Neural Circuitry of Impaired Emotion Regulation in Substance Use Disorders

Abstract

Impaired emotion regulation contributes to the development and severity of substance use disorders (substance disorders). This review summarizes the literature on alterations in emotion regulation neural circuitry in substance disorders, particularly in relation to disorders of negative affect (without substance disorder), and it presents promising areas of future research. Emotion regulation paradigms during functional magnetic resonance imaging are conceptualized into four dimensions: affect intensity and reactivity, affective modulation, cognitive modulation, and behavioral control. The neural circuitry associated with impaired emotion regulation is compared in individuals with and without substance disorders, with a focus on amygdala, insula, and prefrontal cortex activation and their functional and structural connectivity. Hypoactivation of the rostral anterior cingulate cortex/ventromedial prefrontal cortex (rACC/vmPFC) is the most consistent finding across studies, dimensions, and clinical populations (individuals with and without substance disorders). The same pattern is evident for regions in the cognitive control network (anterior cingulate and dorsal and ventrolateral prefrontal cortices) during cognitive modulation and behavioral control. These congruent findings are possibly related to attenuated functional and/or structural connectivity between the amygdala and insula and between the rACC/vmPFC and cognitive control network. Although increased amygdala and insula activation is associated with impaired emotion regulation in individuals without substance disorders, it is not consistently observed in substance disorders. Emotion regulation disturbances in substance disorders may therefore stem from impairments in prefrontal functioning, rather than excessive reactivity to emotional stimuli. Treatments for emotion regulation in individuals without substance disorders that normalize prefrontal functioning may offer greater efficacy for substance disorders than treatments that dampen reactivity.

FIGURE 1

Brain Regions Involved in Emotion Regulation and Alterations in Depressive, Anxiety, and Borderline Personality Disorders and in Substance Use Disorders^{a a}The dorsomedial prefrontal cortex (dmPFC) includes the dorsal anterior cingulate cortex (dACC), presupplementary motor area (preSMA), and supplementary motor area (SMA). The lateral prefrontal cortex (lPFC) includes the dorsolateral prefrontal cortex (dlPFC), ventrolateral prefrontal cortex (vlPFC), and lateral orbitofrontal cortex (lOFC). Other abbreviations: rostral anterior cingulate cortex (rACC), ventromedial prefrontal cortex (vmPFC). ^bThe illustration in part A is by Alexandra B. Hernandez of Gory Details (used by permission). Regions shaded in red are categorized as emotion-generating or emotion-processing regions; regions depicted in blue are categorized as regulatory regions. Further details about the roles of these regions in emotion regulation are specified in Table 1. ^cEmotion regulation tasks were performed during functional magnetic resonance imaging.