Mindfulness training applied to addiction therapy: insights into the neural mechanisms of positive behavioral change

Addiction arises from an imbalance between bottom-up reward-learning processes and top-down executive control in the brain, with drug use weakening prefrontal cognitive control networks and hijacking striatal circuits meant for natural rewards. Mindfulness-based interventions (MBIs) can be seen as mental training that exercises and strengthens these brain networks. This review proposes that MBIs remediate addiction by regulating frontostriatal circuits, restoring balance between top-down and bottom-up processes. Evidence indicates MBIs improve cognitive control over drug-related automaticity, attentional bias, and cue reactivity, while increasing responsiveness to natural rewards. An integrative account of neural mechanisms is offered to inform addiction therapy.

Study at a glance

Abstract

Abstract: Dual-process models from neuroscience suggest that addiction is driven by dysregulated interactions between bottom-up neural processes underpinning reward learning and top-down neural functions subserving executive function. Over time, drug use causes atrophy in prefrontally mediated cognitive control networks and hijacks striatal circuits devoted to processing natural rewards in service of compulsive seeking of drug-related reward. In essence, mindfulness-based interventions (MBIs) can be conceptualized as mental training programs for exercising, strengthening, and remediating these functional brain networks. This review describes how MBIs may remediate addiction by regulating frontostriatal circuits, thereby restoring an adaptive balance between these top-down and bottom-up processes. Empirical evidence is presented suggesting that MBIs facilitate cognitive control over drug-related automaticity, attentional bias, and drug cue reactivity, while enhancing responsiveness to natural rewards. Findings from the literature are incorporated into an integrative account of the neural mechanisms of mindfulness-based therapies for effecting positive behavior change in the context of addiction recovery. Implications of our theoretical framework are presented with respect to how these insights can inform the addiction therapy process. Keywords: mindfulness, frontostriatal, savoring, cue reactivity, hedonic dysregulation, reward, addiction