Cognitive interventions for addiction medicine: Understanding the underlying neurobiological mechanisms

Abstract

Neuroimaging provides a tool for investigating the neurobiological mechanisms of cognitive interventions in addiction. The aim of this review was to describe the brain circuits that are recruited during cognitive interventions, examining differences between various treatment modalities while highlighting core mechanisms, in drug addicted individuals. Based on a systematic Medline search we reviewed neuroimaging studies on cognitive behavioral therapy, cognitive inhibition of craving, motivational interventions, emotion regulation, mindfulness, and neurofeedback training in addiction. Across intervention modalities, common results included the normalization of aberrant activity in the brain's reward circuitry, and the recruitment and strengthening of the brain's inhibitory control network. Results suggest that different cognitive interventions act, at least partly, through recruitment of a common inhibitory control network as a core mechanism. This implies potential transfer effects between training modalities. Overall, results confirm that chronically hypoactive prefrontal regions implicated in cognitive control in addiction can be normalized through cognitive means.

Keywords: CBT; Cognitive control; EEG; Emotion regulation; Neurofeedback; Psychotherapy; Substance use disorders; Training; Treatment; fMRI.

FIGURE 1

Brain circuits in cognitive interventions in addiction. Common results across intervention modalities were the normalization of aberrant activity in the brain’s reward circuitry, and the recruitment and strengthening of the brain’s inhibitory control network (regions involved in reward processing are depicted in red (light gray in the print version): e.g., striatum; NAcc, nucleus accumbens; VTA, ventral tegmental area; inhibitory control network is shown in blue (dark gray in the print version): e.g., IFG, inferior frontal gyrus; dACC, dorsal anterior cingulate). During motivational interventions regions involved in self-referential processing and motivated attention were activated (in green (light gray in the print version): mPFC, medial prefrontal cortex; PCC, posterior cingulate cortex, precuneus).