The contributions of cognitive neuroscience and neuroimaging to understanding mechanisms of behavior change in addiction

The effects of mobile phone dependence on athletic performance and its mechanisms

Mobile phone dependence (also known as internet dependence, MPD), defined as a problematic behavior characterized by excessive use or intermittent craving to use a mobile phone, results in various social, behavioral, and affective problems in daily life. In sports, MPD is directly related to the physical and mental health and sports performance of athletes. The individual and environmental factors, neurobiological mechanisms and theoretical models of MPD affecting athletic performance were analyzed by reviewing previous studies, aiming to construct effective training and development protocols to prevent and control the occurrence of MPD in athletes. At present, athletic performance can be affected by MPD through individual factors and environmental factors. The neurobiological mechanisms between the two are based on the brain reward system and microwave radiation from mobile phones, with athletic performance being restricted by alterations in the corresponding brain regions. Relevant theoretical models mainly include the social cognitive model of self-regulation and the integrative model of self-control, which explain the interrelationship between MPD and athletic performance from the perspectives of athletes' self-regulation and self-control, respectively. As an emerging phenomenon, the influence pathways and mechanisms by which MPD affects athletic performance need to be further investigated. A longitudinal perspective should be adopted to trace the dynamic impact relationship between the two, and developing relevant theoretical frameworks from an interdisciplinary research perspective should be valuable for providing theoretical support for coaches and sports administrators to formulate scientific training protocols and thus improve the mental health of athletes.

Neural Correlates of Cue Reactivity and the Regulation of Craving in Substance Use Disorders

Abstract. Theoretical background: Considerable progress has been made in illuminating the neural basis of the compulsive use patterns characterizing substance use disorders. It has been suggested to utilize these findings to alleviate the health burden associated with substance use. Objective: We address how neuroimaging research can provide these benefits. Methods: Based on neurobiological models of addiction, we highlight neuroimaging research elucidating neural predictors of relapse and how treatments modify these markers. Results: With the focus on cue reactivity, brain activity related to the motivational salience of drugs and automatized use behaviors can predict relapse. Cue reactivity changes with abstinence, and it remains to be determined whether such changes confer periods of critical relapse susceptibility. Conclusions: Several established and emerging interventions modulate brain activity associated with drug value. However, executive deficits in addiction may compromise interventions targeting control-related prefrontal brain areas. Lastly, it remains more difficult to change the brain responses mediating habitual behaviors.

A Comparison of Mathematical and Statistical Modeling with Longitudinal Data: An Application to Ecological Momentary Assessment of Behavior Change in Individuals with Alcohol Use Disorder

Ecological momentary assessment (EMA) has been broadly used to collect real-time longitudinal data in behavioral research. Several analytic methods have been applied to EMA data to understand the changes of motivation, behavior, and emotions on a daily or within-day basis. One challenge when utilizing those methods on intensive datasets in the behavioral field is to understand when and why the methods are appropriate to investigate particular research questions. In this manuscript, we compared two widely used methods (generalized estimating equations and generalized linear mixed models) in behavioral research with three other less frequently used methods (Markov models, generalized linear mixed-effects Markov models, and differential equations) in behavioral research but widely used in other fields. The purpose of this manuscript is to illustrate the application of five distinct analytic methods to one dataset of intensive longitudinal data on drinking behavior, highlighting the utility of each method.

How Alcohol Influences Mechanisms of Sexual Risk Behavior Change: Contributions of Alcohol Challenge Research to the Development of HIV Prevention Interventions

This paper examines the contributions of laboratory-based alcohol challenge research (ACR) to the development of HIV prevention interventions. Following a brief overview of HIV prevention interventions and related health behavior change models, we discuss how alcohol may influence mechanisms of behavior change. The paper highlights the value of ACR for: (1) elucidating mechanisms of action through which alcohol affects sexual risk behavior, (2) testing how alcohol may influence mechanisms thought to underlie HIV prevention interventions, (3) clarifying moderators of the causal influences of alcohol, (4) identifying novel intervention targets, and (5) developing strategies to reduce sexual risk among those who consume alcohol. We conclude with a discussion of the importance of using experimental research to identify mechanisms of behavior change that are specific to populations at high risk for HIV and outline some key implications for developing HIV prevention interventions that integrate the role of alcohol.

Digital health data-driven approaches to understand human behavior

Advances in digital technologies and data analytics have created unparalleled opportunities to assess and modify health behavior and thus accelerate the ability of science to understand and contribute to improved health behavior and health outcomes. Digital health data capture the richness and granularity of individuals' behavior, the confluence of factors that impact behavior in the moment, and the within-individual evolution of behavior over time. These data may contribute to discovery science by revealing digital markers of health/risk behavior as well as translational science by informing personalized and timely models of intervention delivery. And they may help inform diagnostic classification of clinically problematic behavior and the clinical trajectories of diagnosable disorders over time. This manuscript provides a review of the state of the science of digital health data-driven approaches to understanding human behavior. It reviews methods of digital health assessment and sources of digital health data. It provides a synthesis of the scientific literature evaluating how digitally derived empirical data can inform our understanding of health behavior, with a particular focus on understanding the assessment, diagnosis and clinical trajectories of psychiatric disorders. And, it concludes with a discussion of future directions and timely opportunities in this line of research and its clinical application.

Commentary: Suggesting Shinrin-yoku (forest bathing) for treating addiction

Shinrin-yoku ('') (i.e., forest bathing), a Japanese wellbeing practice, aims to harmonise a person with a forest by bathing in the forest mindfully using our five senses (Miyazaki, 2018). Practitioners can choose whatever they like to focus on in the forest: different colours of leaves, the sounds of streams, or the warmth of sunshine beaming between leaves. Since the birth of this practice in 1982, shinrin-yoku has been widely used in the Japanese clinical fields (Hansen, Jones, & Tocchini, 2017). Recently, this healing practice has received attention from healthcare practitioners and researchers worldwide (Wen, Yan, Pan, Gu, & Liu, 2019). In this commentary, we will discuss limitations of the current shinrin-yoku research, and how future research can be conducted to appraise the effects of shinrin-yoku on addiction.

Prevalent Misconceptions About Opioid Use Disorders in the United States Produce Failed Policy and Public Health Responses

The current opioid crisis in the United States has emerged from higher demand for and prescribing of opioids as chronic pain medication, leading to massive diversion into illicit markets. A peculiar tragedy is that many health professionals prescribed opioids in a misguided response to legitimate concerns that pain was undertreated. The crisis grew not only from overprescribing, but also from other sources, including insufficient research into nonopioid pain management, ethical lapses in corporate marketing, historical stigmas directed against people who use drugs, and failures to deploy evidence-based therapies for opioid addiction and to comprehend the limitations of supply-side regulatory approaches. Restricting opioid prescribing perversely accelerated narco-trafficking of heroin and fentanyl with consequent increases in opioid overdose mortality As injection replaced oral consumption, outbreaks of hepatitis B and C virus and human immunodeficiency virus infections have resulted. This viewpoint explores the origins of the crisis and directions needed for effective mitigation.

Alcohol Cue-Induced Ventral Striatum Activity Predicts Subsequent Alcohol Self-Administration

BACKGROUND

Human laboratory paradigms are a pillar in medication development for alcohol use disorders (AUD). Neuroimaging paradigms, in which individuals are exposed to cues that elicit neural correlates of alcohol craving (e.g., mesocorticolimbic activation), are increasingly utilized to test the effects of AUD medications. Elucidation of the translational effects of these neuroimaging paradigms on human laboratory paradigms, such as self-administration, is warranted. The current study is a secondary analysis examining whether alcohol cue-induced activation in the ventral striatum is predictive of subsequent alcohol self-administration in the laboratory.

METHODS

Non-treatment-seeking heavy drinkers of East Asian descent (n = 41) completed a randomized, placebo-controlled, double-blind, crossover experiment on the effects of naltrexone on neuroimaging and human laboratory paradigms. Participants completed 5 days of study medication (or placebo); on day 4, they completed a neuroimaging alcohol taste cue-reactivity task. On the following day (day 5), participants completed a 60-minute alcohol self-administration paradigm.

RESULTS

Multilevel Cox regressions indicated a significant effect of taste cue-elicited ventral striatum activation on latency to first drink, Wald χ²  = 2.88, p = 0.05, such that those with higher ventral striatum activation exhibited shorter latencies to consume their first drink. Similarly, ventral striatum activation was positively associated with total number of drinks consumed, F(1, 38) = 5.90, p = 0.02. These effects were significant after controlling for alcohol use severity, OPRM1 genotype, and medication. Other potential regions of interest (anterior cingulate, thalamus) were not predictive of self-administration outcomes.

CONCLUSIONS

Neuroimaging alcohol taste cue paradigms may be predictive of laboratory paradigms such as self-administration. Elucidation of the relationships among different paradigms will inform how these paradigms may be used synergistically in experimental medicine and medication development.

The determinants of handwashing behaviour in domestic settings: An integrative systematic review

BACKGROUND

Hygiene promotion interventions are likely to be more effective if they target the determinants of handwashing behaviour. Synthesis of the evidence on the determinants of handwashing behaviour is needed to enable practitioners to use evidence in hygiene promotion programming.

PURPOSE

To identify, define and categorise the determinants of handwashing behaviour in domestic settings and to appraise the quality of this evidence.

METHODS

We conducted an integrative review, searching three databases for terms related to handwashing and behaviour change determinants. Studies were summarised and their quality assessed against a pre-defined set of criteria for qualitative, quantitative and mixed-method studies. Data on determinants were extracted and classified according to a predefined theoretical taxonomy. The effect of each association between a determinant and handwashing behaviour was summarised and weighted based on the quality of evidence provided. Determinants that were reported more than three times were combined into a meta-association and included in the main analysis. Sub-analyses were done for studies conducted during outbreaks or humanitarian crises.

RESULTS

Seventy-eight studies met the criteria. Of these, 18% were graded as 'good quality' and 497 associations between determinants and handwashing behaviour were extracted. We found that 21% of these associations did not clearly define the determinant and 70% did not use a valid or reliable method for assessing determinants and/or behaviour. Fifty meta-associations were included in the main analysis. The determinants of handwashing that were most commonly reported were knowledge, risk, psychological trade-offs or discounts, characteristic traits (like gender, wealth and education), and infrastructure. There was insufficient data to draw conclusions about the determinants of behaviour in outbreaks or crises.

CONCLUSIONS

This review demonstrates that our understanding of behavioural determinants remains sub-optimal. We found that there are limitations in the way behavioural determinants are conceptualised and measured and that research is biased towards exploring a narrow range of behavioural determinants. Hygiene promotion programmes are likely to be most successful if they use multi-modal approaches, combining infrastructural improvement with 'soft' hygiene promotion which addresses a range of determinants rather than just education about disease transmission.

Sensitivity to gains during risky decision-making differentiates chronic cocaine users from stimulant-naïve controls

BACKGROUND

Chronic cocaine use has been consistently associated with decision-making impairments that contribute to the development and maintenance of drug-taking. However, the underlying cognitive processes of risk-seeking behaviours observed in chronic cocaine users (CU) have so far remained unclear. Here we therefore tested whether CU differ from stimulant-naïve controls in their sensitivity to gain, loss, and probability of loss information when making decisions under risk.

METHOD

A sample of 96 participants (56 CU and 40 controls) performed the no-feedback version of the Columbia Card Task, designed to assess risk-taking in relation to gain, loss, and probability of loss information. Additionally, cognitive performance and impulsivity were determined. Current and recent substance use was objectively assessed by toxicological urine and hair analysis.

RESULTS

Compared to controls, CU showed increased risk-seeking in unfavourable decision scenarios in which the loss probability was high and the returns were low, and a tendency for increased risk aversion in more favourable decision scenarios. In comparison to controls, CU were less sensitive to gain, but similarly sensitive to loss and probability of loss information. Further analysis revealed that individual differences in sensitivity to loss and probability of loss information were related to cognitive performance and impulsivity.

CONCLUSION

Reduced sensitivity to gains in people with CU may contribute to their propensity for making risky decisions. While these alterations in gain sensitivity might directly relate to cocaine use per se, the individual psychopathological profile of CU might moderate sensitivity to loss information.

Behavioral Treatments for Adolescent Cannabis Use Disorder: a Rationale for Cognitive Retraining

Purpose of Review

Adolescent cannabis use represents a significant public health concern. Cannabis experimentation typically begins in adolescence and increases the odds of meeting criteria for cannabis use disorder. Cannabis use disorder is associated with numerous short- and long-term adverse consequences for adolescents, highlighting the critical need for efficacious behavioral treatments. This brief review aims to synthesize the state of the behavioral treatment literature on adolescents with cannabis use disorder and to discuss new pathways to leverage neuroscience to inform novel targets for behavioral intervention.

Recent Findings

To date, effective treatment options for adolescent cannabis use disorder that have been tested in randomized controlled trials include cognitive behavioral therapy, motivational enhancement therapy, and multidimensional family therapy. However, established behavioral treatment approaches focus on higher-order cognitive control and have only been modestly effective.

Summary

There is a need to develop new pathways that translate neuroscience findings into novel targets for behavioral interventions.

Biological and Psychological Factors Associated With Smoking Abstinence Six Years Post-Stroke

Introduction

Tobacco use is a public health problem causing high morbidity and mortality, including stroke. This study evaluates predictive factors of smoking cessation in the long term after stroke.

Methods

We followed a cohort of 110 consecutive smokers with stroke for up to 6 years. Sociodemographic variables, stroke severity, insular involvement, stage of change in smoking habit before stroke and disruption of addiction variable (smoking cessation, absence of relapses, having stopped smoking without difficulties and not having had urge) were evaluated.

Results

Twenty patients died during follow-up and two patients were lost leaving a final cohort of 88 patients. The prevalence of smoking cessation in the remaining population was 65.9% post-stroke, 54.9% at 3-6 months, 40.9% at 1 year and 37.5% at 6 years. Prevalence was significantly higher in patients with insular involvement during the first year of follow-up, but not at 6 years. Disruption immediately after stroke (OR = 10.1; 95% CI = 2.5 to 40.1) and intention to change before having the stroke (OR = 4.8; 95% CI = 1.0 to 23.0) were predictors of abstinence at 6 years after adjusting for age, sex and stroke severity at baseline. When tobacco abstinence at the 1 year follow-up was included in the model, this factor was the best predictor of tobacco abstinence at 1 year (OR = 10.5; 95% CI = 2.2 to 49.4).

Conclusions

Intention of change, having the disruption criteria, and abstinence 1 year after stroke were predictors of abstinence at 6 years. An insular lesion in the acute phase of stroke does not determine the tobacco use status at 6 years.

Implications

This study is the first prospective investigation with a cohort of stroke patients to examine the long-term influence of biological and psychological factors on smoking cessation. Tobacco abstinence 1 year after stroke was the strongest predictor of abstinence at 6 years of follow-up. The effect of the insular cortex lesion on tobacco cessation, which had been relevant during the first year, no longer had an influence over the longer period studied here.

An Examination of Motivation to Change and Neural Alcohol Cue Reactivity Following a Brief Intervention

Background: Brief interventions represent a promising psychological intervention targeting individuals with heavy alcohol use. Motivation to change represents an individual's openness to engage in a behavior change strategy and is thought to be a crucial component of brief interventions. Neuroimaging techniques provide a translational tool to investigate the neurobiological mechanisms underlying potential mediators of treatment response, including motivation to change. Therefore, this study aimed to examine the effect of a brief intervention on motivation to change drinking behavior and neural alcohol taste cue reactivity. Methods: Non-treatment-seeking heavy drinkers were randomized to receive a brief drinking intervention (n = 22) or an attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and after the intervention or control session: importance, confidence, and readiness. Immediately following the intervention or control session, participants also underwent an functional magnetic resonance imaging (fMRI) during which they completed an alcohol taste cues paradigm. Results: There was a significant effect of the brief intervention on increasing ratings of importance of changing drinking behavior, but not on ratings of confidence or readiness to change. Ratings of importance after the intervention or control session were associated with neural alcohol taste cue reactivity, but notably, this effect was only significant for participants who received the intervention. Individuals in the intervention condition showed a positive association between ratings of importance and activation in the precuneus, posterior cingulate, and insula. Conclusions: The brief drinking intervention was successful at improving one dimension of motivation to change among non-treatment-seeking heavy drinkers. The brief intervention moderated the relationship between ratings of importance and brain activation in circuitry associated with interoceptive awareness and self-reflection. Together, findings represent an initial step toward understanding the neurobiological mechanisms through which a brief intervention may improve motivation to change.

fMRI Stroop and behavioral treatment for cocaine-dependence: Preliminary findings in methadone-maintained individuals

BACKGROUND

Although behavioral treatment for cocaine use disorders is common, the use of cognitive neuroscience methods to investigate these treatments' mechanisms of action remains limited. Cognitive control (e.g., as measured by the Stroop task) has been proposed to be central to cocaine-use disorders, including treatment response.

METHODS

Participants were methadone-maintained, cocaine-dependent individuals who were participating in a randomized clinical trial (RCT) of 8 weeks of treatment for cocaine-use disorder and randomized to outpatient treatment as usual (TAU) or computer-based cognitive-behavioral therapy (CBT4CBT) plus TAU. Participants completed fMRI Color-Word Stroop task at beginning-of-treatment (N = 19) and post-treatment (N = 10). Analyses assessed correlations between beginning-of-treatment Stroop effect with methadone dose or within-treatment cocaine abstinence, change in Stroop-effect at post- versus beginning-of-treatment, and correlations between 'change in Stroop effect' with methadone dose or within-treatment cocaine abstinence.

RESULTS

Higher methadone dose was associated with higher beginning-of-treatment Stroop-related activity in the declive, culmen, and lingual gyrus. Stroop-related activity was reduced at post-treatment relative to beginning-of-treatment in the medial frontal gyrus/cingulate gyrus and thalamus/midbrain/culmen. Greater reduction in Stroop-related activity was associated with better within-treatment abstinence.

CONCLUSIONS

Diminished Stroop-related activity following treatment may be consistent with improved efficiency of cognitive-control-related activity. Although preliminary, this study is the first to demonstrate a relationship between better treatment outcomes (lower cocaine use during treatment) and greater reduction in Stroop-related activity at post- versus beginning-of-treatment in cocaine users. These findings extend prior work.

Leveraging digital technology to intervene on personality processes to promote healthy aging

The scientific evidence is clear that personality processes (particularly conscientiousness and neuroticism) play an important role in healthy aging. Assuming it would be desirable to assist individuals to change their personality in directions that would promote healthy aging, the next step is designing interventions for the task. During the past decade, technological advances have made it possible to develop and evaluate interventions delivered via web and mobile digital technologies. The purpose of this article is to discuss the possibilities for leveraging technology to intervene on personality processes to promote healthy aging, with a specific emphasis on applications for older adults. We begin by reviewing interventions that target personality change to treat mental health problems and physical health, followed by the scant research leveraging digital technologies in targeting personality processes. We present a rationale for adopting a transdiagnostic model to guide intervention development and review the brief literature supporting transdiagnostic interventions when adapted for digital delivery (transdiagnostic Internet-based cognitive-behavioral therapy). We then summarize the literature on designing technology interventions to meet the specific needs of older adults and some of the impressive results from digital technology (Internet-based cognitive-behavioral therapy) intervention studies. We conclude with suggestions for addressing gaps in this important but understudied area of research, with a focus on research targeted to older adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Commentary on Litt et al. (2018): Identifying treatment-targeted mechanisms-aim and measure the bullseye

The search for mechanisms unique to a specific treatment requires identification of an exact treatment target, instruments that are precise in measuring the target, and a statistical approach that will determine whether the given treatment hit the target.

Striatal reward sensitivity predicts therapy-related neural changes in alcohol addiction

Individual differences in reward sensitivity along with weakened executive control are characteristic for alcohol use disorder (AUD). Emerging translational models of psychotherapy propose the integration of such neurobiological risk profiles to elucidate the mechanisms underlying behavior change in order to improve intervention efficacy. The primary aim of the study was to investigate whether striatal baseline reward sensitivity can be used as a neurobiological predictor of intervention-specific changes in neural functioning during AUD therapy. Fifty-eight detoxified AUD patients were randomly assigned to either receive cue exposure training (CET + TAU, N = 40) or treatment as usual (TAU only, N = 18). Pre- and post-treatment sensitivity to reward was assessed by a functional magnetic resonance imaging monetary reward paradigm. A moderated multiple regression analysis revealed a positive relationship between striatal baseline reward sensitivity and activation changes in the superior frontal gyrus and anterior cingulate cortex (ACC) after CET + TAU in contrast to a negative relationship after TAU only. Over all subjects, a stronger signal change in the superior frontal gyrus and ACC was associated with increased self-efficacy to abstain alcohol. These results provide evidence that reward sensitivity at baseline predicts neural changes in inhibitory networks after receiving CET + TAU. Striatal reward sensitivity might be a promising neurobiological marker to inform therapeutic decisions.

The Translational Value of Psychophysiology Methods and Mechanisms: Multilevel, Dynamic, Personalized

OBJECTIVE

It has been nearly 15 years since Kazdin and Nock published methodological and research recommendations for understanding mechanisms of change in child and adolescent therapy. Their arguments and enthusiasm for research on mechanisms of behavior change (MOBCs) resonated across disciplines and disorders, as it shined a light on the crucial importance of understanding how and for whom treatments instigate behavior change and how therapeutic mechanisms might be extended to "situations and settings of everyday life." Initial efforts focused on how psychotherapy works and linear models, yet the use of theory to guide the study of mechanisms, and laboratory experiments to manipulate them, is broadly applicable.

METHOD

This article considers dynamic physiological processes that support behavior change. Specifically, it examines the utility of psychophysiological methods to measure and promote behavior change. Moreover, it embeds the baroreflex mechanism, a well-defined heart-brain feedback loop, within the theories and strategies of MOBC research.

RESULTS AND CONCLUSION

Individuals' subjective and expressive experience of change does not always align with their physiological reactivity. Thus, behavior change may be best understood when concurrently assessed across multiple biobehavioral levels. Further, behavior is initiated in the moment, often before conscious deliberation, suggesting that multilevel behavior change research may benefit from real-time methodological designs. Last, substance use trajectories vary widely, suggesting that different MOBCs are more or less active in individuals depending on their personal constituency and the functional need that their substance use serves; thus, methods that are amenable to personalized modeling approaches are important.

Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again

Cognitive-behavioral therapy (CBT) approaches have among the highest level of empirical support for the treatment of drug and alcohol use disorders. As Psychology of Addictive Behaviors marks its 30th anniversary, we review the evolution of CBT for the addictions through the lens of the Stage Model of Behavioral Therapies Development. The large evidence base from Stage II randomized clinical trials indicates a modest effect size with evidence of relatively durable effects, but limited diffusion in clinical practice, as is the case for most empirically validated approaches for mental health and addictive disorders. Technology may provide a means for CBT interventions to circumvent the "implementation cliff" in Stages III-V by offering a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations. Moreover, returning to Stage I to reconnect clinical applications of CBT to recent developments in cognitive science and neuroscience holds great promise for accelerating understanding of mechanisms of action. It is critical that CBT not be considered as a static intervention, but rather 1 that constantly evolves and is refined through the stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions. (PsycINFO Database Record

Dynamical Systems Modeling to Identify a Cohort of Problem Drinkers with Similar Mechanisms of Behavior Change

One challenge to understanding mechanisms of behavior change (MOBC) completely among individuals with alcohol use disorder is that processes of change are theorized to be complex, dynamic (time varying), and at times non-linear, and they interact with each other to influence alcohol consumption. We used dynamical systems modeling to better understand MOBC within a cohort of problem drinkers undergoing treatment. We fit a mathematical model to ecological momentary assessment data from individual patients who successfully reduced their drinking by the end of the treatment. The model solutions agreed with the trend of the data reasonably well, suggesting the cohort patients have similar MOBC. This work demonstrates using a personalized approach to psychological research, which complements standard statistical approaches that are often applied at the population level.

A contextual model of self-regulation change mechanisms among individuals with addictive disorders

Numerous behavioral treatments for addictive disorders include components explicitly aimed at targeting self-regulation (e.g., coping and emotion regulation). We first provide a summary of key findings to date among studies that have examined self-regulation as a mechanism of behavior change (MOBC) in behavioral treatments for addictive disorders. Based on our review, we conclude that the role of self-regulation as a MOBC across behavioral treatments for addictive disorders is not well-characterized and findings are inconsistent across studies. For example, our review indicates that there is still inconsistent evidence that coping is a unique MOBC in cognitive-behavioral approaches for addictive behaviors. We propose that there has been slow progress in understanding self-regulation as a MOBC in addiction treatment because of a lack of attention to contextual factors. Accordingly, in the second half of this paper, we propose a contextual model of self-regulation change mechanisms, which emphasizes that the role of various facets of self-regulation as MOBC may depend on contextual factors in the immediate situational context (e.g., fluctuating internal and external cues) and in the broader context in which an individual is embedded (e.g., major life stressors, environmental conditions, dispositions). Additionally, we provide specific recommendations to guide future research for understanding both between-person and within-person self-regulation MOBC in addiction treatment. In particular, we provide key recommendations for how to capitalize on intensive longitudinal measurement methods (e.g., ecological momentary assessment) when bringing a contextual perspective to the study of self-regulation as MOBC in various addiction treatments.

Event-Related Potentials as Biomarkers of Behavior Change Mechanisms in Substance Use Disorder Treatment

Substance use disorders (SUDs) are one of the most prevalent psychiatric conditions and represent a significant public health concern. Substantial research has identified key processes related to reinforcement and cognition for the development and maintenance of SUDs, and these processes represent viable treatment targets for psychosocial and pharmacological interventions. Research on SUD treatments has suggested that most approaches are comparable in effectiveness. As a result, recent work has focused on delineating the underlying mechanisms of behavior change that drive SUD treatment outcome. Given the rapid fluctuations associated with the key neurocognitive processes associated with SUDs, high-temporal-resolution measures of human brain processing, namely event-related potentials (ERPs), are uniquely suited to expand our understanding of the underlying neural mechanisms of change during and after SUD treatment. The value of ERPs in the context of SUD treatment are discussed along with work demonstrating the predictive validity of ERPs as biomarkers of SUD treatment response. Example associations between multiple ERP components and psychosocial and/or pharmacological treatment outcome include the P3a and P3b (in response to neutral and substance-related cues), the attention-related negativities (e.g., N170, N200), the late positive potential, and the error-related negativity. Also addressed are limitations of the biomarker approach to underscore the need for research programs evaluating mechanisms of change. Finally, we emphasize the advantages of ERPs as indices of behavior change in SUD treatment and outline issues relevant for future directions in this context.

Functional neural changes following behavioral therapies and disulfiram for cocaine dependence

A growing literature exists on neural correlates of treatment outcome. However, different types-or components of-treatment have distinct theorized mechanisms of action. And it is not yet known how changes in neural activity across treatment relate to engagement in different treatment components. Participants with cocaine use disorders in a randomized clinical trial received cognitive-behavioral therapy (CBT) plus, in a 2 × 2 design, contingency management (CM) or no CM, and disulfiram or placebo. Participants performed a functional MRI Stroop task, a measure of cognitive control, at the beginning of and after the 12-week treatment. Analyses assessed changes in Stroop-related neural activity within the sample overall and assessed how changes in Stroop-related activity correlated with measures of treatment process specific to each form of treatment (i.e., participation in CBT sessions, receipt of CM prizes, administration of disulfiram pills). Within the sample overall, compared with beginning of treatment, posttreatment Stroop-related neural activity was diminished in the hippocampus, thalamus, cingulate, precentral, post- and precentral gyrus, and precuneus and culmen regions (pFWE < .05). In separate whole-brain correlation analyses, greater reductions in Stroop-related activity were associated with more treatment engagement-"CBT sessions" with the precentral gyrus, inferior parietal lobule, and middle and medial frontal gyrus; "CM prizes" with the postcentral frontal gyrus. Disulfiram "medication days" were not associated with changes in Stroop-related activity. Findings suggest that key process indicators of CBT and CM may be associated with functional changes in cognitive-control-related neurocircuitry. (PsycINFO Database Record

A Clinician's Guide to Co-occurring ADHD among Adolescent Substance Users: Comorbidity, Neurodevelopmental Risk, and Evidence-based Treatment Options

This article introduces neurodevelopmental and clinical considerations for treating adolescents with co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) and substance use (ASU) in outpatient settings. We first describe neurobiological impairments common to ADHD and ASU, including comorbidity with conduct disorder, that evoke a profile of multiplicative developmental risk. We then present two evidence-based options for targeting ADHD-related problems during ASU treatment. Medication integration interventions utilize family ADHD psychoeducation to prompt decision-making about ADHD medication and integrate medication management into behavioral services. Clinic-based academic training interventions utilize family interventions to improve the home academic environment and boost organization skills. We conclude with recommendations for ADHD assessment and intervention sequencing.

Lifetime alcohol use and cognitive performance in older adults

Substance use is an important clinical issue in the older adult population. As older adults are susceptible to cognitive disorders, the intersection of the fields of substance use and cognitive neuroscience is an active area of research. Prior studies of alcohol use and cognitive performance are mixed, and inconsistencies may be due to under- or over-adjustment for confounders. This article adds to this literature by conducting a secondary analysis of self-reported lifetime history of alcohol use and cognitive performance in older adults (n = 133). It was hypothesized that current alcohol users would have poorer cognitive performance compared to never/minimal and former alcohol users. Older adult participants were classified into never/minimal alcohol users, former alcohol users, and current alcohol users. A neurocognitive battery included a global cognitive measure and individual measures of attention, memory, fluency, and executive function. A directed acyclic graph-based approach was used to select variables to be included in the multiple linear regression models. Though unadjusted analyses showed some significant associations between alcohol use and cognitive performance, all associations between alcohol use and cognitive performance were eliminated after adjusting for age, education, sex, race, and smoking pack years. Alcohol drink years were not significantly associated with cognitive performance among current and former alcohol users. These results suggest that lifetime alcohol use is not significantly associated with cognitive performance in older adults after adjustment for key confounders. Inconsistencies in prior studies may be due to uncontrolled confounding and/or unnecessary adjustment of mediators and/or colliders.

Brain mechanisms of Change in Addictions Treatment: Models, Methods, and Emerging Findings

Increased understanding of "how" and "for whom" treatment works at the level of the brain has potential to transform addictions treatment through the development of innovative neuroscience-informed interventions. The 2015 Science of Change meeting bridged the fields of neuroscience and psychotherapy research to identify brain mechanisms of behavior change that are "common" across therapies, and "specific" to distinct behavioral interventions. Conceptual models of brain mechanisms underlying effects of Cognitive Behavioral Therapy, mindfulness interventions, and Motivational Interviewing were discussed. Presentations covered methods for integrating neuroimaging into psychotherapy research, and novel analytic approaches. Effects of heavy substance use on the brain, and recovery of brain functioning with sustained abstinence, which may be facilitated by cognitive training, were reviewed. Neuroimaging provides powerful tools for determining brain mechanisms underlying psychotherapy and medication effects, predicting and monitoring outcomes, developing novel interventions that target specific brain circuits, and identifying for whom an intervention will be effective.

Within-person associations between daily motivation and self-efficacy and drinking among problem drinkers in treatment

Gaining a better understanding of the change process holds promise to improve alcohol treatment. Ecological momentary assessment (EMA) coupled with intensive longitudinal data (ILD) approaches have been proposed as promising methods that can advance change process research but have been used infrequently in alcohol use disorder (AUD) treatment research. The current study used these approaches to examine the within-person associations of motivation and self-efficacy and drinking among treatment-seeking problem drinkers. Participants (N = 96) received daily EMA surveys before, during, and after treatment for 7 weeks spread over a 9-month period. Multilevel modeling was used to test the within-person relationships between the change processes and drinking, controlling for between-person associations and prior drinking. Results indicated that daily fluctuations in motivation and self-efficacy significantly predicted drinking over the next 24 hours; however, several theory-driven hypotheses regarding factors that might moderate that relationship were not supported. Overall, results support the advantages of EMA and ILD as methods that can advance AUD treatment research. (PsycINFO Database Record

The first day is always the hardest: Functional connectivity during cue exposure and the ability to resist smoking in the initial hours of a quit attempt

Quitting smoking is the single best change in behavior that smokers can make to improve their health and extend their lives. Although most smokers express a strong desire to stop using cigarettes, the vast majority of quit attempts end in relapse. Relapse is particularly likely when smokers encounter cigarette cues. A striking number of relapses occur very quickly, with many occurring within as little as 24h. Characterizing what distinguishes successful quit attempts from unsuccessful ones, particularly just after cessation is initiated, is a research priority. We addressed this significant issue by examining the association between functional connectivity during cigarette cue exposure and smoking behavior during the first 24h of a quit attempt. Functional MRI was used to measure brain activity during cue exposure in nicotine-deprived daily smokers during the first day of a quit attempt. Participants were then given the opportunity to smoke. Using data collected in two parent studies, we identified a subset of participants who chose to smoke and a matched subset who declined (n=38). Smokers who were able to resist smoking displayed significant functional connectivity between the left anterior insula and the dorsolateral prefrontal cortex, whereas there was no such connectivity for those who chose to smoke. Notably, there were no differences in mean levels of activation in brain regions of interest, underscoring the importance of assessing interregional connectivity when investigating the links between cue-related neural responses and overt behavior. To our knowledge, this is the first study to link patterns of functional connectivity and actual cigarette use during the pivotal first hours of attempt to change smoking behavior.

Cognitive regulation of craving in alcohol-dependent and social drinkers

BACKGROUND

Helping alcohol-dependent individuals to cope with, or regulate, cue-induced craving using cognitive strategies is a therapeutic goal of cognitive behavioral therapy (CBT) for alcohol dependence. An assumption that underlies this approach is that alcohol dependence is associated with deficits in such cognitive regulation abilities. To date, however, the ability to utilize such strategies for regulation of craving has never been tested in a laboratory setting.

METHODS

Here we compared 19 non-treatment-seeking, alcohol-dependent drinkers (AD) to 21 social drinkers (SD), using a laboratory task that measured the ability to reduce cue-induced alcohol craving by thinking about long-term negative consequences of drinking, which is a specific cognitive regulation strategy that is taught in CBT. The task also assessed the ability to reduce food craving elicited by high-calorie food cues using a similar strategy.

RESULTS

The reduction in craving when using this cognitive regulation strategy was approximately double in SD, compared to AD, for both alcohol and food cues. Furthermore, in SD but not AD, the ability to regulate cue-induced alcohol craving was correlated with the ability to regulate food craving. There were no significant correlations found between the ability to regulate cue-induced alcohol craving and a number of self-report measures related to severity of alcohol dependence, baseline craving, impulsivity, and general self-regulation ability, for either AD or SD.

CONCLUSIONS

The results suggest that alcohol dependence is associated with deficits in cognitive regulation of cue-induced craving and that these deficits are not specific to the regulation of alcohol craving, but generalize to the regulation of other appetitive states, such as food craving. Future studies may use similar procedures to address the neural and cognitive processes that underlie such regulation deficits, as well as the effects of treatments such as CBT on these processes.

Mechanisms of change in adolescent substance use treatment: how does treatment work?

BACKGROUND

Adolescent substance use treatment outcome research generally shows small to moderate effects in reducing substance use, with no specific "brand" of treatment emerging as clearly superior to any other, and treatment gains that fade over time. The relatively weak and temporary effects of treatment call for improving the potency and durability of intervention effects. In response to this call, this critical narrative review summarizes research on mechanisms of change for both adults and adolescents in substance use treatment, with a particular focus on reviewing what is known regarding "how" adolescent substance use treatment works.

METHODS

A comprehensive review of the adolescent (aged 11-18) substance use treatment literature was conducted to identify empirical studies that examined mediators of intervention effects. Relevant databases (e.g., PsychINFO, MEDLINE) were searched using key words (e.g., "mediator"), and relevant articles from reference sections of identified studies and review papers were considered.

RESULTS

Studies of mechanisms of psychotherapy change are rare in the adult, and particularly adolescent, substance use treatment outcome literature. The 4 adolescent studies that examined substance use treatment mechanisms found that positive social support, motivation to abstain, and positive parenting behaviors mediated treatment effects. To date, research has not supported therapy-specific mechanisms of change, finding instead that "common" processes of change largely account for improvements in outcome across distinct "brands" of treatment.

CONCLUSIONS

The lack of empirical support for treatment-specific mechanisms of change may be due to the need for greater precision in defining and measuring treatment-specific causal chains. Future directions include neuroscience approaches to examining changes in brain functioning that are associated with treatment response and recovery and examining mechanisms in adaptive treatment designs, which can accommodate individual differences in targets for intervention and response to treatment.

Substance use history in behavioral-variant frontotemporal dementia versus primary progressive aphasia

As older adults are prone to cognitive disorders, the interaction of the fields of substance use and misuse and cognitive neuroscience is an emerging area of research. Substance use has been reported in some subtypes of frontotemporal dementia, such as behavioral variant frontotemporal dementia. However, characterization of substance use in other subtypes of frontotemporal dementia, such as primary progressive aphasia, is unknown. The objective of this baseline analysis was to explore whether any measures of substance use history differed significantly among behavioral variant frontotemporal dementia (n = 842) and primary progressive aphasia (n = 526) in a large national dataset. The National Alzheimer's Coordinating Center's Uniform Data Set study is a national dataset that collects data on patients with various cognitive disorders and includes some questions on substance use. Each substance use variable was used as the outcome and the frontotemporal dementia subtype as the predictor. Total years smoked cigarettes, age when last smoked cigarettes, average number of packs/day smoked when participants smoked, and any recent, remote, or combined recent/remote history of alcohol abuse or drug abuse did not significantly differ between the behavioral variant frontotemporal dementia and primary progressive aphasia subtypes (all p-values > .001). A significantly greater percentage of participants smoked in the last 30 days in the behavioral variant frontotemporal dementia subtype (10.4%, n = 834) compared to the primary progressive aphasia subtype (3.3%, n = 517; p < .001). Clinical providers in both the dementia and substance use fields are encouraged to screen for and monitor substance use in all frontotemporal dementia subtypes.

Active Ingredients of Treatment and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later

BACKGROUND

The current review revisits the article entitled: "Active Ingredients: How and Why Evidence-Based Alcohol Behavioral Treatment Interventions Work" published in Alcoholism: Clinical and Experimental Research. This work summarized proceedings from a 2004 Symposium of the same name that was held at the Annual Meeting of the Research Society on Alcoholism (RSA). A decade has passed, which provides occasion for an evaluation of progress. In 2014, an RSA symposium titled Active Treatment Ingredients and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later did just that.

METHODS

The current review revisits state-of-the-art research on the 3 treatments examined 10 years ago: cognitive behavioral therapy, alcohol behavior couples therapy, and 12-step facilitation. Because of its empirically validated effectiveness and robust research agenda on the study of process outcome, motivational interviewing has been selected as the fourth treatment modality to be discussed. For each of these 4 treatments, the reviewers provide a critical assessment of current theory and research with a special emphasis on key recommendations for the future.

RESULTS

Noteworthy progress has been made in identifying active ingredients of treatments and mechanisms of behavior change in these 4 behavioral interventions for alcohol and other drug use disorders. Not only have we established some of the mechanisms through which these evidence-based treatments work, but we have also uncovered some of the limitations in our existing frameworks and methods.

CONCLUSIONS

Further progress in this area will require a broader view with respect to conceptual frameworks, analytic methods, and measurement instrumentation.

Behavioral economic predictors of brief alcohol intervention outcomes

OBJECTIVE

The present study attempted to determine whether behavioral economic indices of elevated alcohol reward value, measured before and immediately after a brief alcohol intervention, predict treatment response.

METHOD

Participants were 133 heavy drinking college students (49.6% female, 51.4% male; 64.3% Caucasian, 29.5% African American) who were randomized to 1 of 3 conditions: motivational interviewing plus personalized feedback (brief motivational interventions; BMI), computerized personalized feedback intervention (electronic check-up to go; e-CHUG), and assessment only.

RESULTS

Baseline level of alcohol demand intensity (maximum consumption) significantly predicted drinks per week and alcohol problems at 1-month follow-up and baseline relative discretionary expenditures on alcohol significantly predicted drinks per week and alcohol problems at 6-month follow-up. BMI and e-CHUG were associated with an immediate postsession reduction in alcohol demand (p < .001, ηp2 = .29) that persisted at the 1-month follow-up, with greater postsession reductions in the BMI condition (p = .02, ηp2 = .06). Reductions in demand intensity and Omax (maximum expenditure) immediately postintervention significantly predicted drinking reductions at 1-month follow up (p = .04, ΔR2 = .02, and p = .01, ΔR2 = .03, respectively). Reductions in relative discretionary expenditures on alcohol at 1-month significantly predicted drinking (p = .002, ΔR2 = .06,) and alcohol problem (p < .001, ΔR2 = .13) reductions at the 6-month follow-up.

CONCLUSIONS

These results suggest that behavioral economic reward value indices may function as risk factors for poor intervention response and as clinically relevant markers of change in heavy drinkers.

Mechanisms of change associated with technology-based interventions for substance use

BACKGROUND

Technology-based interventions (TBIs) for substance use disorders have been increasing steadily. The mechanisms by which TBIs produce change in substance use outcomes have not been reviewed. This article is the first review of the conceptual and empirical underpinnings of the mechanisms associated with TBIs for substance use disorders.

METHODS

We review the literature on potential mechanisms associated with TBIs targeting tobacco, alcohol, and poly-substance use. We did not identify TBIs targeting other drug classes and that assessed mechanisms.

RESULTS

Research suggests that TBIs impact outcomes via similar potential mechanisms as in non-TBIs (e.g., in-person treatment), with the exception of substance use outcomes being associated with changes in the quality of coping skills. The most frequent potential mechanisms detected were self-efficacy for tobacco abstinence and perceived peer drinking for alcohol abstinence.

CONCLUSIONS

Research on mechanisms associated with TBIs is still in a nascent stage. We provide several recommendations for future work, including broadening the range of mechanisms assessed and increasing the frequency of assessment to detect temporal relations between mechanisms and outcomes. We also discuss unique challenges and opportunities afforded by technology that can advance theory, method, and clinical practice.

Cognitive Neuroscience Approaches to Understanding Behavior Change in Alcohol Use Disorder Treatments

Researchers have begun to apply cognitive neuroscience concepts and methods to study behavior change mechanisms in alcohol use disorder (AUD) treatments. This review begins with an examination of the current state of treatment mechanisms research using clinical and social psychological approaches. It then summarizes what is currently understood about the pathophysiology of addiction from a cognitive neuroscience perspective. Finally, it reviews recent efforts to use cognitive neuroscience approaches to understand the neural mechanisms of behavior change in AUD, including studies that use neural functioning to predict relapse and abstinence; studies examining neural mechanisms that operate in current evidence-based behavioral interventions for AUD; as well as research on novel behavioral interventions that are being derived from our emerging understanding of the neural and cognitive mechanisms of behavior change in AUD. The article highlights how the regulation of subcortical regions involved in alcohol incentive motivation by prefrontal cortical regions involved in cognitive control may be a core mechanism that plays a role in these varied forms of behavior change in AUD. We also lay out a multilevel framework for integrating cognitive neuroscience approaches with more traditional methods for examining AUD treatment mechanisms.

N-acetyl cysteine does not modify the sensitization of the rewarding effect of amphetamine as assessed with frequency-modulated 50-kHz vocalization in the rat

A satisfactory pharmacological cure for addictions to psychostimulants has not yet been developed. Because of the well-known role of changes in the corticoaccumbal and corticostriatal glutamatergic system(s) in drug seeking and relapses in psychostimulant addiction, much hope is presently linked to the use of agents that restore glutamate homeostasis. In this regard, one of the most promising agents is N-acetyl cysteine, which has been shown to reverse some changes in neuroplasticity associated with psychostimulant addiction/dependence. In this study, we used the enhancement of locomotor activity and the induction of frequency-modulated 50-kHz ultrasonic vocalization (FM 50-kHz USV) to test the possible stimulant properties of N-acetyl cysteine itself in various experimental settings (acute and subchronic administration in amphetamine-naïve and amphetamine-pretreated rats) and the capacity of N-acetyl cysteine to attenuate both the rewarding effects of amphetamine and the behavioral sensitization to this stimulant in rats showing considerable differences in their susceptibility to the FM 50-kHz USV sensitization. Our data showed no stimulant properties of N-acetyl cysteine and no acute effect of the drug on the rewarding properties of amphetamine. Moreover, no effect of N-acetyl cysteine on the pre-existing sensitization of the FM 50-kHz USV and locomotor activity responses to amphetamine were observed, independent of the susceptibility of the rats to the FM 50-kHz USV sensitization. Hence, N-acetyl cysteine seems to be ineffective at reversing the neurobiological changes underlying the sensitization of these responses to amphetamine in rats.

Neuroimaging and biomarkers in addiction treatment

Neuroimaging studies have made a significant contribution to the efforts to identify measurable indices, or biomarkers, of addictions and their treatments. Biomarkers in addiction treatment are needed to provide targets for treatment, detect treatment subgroups, predict treatment response, and broadly improve outcomes. Neuroimaging is important to biomarkers research as it relates neural circuits to both molecular mechanisms and behavior. A focus of recent efforts in neuroimaging in addiction has been to elucidate the neural correlates associated with dimensions of functioning in substance-use and related disorders, such as cue-reactivity, impulsivity, and cognitive control, among others. These dimensions of functioning have been related to addiction treatment outcomes and relapse, and therefore, a better understanding of these dimensions and their neural correlates may help to identify brain-behavior biomarkers of treatment response. This paper reviews recent neuroimaging studies that report potential biomarkers in addiction treatment related to cue-reactivity, impulsivity, and cognitive control, as well as recent advances in neuroimaging that may facilitate efforts to determine reliable biomarkers. This important initial work has begun to identify possible mediators and moderators of treatment response, and multiple promising indices are being tested.

The relationship between self-report of depression and media usage

Depression is a debilitating condition that adversely affects many aspects of a person's life and general health. Earlier work has supported the idea that there may be a relationship between the use of certain media and depression. In this study, we tested if self-report of depression (SRD), which is not a clinically based diagnosis, was associated with increased internet, television, and social media usage by using data collected in the Media Behavior and Influence Study (MBIS) database (N = 19,776 subjects). We further assessed the relationship of demographic variables to this association. These analyses found that SRD rates were in the range of published rates of clinically diagnosed major depression. It found that those who tended to use more media also tended to be more depressed, and that segmentation of SRD subjects was weighted toward internet and television usage, which was not the case with non-SRD subjects, who were segmented along social media use. This study found that those who have suffered either economic or physical life setbacks are orders of magnitude more likely to be depressed, even without disproportionately high levels of media use. However, among those that have suffered major life setbacks, high media users—particularly television watchers—were even more likely to report experiencing depression, which suggests that these effects were not just due to individuals having more time for media consumption. These findings provide an example of how Big Data can be used for medical and mental health research, helping to elucidate issues not traditionally tested in the fields of psychiatry or experimental psychology.

New developments in human neurocognition: clinical, genetic, and brain imaging correlates of impulsivity and compulsivity

Impulsivity and compulsivity represent useful conceptualizations that involve dissociable cognitive functions, which are mediated by neuroanatomically and neurochemically distinct components of cortico-subcortical circuitry. The constructs were historically viewed as diametrically opposed, with impulsivity being associated with risk-seeking and compulsivity with harm-avoidance. However, they are increasingly recognized to be linked by shared neuropsychological mechanisms involving dysfunctional inhibition of thoughts and behaviors. In this article, we selectively review new developments in the investigation of the neurocognition of impulsivity and compulsivity in humans, in order to advance our understanding of the pathophysiology of impulsive, compulsive, and addictive disorders and indicate new directions for research.

New developments in behavioral treatments for substance use disorders

After decades of defining which behavioral treatments are effective for treating addictions, the focus has shifted to exploring how these treatments work, how best to disseminate and implement them in the community, and what underlying factors can be manipulated in order to increase the rates of treatment success. These pursuits have led to advances in our understanding of the mechanisms of treatment effects, the incorporation of technology into the delivery of current treatments and development of novel applications to support relapse prevention, as well as the inclusion of neurocognitive approaches to target the automatic and higher-order processes underlying addictive behaviors. Although such advances have the promise of leading to better treatments for more individuals, there is still much work required for these promises to be realized. The following review will highlight some of these recent developments and provide a glimpse into the future of behavioral treatments.

Neuroimaging mechanisms of change in psychotherapy for addictive behaviors: emerging translational approaches that bridge biology and behavior

Research on mechanisms of behavior change provides an innovative method to improve treatment for addictive behaviors. An important extension of mechanisms of change research involves the use of translational approaches, which examine how basic biological (i.e., brain-based mechanisms) and behavioral factors interact in initiating and sustaining positive behavior change as a result of psychotherapy. Articles in this special issue include integrative conceptual reviews and innovative empirical research on brain-based mechanisms that may underlie risk for addictive behaviors and response to psychotherapy from adolescence through adulthood. Review articles discuss hypothesized mechanisms of change for cognitive and behavioral therapies, mindfulness-based interventions, and neuroeconomic approaches. Empirical articles cover a range of addictive behaviors, including use of alcohol, cigarettes, marijuana, cocaine, and pathological gambling and represent a variety of imaging approaches including fMRI, magneto-encephalography, real-time fMRI, and diffusion tensor imaging. Additionally, a few empirical studies directly examine brain-based mechanisms of change, whereas others examine brain-based indicators as predictors of treatment outcome. Finally, two commentaries discuss craving as a core feature of addiction, and the importance of a developmental approach to examining mechanisms of change. Ultimately, translational research on mechanisms of behavior change holds promise for increasing understanding of how psychotherapy may modify brain structure and functioning and facilitate the initiation and maintenance of positive treatment outcomes for addictive behaviors.