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The neurobiology of impulsivity and substance use disorders: implications for treatment.

Authors
  • Kozak, Karolina1, 2, 3
  • Lucatch, Aliya M1
  • Lowe, Darby J E1
  • Balodis, Iris M4
  • MacKillop, James4
  • George, Tony P1, 2, 3
  • 1 Addictions Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 2 Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 3 Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. , (Canada)
Type
Published Article
Journal
Annals of the New York Academy of Sciences
Publisher
Wiley (Blackwell Publishing)
Publication Date
Sep 01, 2019
Volume
1451
Issue
1
Pages
71–91
Identifiers
DOI: 10.1111/nyas.13977
PMID: 30291624
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Impulsivity is strongly associated with substance use disorders (SUDs). Our review discusses impulsivity as an underlying vulnerability marker for SUDs, and treatment of co-occurring impulsivity in SUDs. Three factors should be considered for the complex relationship between impulsivity and a SUD: (1) the trait effect of impulsivity, centering on decreased cognitive and response inhibition, (2) the state effect resulting from either acute or chronic substance use on brain structure and function, and (3) the genetic and environmental factors (e.g., age and sex) may influence impulsive behavior associated with SUDs. Both subjective and objective measures are used to assess impulsivity. Together, treatment developments (pharmacological, behavioral, and neurophysiological) should consider these clinically relevant dimensions assessed by a variety of measures, which have implications for treatment matching in individuals with SUD. Despite its heterogeneity, impulsivity is a marker associated with SUDs and may be understood as an imbalance of bottom-up and top-down neural systems. Further investigation of these relationships may lead to more effective SUD treatments. © 2018 New York Academy of Sciences.

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