Therapeutic Opportunities for Self-Control Repair in Addiction and Related Disorders

Abstract

Contemporary neuro-economic approaches hypothesize that self-control failure results from drugs annexing normal learning mechanisms that produce pathological reward processing and distort decision-making as a result from the dysregulation of two valuation systems. An emphasis on processes shared across different diseases and disorders is at odds with the contemporary approach that assumes unique disease etiologies and treatments. Studying trans-disease processes can identify mechanisms that operate in multiple disease states and ascertain if factors that influence processes in one disease state may be applicable to all disease states. In this paper we review the dual model of self-control failure, the Competing Neurobehavioral Decision Systems approach, the relationship of delay discounting to the relative control of these two systems, and evidence that the executive system can be strengthened. Future research that could result in more potent interventions for executive system improvement and potential constraints on the repair of self-control failure are discussed.

A Competing Neurobehavioral Decision Systems model of SES-related health and behavioral disparities

“…The prefrontal cortices, the primary seat of executive function abilities, are highly plastic and highly adaptive to extant conditions. This plasticity is consistent with the view that executive dysfunction is likely an adaption to environmental conditions and is a potential strength in treatments designed to improve executive function and its influence on health behavior (see Bickel et al, in press). The recognition of significant executive dysfunction among individuals who abuse alcohol, illicit substances, and use tobacco has generated interest in the use of executive function remediation strategies as part of treatment.…”

Impulsive choice and pre-exposure to delays: III. Four-month test-retest outcomes in male wistar rats

“…Because excessive delay discounting is a common process shared among many problematic behaviors, some consider it a trans-disease process (Bickel et al, 2012; Bickel and Mueller, 2009). If excessive delay discounting underlies poor decision-making, exploring techniques for reducing impulsive choice may yield therapeutic benefits for a wide range of behavioral maladies (Bickel et al, 2015; Gray and MacKillop, 2015; Koffarnus et al, 2013). …”

Discounting of Delayed Rewards as an Endophenotype

“…Estimates of discounting for individuals in recovery from drug dependence are near or within a normative range. Mechanistically, discounting is thought by most investigators to involve dual neurobehavioral processes, and those mechanisms have suggested novel interventions (8). Whether discounting can serve as a candidate marker for the diseases and disorders or behaviors listed in the preceding paragraph remains to be determined.…”