Cognitive mechanisms and therapeutic targets of addiction

- Cognitive mechanisms of addiction include automatic and controlled processes.
- Strengthening of automatic and weakening of controlled processes are multicausal.
- Automatic processes can disrupt substance use-related self-awareness.
- Promising new therapeutic strategies target various mechanisms of addiction.
- More research is needed to examine effectiveness of neurocognitive rehabilitation.

Fundamental to cognitive models of addiction is the gradual strengthening of automatic, urge-related responding that develops in tandem with the diminution of self-control-related processes aimed at inhibiting impulses. Recent conceptualizations of addiction also include a third set of cognitive processes related to self-awareness and superordinate regulation of self-control and other higher brain function. This review describes new human research evidence and theoretical developments related to the multicausal strengthening of urge-related responding and failure of self-control in addiction, and the etiology of disrupted self-awareness and rational decision-making associated with continued substance use. Recent progress in the development of therapeutic strategies targeting these mechanisms of addiction is reviewed, including cognitive bias modification, mindfulness training, and neurocognitive rehabilitation.