Recent concepts of addiction to drugs (e.g., cocaine) and non-drugs (e.g., gambling) have proposed that these behaviors are the product of an imbalance between three separate, but interacting, neural systems: (a) an impulsive, largely amygdala-striatum dependent, neural system that promotes automatic, habitual and salient behaviors; (b) a reflective, mainly prefrontal cortex dependent, neural system for decision-making, forecasting the future consequences of a behavior, and inhibitory control; and (c) the insula that integrates interoception states into conscious feelings and into decision-making processes that are involved in uncertain risk and reward. These systems account for poor decision-making (i.e., prioritizing short-term consequences of a decisional option) leading to more elevated addiction risk and relapse. This article provides neural evidence for this three-systems neural model of addiction.

There is growing interest in non-invasive brain stimulation (NIBS) as a novel treatment option for substance-use disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience demonstrating links between neural circuits and drug consuming behavior, as well as recent FDA-approval of NIBS treatments for mental health disorders that share overlapping pathology with SUDs. As with any emerging field, enthusiasm must be tempered by reason; lessons learned from the past should be prudently applied to future therapies. Here, an international ensemble of experts provides an overview of the state of transcranial-electrical (tES) and transcranial-magnetic (TMS) stimulation applied in SUDs. This consensus paper provides a systematic literature review on published data-emphasizing the heterogeneity of methods and outcome measures while suggesting strategies to help bridge knowledge gaps. The goal of this effort is to provide the community with guidelines for best practices in tES/TMS SUD research. We hope this will accelerate the speed at which the community translates basic neuroscience into advanced neuromodulation tools for clinical practice in addiction medicine.

Interpersonal difficulties serve as a mediator between EFE accuracy problems and alcoholism. Impaired EFE recognition could have a role in the interpersonal difficulties encountered by RA and may therefore constitute a relapse factor.

Objective: Addicted people are characterized by enhanced attention for drug cues leading to drug use. However, there is little research on the component processes of attention in individuals with alcoholism. Here, we examine 2 distinct components of attention in abstinent alcohol-dependent individuals and social drinkers of alcohol, that is to say, the initial orienting to alcohol-related cues, and the maintenance of attention to them.Method: The present study used an ''alcohol'' version of the visual probe detection task with alcohol-related or neutral pictures being presented briefly (i.e., 50 ms), to assess initial orienting, or longer (i.e., 500 and 1,250 ms), to assess the maintenance of attention.Results: Only alcoholic patients were faster in detecting a probe displayed immediately after pictures related to alcohol presented for 50 ms than in detecting the same probe replacing nonalcohol-related pictures. However, when pictures were presented for 500 ms, only social alcohol drinkers were faster in detecting the probe replacing alcohol scenes. At a stimulus of 1,250 ms duration, no group showed attentional bias toward alcohol cues. In addition, the severity of alcoholism measured by the total number of prior detoxification treatments was positively correlated with the attentional bias (or ''attraction'') for alcohol pictures presented for 50 ms.Conclusions: These results show that, subsequent to initial visual orienting to alcohol-related cues, abstinent patients' attention was disengaged from these stimuli, thus suggesting a visual approachdisengagement attentional pattern. The influence of these findings on relapse was discussed.

Chronic alcohol consumption seems to be associated with severe executive function deficits, which are still present after a protracted period of alcohol abstinence. These data support the idea that the cognitive deficits in recently detoxified sober alcoholic subjects are due, at least partly, to frontal lobe dysfunctioning.