order for them to be more efficient such as brushing teeth before going to sleep and when waking up. On the contrary, the repetitive behaviors of OCD are distracting, non-functional and eventually elevate stress and tension even more. Most of us associate behaviours such as hand washing, cleaning, organizing, checking or counting our steps with OCD [1]. However, in fact, OCD can take a variety of forms, which are not always easy for people to recognize in themselves, nor are very obvious to the observer, thus making the phenomenon more difficult to identify, diagnose and treat at its early stages. According to Colon-Rivera and Howland [1], OCD develops from a strong sensation of anxiety aroused by recurring threatening thoughts [1]. Although for the observer, the conviction of the person suffering from OCD tends to appear unfounded, the person suffering from the disorder is convinced that the threat is very real, and possesses practical implications
... Therefore, obsessive-compulsive disorder (OCD), impulse control disorders (ICD) and substance-related disorders (SUD) overlap on various levels, including neurochemistry and neurocognition, phenomenology as comorbidity, neurocircuitry, as well as family biography. Lubman, Yucel and Pantelis, [3] suggested that malfunctional behaviours and high relapse rates in individuals suffering from chronic addictions, may be viewed as 'compulsive' activities which are a result of dysfunction within inhibitory brain circuits. This explanation may provide a rationale for why addicts tend to lose control over their drug use and persistently revert to self-destructive behaviors of drug-seeking and drug use, while sacrificing other essential activities in their lives [3]. ...
... Lubman, Yucel and Pantelis, [3] suggested that malfunctional behaviours and high relapse rates in individuals suffering from chronic addictions, may be viewed as 'compulsive' activities which are a result of dysfunction within inhibitory brain circuits. This explanation may provide a rationale for why addicts tend to lose control over their drug use and persistently revert to self-destructive behaviors of drug-seeking and drug use, while sacrificing other essential activities in their lives [3]. ...
... Lubman, Yucel and Pantelis, [3] claimed that although controlrelated cognitions have often been implicated in discourse related to Obsessive Compulsive Disorder (OCD), scientific inquiries related to the relationship between 'need of control' constructs and OCD symptoms are still insufficient (Lubman, Yucel and Pantelis, 2004). Moulding and Kyrios [5] found that higher levels of the desire to control and low levels of sense of control were associated with high levels of OCD-related beliefs and symptoms. ...
Article
Full-text available
As clinicians specializing in the treatment of patients who suffer from Obsessive Compulsive Disorder (OCD) and those suffering from other anxiety disorders, the Covid 19 pandemic had revealed surprising features of these patients' coping mechanisms. We observed that while the general population reported an increase in anxiety levels and associated symptoms, patients suffering from OCD reported less anxiety and stress than before the pandemic. While the feeling of uncertainty in almost all life domains was the predominating experience of the general population, OCD patients surprisingly reported experiencing a reduction in stress. As psychotherapists, we were fascinated by this phenomenon and attempted to investigate the origin of this paradox. In this paper, in order to contain the complexity of OCD in both the theory and practice of it's treatment, we present a two-track approach to the disorder involving the structures and mechanisms of addiction. People who suffer from OCD experience recurring, intruding sensations, thoughts, and ideas (obsessions) that make them feel impelled to conduct repetitive actions (compulsions) [1]. These repetitive cycles significantly interfere with the person's daily functioning as well as their social interactions. A lot of people experience preoccupation with troublesome recurring thoughts, as well as behaviours which they regularly repeat. However, these may contribute structure to their daily lives and some necessary functions require repeated actions in order for them to be more efficient such as brushing teeth before going to sleep and when waking up. On the contrary, the repetitive behaviors of OCD are distracting, non-functional and eventually elevate stress and tension even more. Most of us associate behaviours such as hand washing, cleaning, organizing, checking or counting our steps with OCD [1]. However, in fact, OCD can take a variety of forms, which are not always easy for people to recognize in themselves, nor are very obvious to the observer, thus making the phenomenon more difficult to identify, diagnose and treat at its early stages. According to Colon-Rivera and Howland [1], OCD develops from a strong sensation of anxiety aroused by recurring threatening thoughts [1]. Although for the observer, the conviction of the person suffering from OCD tends to appear unfounded, the person suffering from the disorder is convinced that the threat is very real, and possesses practical implications. In this process, internal conviction develops concerning actions which the person should conduct in order to prevent the realisation of the danger resulting from the threat [2]. Under the instruction of the OCD mechanism, the person develops a mystical belief in the efficiency of the compulsion dictated by the disorder, which it is necessary to conduct in order to reduce the danger in real occurrence, providing him with immediate relief. This results in an illusionary feeling of control over external occurrences which he believes to be very real. The person also possesses internal and absolute conviction that if he does not take the necessary action (compulsion), the likelihood that the worst scenario will soon occur is certain. This conviction is usually based upon his internal omnipotent thinking and the person suffering from the disorder can provide a rational explanation for the protocol of activities. The complexity of the structure and mechanisms of OCD requires a profound investigation into its etiological roots as well as the development and progress of the disorder. Moreover, many features
... At the cognitive level, the inhibition of non-optimal responses relies on inhibitory control, a "lower order" component of executive functions responsible for the regulation of attention, thoughts, or behaviors, according to internal and external stimuli [66][67][68][69]. Chronic drug use is associated with severe frontal and prefrontal cognitive dysfunctions which result in the inability to inhibit dominant behavioral responses activated by craving, which lead to the search and assumption of drugs [70][71][72]. Impairments in prefrontal activity are responsible for the onset and maintenance of substance dependence [70][71][72][73][74][75] and have been found in mothers with SUD also when observing infants displaying different emotional expressions [62,76]. ...
... Chronic drug use is associated with severe frontal and prefrontal cognitive dysfunctions which result in the inability to inhibit dominant behavioral responses activated by craving, which lead to the search and assumption of drugs [70][71][72]. Impairments in prefrontal activity are responsible for the onset and maintenance of substance dependence [70][71][72][73][74][75] and have been found in mothers with SUD also when observing infants displaying different emotional expressions [62,76]. ...
Article
Full-text available
Background Maternal substance use disorder (SUD) represents a risk condition for quality of parenting and child development. The current literature highlights the need to identify interventions that effectively enhance the quality of parenting and to better understand which mechanisms are involved in the process of change. The present study protocol describes a randomized wait-list controlled trial that aims to examine (1) the efficacy of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) in improving the quality of parenting (i.e., sensitive parenting and sensitive discipline) in mothers with SUD, (2) whether the intervention affects parental cognitive mechanisms (i.e., attentional disengagement to infant negative emotions, inhibitory control confronted with children’s affective expression, and parental reflective functioning), and (3) whether changes in these processes act as mechanisms of change, mediating the effect of the VIPP-SD program on quality of parenting. Moreover, the study aims (4) to explore whether the VIPP-SD has an effect on parenting stress and (5) to compare mothers with SUD to low-risk mothers on the outcome measures. Methods The study will involve 40 mothers with SUD and 20 low-risk mothers of children aged between 14 months and 6 years old. Mothers in the SUD group will be randomly divided into two groups, one receiving the intervention (SUD experimental group) and one undergoing treatment as usual (SUD control group). All the mothers will be assessed pre-test and post-test. Quality of parenting will be assessed through observed parenting behaviors, whereas parental cognitive mechanisms will be assessed through neuropsychological tasks and self-report measures. Discussion The results of the study will reveal whether an intervention that has been proven effective in other at-risk samples is also effective in improving parenting behaviors in the context of SUD. The results will also provide insight into potential cognitive mechanisms involved in the process of change. Trial registration ISRCTN registry ISRCTN63070968 . Registered on 25 June 2021. Retrospectively registered
... Cognitive deficits in the area of executive functioning (e.g. planning, reasoning, selfregulation, problem-solving) are particularly prevalent and negatively impact community functioning [4][5][6][7]. Executive functions are mediated by the frontal cortex, an area of the brain particularly affected by problematic substance use [8]. Since cognitive impairment can affect 50-80% of people seeking treatment for substance use problems [9,10], it is important for substance treatment settings to adapt to and address the cognitive health needs of their participants. ...
... There is good access to residents, who are usually in a live-in program for at least 6 weeks. The most common cognitive deficit observed in this population is executive function deficits, which are critical for transfer of treatment gains to real world functioning [4,5,35]. We found that even with an average of 13 sessions, there was a larger effect on executive functioning in the CR group. ...
Article
Introduction. There are high rates of cognitive impairment among people seeking treatment for problematic substance use, which is rarely addressed in treatment programs. The aim of this pilot study was to evaluate the feasibility and outcomes of the neuropsychological and educational approach to cognitive remediation (NEAR) in a residential substance treatment setting. Methods. A non-randomised trial conducted between November 2018 and November 2019, compared outcomes for 34 residents who received cognitive remediation (CR) plus treatment as usual (TAU) to 31 residents who received TAU only. Number of groups and attendance, and a measure of client satisfaction assessed feasibility. Cognitive function was assessed at baseline (service admission), and at 2 and 6 months post-admission. Results. A total of 95 CR groups were delivered over a 36-week time period with a high degree of treatment fidelity and acceptability to participants. Cognitive outcomes improved across both the CR+TAU and TAU groups by 2 months, which was maintained at 6 months for outcomes related to executive functioning. There were no significant differences between the CR+TAU and TAU groups at 2 or 6 months, although a large effect size and confidence intervals indicated a potentially larger change in cognitive flexibility after receiving CR. Discussion and Conclusions. This study contributes to our understanding of the implementation of CR in the alcohol and other drug rehabilitation setting. It is feasible to incorporate the NEAR program in treatment. The small sample size and lower than expected treatment dose likely contributed to the lack of significant findings. [Allan J, Thompson A, Carlyle M, Thomas M, Medalia A. Feasibility and pilot efficacy of cognitive remediation for people in residential substance use treatment. Drug Alcohol Rev 2021]
... It is likely that the mild persistent of MMT-induced locomotor sensitization in morphine-withdrawn rats and also, grooming behavior as a driver of drug-seeking behavior (Lubman, Yücel, & Pantelis, 2004) in turn may intensify drug craving and relapse in addicted individuals (Boileau et al., 2006). The observed behavioral dysfunction as a part of psychological dependence can increase the risk of relapse and drug-seeking after protracted abstinence (Lubman et al., 2004). ...
... It is likely that the mild persistent of MMT-induced locomotor sensitization in morphine-withdrawn rats and also, grooming behavior as a driver of drug-seeking behavior (Lubman, Yücel, & Pantelis, 2004) in turn may intensify drug craving and relapse in addicted individuals (Boileau et al., 2006). The observed behavioral dysfunction as a part of psychological dependence can increase the risk of relapse and drug-seeking after protracted abstinence (Lubman et al., 2004). ...
Article
Introduction: Previous studies have shown that physical and psychological dependence and the vulnerability to relapse are still present during MMT. Thus, this study examined whether Enriched Environment (EE) would attenuate anxiety, depressive, and obsessive-compulsive-like behaviors, as well as voluntary morphine consumption following Methadone Maintenance Treatment (MMT) in morphine withdrawn rats. Methods: The rats were injected bi-daily doses (10 mg/kg, 12-h interval) of morphine for 14 days. Then, the rats were reared in a Standard Environment (SE) or EE for 30 more days during morphine withdrawal, simultaneous with receiving MMT. The rats were tested for anxiety (the Elevated Plus Maze [EPM]) and depression (Sucrose Preference Test [SPT]), Obsessive-Compulsive Disorder (OCD) as grooming behavior, and voluntary morphine consumption using a Two-Bottle Choice (TBC) paradigm. Results: The findings revealed that EE experience in morphine withdrawn rats under MMT significantly increased the EPM open-arm time and higher sucrose preference than SE rats. Also, we found that the EE decreased the self-grooming behavior and morphine preference ratio in morphine withdrawn rats receiving MMT compared to the SE group. Conclusion: We conclude that exposure to EE decreased methadone-induced anxiety, depressive and OCD-like behaviors, and voluntary morphine consumption in morphine withdrawn rats under MMT. Thus, the EE seems to be one of the strategies for reducing MMT-induced behavioral dysfunction and the risk of relapse induced by morphine withdrawal.
... However, another aspect of inhibitory control is interference control, which requires selective attention and allows the suppression of all stimuli except the target stimulus. Impaired inhibitory control has been associated with drug abuse and implicated in the maintenance of drug dependence (Crews & Boettiger, 2009;Goldstein & Volkow, 2002;Lubman, Yücel, & Pantelis, 2004). On the Stroop task, a measure of interference control, poorer performance on Stroop interference has been found in college student binge drinkers, methamphetamine-dependent individuals, cocaine polysubstance users, and other illicit drug users relative to healthy controls (Hallgren & McCrady, 2013;Salo et al., 2002;Verdejo-García & Pérez-García, 2007;Lillis et al., 2012); the current study aims to identify if heavy MJ use during young adulthood is associated with similar deficits in interference control. ...
... ventral striatum, hipokampus, singulat korteks) benzer şekilde MKB tanılı hastalarda da bozulma gösterdiği bulunmuştur. 28 DEHB ve MKB'de görülen benzer nöroanatomik yapı hayvan modellerinde de desteklenmiş ve her iki grupta bazal ganglion bölgeler, ön ventrolateral ve singulat korteksde tepki ketlemesinde bozulmalar olduğu gösterilmiştir. 29 Bu bölgelerin işleyişlerindeki bireysel farklılıklar psikoaktif maddelerin kötüye kullanılma riskini etkileyebilmektedir. ...
Chapter
Dikkat Eksikliği ve Hiperaktivite Bozukluğu ile Madde Kullanım Bozukluğu Birlikteliği
... People low (vs. high) in trait self-control are poor in impulse control and report more deviant behavior and addiction (Lubman et al. 2004). Low trait self-control thus predisposes individuals to develop IT addiction. ...
Article
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The purpose of this study is to develop a research model using prior research and to investigate the influence of selfcontrol, time spent on Internet and relationship satisfaction on Internet addiction. The model includes the impact of self-control, the time spent on the Internet, and the relationship satisfaction on Internet addiction. We postulate that Internet addiction in its turn impacts academic success. The model was tested by using survey data and the results showed a relationship between self-control and time spent on Internet and Internet addiction. The study data did not support any significant connection between relationship satisfaction and the Internet addiction, as well as between Internet addiction and academic success.
... Among the psychological behavioral factors, novelty-seeking predicts the early onset of the use of tobacco and alcohol-drinking but not the more norm-breaking patterns of drunkenness or the use of drugs. Novelty-seeking is a heritable temperament factor, related to impulsivity and sensation-seeking, i.e., willingness to search for sensations, and found to represent an increased risk of adolescent substance use (Lubman et al., 2004). It has been found to be strongly related to alcohol problems in adults, especially those with early onset and rapid course, i.e., 'Type II alcoholism' (Cloninger et al., 1996). ...
Article
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Problem: Early onset, prevalence, and predictors of substance use – tobacco, alcohol-drinking, alcohol-drunkenness, and drugs – were studied in 13 and 14-year-old boys and girls in Sweden. Methods: Self-reported data in four communities were used (n = 1,716). A large set of psychological and social factors were tried as predictors of early onset use (n = 1,459). Results: There were few gender differ- ences and low prevalence. Primary predictor for early onset in tobacco use was availability; perceived parental approval for alcohol use, and delinquent behaviors for alcohol-drunkenness and drug use. Conclusions: Individual behavioral factors and parental norms seem to be most important in this age.
... Further, alcohol use disorder (AUD) is associated with lower alpha power in frontal regions during inhibitory control relative to healthy controls (Kaufman et al., 2003;Pandey et al., 2016). Despite the important role of IC in SUD and substance use treatment response (Lubman et al., 2004;Luijten et al., 2014), interventions for IC have yet to establish empirical support (Allom et al., 2016;Sofuoglu et al., 2013). The current findings suggest that further research testing the effect of alpha-tACS on IC is warranted. ...
Article
Background Deficits in inhibitory control (IC) and distress tolerance (DT) are associated with substance use disorders (SUD) and post-treatment return to substance use. Transcranial alternating current stimulation (tACS) modulates the neural oscillations that are associated with the cognitive and affective mechanisms contributing IC and DT. The aims of the current study were to examine the feasibility and acceptability of administering tACS in a community-based SUD treatment setting, and to test the effect of alpha-tACS on IC and DT. Method A double-blind, randomized, active sham-controlled trial of treatment-seeking adults with a SUD (N = 30, Meanage = 43.2 years, 70.0% male). Participants attended two sessions and completed computerized inhibitory control and distress tolerance tasks while receiving tACS targeting the bilateral dorsolateral prefrontal cortex (DLPFC). Participants received sham-tACS and were then randomized to receive sham-, alpha-, or gamma-tACS within 2-3 days. Results Treatment retention was 87%. Participant self-reported belief of having received tACS and mean side effect intensity ratings did not differ across conditions, with all side effect ratings in the absent to mild range. There was a large (d = 0.83) and significant effect of alpha-tACS on inhibitory control compared to sham-tACS (β = 1.78, SE = 0.65, 95% CI: 0.41, 3.14, p<0.01). There were no significant effects of condition on distress tolerance. Conclusions To our knowledge, this is the first study of tACS in people with SUD. Our findings provide preliminary evidence for recruitment, retention, and administration feasibility of tACS in a community-based substance use treatment program and a beneficial effect of alpha-tACS on inhibitory control.
... Over time the reward motivation associated with weight loss cues increases, and so the associated eating disorder behaviours become compulsive and are repeated despite aversive consequences, such as negative affect, social isolation, and poor physical health. Thus, these theoretical models highlight similarities between AN and addiction, both of which are considered to be disorders of compulsivity and share a number of characteristics such as obsessionality and preoccupation (Crane, Roberts, & Treasure, 2007;Fontenelle, Oostermeijer, Harrison, Pantelis, & Yücel, 2011;Lubman, Yücel, & Pantelis, 2004;Serpell, Livingstone, Neiderman, & Lask, 2002). ...
Article
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Background: Reward-centred models have proposed that anomalies in the basal ganglia circuitry that underlies reward learning and habit formation perpetuate anorexia nervosa (AN). The present study aimed to investigate the volume and shape of key basal ganglia regions, including the bilateral caudate, putamen, nucleus accumbens (NAcc), and globus pallidus in AN. Methods: The present study combined data from two existing studies resulting in a sample size of 46 women with AN and 56 age-matched healthy comparison (HC) women. Group differences in volume and shape of the regions of interest were examined. Within the AN group, the impact of eating disorder characteristics on volume and shape of the basal ganglia regions were also explored. Results: The shape analyses revealed inward deformations in the left caudate, right NAcc, and bilateral ventral and internus globus pallidus, and outward deformations in the right middle and posterior globus pallidus in the AN group. Conclusions: The present findings appear to fit with the theoretical models suggesting that there are alterations in the basal ganglia regions associated with habit formation and reward processing in AN. Further investigation of structural and functional connectivity of these regions in AN as well as their role in recovery would be of interest.
... There are numerous factors that may make it difficult for people to reduce or cease their drinking, and recent research suggests that these include learned associations between alcohol and related stimuli, which have a strong influence on behavior at a subconscious level. According to the highly influential incentive-sensitization model [6], repeated use of addictive drugs sensitizes the neural reward system, thereby strengthening the attention-grabbing and motivational properties of drugs and their associated cues [7]. Stimuli associated with drug use (such as physical and social contexts, sights, sounds, and scents) increasingly capture attention (ie, developing an "attentional bias" [8]), resulting in cue-induced cravings [9]. ...
Article
Background: Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to "avoid" alcohol-related images and "approach" neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app-delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. Objective: We aim to test the feasibility and acceptability of "SWIPE," a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. Methods: We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants' intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE's functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. Results: We expect to commence recruitment in August 2020 and complete data collection in March 2021. Conclusions: This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p. International registered report identifier (irrid): PRR1-10.2196/21278.
... Moreover, impaired cognitive control in AUD subjects is considered to be both a determinant and a consequence of addictive behaviors [10], and thereby contributes to difficulty in maintaining abstinence [11]. Another central concept in the current understanding of AUD is alcohol-cue reactivity [3,12,13]. It is thought to originate from classical conditioning during long-term problematic alcohol use [14] and can be assessed on behavioral, (neuro)physiological, and subjective levels. ...
Article
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Alcohol use disorder (AUD) is characterized by both impaired inhibitory control and heightened cue reactivity, including enhanced craving and drinking urges in response to alcohol-related stimuli. The interaction between these two mechanisms is thought to be crucial in the maintenance of addiction and relapse. The present study used a newly developed alcohol-related Go/NoGo-task to investigate how exposure to alcohol-related cues affects neural processing of inhibitory control in subjects with AUD. Functional magnetic resonance imaging (fMRI) was recorded during performance of a Go/NoGo task, which incorporated alcohol-related and neutral stimuli as Go and NoGo trials in abstinent AUD patients and healthy controls (HC). AUD patients exhibited increased activation of a fronto-striatal-parietal network during successful response inhibition relative to HC. Within the AUD group, activation for alcohol-related (relative to neutral) inhibition was enhanced in regions including bilateral anterior cingulate cortex (ACC), right medial frontal and precentral gyri, and right putamen. Activation differences in the right ACC increased with subjective craving. These preliminary findings suggest that AUD patients need to recruit enhanced neuronal resources for successful inhibition. In parts of the inhibitory network, this hyperactivation is enhanced when inhibition takes place in an alcohol-related context. Activation in the ACC increased stronger in patients experiencing high craving, possibly because of an enhanced conflict. The task introduced here thus allows to investigate neural processing of alcohol-related inhibition in an AUD sample. The preliminary results suggest that exposure to alcohol-related cues intensifies the demand on an already challenged inhibitory system in recently abstinent patients with AUD.
... Nutrients 2020, 12, 3563 2 of 22 eating behavior domain [10]. These symptoms include frequent and excessive cravings for rewarding food [11], associated with an urgency to relieve stress and negative affect; hypersensitivity to external cues signaling the rewarding food [12]; impulsivity [13] and disinhibition of eating restraint in response to the cues [14]; recurrent overeating past the point of satiety [15], and reduced inhibitory control over eating [16], despite being conscious to the adverse consequences of the behavior [17]. Individuals with these symptoms may experience binge-eating episodes, but many do not satisfy the diagnostic criteria for BED, such as eating binges that occur in a 2-h time window [18]. ...
Article
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Obesity is associated with food and eating addiction (FA), but the biobehavioral markers of this condition are poorly understood. To characterize FA, we recruited 18 healthy controls and overweight/obese adults with (n = 31) and without (n = 17) FA (H-C, FAOB, NFAOB, respectively) to assess alpha brain asymmetry at rest using electroencephalogram; event-related potentials following exposure to high-calorie food (HCF), low-calorie food (LCF), and nonfood (NF) images in a Stroop paradigm; reaction time reflective of the Stroop bias; and symptoms of depression and disordered eating behavior. The FAOB group had the greatest emotional and uncontrollable eating, depressive, and binge-eating symptoms. The FAOB group displayed lower resting left alpha brain asymmetry than that of the NFAOB group. Differently from the other groups, the FAOB group presented attenuated Stroop bias following exposure to HCF relative to NF images, as well as a lower late positive potential component (LPPb; 450-495 ms) in both frontal and occipital regions. In the total cohort, a correlation was found between the Stroop bias and the LPPb amplitude. These results point to biobehavioral hypervigilance in response to addictive food triggers in overweight/obese adults with FA. This resembles other addictive disorders but is absent in overweight/obesity without FA.
... Specifically, dysfunction in dorsolateral subregions of the prefrontal cortex (dlPFC), associated with impairments in executive control, is thought to contribute to impulsive, compulsive, inflexible, or stimulus-driven behaviors (Lubman et al., 2004;Simon et al., 2007;Garavan et al., 2008), including craving. Drug craving, the intense subjective urge to use drugs, predicts clinical outcomes such as drug use and the propensity to relapse in drug addicted individuals (Ludwig & Wikler, 1974;Weiss et al., 2003;Paliwal et al., 2008;Chaves et al., 2011). ...
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Impaired inhibitory control accompanied by enhanced salience attributed to drug-related cues, both dorsolateral prefrontal cortex (dlPFC) functions, are hallmarks of drug addiction, contributing to worse symptomatology including craving. dlPFC modulation with transcranial direct current stimulation (tDCS) showed craving reduction in inpatients with cocaine use disorder (CUD). Our study aimed at assessing feasibility of a longer tDCS protocol in CUD (15 vs. the common five/10 sessions), and replicability of previous results. In a randomized double-blind sham-controlled protocol, 17 inpatients were assigned to either a real-tDCS (right anodal/left cathodal) or a sham-tDCS condition, for 15 sessions. Primary outcome measures were self-reported craving, anxiety, depression, and quality of life. Secondary measures included sleepiness, readiness to change drug use, and affect. We also assessed cognitive function including impulsivity. An 82% retention rate demonstrated feasibility. Partially supporting previous results, there was a trend for self-reported craving to decrease in the real-tDCS group more than the sham group, an effect that would reach significance with 15 subjects per group. Quality of life and impulsivity improved over time of treatment in both groups. Significant group × time interactions showed improvements after treatment only in the real-tDCS group for daytime sleepiness and readiness to change drug use. One-month follow-up suggested transient effects of tDCS on sleepiness and craving. This study suggests that more subjects are needed to show a unique effect of real-tDCS on craving and to examine the duration of effect. Increased vigilance and motivation to change in the real-tDCS group suggest fortification of dlPFC-supported executive functions.
... Young smokers may become lifelong smokers which will make it difficult to quit smoking in the future. The failure of young smokers to quit smoking is probably related to inhibition control (Lubman et al., 2015). The weakening of the inhibition control ability may make them unable to control their desire to smoke leading to relapse. ...
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Decreased inhibition control ability and increased craving may be the most important causes of relapsing in smoking. Although inhibition control defects in young smokers were investigated, the effects of short-term abstinence on inhibition control in young smokers were still unclear. Thirty young smokers participated in the present study. The EEG signals during the Go/NoGo task were recorded in both satiety and 12 h abstinence conditions. The task performances were observed and compared between the two conditions. Event-related potential (ERP) analysis was used to investigate changes in N200 and P300 amplitude and latency induced by 12 h of abstinence. After 12 h of abstinence, the latency of N200 was prolonged in young smokers. No significant changes were found in the number of NoGo errors and the response time of Go in young smokers after 12 h of abstinence. Correlation analysis showed that the N200 latency of abstinence condition was significantly correlated with the number of NoGo errors and the response time of Go in the abstinence condition. The present findings may improve the understanding of the effect of short-term abstinence in young smokers. We suggested that the latency of N200 may be associated with inefficient inhibitory control of the abstinence condition in young smokers. Our results may contribute new insights into the neural mechanism of nicotine abstinence in young smokers.
... Substance use has been associated with long-term changes in cognitive function (i.e., higher-order skills responsible for selection, monitoring, and fine-tuning of goal-directed behavior) (Goldstein and Volkow, 2002;Lubman et al., 2004). Reasoning, which has been considered as one of the most important cognitive process (Fisher, 1951), is a form of thinking in which a person generalizes a general law in a specific situation or introduces a new conclusion based on existing judgments (Stanovich and West, 2000). ...
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The present study examined the relationship between substance use and reasoning in adolescents, and further investigated the modulation role of growth mindset on this relationship. A total of 1759 adolescents in China with substance use experience were investigated. The results showed that substance use (smoking, drinking, and illicit drug use) was negatively correlated with reasoning (r = −0.24 ∼−0.39, p < 0.01) and growth mindset (r = −0.18 ∼−0.32, p < 0.01). Regression analysis revealed that after controlling for the background variables (i.e., age, family annual income, and parents’ educational level), only illicit drug use was the significant predictor of reasoning (β = −0.325, t = −14.28, p < 0.001). The interaction effect between growth mindset and illicit drug use was also a significant predictor of reasoning (β = −0.067, t = −2.92, p = 0.004), indicating growth mindset modulated the relationship between illicit drug use and reasoning ability. Further analysis found that the negative correlation between frequency of illicit drug use and reasoning in high growth mindset group was weaker than that of low growth mindset group (F(3,1733) = 332.51, p < 0.001, f2 = 0.22). This suggests that growth mindset plays a significant moderating role in the relationship between substance use and reasoning. Overall, substance use has adverse effect on adolescent reasoning, however, growth mindset could reduce this adverse effect.
... It has been hypothesized that testosterone increases the propensity for aggression by reducing the orbitofrontal cortex (OFC) activity (Mehta and Beer, 2010). The OFC is a key region implicated in executive control and regulation (Kringelbach, 2005;Lubman et al., 2004;Volkow and Fowler, 2000), and dysfunction in this region is associated with aggression and violent behavior (Davidson et al., 2000), antisocial traits (Dolan and Park, 2002;Yang and Raine, 2009), substance use disorder (Volkow and Fowler, 2000;Winstanley, 2007) and conduct disorder (Itami and Uno, 2002;Rubia, 2011). Our research group has recently shown that dependent AAS users had thinner cortical thickness in orbitofrontal regions (Hauger et al., 2019b) and reduced executive functions, such as behavioral regulation (Hauger et al., 2020). ...
Article
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Background Anabolic androgenic steroid (AAS) use is associated with a wide range of adverse physical, psychological and social effects. While some experience few side effects, others might experience severe consequences. Aggression and violence are among the often-cited side effects associated with high-dose AAS use; however, most of the knowledge is generated from subgroups, such as prison populations. A likely hypothesis is that AAS use is associated with aggression and violence, but that these associations are complex and may be mediated by several factors, such as substance use, AAS dependence and personality traits. Methods In the present study, we tested this hypothesis by examining the relations between long-term AAS use and AAS dependence, aggression, interpersonal violence and potential mediating factors in a sample of male AAS exposed and non-exposed weightlifting controls (WLC), using self-report questionnaires. Based upon AAS dependence criteria, a sample of male AAS users and WLC (N = 139) were stratified into three groups: WLC (n = 66), AAS dependents (n = 41) and AAS non-dependents (n = 32). Results The results demonstrate that AAS dependents reported significantly higher levels of aggression compared to WLC and AAS non-dependents. While interpersonal violence was reported in all three groups, the highest percentage was found in the AAS dependent group. Conclusion In summary, our study confirms a link between AAS use, aggression and violence in a weightlifting population. However, the association is foremost seen in AAS dependent users and it seems that antisocial personality traits are an important mediator.
... These findings imply a close relationship between attentional allocation and response inhibition (e.g. Wilcockson & Pothos, 2015) and that addictive behaviours are associated with compromised inhibitory control (Dawe, Gullo, & Loxton, 2004;Klinger & Cox, 2004;Lubman, Yücel, & Pantelis, 2004;Olmstead, 2006;Wiers, Beckers, Houben, & Hofmann, 2009). One might conjecture that this inability to inhibit attention may manifest itself as an inability to control the consumption substances (e.g. ...
Article
Introduction Substance use causes attentional biases for substance-related stimuli. Both bottom-up (preferential processing) and top-down (inhibitory control) processes are involved in attentional biases. We explored these aspects of attentional bias by using dependent and non-dependent cigarette smokers in order to see whether these two groups would differ in terms of general inhibitory control, bottom-up attentional bias, and top-down attentional biases. This enables us to see whether consumption behaviour would affect these cognitive responses to smoking-related stimuli. Methods Smokers were categorised as either dependent (N=26) or non-dependent (N=34) smokers. A further group of non-smokers (N=32) were recruited to act as controls. Participants then completed a behavioural inhibition task with general stimuli, a smoking-related eye tracking version of the dot-probe task, and an eye-tracking inhibition task with smoking-related stimuli. Results Results indicated that dependent smokers had decreased inhibition and increased attentional bias for smoking-related stimuli (and not control stimuli). By contrast, a decreased inhibition for smoking-related stimuli (in comparison to control stimuli) was not observed for non-dependent smokers. Conclusions Preferential processing of substance-related stimuli may indicate usage of a substance, whereas poor inhibitory control for substance-related stimuli may only emerge if dependence develops. The results suggest that how people engage with substance abuse is important for top-down attentional biases.
... Deficits in inhibitory control mechanisms, which are responsible for suppressing inappropriate actions, cause "loss of control." Preexisting deficits may confer vulnerability to addictive behavior and/or deficits may emerge from continued drug use or palatable food overconsumption (Chen et al., 2013;Lubman, Yucel, & Pantelis, 2004;Volkow et al., 2013a). Compulsivity and impulsivity are two highly interrelated behaviors, both interpreted as resulting from failure of inhibitory "top-down" control mechanisms (Dalley, Everitt, & Robbins, 2011). ...
Chapter
Forms of obesity, eating disorders, and the recently defined construct of food addiction are all characterized by compulsive eating behavior. Compulsive eating behavior can be deconstructed into three major elements, similar to the conceptualization of compulsive drug use in addiction: (1) habitual overeating, (2) overeating to relieve a negative emotional state, and (3) overeating despite aversive consequences. These elements arise from dysfunctions in three distinct, but overlapping, psychobiological processes, i.e., habit formation, negative emotional states, and behavioral control. The major neurobiological systems that underlie these processes comprise of the basal ganglia, the extended amygdala, and the prefrontal cortex: neuroadaptations occurring in these systems can result in compulsive eating behaviors. The focus of this chapter is to review studies on compulsive eating behavior, as well as relevant research into compulsive drug use, and to describe the underlying neuropharmacology and neurobiological systems involved.
... Throughout, we detail pertinent data addressing the contributions of interconnected meso-cortico-limbic-striatal structures to risky decision-making (Fig. 2). This focus on structures interconnected with the midbrain dopamine (DA) system arises from the well-established link between DA dysfunction and psychiatric illnesses characterized by maladaptive risk-seeking behavior (e.g., SUDs) (Feil et al., 2010;Lubman et al., 2004;Volkow and Morales, 2015). We refer the reader to excellent recent reviews that address relevant regions and transmitter systems not discussed here (Jean-Richard-Dit- Bressel et al., 2018;. ...
Article
The risk of an aversive consequence occurring as the result of a reward‐seeking action can have a profound effect on subsequent behavior. Such aversive events can be described as punishers, as they decrease the probability that the same action will be produced again in the future and increase the exploration of less risky alternatives. Punishment can involve the omission of an expected rewarding event (‘negative’ punishment) or the addition of an unpleasant event (‘positive’ punishment). Although many individuals adaptively navigate situations associated with the risk of negative or positive punishment, those suffering from substance use disorders or behavioral addictions tend to be less able to curtail addictive behaviors despite the aversive consequences associated with them. Here, we discuss the psychological processes underpinning reward seeking despite the risk of negative and positive punishment and consider how behavioral assays in animals have been employed to provide insights into the neural mechanisms underlying addictive disorders. We then review the critical contributions of dopamine signaling to punishment learning and risky reward seeking, and address the roles of interconnected ventral striatal, cortical, and amygdala regions to these processes. We conclude by discussing the ample opportunities for future study to clarify critical gaps in the literature, particularly as related to delineating neural contributions to distinct phases of the risky decision‐making process.
... In particular, the orbitofrontal cortex (OFC) contributes to the representation of reward and punishment, and inhibitory control. Therefore, dysfunction of the OFC is associated with deficiency in the function of response inhibition and impaired decisionmaking [70][71][72][73] . ...
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This study investigated attentional bias toward game-related cues in Internet gaming disorder (IGD) using electrophysiological markers of late positive potential (LPP) and identifying the sources of LPP. In addition, the association between LPP and decision-making ability was investigated. The IGD (n = 40) and healthy control (HC; n = 39) participants viewed a series of game-related and neutral pictures, while their event-related potentials (ERPs) were recorded. LPPs were calculated as the mean amplitudes between 400 and 700 ms at the centro-parietal (CP3, CP1, Cpz, CP2, and CP4) and parietal (P3, P1, Pz, P2, and P4) electrode sites. The source activations of LPP were estimated using standardized low-resolution brain electromagnetic tomography (sLORETA). In addition, decision-making ability was evaluated by the Cambridge Gambling Task. Higher LPP amplitudes were found for game-related cues in the IGD group than in the HC group. sLORETA showed that the IGD group was more active in the superior and middle temporal gyri, which are involved in social perception, than in the HC group, whereas it was less active in the frontal area. Individuals with IGD have deficits in decision-making ability. In addition, in the HC group, the lower the LPP when looking at the game-related stimuli, the better the quality of decision-making, but not in the IGD group. Enhanced LPP amplitudes are associated with emotional arousal to gaming cues and decision-making deficits in IGD. In addition, source activities suggest that patients with IGD perceive game-related cues as social stimuli. LPP can be used as a neurophysiological marker of IGD.
... the limbic system in the incentive-sensitisation of drugs 7 and the prefrontal circuitry (PFC) 4,[8][9][10] in regulating control over drug seeking behaviours. These cortical structures do not act in isolation, but rather, they recruit an interconnected network of brain regions. ...
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Although previous research in alcohol dependent populations identified alterations within local structures of the addiction 'reward' circuitry, there is limited research into global features of this network, especially in early recovery. Transcranial magnetic stimulation (TMS) is capable of non-invasively perturbing the brain network while electroencephalography (EEG) measures the network response. The current study is the first to apply a TMS inhibitory paradigm while utilising network science (graph theory) to quantify network anomalies associated with alcohol dependence. Eleven individuals with alcohol-dependence (ALD) in early recovery and 16 healthy controls (HC) were administered 75 single pulses and 75 paired-pulses (inhibitory paradigm) to both the left and right prefrontal cortex (PFC). For each participant, Pearson cross-correlation was applied to the EEG data and correlation matrices constructed. Global network measures (mean degree, clustering coefficient, local efficiency and global efficiency) were extracted for comparison between groups. Following administration of the inhibitory paired-pulse TMS to the left PFC, the ALD group exhibited altered mean degree, clustering coefficient, local efficiency and global efficiency compared to HC. Decreases in local efficiency increased the prediction of being in the ALD group, while all network metrics (following paired-pulse left TMS) were able to adequately discriminate between the groups. In the ALD group, reduced mean degree and global clustering was associated with increased severity of past alcohol use. Our study provides preliminary evidence of altered network topology in patients with alcohol dependence in early recovery. Network anomalies were predictive of high alcohol use and correlated with clinical features of alcohol dependence. Further research using this novel brain mapping technique may identify useful network biomarkers of alcohol dependence and recovery.
... According to the "incentive-sensitization" model [10], repeated use of addictive drugs sensitizes the neural reward system, strengthening the attention-grabbing and motivational properties of alcohol and its associated cues [11] (such as physical and social contexts, sights, sounds, scents), leading to "attentional bias" [12] toward these cues and cue-induced craving [13]. This also leads to the development of "approach bias" (the automatic, impulsive action tendency to approach alcohol-related cues) [12]. ...
... In a review study, Figee et al. (2016) point to the following processes that underlie compulsivity in obsessive compulsive disorders and drug and behavioral addictions: impaired reward and punishment processing, cognitive and behavioral inflexibility, and habitual responding regardless of its consequences. Lubman et al. (2004) provide neuropsychological evidence of deficient inhibitory control over maladaptive behavior seen in both addictions and obsessive-compulsive disorders. Albertella et al. (2019), assume that interindividual differences in attentional capture by reward-related cues, i. e. the ability of reward or safety signals to acquire incentive salience for persons and to elicit behavioral responses in those persons, may explain proneness to compulsive behaviors. ...
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Internet addiction has gained increased scientific attention during the last decades. However, theoretical models explaining mechanisms underlying Internet addiction are scarce, impeding further development of prevention and treatment approaches. In the present study, we applied the principles of Rational Emotive and Cognitive Behavior Therapy (RE&CBT) to gain insight into relevant predictors of Internet addiction. We hypothesized that irrational beliefs are positively, and rational beliefs negatively related to Internet addiction, and that these relationships are mediated by psychopathological tendencies. A sample of 300 adolescents (151 girls and 149 boys, age range 15–18 years, M = 16. 21, SD = 1. 03) completed the following questionnaires: Internet Addiction Test, Serbian Version of the General Attitude and Belief scale, and Symptom Checklist-90-Revised. Irrational beliefs were positively correlated with Internet addiction, while rational beliefs were unrelated to Internet addiction. The relationship between irrational beliefs and Internet addiction was partially mediated through phobic anxiety and obsessive–compulsive tendencies. The results suggest that the RE&CBT approach might be useful in the prevention and treatment of Internet addiction.
... These findings indicate that the BWAS includes somewhat compulsive aspects of working behavior. In the literature, evidence has increasingly indicated the importance of the inhibitory system in the brain for compulsive behavior of drug addiction (Lubman et al., 2004). However, inhibitory dysregulation in behavioral addictions remains unclear. ...
Article
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The aim of the present study was to examine the psychometric properties of the Turkish version of the Bergen Work Addiction Scale (BWAS-T). The study sample comprised 448 participants (279 females and 169 males) who completed a survey including the BWAS-T, Workaholism Battery (WorkBAT), Dutch Work Addiction Scale (DUWAS), and Depression Anxiety Stress Scales (DASS). The Turkish version of BWAS had good internal consistency (Cronbach’s α = .76). As expected, score on the BWAS-T was positively correlated with scores on the Drive subscale of the WorkBAT and Working Excessively and Working Compulsively subscales of the DUWAS. No relationship was found between the BWAS-T and Work Enjoyment subscale of the WorkBAT. Regarding concurrent validity, scores on the BWAS-T were strongly correlated with those on the DASS and its subscales. The factor structure of the BWAS-T was also tested using confirmatory factor analysis which found support for the original unidimensional factor structure. Results demonstrated that the reliability and validity of the Turkish version of the BWAS were robust. Limitations and recommendations for further studies are discussed.
... According to the "incentive-sensitization" model [10], repeated use of addictive drugs sensitizes the neural reward system, strengthening the attention-grabbing and motivational properties of alcohol and its associated cues [11] (such as physical and social contexts, sights, sounds, scents), leading to "attentional bias" [12] toward these cues and cue-induced craving [13]. This also leads to the development of "approach bias" (the automatic, impulsive action tendency to approach alcohol-related cues) [12]. ...
Article
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Background Approach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. Objective We examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use. Methods In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. Results We recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2% (409/1309) completed ≥8 sessions; and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001). Conclusions The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID) RR2-10.2196/21278
... Despite this gap in cognitive treatment, nowadays several candidate target functions for cognitive training are being studied, based on the most documented impairments of gambling disease, that is mainly inhibitory control (Bari & Robbins, 2013;Lubman et al., 2004;Morein-Zamir & Robbins, 2015;Verdejo-Garcia, 2016), DM (Kovács et al., 2017), and metacognition (Gehlenborg et al., 2021). ...
Chapter
Currently, cognitive neuroscience and innovation technology provide various tools that can be used both for cognitive rehabilitation and for functional neuroenhancement of executive functions (EFs) in the context of addiction, such as computer-based cognitive training, non-invasive brain stimulation through neuromodulation techniques and other promising tools such as serious games and virtual reality-based approaches. The most common cognitive training adopted in substance use disorder can be clustered in two classes and has been here described in parallel with their neurocognitive findings: Cognitive Bias Modification and response inhibition training, which have shown to operate via reorientation of stimulus–action approach biases and rewiring of the medial Prefrontal Cortex (PFC) and the amygdala; Working Memory and Goal Management interventions, which have been associated with improvements in stimulus–outcome representations, for example, increased future-based delay-discounting and decision-making, and rewiring of the dorsolateral and ventral PFC. The use and efficacy data of these four cognitive training programmes in behavioural addictions are still missing. The combination of various neuroscience-informed interventions that synergistically tap into bottom-up versus top-down cognitive processes, together with phenotype-matched cognitive approaches for precision medicine, are two intriguing emerging approaches for finding the best way to empower EFs in addiction.
... Lors de cette phase, se mettent en place les automatismes de consommation, véritable procéduralisation qui va renforcer les phénomènes de craving face à des stimuli liés directement ou indirectement à l'alcool (Lubman et al., 2004), ce qui est en faveur du rôle de l'hypothèse H2. Cette bascule se fait aussi sous le contrôle des différentes parties du striatum (Balleine et al., 2007;Yager et al., 2015). ...
Thesis
Le trouble de l’usage d’alcool (TUAL) est fortement associé à l’impulsivité, un concept multi-déterminé, difficile à circonscrire. Le modèle triadique postule l’existence, dans l’addiction, de trois systèmes cérébraux distincts mais en interaction. Dans ce modèle, l’impulsivité et les émotions, le fonctionnement cognitif et notamment exécutif, ainsi que le craving jouent des rôles clés. Des outils thérapeutiques innovants comme l’activité physique adaptée pourraient cibler l’ensemble de ces dimensions. L’objectif de ce travail de thèse était de mieux comprendre les substrats psychologiques, neuropsychologiques et cérébraux de l’impulsivité dans le TUAL sévère afin de proposer de nouvelles perspectives de prise en soins. Les résultats de ce travail de thèse montrent que dans le TUAL sévère, l'impulsivité évaluée par questionnaires était liée à l’état psychoaffectif des patients plutôt qu’à leur fonctionnement exécutif, et spécifiquement liée à l’intégrité structurelle du système impulsif (noyau accumbens). L’activité physique adaptée a confirmé sa faisabilité et son acceptabilité comme traitement adjuvant chez des patients TUAL sévère hospitalisés, avec une efficacité spécifique sur la réduction de l’anxiété et de l'impulsivité. Dans l'ensemble ces résultats semblent conforter le modèle triadique et incitent à le faire évoluer, notamment en considérant les relations impulsivité-compulsivité. Des pistes sont proposées pour une nouvelle modélisation et opérationnalisation de l’impulsivité dans le TUAL. L’activité physique apparaît prometteuse pour agir sur les déterminants du TUAL comme l’impulsivité.
... Despite this gap in cognitive treatment, nowadays several candidate target functions for cognitive training are being studied, based on the most documented impairments of gambling disease, that is mainly inhibitory control (Bari & Robbins, 2013;Lubman et al., 2004;Morein-Zamir & Robbins, 2015;Verdejo-Garcia, 2016), DM (Kovács et al., 2017), and metacognition (Gehlenborg et al., 2021). ...
Chapter
Addiction is a chronic relapsing disorder. Despite pharmacological and psychological interventions during rehabilitation, a majority of patients still relapse. In this seventh chapter, we present neuromodulation techniques as a complementary intervention for addiction. Firstly, while deep brain stimulation (DBS) has shown promising results, its cost–benefit–risk ratio is nonetheless too high to be implemented in routine clinical care. Secondly, repeated transcranial magnetic stimulation (rTMS) and transcranial direct courant stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) have shown reduced craving and relapses, but the results are mixed. To improve efficacy, new perspectives envisioned that the insula could be a promising target for rTMS and DBS in combination with cognitive remediation and while participants are exposed to key conditioned stimuli. Additionally, neurofeedback could be a useful tool in teaching patients to actively regulate their neural activity, although better controlled experimental designs and rigorous measures of brain changes are needed. Despite the heterogeneity of studies, neuromodulation techniques as complementary tools to conventional care seem to constitute a turning point in the management of addictions.
... Therefore, according to these theories, addiction is a rational choice made by individuals in favor of the benefits of the addictive behavior over the costs. The Inhibition dysfunction theories suggest that addiction is an ongoing dysregulation of the ability to inhibit a rewarded behavior due to impairment of impulse controlling mechanisms [63]. In other words, addiction involves impairment of the inhibitory system of the brain regions related to features of response selection, inhibition, and motivation of compulsive behaviors associated with drugs. ...
Chapter
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A considerable body of research has accumulated over several decades and altered the current understanding of substance use and its effects on the brain. This knowledge has improved the perception of the disease of addiction and has opened the door to new ways of thinking about diagnosis, prevention, and treatment of substance use disorders. The purpose of the current chapter is to briefly outline and summarize the major psychopharmacological framework underlying substance use disorder (SUD) and the factors that involve in the transformation of some people from recreational use or misuse of alcohol or drugs to SUD. The chapter explains the overall neurocircuitry theories of the addiction cycle: binge/ intoxication, withdrawal/negative affect, and preoccupation/anticipation. It briefly discusses how psychoactive substances produce changes in brain functioning that facilitate the development of addiction and contribute to craving which eventually leads to relapse. The chapter also deals with similarities and differences among various classes of addictive substances in their effects on the brain and behavior and briefly describes the main risk factors that involve SUD. Finally, an attempt is made to briefly discuss the major DSM 5 based behavioral criteria that involve SUD, corresponding to the most abused substances worldwide.
... The areas identified here (DLPFC, dACC and anterior insulae) are known to play a role in executive functions and different strategies and goals of emotion regulation and cognitive reward control. 17,31,[38][39][40] Previous studies found the dACC to be involved in cognitive reappraisal and cognitive modulation of emotion as well as in quitting motivated smokers when instructed to actively suppress their urge for cigarettes. 41,42 These results suggest that dACC activation represents an important substrate of inhibition of cue-induced craving in smokers. ...
Article
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Aversive drug cues can be used to support smoking cessation and create awareness of negative health consequences of smoking. Better understanding of the effects of aversive drug cues on craving and the processing of appetitive drug cues in abstinence motivated smokers is important to further improve their use in cessation therapy and smoking-related public health measures. In this study, 38 quitting motivated smokers underwent functional magnetic resonance imaging (fMRI) scanning while performing a novel extended cue-reactivity paradigm. Pictures of cigarettes served as appetitive drug cues, which were preceded by either aversive drug cues (e.g., smokers' leg) or other cues (neutral or alternative reward cues). Participants were instructed to rate their craving for cigarettes after presentation of drug cues. When aversive drug cues preceded the presentation of appetitive drug cues, behavioural craving was reduced and activations in prefrontal (dorsolateral prefrontal cortex) and paralimbic (dorsal anterior cingulate cortex [dACC] and anterior insulae) areas were enhanced. A positive association between behavioural craving reduction and neurofunctional activation changes was shown for the right dACC. Our results suggest that aversive drug cues have an impact on the processing of appetitive drug cues, both on a neurofunctional and a behavioural level. A proposed model states that aversive drug-related cues activate control-associated brain areas (e.g., dACC), leading to increased inhibitory control on reward-associated brain areas (e.g., putamen) and a reduction in subjective cravings.
... The ability to exert control over behavioural urges or unhelpful thoughts plays a key role in mental health and wellbeing (Aron, 2007;Aron et al., 2003;Bari & Robbins, 2013;Barkley, 1997;Chamberlain et al., 2005). Impairment in this ability, inhibitory control, is also a core feature of many neurological conditions and mental illnesses characterised by intrusive thoughts and behavioural impulsivity, such as obsessive compulsive disorder (OCD) (Berlin & Lee, 2018;Chamberlain et al., 2005;Lipszyc & Schachar, 2010), substance and behavioural addictions (Lubman et al., 2004;Luijten et al., 2014;Smith et al., 2014a, b;, Parkinson's disease (Obeso et al., 2011), and attention deficit hyperactivity disorder (ADHD) (Lipszyc & Schachar, 2010). Currently there are no interventions that effectively and directly enhance inhibitory control. ...
Article
While strong inhibitory control is critical for health and wellbeing, there are no broadly applicable effective behavioural interventions that enhance it. This meta-analysis examined the neurocognitive rationale for combined physical and cognitive training and synthesised the rapidly growing body of evidence examining combined paradigms to enhance inhibitory control. Across the research to date, there was a small positive effect (n studies = 16, n participants = 832) of combined training on improving inhibitory control. Sub-group analyses showed small-moderate positive effects when the physical component of the combined training was moderately intense, as opposed to low or vigorous intensities; moderate positive effects were found in older adults, as compared to adolescents and adults; and healthy individuals and those with vascular cognitive impairment, as compared to ADHD, ASD, mild cognitive impairment and cancer survivors. This is the first meta-analysis to provide evidence that combined physical, specifically when moderately intense, and cognitive training has the capacity to improve inhibitory control, particularly when delivered to healthy individuals and those experiencing age-related decline.
... Typically, CBM involves training to approach a nondrug cue and avoid a drug cue with a motor response such as the movement of a joystick. Given the role of top-down neural circuits involved in inhibitory control of behavioral urges [99], targeting these circuits by cognitive training or remediation is a mechanism-based approach to the treatment of SUDs. However, findings regarding the efficacy of CBM are inconclusive, with a recent meta-analysis of individuals with alcohol and/or nicotine use disorders demonstrating a moderate effect of CBM on the cognitive bias but no effect on substance use or craving [100]. ...
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Purpose of Review To provide an overview of the state of translational substance use disorder (SUD) research by evaluating the extent to which psychosocial interventions target neurobiological processes known to contribute to the maintenance of SUD. Recent Findings A limited number of studies have investigated neurobiological mechanisms of action for commonly utilized SUD treatment approaches. Restrictive samples, post-treatment-only designs, and failure to include substance use outcomes significantly limit the interpretation of these findings. Summary Much work is needed to bridge the translational gap between neuroscience and psychosocial treatment research for SUD. Despite existing gaps, addiction neuroscience is highly relevant to SUD assessment, case conceptualization, and treatment. Implications are discussed in addition to suggestions for future research.
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Introduction Cognitive biases (among them attentional bias, AB) are considered an important factor in the development, maintenance, and recurrence of addiction. However, traditional paradigms to measure AB have been criticized regarding external validity and methodical issues. Therefore, and because the neurophysiological correlates of anti-saccade tasks are known, we implemented a novel smoking anti-saccade task in virtual reality (VR) to measure AB and inhibitory control in different contexts and with higher ecological validity. Methods Smokers (n = 20) and non-smokers (n = 20) were tested on a classic pro- and anti-saccade task, a VR anti-saccade task and a VR attention fixation task (all containing smoking-related and neutral stimuli) while eye-tracking data was collected. Two VR contexts (park and office room) were applied Results Saccade latencies were significantly higher for the smoking group in the VR anti-saccade task. However, this effect did not differ between smoking-related and neutral stimuli, thus overall no AB was observed. Instead, AB was only present in the park context. Additionally, saccade latencies and error rates were significantly higher in the park context Conclusions Results indicate impaired inhibitory control in smokers relative to non-smokers. The lack of evidence for a general AB might be due to the lower severity of smoking dependence in the smoking sample. Instead, results suggest context specificity of AB. Implications for smoking cessation interventions in the field of inhibitory control training and attention bias modification are discussed.
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Background Approximately half of the substance dependence treatment population is estimated to have a cognitive impairment, which reduces participation, retention, and post-treatment outcomes. Cognitive behaviour change approaches are less effective for this population and cognitive remediation strategies have been found to improve outcomes. Evidence on modified programs to remove environmental barriers for treatment seekers with disability does not exist. Objective A modified residential substance misuse treatment program in New South Wales, Australia was piloted and evaluated to address this knowledge gap. Method Of 67 residents who received treatment during the evaluation period, 33 were screened as having cognitive impairment. Twelve residents took part in an interview and 10 staff in a focus group to understand their views of the pilot program. Resident characteristics and retention rates and themes about program benefits and challenges are reported. Results Treatment completion was up to 5 times higher for residents with cognitive impairment after the new program was implemented. The pilot program provided simplified written and visual materials and concrete examples and introduced a daily virtues program to embed new learning and support behaviour change. Resources to allow staff to engage more intensively with residents and provision of ongoing staff training were viewed as essential for program success. Conclusions Environmental adaptations, including a combination of conventional treatment modalities with accessible design and person-centred principles, removed barriers to treatment for residents with cognitive impairment. Creating a climate where respect, tolerance and peer support were normalised was likely to have been particularly beneficial for these residents.
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The present study aims at providing electrophysiological evidence for deficient inhibitory control in problematic mobile phone use and at investigating whether reduced inhibition is more pronounced during exposure to a mobile phone related background cue. A screen scale of smartphone addiction was completed by 227 college students, and finally an experimental group and a control group consisting of 20 problematic mobile phone users and 19 controls were included in the study. Event-related potentials were recorded during a backgrounded Go/NoGo task performed by those two groups, in which either a frequent Go signal (letter ‘‘M”) or a rare NoGo signal (letter ‘‘W”) was superimposed on three different background cues: neutral, mobile phone application-related and mobile phone using-related pictures. Results showed that problematic mobile phone users performed more commission errors than controls following mobile phone application background. Furthermore, problematic mobile phone users displayed a weaker NoGo P3 amplitude than controls on the mobile phone application background. The result might suggest that there is no general impairment of inhibitory control in problematic mobile phone use. The deficient inhibitory control in behavioral and psychophysiological level appeared merely in mobile phone related background. Such deficient stimuli-specific inhibitory control appears at the late stage of inhibitory control. Prevention programs should be designed to curtail exposure to mobile phone related stimulus and enhance cognitive control of potential problematic mobile phone users.
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Impulsivity and emotion dysregulation have been known to be risk factors for Internet gaming disorder (IGD), but their underlying neural mechanisms are not yet fully understood. Given that the prefrontal cortex has a key role in higher order cognition and addiction, the present study aimed to investigate emotional influences on response inhibition in situations with different cognitive demands. A total of 41 young male adults (20 with and 21 without IGD) were scanned while performing two versions of an emotional go/no‐go task with demands on low and high working memory load. Patients with IGD showed a failure in response inhibition and increased activation of widespread brain regions, including prefrontal, motor‐sensory, parietal, occipital, insula, and striatal regions across tasks. Among these regions, involvement of the dorsolateral prefrontal cortex and ventral striatum was observed only during the task with high demands on working memory. Moreover, it was also only during the high‐load task that interaction between response inhibition and emotional states was observed in the dorsomedial prefrontal cortex, with observations revealing that its alteration in patients with IGD was associated with number of hours spent on Internet gaming. Our findings highlight a failure of response inhibition and dysfunction within the inhibitory control network. The special significance of our study is that dysfunctional dorsomedial prefrontal cortex may mediate abnormal emotional influences on response inhibition in patients with IGD. It was only during the high‐load task that interaction between response inhibition and emotional states was observed in the dorsomedial prefrontal cortex, with observations revealing that its alteration in patients with IGD was associated with number of hours spent on Internet gaming. Dysfunctional dorsomedial prefrontal cortex may mediate abnormal emotional influences on response inhibition in patients with IGD.
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Impaired control in addiction involves a characteristic but obscure kind of partial control. Certain aspects of control over drug use are clearly reduced, reflected in difficulty cutting back and relapse. However, other aspects of control are clearly preserved, as reflected in substantial sensitivity to situational incentives, for example the ability to defer use when needed. This juxtaposition is puzzling, and a clear mechanistically precise understanding of impaired control has yet to emerge. In this article, a Distortion model of impaired control is put forward. The key insight of the model is that the puzzling pattern of partial control seen in addiction can be understood in terms of unreliable control. The model posits large populations of distorted automatic thoughts (e.g., about drugs, one’s self, one’s circumstances, and one’s abilities to cope), coupled with unreliable control over these distorted thoughts. These distorted thoughts, typically gradually and cumulatively, lead to illusion-like misvaluation of costs and benefits of drug use, which in turn eventually lead to decisions to use. The model captures an elusive middle ground in addiction in which substantially preserved control over drug use for briefer intervals co-exists with difficulty maintaining sobriety over the long-term. Moreover, the model explains a range of clinical findings in addiction that are not easily accommodated on leading alternative views.
Chapter
In this chapter, we discuss the concept of addiction and the most influential theories of behaviour change under a common theory framework, including theories on motivation such as the PRIME theory. Motivational interviewing (MI) has been an influential therapeutic approach proposed by Miller in 1983. MI is a way of interviewing people with an addiction problem, which goal is directed and aims to empower the person to explore their ambivalence, mixed feelings, and thoughts about their addictive behaviour and develop their own plan of action to address it. We discuss the main components of MI and how to use it in everyday clinical practice. MI is the major ingredient of brief interventions for alcohol use disorder and other substance use disorders. MI can also be a component of other structured psychological interventions (such as cognitive behavioural therapy) for people with dependence on alcohol or other substances. Finally, we discuss the evidence supporting the effectiveness of MI from the early individual trials to the most recent systematic reviews.
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Difficulty stopping unwanted or inappropriate actions (i.e., inhibitory control) is implicated in antisocial behaviors, which are common in people high in psychopathic traits. Recent research indicates that, for those with antisocial personality, inhibitory control is impaired under negative emotional contexts; however, it is unclear whether this impairment extends to persons with psychopathic traits and to impairments under positive emotional contexts. Identifying some of these distinctions can point to therapeutics that target negative emotion specifically or emotion dysregulation broadly. We sought to identify unique relationships between distinct facets of psychopathy and inhibitory control in the context of positive, negative, and neutral stimuli. Using a community sample (N = 117), event‐related potentials were recorded during an emotional‐linguistic Go/No‐Go task. Results indicated distinct cognition–emotion relationships for each psychopathy facet. Higher interpersonal facet scores related to reciprocal interference between cognition and emotion. Higher callous affect facet scores related to reduced inhibitory and emotional processing, except when stimuli were most engaging (emotional No‐Go trials). Higher erratic lifestyle facet scores related to increased effort required to process both emotion and inhibition cues. Finally, higher antisocial facet scores related to poorer behavioral inhibition overall. This research challenges the theoretical accounts of psychopathy focused on specific deficits in negative emotion, such as fearlessness, while offering some support for theories related to attentional dysfunction. Results also highlight the importance of facet‐level theorizing, as results varied by facet. This study may inform efforts to reduce disinhibited behaviors, particularly in emotional contexts, among those high in certain psychopathic traits.
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Introduction There are high rates of cognitive impairment among people seeking treatment for problematic substance use, which is rarely addressed in treatment programs. The aim of this pilot study was to evaluate the feasibility and outcomes of the neuropsychological and educational approach to cognitive remediation (NEAR) in a residential substance treatment setting. Methods A non‐randomised trial conducted between November 2018 and November 2019, compared outcomes for 34 residents who received cognitive remediation (CR) plus treatment as usual (TAU) to 31 residents who received TAU only. Number of groups and attendance, and a measure of client satisfaction assessed feasibility. Cognitive function was assessed at baseline (service admission), and at 2 and 6 months post‐admission. Results A total of 95 CR groups were delivered over a 36‐week time period with a high degree of treatment fidelity and acceptability to participants. Cognitive outcomes improved across both the CR+TAU and TAU groups by 2 months, which was maintained at 6 months for outcomes related to executive functioning. There were no significant differences between the CR+TAU and TAU groups at 2 or 6 months, although a large effect size and confidence intervals indicated a potentially larger change in cognitive flexibility after receiving CR. Discussion and Conclusions This study contributes to our understanding of the implementation of CR in the alcohol and other drug rehabilitation setting. It is feasible to incorporate the NEAR program in treatment. The small sample size and lower than expected treatment dose likely contributed to the lack of significant findings.
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Despite markedly different clinical presentations, few studies have reported differences in neuropsychological functioning between mania and depression. The disinhibited behaviour characteristic of mania and evidence that subgenual prefrontal cortex is differentially activated in mania and depression both suggest that dissociable deficits will emerge on tasks that require inhibitory control and are subserved by ventromedial prefrontal cortex. Manic patients and controls undertook computerized neuropsychological tests of memory and planning ability. In addition, manic and depressed patients were directly compared with controls on a novel affective shifting task that requires inhibitory control over different components of cognitive and emotional processing. Manic patients were impaired on tests of memory and planning. Importantly, affective shifting performance of manic patients differed from that of depressed patients. Manic patients were impaired in their ability to inhibit behavioural responses and focus attention, but depressed patients were impaired in their ability to shift the focus of attention. Depressed patients exhibited an affective bias for negative stimuli, and we believe this to be the first demonstration of an affective bias for positive stimuli in manic patients. Observed impairments on tests of memory and planning suggest a global pathology for mania consistent with previous profiles for this disorder and similar to established profiles for depression. The results on the affective shifting task demonstrate the presence of mood-congruent bias and dissociable components of inhibitory control in mania and depression. Against a background of memory and planning impairments in the two groups, these findings are consistent with a role for the ventromedial prefrontal cortex in mediating mood-cognition relationships.
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This paper presents data from the first British prospective study to investigate relapse among opiate addicts after treatment. Eighty subjects were followed up over the six-month period immediately after discharge from treatment and were interviewed on several occasions. Large numbers of subjects used opiates within a very short time after discharge; 71% used them within the first six weeks. However, this first lapse to opiate use did not herald a full-blown relapse to dependent use. There was a gradual increase in the number of abstinent subjects, with 45% abstinent and living in the community at the six-month point. The practical and theoretical implications may be regarded as broadly encouraging.
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Occurrence of cerebrovascular accidents has been associated with cocaine abuse. We investigated the relative distribution of cerebral blood flow (CBF) in groups of chronic cocaine users, and of normal controls. Relative CBF was measured using positron emission tomography and 15 oxygen-labelled water. The cocaine users showed areas of deranged CBF as evidenced by patchy regions of defective isotope accumulation throughout their brain. The chronic cocaine users showed decreased relative CBF in the prefrontal cortex when compared with normal subjects. The repeated scans of some cocaine users, after 10 days of cocaine withdrawal, continued to show decreased relative CBF of the prefrontal cortex. We hypothesise that some of the widespread defects in CBF in the cocaine users could reflect the effects of vasospasm in cerebral arteries exposed chronically to the sympathomimetic actions of cocaine.
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In the present review, an integrated approach to craving and addiction is discussed, which is based on recent insights from psychology and neuropsychopharmacology. An integrated model explains craving and relapse in humans by the psychological mechanism of "attentional bias" and provides neuropsychopharmacological mechanisms for this bias. According to this model, cognitive processes mediate between drug stimulus and the subject's response to this stimulus and subsequent behavioral response (e.g., drug use, relapse). According to the model, a conditioned drug stimulus produces an increase in dopamine levels in the corticostriatal circuit, in particular the anterior cingulate gyrus, amygdala, and nucleus accumbens, which in turn serves to draw the subject's attention towards a perceived drug stimulus. This process results in motor preparation and a hyperattentive state towards drug-related stimuli that, ultimately, promotes further craving and relapse. Evidence for this attentional bias hypothesis is reviewed from both the psychopharmacological and the neuroanatomical viewpoints. The attentional bias hypothesis raises several suggestions for clinical approaches and further research.
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This paper presents a biopsychological theory of drug addiction, the 'Incentive-Sensitization Theory'. The theory addresses three fundamental questions. The first is: why do addicts crave drugs? That is, what is the psychological and neurobiological basis of drug craving? The second is: why does drug craving persist even after long periods of abstinence? The third is whether 'wanting' drugs (drug craving) is attributable to 'liking' drugs (to the subjective pleasurable effects of drugs)? The theory posits the following. (1) Addictive drugs share the ability to enhance mesotelencephalic dopamine neurotransmission. (2) One psychological function of this neural system is to attribute 'incentive salience' to the perception and mental representation of events associated with activation of the system. Incentive salience is a psychological process that transforms the perception of stimuli, imbuing them with salience, making them attractive, 'wanted', incentive stimuli. (3) In some individuals the repeated use of addictive drugs produces incremental neuroadaptations in this neural system, rendering it increasingly and perhaps permanently, hypersensitive ('sensitized') to drugs and drug-associated stimuli. The sensitization of dopamine systems is gated by associative learning, which causes excessive incentive salience to be attributed to the act of drug taking and to stimuli associated with drug taking. It is specifically the sensitization of incentive salience, therefore, that transforms ordinary 'wanting' into excessive drug craving. (4) It is further proposed that sensitization of the neural systems responsible for incentive salience ('for wanting') can occur independently of changes in neural systems that mediate the subjective pleasurable effects of drugs (drug 'liking') and of neural systems that mediate withdrawal. Thus, sensitization of incentive salience can produce addictive behavior (compulsive drug seeking and drug taking) even if the expectation of drug pleasure or the aversive properties of withdrawal are diminished and even in the face of strong disincentives, including the loss of reputation, job, home and family. We review evidence for this view of addiction and discuss its implications for understanding the psychology and neurobiology of addiction.
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• We studied 14 patients with obsessive-compulsive disorder (OCD) by positron emission tomography and the fluorodeoxyglucose method, looking for abnormalities in local cerebral metabolic rates for glucose in brain structures that have been hypothesized to function abnormally in OCD.These patients were compared with 14 normal controls and 14 patients with unipolar depression. The patients with unipolar depression and OCD did not differ in levels of anxiety, tension, or depression. In OCD, metabolic rates were significantly increased in the left orbital gyrus and bilaterally in the caudate nuclei. This was apparent on all statistical comparisons with both controls and unipolar depression. The right orbital gyrus showed at least a trend to an increased metabolic rate in all comparisons. The metabolic rate in the left orbital gyrus, relative to that in the ipsilateral hemisphere (orbital gyrus/ hemisphere ratio), was significantly elevated compared to controls and subjects with unipolar depression, and stayed high even with successful drug treatment. Though it was in the normal range in the morbid state, with improvement in OCD symptoms after drug treatment, the caudate/hemisphere metabolic ratio increased uniformly and significantly bilaterally. This ratio did not increase in patients who did not respond to treatment. Thus, OCD showed cerebral glucose metabolic patterns that differed from controls in both the symptomatic and recovered states.
Article
Background: The new technique of functional magnetic resonance imaging was used to investigate the mediating neuroanatomy of obsessive-compulsive disorder symptoms.Methods: Ten patients with obsessive-compulsive disorder and 5 normal subjects were studied via functional magnetic resonance imaging during control and provoked conditions. Data analysis entailed parametric and nonparametric statistical mapping.Results: Statistical maps (nonparametric; P<10-3) showed activation for 70% or more of patients with obsessive-compulsive disorder in medial orbitofrontal, lateral frontal, anterior temporal, anterior cingulate, and insular cortex, as well as caudate, lenticulate, and amygdala. No normal subjects exhibited activation in any brain region.Conclusions: Results of functional magnetic resonance imaging were consistent with past studies of obsessive-compulsive disorder that used other functional neuroimaging modalities. However, paralimbic and limbic activations were more prominent in the present study.
Article
Client ambivalence is a key stumbling block to therapeutic efforts toward constructive change. Motivational interviewing—a nonauthoritative approach to helping people to free up their own motivations and resources—is a powerful technique for overcoming ambivalence and helping clients to get "unstuck." The first full presentation of this powerful technique for practitioners, this volume is written by the psychologists who introduced and have been developing motivational interviewing since the early 1980s. In Part I, the authors review the conceptual and research background from which motivational interviewing was derived. The concept of ambivalence, or dilemma of change, is examined and the critical conditions necessary for change are delineated. Other features include concise summaries of research on successful strategies for motivating change and on the impact of brief but well-executed interventions for addictive behaviors. Part II constitutes a practical introduction to the what, why, and how of motivational interviewing. . . . Chapters define the guiding principles of motivational interviewing and examine specific strategies for building motivation and strengthening commitment for change. Rounding out the volume, Part III brings together contributions from international experts describing their work with motivational interviewing in a broad range of populations from general medical patients, couples, and young people, to heroin addicts, alcoholics, sex offenders, and people at risk for HIV [human immunodeficiency virus] infection. Their programs span the spectrum from community prevention to the treatment of chronic dependence. All professionals whose work involves therapeutic engagement with such individuals—psychologists, addictions counselors, social workers, probations officers, physicians, and nurses—will find both enlightenment and proven strategies for effecting therapeutic change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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“Craving” for alcohol needs improved definition and measurement. This review provides a rationale for considering at least certain aspects of craving as having obsessive and compulsive features. As such, there may be phenomenological, but not necessarily etiological, overlap with obsessive-compulsive disorder. There are increasing data that suggest a neuroanatomical overlap between addiction/craving and obsessive-compulsive symptoms. The self-rated Obsessive Compulsive Drinking Scale (OCDS), based on the Yale-Brown Obsessive Compulsive Scale for heavy drinking interview (YBOCS-hd), was developed to assist in the examination of certain aspects of “craving” in alcoholics. The development, reliability, face validity, congruent validity and predictive validity of the OCDS are presented and discussed in this paper. The utility of the OCDS as a measurement tool in cognitive-behavioral and pharmacological alcoholism treatment research is highlighted. The potential of this instrument as a research and clinical tool for the understanding and evaluation of alcohol dependence needs further evaluation.
Article
Studies of neurotransmitter metabolites in cerebrospinal fluid (CSF) were initially focused on depressive illness. Although several studies have demonstrated low concentrations of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), and the dopamine metabolite, homovanillic acid (HVA), in depressed patients, these early studies may have been biased by concomitant administration of antidepressant drugs (which tend to lower CSF 5-HIAA), amount of CSF drawn (there is a concentration gradient for both metabolites), and selection of control subjects. Once these methodological details are controlled for, the differences between depressed patients and controls are unimpressive.However, there is a remarkably consistent association between low concentrations of CSF 5-HIAA and suicidal behavior, as evidenced by over 20 studies. The association is not confined to depressive illness but has also been found in schizophrenia, personality disorder, and certain impulse control disorders (but, interstingly, not in bipolar disorder). A low concentration of CSF 5-HIAA in a suicide attempter is associated with a substantial increase in short-term suicide risk. CSF studies in violent criminals, and in nonhuman primates, suggest that aggression dyscontrol may partly explain the association between suicide and serotonin, which is of considerable theoretical interest. CSF 5-HIAA determinations may also be helpful in the clinical assessment of suicide risk.
Article
The results of a follow-up study of 200 males committed wader the MARA Act have been compared with general findings of other such studies. It was found that, if relapse is defined as any re-use of narcotics, the observed relapse rate of 87 per cent is equivalent to the 80–90 per cent relapse rates reported in other studies. Variables which have been related to relapse in other studies were also examined in this project. Some support was found for Wirdek's “maturation hypothesis”. Although no relationship was found between length of addiction and relapse, age was found to be related to relapse. Specifically, it was found that patients under 30 years of age used narcotics regularly or became readdicted at much higher rates than those over 30. Similarly, the rates of total abstinence or occasional use of narcotics were higher for those over 30. These findings indicate that Winick's hypothesis cannot be completely rejected. Employment was also found to be related to relapse in that those who found jobs relapsed less often than those unable to obtain employment. Most of the problems patients encountered in seeking a job seemed to be related more to their own personality problems than to other factors. Two other variables, ethnicity and education, were generally unrelated to relapse. Both the counselors and patients cited three general factors which led to relapse. One factor was use of narcotics to alleviate interpersonal stress. The second factor was the patient's craving or enjoyment of the euphoric effects and the “magnetic” pull of the addict subculture. Inability to cope with his own problems and frustration constituted the third general factor which helped to explain the relapse phenomenon. In citing reasons for abstinence, counselors and patients agreed that the patient's desire to stay clean, effectiveness of therapy, emotional support of the family and fear of the consequences of continued involvement in the drag subculture were the mast important factors in a patient remaining drug free. Further analysis of the stated reasons for abstinence indicated that little support was found for Winick's hypothesis that addicts “burn out”.
Article
The question of addiction specifically concerns (1), the process by which drug-taking behavior, in certain individuals, evolves into compulsive patterns of drug-seeking and drug-taking behavior that take place at the expense of most other activities and (2), the inability to cease drug-taking; the problem of relapse. In this paper current biopsychological views of addiction are critically evaluated in light of the “incentivesensitization theory of addiction”, which we first proposed in 1993, and new developments in research are incorporated. We argue that traditional negative reinforcement, positive reinforcement, and hedonic accounts of addiction are neither necessary nor sufficient to account for compulsive patterns of drug-seeking and drug-taking behavior. Four major tenets of the incentive-sensitization view are discussed. These are: (1) Potentially addictive drugs share the ability to produce long-lasting adaptations in neural systems. (2) The brain systems that are changed include those normally involved in the process of incentive motivation and reward. (3) The critical neuroadaptations for addiction render these brain reward systems hypersensitive (“sensitized”) to drugs and drug-associated stimuli. (4) The brain systems that are sensitized do not mediate the pleasurable or euphoric effects of drugs (drug “liking”), but instead they mediate a subcomponent of reward we have termed incentive salience (drug “wanting”). We also discuss the role that mesolimbic dopamine systems play in reward, evidence that neural sensitization happens in humans, and the implications of incentive-sensitization for the development of therapies in the treatment of addiction.
Article
The anterior cingulate is believed to play a crucial role in the regulation of thought and action. Recent evidence suggests that the anterior cingulate may play a role in the detection of inappropriate responses. We used event-related functional magnetic resonance imaging techniques to examine the neural responses to appropriate (correct rejects and correct hits) and inappropriate (errors of commission) behavioral responses during a go/no-go task. Analyses of the inappropriate responses revealed extensive activation in the rostral anterior cingulate cortex and in the left lateral frontal cortex. These areas were not activated for correctly classified trials (correct rejects and correct hits). These data suggest that the rostral anterior cingulate and left lateral frontal cortex are integral components of the brain's error checking system.
Article
Changes in GABA function have been postulated to be involved in alcohol tolerance, withdrawal and addiction. In this study we measured regional brain metabolic responses to lorazepam, to indirectly assess GABA function (benzodiazepines facilitate GABAergic neurotransmission), in alcoholics during early and late withdrawal. Brain metabolism was measured using PET and 2-deoxy-2[18F]fluoro-D-glucose after placebo (baseline) and after lorazepam (30 μg/kg intravenously) in 10 alcoholics and 16 controls. In the alcoholics evaluations were performed 2 to 3 weeks after detoxification and were repeated 6 to 8 weeks later. Controls were also evaluated twice at a 6 to 8 weeks interval. While during the initial evaluation metabolism was significantly lower for most brain regions in the alcoholics than in controls in the repeated evaluation the only significant differences were in cingulate and orbitofrontal cortex. Lorazepam-induced decrements in metabolism did not change with protracted alcohol withdrawal and the magnitude of these changes were similar in controls and alcoholics except for a trend towards a blunted response to lorazepam in orbitofrontal cortex in alcoholics during the second evaluation. Abnormalities in orbitofrontal cortex and cingulate gyms in alcoholics are unlikely to be due to withdrawal since they persist 8 to 11 weeks after detoxification. The fact that there was only a trend of significance for an abnormal response to lorazepam in orbitofrontal cortex indicates that mechanisms other than GABA are involved in the brain metabolic abnormalities observed in alcoholic subjects.
Article
The analysis of the behavioural and neural mechanisms of reinforcement and motivation has benefited from the recent application of learning theory and better anatomical knowledge of the connectivity of certain key neural structures, such as the nucleus accumbens. This progress has enabled the dissection of motivational processes into components that can begin to be related to the functioning of specific limbic cortical structures that project to different compartments of the ventral striatum.
Article
A defining feature of drug addiction is persistent drug use despite long-term adverse consequences. This study examined the performance of drug abusers on a neuropsychological test that requires evaluation of long-term outcomes in the presence of a complex set of mixed reward/punishment contingencies (the Gambling Task). In order to control for generalized deficits related to choice and planning, subjects were also administered the Wisconsin Card Sorting Task. Thirty polysubstance abusers were compared to a comparison group of 24 subjects who did not use illicit drugs of abuse. Drug abusers performed much more poorly on the Gambling Task (net score = 10.2 ± 4.7, mean ± s.e.m.) than controls (26.0 ± 5.3), but did not differ from controls on the Wisconsin Card Sorting Task. The results show that drug abusers are more likely to make maladaptive decisions in the Gambling Task that result in long-term losses exceeding short-term gains. These findings indicate that the Gambling Task may be a useful model in laboratory studies of cognitive dysfunctions associated with drug abuse.
Article
The argument advanced in this review is that drug addiction can be understood in terms of normal learning and memory systems of the brain which, through the actions of chronically self-administered drugs, are pathologically subverted, thereby leading to the establishment of compulsive drug-seeking habits, strengthened by the motivational impact of drug-associated stimuli and occurring at the expense of other sources of reinforcement. We review data from our studies that have utilized procedures which reveal the various influences of pavlovian stimuli on goal-directed behaviour, namely discriminated approach, pavlovian-to-instrumental transfer and conditioned reinforcement, in order to demonstrate their overlapping and also unique neural bases. These fundamental studies are also reviewed in the context of the neural and psychological mechanisms underlying drug-seeking behaviour that is under the control of drug-associated environmental stimuli. The ways in which such drug-seeking behaviour becomes compulsive and habitual, as well as the propensity for relapse to drug-seeking even after long periods of relapse, are discussed in terms of the aberrant learning set in train by the effects of self-administered drugs on plastic processes in limbic cortical–ventral striatal systems.
Article
This paper presents a biopsychological theory of drug addiction, the ‘Incentive-Sensitization Theory’. The theory addresses three fundamental questions. The first is: why do addicts crave drugs? That is, what is the psychological and neurobiological basis of drug craving? The second is: why does drug craving persist even after long periods of abstinence? The third is whether ‘wanting’ drugs (drug craving) is attributable to ‘liking’ drugs (to the subjective pleasurable effects of drugs)? The theory posits the following.