Opinion
Circuitry of self-control and its role in reducing addiction

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We discuss the idea that addictions can be treated by changing the mechanisms involved in self-control with or without regard to intention. The core clinical symptoms of addiction include an enhanced incentive for drug taking (craving), impaired self-control (impulsivity and compulsivity), negative mood, and increased stress reactivity. Symptoms related to impaired self-control involve reduced activity in control networks including anterior cingulate (ACC), adjacent prefrontal cortex (mPFC), and striatum. Behavioral training such as mindfulness meditation can increase the function of control networks and may be a promising approach for the treatment of addiction, even among those without intention to quit.

Section snippets

Intention and self-control in behavioral change

Traditionally, intentions are viewed as being crucial for behavioral change [1]. However, many influences on behavior are not conscious. Dual process models provide a role for both automatic (implicit) and controlled (explicit) processes that make complementary and possibly interactive contributions to changing addictive behavior [2]. ‘Automatic’ usually refers to either attention or memory bias toward the substance cues related to the addiction, whereas ‘controlled’ involves motivation and

Addiction networks and deficits of self-control

Studies of humans are revealing neuroadaptations in frontocortical regions of the brain that underlie compulsive drug-seeking behaviors in addiction [16]. Imaging studies have provided compelling evidence for the involvement of the brain control network areas, such as ACC and adjacent mPFC, in the addiction process 17, 18.

Development of self-control

It has recently become common to study the brains of infants, children, and adults while they are resting to map functional networks in the brain (resting-state fMRI) [39]. Resting-state fMRI methods for mapping brain functional connectivity can be applied at any age because they do not require the person to perform a task, and are reproducible across laboratories and within subjects. They also predict an individual's brain maturity across development [40].

Resting-state studies have shown that,

Training self-control

In the case of smoking, participants are usually recruited who intend to reduce or quit smoking. However, some evidence suggests that the intention is not a prerequisite for overcoming addiction in drinking [4]. Moreover, given the central role of self-control in addiction, interventions that improve self-control capacity – with or without the intention to quit – have the potential to be effective in combating addiction. This section examines methods designed to improve self-control.

Concluding remarks and future directions

Is conscious intention required for a change of addictive behavior? In most smoking studies, participants were either recruited based on their intention to quit or their awareness about the goal of reduced smoking [63]. Future research needs to study how this awareness relates to the reduction of drug taking in addiction. It remains to be seen if the conscious intention to quit, and strengthening of self-control by training, have separate additive therapeutic influences on addictions such as

Acknowledgments

This work was supported by the Office of Naval Research and the National Institute of Child Health and Human Development.

Glossary

Cortisol
a steroid hormone, more specifically a glucocorticoid, is produced by the adrenal cortex. It is released in response to stress and to a low level of blood glucose. Its functions are to increase blood sugar and suppress the immune system.
Dopamine receptor type 2 (D2R)
one subtype of dopamine receptors. Dopamine receptors are implicated in many neurological processes, including motivation, pleasure, cognition, memory, learning, and fine motor control, as well as the modulation of

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