Self-control and motivation in addictions

点击翻译按钮获取中文摘要

Harmful alcohol use is one of the most pressing public health issues internationally. In the United Kingdom, alcohol misuse represents 10% of the burden of disease and death costing in excess of £21 billion per year. Despite this, these disorders remain poorly treated emphasizing the urgent need to develop novel therapeutic approaches. This proposal aims to understand the interaction between impulsivity and motivation, processes fundamental to regulating behavior and crucial to understanding the risk for and relapse in addictions. Impulsivity or self-control is the tendency towards rapid poorly considered decisions or the inability to stop actions. There are multiple types of impulsivity. Here I focus on a specific form known as waiting impulsivity, or the tendency to act too early. Waiting impulsivity has robust evidence in animal studies for an association with addictions, and is less well understood in humans. I propose that waiting impulsivity in humans involves two processes: voluntary stopping and motivation. Voluntary stopping involves the internal decision to stop. Motivation involves the role of rewards to influence actions or energize behavior. I use a novel task and multiple innovative techniques to understand this relationship between voluntary stopping and motivation and the relationship between prefrontal cortical brain regions and the basal ganglia. I then develop an intervention based on these processes to train voluntary self-control in alcohol use disorders paired with stimulation of the underlying brain network. Finally I extend this to a population level and ask how these processes along with other factors predict alcohol misuse. Together these studies emphasize a testable theory-driven model of waiting impulsivity with immediate translational treatment for addictions.