The Role of Executive Cognitive Functions in Changing Substance Use: What We Know and What We Need to Know
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ORIGINAL ARTICLE
The Role of Executive Cognitive Functions in Changing Substance Use: What We Know and What We Need to Know Arthur W. Blume, Ph.D. & G. Alan Marlatt, Ph.D.
Published online: 28 March 2009 # The Society of Behavioral Medicine 2009
Abstract Background Executive cognitive functions (ECF) have been linked to skills such as planning, organizing, problem solving, decision-making, initiating and self-regulating behavior, working memory, and motivation; critical activities needed to monitor and change substance use behavior. Purpose The purpose of this study is to investigate how ECF may impact important variables associated with changing substance use behavior. Methods This study is a critical review of the extant literature about how ECF may influence substance abuse treatment outcomes and behavior change. Results A review of the literature found evidence that poorer ECF likely hinders substance use behavior change and is often associated with behavior labeled as denial. However, the relationship between ECF and substance abuse appears to be highly complex. Conclusions Traditional methods of substance abuse assessment, interpretation of behavior, and intervention may need to be reconsidered in light of new research about executive cognitive dysfunction. Implications for future research are discussed. Keywords Executive cognitive functions . Substance abuse . Alcohol abuse
A. W. Blume (*) Department of Psychology, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28823-0001, USA e-mail: [email protected] G. Alan Marlatt Department of Psychology, University of Washington, Seattle, WA, USA
Introduction Executive cognitive functions (ECF) have been associated with the ability to monitor and change behavior. Executive cognitive functions facilitate people to engage in thoughtful goal-driven activities and include important behaviors such as planning, organizing, problem solving, decision-making, initiating and self-regulating behavior, working memory, and motivation and have been linked to complex cortical circuits that involve the frontal lobes and other areas of the brain [1]. In addition, there is evidence that ECF are associated with emotion regulation processes [2, 3]. Planning, organizing, problem solving, behavioral and emotional self-control, online memory, and motivation are necessary to change substance use. Adults diagnosed with alcohol dependence have been found to have measurable executive cognitive deficits when compared with normal controls [4–6]. Severity of opiate dependence has significantly predicted greater task shifting disabilities associated with executive cognitive dysfunction [7]. Polysubstance abuse has also been linked to ECF deficits such as disinhibition, task shifting disabilities, and problems with decision making and processing of new information [8]. A study that investigated people with alcohol dependence found a significant relationship between ECF function and emotional discomfort, suggesting a link of ECF with emotion dysregulation [9]. O
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