The neurobiology of reward and cognitive control systems and their role in incentivizing health behavior.
OBJECTIVE
This article reviews the neurobiology of cognitive control and reward processes and addresses their role in the treatment of addiction. We propose that the neurobiological mechanisms involved in treatment may differ from those involved in the etiology of addiction and consequently are worthy of increased investigation.


METHODS
We review the literature on reward and control processes and evidence of differences in these systems in drug addicted individuals. We also review the relatively small literature on neurobiological predictors of abstinence.


RESULTS
We conclude that prefrontal control systems may be central to a successful recovery from addiction. The frontal lobes have been shown to regulate striatal reward-related processes, to be among the regions that predict treatment outcome, and to show elevated functioning in those who have succeeded in maintaining abstinence.


CONCLUSIONS
The evidence of the involvement of the frontal lobes in recovery is consistent with the hypothesis that recovery is a distinct process that is more than the undoing of those processes involved in becoming addicted and a return to the pre-addiction state of the individual. The extent to which these frontal systems are engaged by treatment interventions may contribute to their efficacy.
Department of Psychiatry, University of Vermont, University Health Center Campus, 1 S. Prospect St, Burlington, VT 05401, USA. Hugh.Garavan@uvm.edu
Hugh
H
Garavan
Karen
K
Weierstall
D016739:Behavior, Addictive / Q000534:rehabilitation; D003071:Cognition / Q000502:physiology*; D005625:Frontal Lobe; D015438:Health Behavior; D006801:Humans; D009042:Motivation; D059906:Neuroimaging; D012201:Reward; D019966:Substance-Related Disorders / Q000534:rehabilitation