The Executive Functioning Paradox in Substance Use Disorders

Abstract

Deficits in neurocognitive functioning are trait-like vulnerabilities that have been widely studied in persons with substance use disorders (SUD), but their role in the craving–use association and relapse vulnerability remains poorly understood. The main objectives of this study were to examine whether executive capacities moderate the magnitude of the craving–substance use relationship, and if this influence is correlated with the functional connectivity of cerebral networks, combining rsfMRI examinations and ecological momentary assessment (EMA). Eighty-six patients beginning outpatient treatment for alcohol, tobacco or cannabis addiction and 40 healthy controls completed neuropsychological tests followed by EMA to collect real-time data on craving. Fifty-four patients and 30 healthy controls also completed a resting-state fMRI before the EMA. Among the patients with SUD, better verbal fluency and resistance to interference capacities were associated with a greater propensity to use substances when the individual was experiencing craving. Preliminary rsfMRI results identified specific networks that interacted with executive performance capacities to influence the magnitude of the craving–use association. Individuals with better executive functioning may be more prone to relapse after craving episodes. Specifically, better resistance to interference and cognitive flexibility skills may reduce attention to distracting stimuli, leading to a greater awareness of craving and susceptibility to use substances.

Mobile Assessments of Mood, Cognition, Smartphone-Based Sensor Activity, and Variability in Craving and Substance Use in Patients With Substance Use Disorders in Norway: Prospective Observational Feasibility Study

“…Interestingly, we were able to find these differences even in a relatively small sample of only clinical patients with SUDs and not in patients with SUDs versus healthy controls in this feasibility study. There has been some discussion in the literature about whether self-regulatory mechanisms such as cognitive functions and disinhibition influence the vulnerability to act on craving and use substances [ 45 ], but we did not find support for this in our study, as no measures of cognitive functioning were significant in explaining variability in substance use episodes; we did, however, not allow for an interaction term.…”

Identifying the role of (dis)inhibition in the vicious cycle of substance use through ecological momentary assessment and resting-state fMRI

“…Inhibition is defined as the ability to deliberately inhibit dominant, automatic, or prepotent responses when necessary [7]. Deficits in this function have been hypothesized to be directly linked to enhanced use of the primary substance [8], through underlying cerebral alterations [9] or by invoking moderating effects of other risk factors such as craving [10]. However, most patients treated for SUD do not exhibit a single, substance use pattern and co-occuring use of other substances contributes to the morbidity and mortality of hospitalized patients [11].…”

Exploration of Psychiatry Residents’ Attitudes toward Patients with Substance Use Disorder, Bipolar Disorder and Schizophrenia in Saudi Arabia

“…Addiction resistance is a measure of the discrepancy between alcohol intake and alcohol use disorder symptoms, where some people consume more alcohol but show fewer alcohol use disorder symptoms [ 16 ]. Better verbal fluency and interference–resistance abilities were associated with a higher propensity to use drugs to satiate cravings in SUD patients [ 17 ]. Persistent maladaptive memories that maintain drug-seeking and extinction resistance are a feature of addiction [ 18 ].…”