Neuroscience of Behavioral and Pharmacological Treatments for Addictions

Potenza, Marc N.; Sofuoglu, Mehmet; Carroll, Kathleen M.; Rounsaville, Bruce J.

doi:10.1016/j.neuron.2011.02.009

Cited by 191 publications

(195 citation statements)

References 249 publications

(287 reference statements)

Supporting

Mentioning

183

Contrasting

Unclassified

Order By: Relevance

“…In rodent models, pharmacological intervention (42,43), genetic modification (34), and optogenetic stimulation (44) have shown initial success in reversing drug-induced behavior by acting on DA signaling. In humans, both pharmacological and cognitive therapies have been used, although studies have reported mixed findings regarding their general effectiveness (45). Here we show that the mere subjective belief of no nicotine in cigarette exerted a strong reversal effect by attenuating neural responses in the striatum, even in the presence of a powerful neuroactive drug like nicotine.…”

Section: Discussionmentioning

confidence: 61%

Belief about nicotine selectively modulates value and reward prediction error signals in smokers

Lohrenz

Salas

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

Little is known about how prior beliefs impact biophysically described processes in the presence of neuroactive drugs, which presents a profound challenge to the understanding of the mechanisms and treatments of addiction. We engineered smokers' prior beliefs about the presence of nicotine in a cigarette smoked before a functional magnetic resonance imaging session where subjects carried out a sequential choice task. Using a model-based approach, we show that smokers' beliefs about nicotine specifically modulated learning signals (value and reward prediction error) defined by a computational model of mesolimbic dopamine systems. Belief of "no nicotine in cigarette" (compared with "nicotine in cigarette") strongly diminished neural responses in the striatum to value and reward prediction errors and reduced the impact of both on smokers' choices. These effects of belief could not be explained by global changes in visual attention and were specific to value and reward prediction errors. Thus, by modulating the expression of computationally explicit signals important for valuation and choice, beliefs can override the physical presence of a potent neuroactive compound like nicotine. These selective effects of belief demonstrate that belief can modulate modelbased parameters important for learning. The implications of these findings may be far ranging because belief-dependent effects on learning signals could impact a host of other behaviors in addiction as well as in other mental health problems.O ne materialist view of mental function suggests that even the most abstract beliefs can be represented in terms of physiological states available to the brain (1). These mappings are critical in conditions like drug addiction, where our ignorance of how prior beliefs about drugs influence physiological processes related to drugs of abuse presents a profound challenge to the understanding of the mechanism and treatment of addiction (2, 3). Although extensive work has shown that addictive drugs act on the mesolimbic dopaminergic (DA) pathway (2, 4), it has become clear that these purely biochemical explanations are not sufficient to account for the huge heterogeneity among drug-dependent individuals and the low success rate of quitting and remaining drug-free (2, 5) and that cognitive factors such as beliefs and expectations have a profound impact on drug-related neurobiological effects (6, 7).Beliefs are known to contribute to the placebo effect. The placebo effect is a treatment effect not caused by the physical presence of an active drug, but rather by the meaning ascribed to it and the subjective expectation of receiving a treatment (8, 9). A subject's belief that he or she is receiving a treatment could lead to observable improvement even in the absence of active drugs. These treatment effects are putatively accomplished by neurobiological processes usually associated with pharmacological actions of active drugs, even though active drugs are not administered (10-14). Interestingly, beliefs also directly impact behavioral...

show abstract

Section: Discussionmentioning

confidence: 61%

Belief about nicotine selectively modulates value and reward prediction error signals in smokers

Lohrenz

Salas

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

show abstract

“…Contingency Management (CM) for example, might decrease drug or alcohol use by working via impulsive bottom-up brain regions, whereas cognitive behavioral therapy (CBT) may operate by strengthening top-down brain functions (Bickel et al, 2007;DeVito et al, 2012;Potenza, Sofuoglu, Carroll, & Rounsaville, 2011).…”

Section: Introductionmentioning

confidence: 99%

Impulsivity as a vulnerability factor for poor addiction treatment outcomes: A review of neurocognitive findings among individuals with substance use disorders

Stevens

Verdejo-García

Goudriaan

et al. 2014

Journal of Substance Abuse Treatment

274

178

View full text Add to dashboard Cite

With the current review, we explore the hypothesis that individual differences in neurocognitive aspects of impulsivity (i.e., cognitive and motor disinhibition, delay discounting and impulsive decision-making) among individuals with a substance use disorder are linked to unfavorable addiction treatment outcomes, including high drop-out rates and difficulties in achieving and maintaining abstinence. A systematic review of the literature was carried out using PubMed, PsycINFO and Web of Knowledge searches. Twenty-five unique empirical papers were identified and findings were considered in relation to the different impulsivity dimensions. Although conceptual/methodological heterogeneity and lack of replication are key limitations of studies in this area, findings speak for a prominent role of cognitive disinhibition, delay discounting and impulsive decision-making in the ability to successfully achieve and maintain abstinence during and following addiction treatment. In contrast, indices of motor disinhibition appear to be unrelated to abstinence levels. Whereas the relationship between impulsivity and treatment retention needs to be examined more extensively, preliminary evidence suggests that impulsive/risky decision-making is unrelated to premature treatment drop-out among individuals with a substance use disorder. The reviewed findings are discussed in terms of their clinical implications.

show abstract

“…The mechanism-based approach suggests that it makes sense to focus on treatments that target specific mechanisms (Potenza, Sofuoglu, Carroll, & Rounsaville, 2011), rather than on general solutions to "addiction." This idea also provides a rationale for the expectation that interventions targeting certain general mechanisms could work for a large variety of addictions.…”

Section: Comorbidity and Other Sources Of Heuristic Valuementioning

confidence: 99%

Addiction-as-a-kind hypothesis

Ylikoski

Pöyhönen

2015

IJADR

View full text Add to dashboard Cite

The psychiatric category of addiction has recently been broadened to include new behaviors. This has prompted critical discussion about the value of a concept that covers so many different substances and activities. Many of the debates surrounding the notion of addiction stem from different views concerning what kind of a thing addiction fundamentally is. In this essay, we put forward an account that conceptualizes different addictions as sharing a cluster of relevant properties (the syndrome) that is supported by a matrix of causal mechanisms. According to this "addiction-as-a-kind" hypothesis, several different kinds of substance and behavioral addictions can be thought of as instantiations of the same thing-addiction. We show how a clearly articulated account of addiction can facilitate empirical research and the theoretical integration of different perspectives on addiction. The causal matrix approach provides a promising alternative to existing accounts of the nature of psychiatric disorders, the traditional disease model, and its competitors. It is a positive addition to discussions about diagnostic criteria, and sheds light on how psychiatric classification may be integrated with research done in other scientific fields. We argue that it also provides a plausible approach to understanding comorbidity.In recent years, the concept of addiction, as it is used both in research and in policy contexts, has been expanded to include new behaviors (e.g., gambling, eating, sex, shopping, exercise, even internet use). There has also been critical discussion about the value of a concept that covers so many different substances and activities. In this essay, we present an account of the conditions under which several kinds of substance and behavioral addictions can be thought of as instantiations of the same thing-addiction. We call this account the "addiction-as-a-kind" hypothesis.The account describes what addiction would look like if it were a legitimate psychiatric kind. We call it a hypothesis because it is an empirical question whether different addictions really constitute such a kind. In this essay, we will not assess the empirical support for the hypothesis, but will focus on describing some of its general characteristics. In other words, we describe what a general theory of addiction could look like.The paper is structured as follows. First we frame our theory by briefly considering some difficulties with the traditional disease model and its alternatives. Then we present our addiction-as-a-kind hypothesis and the underlying causal matrix view of psychiatric kinds. The final section discusses the issue of comorbidity and, based on the hypothesis, offers some suggestions for addiction research. The Problem With the Traditional Disease Model

show abstract

Neuroscience of Behavioral and Pharmacological Treatments for Addictions

Cited by 191 publications

References 249 publications

Belief about nicotine selectively modulates value and reward prediction error signals in smokers

Belief about nicotine selectively modulates value and reward prediction error signals in smokers

Impulsivity as a vulnerability factor for poor addiction treatment outcomes: A review of neurocognitive findings among individuals with substance use disorders

Addiction-as-a-kind hypothesis

Contact Info

Product

Resources

About