Cognitive, Clinical, and Neural Aspects of Drug Addiction

Ahmed Moustafa, Ahmed A. Moustafa

• Publisher: Academic Press
• Year: 2020
• Print ISBN: 9780128169797
• eBook ISBN: 9780128169803
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

Drug addictions are often difficult to treat. The most successful treatments begin with studying why individuals become addicted to drugs and how to change their thinking and behaviour. Cognitive, Clinical, and Neural Aspects of Drug Addiction focuses on the theories that cause drug addiction, including avoidance behavior, self-medication, reward sensitization, behavioral inhibition and impulsivity. Dr. Moustafa takes this book one step further by reviewing the psychological and neural causes of relapse including the role of stress, anxiety and depression. By examining both the causes of drug addiction and relapse, this book will help clinicians create individualized treatment options for patients suffering from drug addiction. - Identifies key factors contributing to addiction, including stress, anxiety and depression - Reviews inhibition and impulsivity in drug use - Assesses the cognitive underpinnings of behavioral choices in addiction - Discusses the argument of self-medication vs. reward sensitization - Examines the psychological causes of why patients relapse

Part I

Cognitive and learning aspects of drug addiction

Chapter 1

Executive functioning and substance use disorders

Bruno Kluwe-Schiavon^a; Breno Sanvicente-Vieira^b; Thiago Wendt Viola^b; Ahmed A. Moustafa^{c a} Experimental and Clinical Pharmacopsychology Laboratory, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
^b Developmental Cognitive Neuroscience Laboratory, Faculty of Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
^c Marcs Institute for Brain, Behaviour, and Development and School of Psychology, Western Sydney University, Penrith, NSW, Australia

Abstract

Executive functioning has been extensively studied over the past six decades and can be defined as a dynamic multifaceted construct that includes different but intercorrelated processes that aimed to self-regulate stress and cognitive engagement, enabling individuals to learn by experience. Substance-related disorders (SUD) are mainly characterized as a chronic self-regulatory disease where individuals engage in reward-seeking situations despite of the adverse consequences, shifting from impulsive to compulsive drug-seeking behaviors. It has been suggested that SUD are related to the failure to balance cognitive engagement (e.g., self-control, behavior inhibition, cognitive flexibility) over stressful demands (e.g., craving or coping with daily-stressful events). This imbalance leads to alterations on the main processes of decision-making (i.e. representation of adaptive behaviors, valuation of choices, goal-oriented action selection, feedback processing and updating), which are related to changes in both cortical and subcortical neural structures. This book chapter firstly highlight the concept of executive functioning and discuss how SUD are related to alterations in brain structures usually associated with executive performance. Additionally, we describe recent evidence on the role of dopaminergic system and how SUD can be described as a biopsychosocial executive functioning disorder.

Keywords

Addiction; Substance use; Drug abuse; Executive function; Cognition; Decision-making

The concept of executive functioning

Executive functioning has been extensively studied in prior psychological research over the past six decades. Some of the key studies in this area include those of the British experimental psychologist Donald E. Broadbent (1926–93) and the American psychologist Michael I. Posner (1936–) on attentional processing, and the studies of the Russian neuropsychologist Alexander Luria (1902–77) regarding the frontal lobes and the hierarchical organization of brain functioning (Freeman, 1967; Luria, 1965, 1970). What do these authors have in common? Broadly speaking, their work highlighted a variety of behaviors that were accepted to be driven by “high-order cognitive processes” and lately become to be known, for instance, as inhibitory control, attention shifting, working memory, goal-directed behavior, and strategic planning. Although several executive functioning models and theories have emerged since then (Goldstein, Naglieri, Princiotta, & Otero, 2014), such idea remains, and executive functioning has become a multifaceted mental concept that includes more than 30 different components (Barkley, 2012), in which the prefrontal cortex (PFC) and its related structures are still the main neuroanatomical counterpart.

The hierarchical framework of executive functioning and the PFC has its roots on two main fields. Based on a neuroscience view, the role of the PFC in executive functioning emerged with observations of patients who had suffered frontal lobe lesions becoming unable to manipulate, integrate, and respond to internal and external stimulus. In other words, these patients seem to have lost the capacity of prospecting future actions and making reasonable decisions as before, showing difficulties in moderating social behavior and, ultimately, changing their usual personality expression in detriment of impulsive and disinhibit traits (Harlow, 1868). Based a psychological view, the role of PFC in executives functioning was intimately related to the cognitive revolution in the 1950s as an attempt to understand how information is processed by the mind. In this regard, several experimental models on information processing emerged to explain selective attention and multistore memory processes (e.g. the bottleneck theory of attention and the three-component model). These models, however, were not able to explain how information is deliberatively selected or inhibited during demanding tasks and, therefore, the concept of “cognitive control” was introduced to fulfil this gap (Goldstein et al., 2014), while concurrently phenomenologically explaining behavior attributed to the PFC.

With the advent of functional imaging techniques and neuroscience, the exclusive role of the PFC becomes a matter of ongoing debate over the last 20 years (Kluwe-Schiavon, Viola, Sanvicente-Vieira, Malloy-Diniz, & Grassi-Oliveira, 2016; Miyake et al., 2000), but it has been accepted that “the participation of the frontal lobes in virtually any ‘executive process’ is probably a necessary, but largely insufficient, requirement” (Alvarez & Emory, 2006). Thus, as described by the Alvarez and Emory (2006), executive functioning involves the coordination of activity among diffuse anatomical and functional brain areas, with the frontal lobes associated with executive functioning sensitivity, rather than specificity. The idea that PFC might contribute to executive functioning is vastly well-accepted, since it has been shown that executive functioning skills reach their peak at age 20–29, in association with the constant myelination of neurons in the prefrontal cortex (Best & Miller, 2010). Such finding also contributes to elucidate another debate, supporting the idea that executive functioning constitutes related, but distinct, multifaceted processes, instead of one single underlying ability that can explain all the components (Jurado & Rosselli, 2007).

The self-regulatory model the Lezak’s four-component conceptual model (Lesak, 1982) and the three component conceptual model of Diamond (Diamond, 2013), are some of the most influential multifaceted models of executive functioning. Barkley (2001) focused on the evolutionary role of executive functioning and social contexts, and according to him, it serves “to shift the control of behavior from the immediate context, social others, and the temporal now to self-regulation by internal representations regarding the hypothetical social future”. More than that, Barkley pinpoints that executive functioning may have evolved to solve some social adaptive problems such as reciprocal altruism or selfish cooperation, highlighting the crucial role of self-regulation. On the other hand, Lezak proposed simple, but pragmatic, framework where volition, planning, purposeful action, and effective performance are the main core executive functioning processes that enable a person to engage successfully in independent, purposive, and self-serving behavior. This model is broadly used by clinicians and researchers, since it allows us to identify and assess its components. Along the same lines, Diamond (2013) suggested that executive functioning can be described as a family of top-down mental processes recruited when automatic, instinct or intuition would be insufficient to cope with an ongoing demand, emphasizing its role as a self-regulatory process, which is in agreement with Barkley’s model. According to Diamond (2013), the main functions are behavioral/cognitive inhibition (including selective attention), working memory, and cognitive flexibility. Several other models have also been reported in the literature. For example, the Miyake and Friedman’s model is based on latent variable analysis that suggested both the unity and diversity aspects of executive functioning, emphasizing updating, inhibition, and shifting as it processes (Miyake et al., 2000); or the dual-processing frameworks and its branches that have been extensively used to differentiate emotional “hot” processes from rational “cold” processes and to describe cognitive changes associated with psychiatric disorders and/or neurodevelopment (Kahneman, 2003, 2011; Noël, Brevers, & Bechara, 2013; Zelazo & Carlson, 2012).

Nevertheless, in this chapter, rather than describing different models, we will assume that executive functioning is a dynamic multifaceted construct that, consequently, includes different but intercorrelated processes that aimed to self-regulate (or balance) stress and cognitive engagement, enabling individuals to learn by experience inasmuch as they internalize efficient behaviors and use such information to prospect a set of new behaviors and their most likely consequences (Kluwe-Schiavon, Viola, Sanvicente-Vieira, Malloy-Diniz, & Grassi-Oliveira, 2016). Such broad perspective allows us to go beyond the discussion on which specific executive functioning component some neuropsychological test is depicting, by understanding that any highly complex behavior, such as decision-making and theory of mind, demands an efficient executive functioning performance. Here, therefore, we will discuss how substance related disorders (SUD) might impair executive functioning over a series of different perspectives.

Substance use disorders and executive dysfunction

Nonetheless, one may ask, why should we look for specific deficits of executive functioning associated with addictive disorders? Initially, it is widely well-known that addictive disorders are clinically characterized as...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Contributors
• Preface
• Acknowledgement
• Part I: Cognitive and learning aspects of drug addiction
• Part II: Clinical and treatment aspects of drug addiction
• Index