title: A triadic neurocognitive approach to addiction for clinical interventions.
abstract: According to the triadic neurocognitive model of addiction to drugs (e.g., cocaine) and non-drugs (e.g., gambling), weakened "willpower" associated with these behaviors is the product of an abnormal functioning in one or more of three key neural and cognitive systems: (1) an amygdala-striatum dependent system mediating automatic, habitual, and salient behaviors; (2) a prefrontal cortex dependent system important for self-regulation and forecasting the future consequences of a behavior; and (3) an insula dependent system for the reception of interoceptive signals and their translation into feeling states (such as urge and craving), which in turn plays a strong influential role in decision-making and impulse control processes related to uncertainty, risk, and reward. The described three-systems account for poor decision-making (i.e., prioritizing short-term consequences of a decisional option) and stimulus-driven actions, thus leading to a more elevated risk for relapse. Finally, this article elaborates on the need for "personalized" clinical model-based interventions targeting interactions between implicit processes, interoceptive signaling, and supervisory function aimed at helping individuals become less governed by immediate situations and automatic pre-potent responses, and more influenced by systems involved in the pursuit of future valued goals.
authors.affiliation: Psychological Medicine Laboratory, Faculty of Medicine, Université Libre de Bruxelles , Brussels , Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Noël
authors.affiliation: Psychological Medicine Laboratory, Faculty of Medicine, Université Libre de Bruxelles , Brussels , Belgium ; Department of Psychology, Brain and Creativity Institute, University of Southern California , Los Angeles, CA , USA.
authors.forename: Damien
authors.initials: D
authors.lastname: Brevers
authors.affiliation: Department of Psychology, Brain and Creativity Institute, University of Southern California , Los Angeles, CA , USA.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bechara
keywords: addiction; decision making; impulsive system; interoception; self-regulation