Sarah Feldstein Ewing
Sarah Feldstein Ewing

Researchers at the University of New Mexico and the University of Pittsburgh have collaborated to produce a special issue of Psychology of Addictive Behaviors, titled "Neuroimaging mechanisms of change in psychotherapy for addictive behaviors." This special issue includes many researchers across a variety of disciplines in an effort to bridge the gap between brain-based mechanisms underlying effective addictions treatment and improved treatment outcomes.

The collaboration, between UNM Honors College/Center on Alcoholism, Substance Abuse, and Addictions (CASAA) Assistant Professor Sarah Feldstein Ewing and University of Pittsburgh Medical Center Associate Professor Tammy Chung, includes conceptual reviews and empirical studies that examine how brain-based mechanisms and behavioral factors interact to initiate and sustain positive behavioral change as a result of psychotherapy for addictive behaviors.

"The goal of special issue was to take a first step toward integrating brain science and addictions treatment research to begin to understand the processes by which ‘active ingredients' of psychotherapy might have an impact at a more basic biological level—the level of brain structure and functioning," Feldstein Ewing said.

The special issue contains a wide range of highly innovative studies on the topic of brain-based mechanisms underlying effective psychotherapy interventions for addictive behaviors in adolescence through adulthood. The articles cover alcohol, illicit drugs, gambling and smoking, and were peer-reviewed by at least two experts in the field. The issue also features empirical research on brain structure and functioning that may underlie risk for substance use among adolescents, and that may predict treatment outcome.

The introduction to the special issue by co-editors Feldstein Ewing and Chung, states the importance of innovative, integrative approaches to improve treatment for addictive behaviors.

"According to previous research, current gold-standard psychosocial interventions are only moderately successful in initiating and sustaining behavior change, leaving a substantial proportion of the treated population facing significant substance use problems within 12 months post-intervention," Feldstein Ewing said.

"This modest success rate is due, in part, to our limited understanding of how and why psychotherapy works," she added. "Specifically, while biology and behavior clearly interact in the progression of addictive behaviors and response to treatment, there is a divide between biological and behavioral fields of research."

According to research from the National Institutes of Health, one potential avenue to improve outcomes is through the examination of mechanisms of change. Identifying the brain-based mechanisms underlying positive behavior change is a cutting-edge approach that shows great promise in informing how people might more effectively achieve better treatment outcomes (such as lower rates of drinking or marijuana use post-treatment). In the past, researchers have discussed the importance of considering both biology and behavior in therapeutic models and practice, but few true interdisciplinary interchanges and empirical integrative evaluations have been conducted.

Feldstein Ewing and Chung suggest that this special issue is particularly important because it provides a consolidated resource for clinicians, scientists-practitioners, and researchers in the addictions field. This resource not only "introduces" readers to current models and emerging research in the field of translational neuroscience (brain-behavioral intervention links) as applied to addiction, but also highlights emerging theory and research on proposed or empirically supported brain mechanisms (e.g., structure, functioning) that moderates and/or mediates treatment effects for addictive behaviors. This issue provides an important step to resolving the existing gap between basic biology and applied clinical efforts, by presenting information about how biology interacts with treatment outcome in an approachable and clinically relevant way for practitioners.

In the introduction, Feldstein Ewing and Chung point out that, "This is important because innovative translational studies are vital to elucidating how basic biological and behavioral factors interact to catalyze the initiation and maintenance of positive behavior change in psychosocial addictions treatment."

The review articles in the special issue discuss hypothesized mechanisms of change for cognitive and behavioral therapies, motivational interviewing, mindfulness-based interventions, and neuroeconomic approaches. The conceptual reviews converge in referencing two overarching processing pathways relevant to addictive behavior: "top-down" (e.g., cognitive control over sensory processing) and "bottom-up" (e.g., the initial primacy of environmental cues relative to higher level cognition) processing.

Empirical articles represent a variety of imaging approaches including fMRI, magneto-encephalography, real time fMRI and diffusion tensor imaging. Additionally, a few empirical studies directly examined brain-based mechanisms of change, whereas others examined 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, integrative approaches - combining basic biology with psychotherapy - are critical to understanding how psychotherapy works, in order to improve addictions treatment," Feldstein Ewing said.

The publication, produced by the American Psychological Association, can be obtained through the journal's website at Psychology of Addictive Behaviors.