Editorial: Brain and Cognition for Addiction Medicine: From Prevention to Recovery

Abstract

Editorial on the Research Topic Brain and Cognition for Addiction Medicine: From Prevention to Recovery In 2018, 269 million people around the world had used drugs, and over 35 million were suffering from substance use disorders (SUDs) (1). However, there is a serious limitation in the available treatments for SUDs that are effective in the long term (2–4). A question frequently raised by addiction medicine practitioners around the world is how recent advancements in different fields of brain and cognition studies—from molecular to cognitive neuroscience—can help them improve their daily practice for prevention, treatment, and rehabilitation of SUDs. There is a growing body of evidence on neurocognitive alterations that contribute to developing a SUD and to hampering recovery, alongside a plethora of social and environmental factors (5, 6). However, there is a lack of neurocognitive markers and related outcome measures that are sufficiently sensitive and specific to addiction mechanisms, engaged by interventions, repeatable, and indicative of disorder progression and recovery. There is preliminary, but promising evidence for different neural and cognitive markers measured with brain mapping and cognitive assessments that (1) engage key mechanisms of addiction (incentive salience, negative emotionality, and cognitive control), (2) predict reduction of drug use (the gold standard for treatment outcomes), and (3) detect acute and chronic responses to interventions with therapeutic potential (7). However, none of these neurocognitive markers have yet approached formal qualification paths [e.g., Biomarker Qualification Program (BQP) of the FDA] or are being widely used in daily clinical practice. Some of the reasons that none of these markers are playing a formal role as a qualified biomarker in addiction prevention or treatment is because they lack methodological harmony, publicly available tools and normative databases, and strong replication and reliability/validity data. Indeed, although there is a significant body of evidence from brain and cognition studies about SUDs, the impact of this evidence in the daily practice of addiction medicine is minimal and yet to be established. As part of our leadership roles in the Neuroscience Interest Group of the International Society for Addiction Medicine (ISAM-NIG), we believe that we need an orchestrated international effort to bring pieces of basic and clinical evidence together to develop a roadmap from bench to bedside and policy. We also need consensus and guidelines on how to translate currently available evidence to different dimensions of clinical practice, ranging from prevention to recovery. In this cross-listed Research Topic in Frontiers in Psychiatry and Frontiers in Human Neuroscience, our overall goal was to invite researchers to provide evidence that can help bridge the gap between the neuroscientific knowledge of SUDs and its pragmatic use in routine clinical practice. In this successful Research Topic, we published 30 articles (17 original research articles, nine reviews, one systematic review, two mini-reviews, and one brief research report), from 146 authors from 13 countries that overall elicited 86,787 views at the time of submission of this editorial. Contributors to our Research Topic mainly sought to provide evidence on susceptibility/risk, diagnostic, predictive, and treatment monitoring evidence for different neural and cognitive markers. We also received articles providing evidence for different mechanistic-informed interventions (two cognitive/behavioral, one pharmacologic, and two brain stimulation interventions) that effectively engaged these markers. These markers spanned across molecular and biological assessments, genetics, different imaging techniques, cognitive assessments etc. In this e-book, we (Verdejo-Garcia et al.) wrote a consensus paper with a group of ISAM-NIG members about strategies and suggestions to apply the neuroscientific knowledge of addiction medicine into daily practice which has shaped the scope of this Research Topic. In the following sections, we present select highlights of the contributions which we hope will convey a sense of how neuroscience can help increase the understanding of underlying mechanisms of SUDs and how it can inform the development of more impactful interventions. A susceptibility/risk marker in addiction medicine can estimate how likely it is for someone to develop SUDs in the future. Burns et al. in their review discuss how molecular imaging shows that genetics can increase proneness to opioid use disorder and how these inter-individual differences in opioid and dopamine systems underlie the person's reward, cognition, and stress pathways leading to heightened risk of being an opioid user in the future. Among other contributions to this Research Topic, Abram et al. investigated undergraduate university students with a foraging task to assess their ability to associate reward pursuit and reward valuation. They found that in people with more externalizing traits, which confer risk for SUDs, pursuit and valuation were less related. Rose et al. propose distinctive pathways that may increase liability for developing SUDs. The authors discuss how addressing neural mechanisms that differentially characterize these pathways can inform preventive strategies, treatment development, and long-term outcomes. Thus, this e-book brings together promising results on how genetics can predict the level of cognitive functioning and how deficits or delays in specific cognitive dimensions might predict risk to developing SUDs. However, there remain several outstanding questions on the percent variance in this susceptibility/risk for developing a SUD that can be explained by cognitive and neural markers. Supporting evidence with validated cognitive and neuroimaging assessments will be needed on how these...