Academic journal article Alcohol Research: Current Reviews

Cognitive Neuroscience Approaches to Understanding Behavior Change in Alcohol Use Disorder Treatments

Academic journal article Alcohol Research: Current Reviews

Cognitive Neuroscience Approaches to Understanding Behavior Change in Alcohol Use Disorder Treatments

Article excerpt

Researchers have begun to apply cognitive neuroscience concepts and methods to study behavior change mechanisms in alcohol use disorder (AUD) treatments. This review begins with an examination of the current state of treatment mechanisms research using clinical and social psychological approaches. It then summarizes what is currently understood about the pathophysiology of addiction from a cognitive neuroscience perspective. Finally, it reviews recent efforts to use cognitive neuroscience approaches to understand the neural mechanisms of behavior change in AUD, including studies that use neural functioning to predict relapse and abstinence; studies examining neural mechanisms that operate in current evidence-based behavioral interventions for AUD; as well as research on novel behavioral interventions that are being derived from our emerging understanding of the neural and cognitive mechanisms of behavior change in AUD. The

article highlights how the regulation of subcortical regions involved in alcohol incentive motivation by prefrontal cortical regions involved in cognitive control may be a core mechanism that plays a role in these varied forms of behavior change in AUD. We also lay out a multilevel framework for integrating cognitive neuroscience approaches with more traditional methods for examining AUD treatment mechanisms.

Key words: Alcohol use, abuse, and dependence; alcohol use disorder; neuroscience; cognitive neuroscience; brain; cognition; neural mechanisms; pathophysiology; behavior change; behavioral intervention; relapse; abstinence; treatment

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Understanding the mechanisms that underlie recovery from alcohol use disorder (AUD) is critical to advancing AUD treatment science (Huebner and Tonigan 2007; National Institute on Alcohol Abuse and Alcoholism [NIAAA] 2009). Scientific progress over the last three decades has led to the development of a number of effective behavioral and pharmacological AUD interventions (Dutra et al. 2008). However, even evidence-based treatments are only modestly effective. For example, reported rates of nonresponse to treatment interventions in major AUD treatment studies have ranged from 30 percent to 85 percent (Anton 2006; Johnson et al. 2007; McKay 2009; Project MATCH Research Group 1997). There is a general consensus that improving AUD behavioral intervention outcomes requires an understanding of the mechanisms that underlie behavior change in effective treatments (Magill and Longabaugh 2013; Morgenstern and McKay 2007). Thus, building a strong foundation for AUD treatment science includes answering the question of how, not just whether, a treatment is effective (Kazdin 2007).

To date, research on the mechanisms of effective AUD treatments that underlie behavior change have made limited progress, suggesting the need for major revisions in the theory and methods used for this work. Cognitive neuroscience may provide the tools for those revisions. Indeed, the pathophysiological processes that maintain AUD, such as craving, relapse, and withdrawal, are increasingly being understood in terms of the functioning of specific neural systems. As such, any psychosocial treatment for AUD that effectively changes behavior must interact at some level with these processes and, therefore, must influence these same neural systems. This article will review what cognitive neuroscience can tell us about the neural bases of AUD and the mechanisms by which psychosocial treatments may function to elicit behavior change in AUD patients.

Psychosocial Treatment Mechanisms Research in AUD

There is a relatively large research literature on AUD behavioral treatment mechanisms (Huebner and Tonigan 2007; Longabaugh et al. 2013). This research largely represents an extension of assumptions and methods used to test treatment efficacy (Kazdin and Nock 2003; Morgenstern and McKay 2007; Wampold 2001). It has tested the treatment theories that guide evidence-based treatments using a set of mediation analysis procedures embedded within a clinical trials framework (Nock 2007). …

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