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Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders

  • Laura E. Kwako
    Correspondence
    Address correspondence to Laura Kwako, Ph.D., NIAAA/NIH, 10 Center Drive, 1-5340, MC 1108, Bethesda, MD 20892-1108.
    Affiliations
    Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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  • Reza Momenan
    Affiliations
    Section on Brain Electrophysiology and Imaging, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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  • Raye Z. Litten
    Affiliations
    Division of Intramural Clinical and Biological Research; Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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  • George F. Koob
    Affiliations
    Office of the Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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  • David Goldman
    Affiliations
    Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland

    Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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Published:November 17, 2015DOI:https://doi.org/10.1016/j.biopsych.2015.10.024
      This article proposes a heuristic framework for the Addictions Neuroclinical Assessment that incorporates key functional domains derived from the neurocircuitry of addiction. We review how addictive disorders (ADs) are presently diagnosed and the need for new neuroclinical measures to differentiate patients who meet clinical criteria for addiction to the same agent while differing in etiology, prognosis, and treatment response. The need for a better understanding of the mechanisms provoking and maintaining addiction, as evidenced by the limitations of current treatments and within-diagnosis clinical heterogeneity, is articulated. In addition, recent changes in the nosology of ADs, challenges to current classification systems, and prior attempts to subtype individuals with ADs are described. Complementary initiatives, including the Research Domain Criteria project, that have established frameworks for the neuroscience of psychiatric disorders are discussed. Three domains—executive function, incentive salience, and negative emotionality—tied to different phases in the cycle of addiction form the core functional elements of ADs. Measurement of these domains in epidemiologic, genetic, clinical, and treatment studies will provide the underpinnings for an understanding of cross-population and temporal variation in addictions, shared mechanisms in addictive disorders, impact of changing environmental influences, and gene identification. Finally, we show that it is practical to implement such a deep neuroclinical assessment using a combination of neuroimaging and performance measures. Neuroclinical assessment is key to reconceptualizing the nosology of ADs on the basis of process and etiology, an advance that can lead to improved prevention and treatment.

      Keywords

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