title: Competing neurobehavioral decision systems theory of cocaine addiction: From mechanisms to therapeutic opportunities.
abstract: Cocaine dependence is a difficult-to-treat, chronically relapsing disorder. Multiple scientific disciplines provide distinct perspectives on this disorder; however, connections between disciplines are rare. The competing neurobehavioral decision systems (CNDS) theory posits that choice results from the interaction between two decision systems (impulsive and executive) and that regulatory imbalance between systems can induce pathology, including addiction. Using this view, we integrate a diverse set of observations on cocaine dependence, including bias for immediacy, neural activity and structure, developmental time course, behavioral comorbidities, and the relationship between cocaine dependence and socioeconomic status. From the CNDS perspective, we discuss established and emerging behavioral, pharmacological, and neurological treatments and identify possible targets for future treatments. The ability of the CNDS theory to integrate diverse findings highlights its utility for understanding cocaine dependence and supports that dysregulation between the decision systems contributes to addiction.
authors.affiliation: Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA, USA. Electronic address: wkbickel@vtc.vt.edu.
authors.forename: Warren K
authors.initials: WK
authors.lastname: Bickel
authors.affiliation: Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Snider
authors.affiliation: Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA, USA.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Quisenberry
authors.affiliation: Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, VA, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Stein
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Hanlon
mesh_terms: D000818:Animals; D016739:Behavior, Addictive / Q000503:physiopathology / Q000523:psychology*; D002755:Choice Behavior / Q000502:physiology*; D003042:Cocaine / Q000494:pharmacology*; D019970:Cocaine-Related Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D012919:Social Behavior; D013598:Systems Theory
chemical_list: D003042:Cocaine
keywords: Cocaine dependence; Competing neurobehavioral decision systems; Delay discounting; Dual systems; Executive function; Impulsivity; Self-control; Transcranial magnetic stimulation