Addiction, cognitive decline and therapy: seeking ways to escape a vicious cycle

Abstract

Any type of behavioral change is an effortful process. Thus, the process of behavioral therapy, where clients seek to change maladaptive behavioral patterns, requires high-level cognitive engagement. It is unfortunate, then, that cognitive impairment is a feature of substance use disorders (SUDs), and especially because the domains that tend to be impaired are the very ones involved in the process of therapeutic behavioral change. In this review, we compare the cognitive profile that is frequently observed with chronic SUD with the skills that are required to initiate and sustain behavioral change during rehabilitation. Furthermore, we look to new therapeutic developments that seek to improve cognitive function. We propose that the use of these cognitive enhancing agents as adjuncts to behavioral therapy should help to overcome some of the cognitive barriers imposed by the disorder itself, and hence reduce the chance of relapse.Keywords: Abstinence, addiction, animal models, behavioral therapy, cognition, cognitive enhancement, cognitive impairment, exercise, relapse, substance use disorder, therapy Received 31 May 2016, revised 14 August 2016, accepted for publication 25 August 2016Substance use disorder (SUD) is a maladaptive pattern of drug use involving impaired control over drug-taking activities, social impairment, risky use and pharmacological indicators such as tolerance and withdrawal (American Psychiatric Association & DSM-5 Task Force 2013). Leaving aside the final point, these diagnostic criteria are clearly indicative of maladaptive cognition and behavior arising from suboptimal decision-making, poor executive function and inappropriate prioritization of goals. Drug seeking and drug taking has replaced normal social, work and leisure activities. Thus, the aim of addiction therapy is to inhibit and replace the maladaptive behaviors with others that will allow the individual to lead a more fulfilling lifestyle. A problem that arises with SUD is that the very cognitive impairments that define the disorder are to domains that need to be engaged in order to initiate and maintain the behavioral changes necessary for recovery. This creates a vicious cycle, which is no doubt a major contributory factor behind the poor retention rates and high incidence of relapse that are hallmarks of the disorder.Addiction or SUD is frequently conceptualized as a disorder of the brain and mind that is brought about by exposure to drugs of abuse -psychostimulants, opiates, barbiturates, alcohol, nicotine and cannabis -in combination with genetic and environmental influences (Leshner 1997). This description is somewhat contentious, partly because of the stigma implied, but perhaps more importantly because it may disempower those who are seeking to change their drug-taking patterns. If maladaptive drug seeking is seen as the result of a disordered mind, and not the free will of the subject, then perhaps that person will be less engaged or motivated to change those behavioral patterns (Kellogg & Tatarsky 2012). This, however, ...

Brain and Cognition for Addiction Medicine: From Prevention to Recovery Neural Substrates for Treatment of Psychostimulant-Induced Cognitive Deficits

“…In abstinent addicts, exposure to stress, drug of abuse itself, and/or drug-associated environmental cues induces cravings, which promotes drug seeking often resulting in relapse (81–84). In humans, several behavioral and cognitive therapies, such as behavioral therapy, cue exposure therapy, motivational enhancement therapy, and contingency management, are used to help abstinent addicts overcome craving (6, 85). The main goal of all these therapies is to decrease emotional and physiological responses to drug-associated cues among abstinent addicts.…”

Drug addictions: new insight into causes, comorbidity and potential treatments

“…In the more immediate term, existing therapies, such as those that seek to help patients establish more adaptive patterns of thinking and behaving around drugs, remain the best hope for patients. Perry and Lawrence () espouse the compelling case for the centrality of cognitive deficits (inflexibility, inattention and poor impulse control) in addictions and propose the use of pharmacological adjuncts to cognitive behavioral therapies to more effectively correct these deficits. They catalogue some of the drugs that have potential promise in this regard – from mGluR5 metabotropic glutamate receptor allosteric modulators to psychostimulants such as methylphenidate – and also the non‐drug interventions including brain stimulation and even exercise.…”

Salivary Cortisol Levels Are Associated with Craving and Cognitive Performance in Cocaine-Abstinent Subjects: A Pilot Study

“…Therefore, it seems necessary to determine the neuropsychological profile of subjects with SUD as they may be part of the set of factors that maintain drug use [ 42 ]. Additionally, these cognitive deficits may alter the awareness of the addiction problem, as well as the follow-up of the treatment program and the assimilation of instructions which demand a high cognitive challenge [ 41 , 72 , 73 , 74 ].…”