How Can Cognitive Control Training Help Treat Substance Use Disorder?

Muhammad Parvaz, PhD, described persistent challenges in the treatment of substance use disorders (SUDs), emphasizing the limited availability of US Food and Drug Administration–approved medications.¹ Parvaz stated, “the major challenge that I see in my field, which is substance use disorders, is that we have very limited FDA-approved medications, especially for stimulant use disorders.” He noted that this therapeutic gap contributed to high relapse rates and a “revolving door” pattern in which patients relapsed soon after treatment initiation and returned to care.

Parvaz reported that his research examined longitudinal changes in brain and behavior across abstinence and treatment.² The group focused on developing behavioral interventions targeting cognitive control mechanisms. He explained that one approach involved training patients “to volitionally down-regulate or decrease craving when we are, when we face context and cues that remind us of the drug.” Using neuroimaging, Parvaz observed that individuals with stimulant use disorders were able to decrease neural reactivity to drug-related cues, demonstrating measurable reductions in brain responses associated with craving.

Parvaz emphasized the dynamic interaction between cognitive and affective processes, characterizing craving as an internally generated state triggered by external or internal cues. He noted that early recognition was critical because “the longer that craving, or this internal feeling of drug seeking, stays, it becomes more and more difficult to regulate.” He observed that many individuals with chronic substance use did not recognize escalating craving until it became difficult to control, underscoring the importance of identifying triggers and incorporating cognitive coping strategies into individualized treatment plans.

Parvaz also advocated for integrating input from individuals with lived experience and caregivers into research and treatment development. Looking forward, he hopes for increased funding, industry partnerships, and advances in pharmacologic, behavioral, neuromodulatory, and artificial intelligence–based approaches, while emphasizing the need for rigorous oversight to ensure scientific validity and reduce stigma by framing SUDs as biologically based disorders.

References

1. Douaihy AB, Kelly TM, Sullivan C. Medications for substance use disorders. Soc Work Public Health. 2013;28(3-4):264-278.

2.Parvaz MA, Rabin RA, Adams F, et al. Structural and functional brain recovery in individuals with substance use disorders during abstinence: a review of longitudinal neuroimaging studies. Drug Alcohol Depend. 2022;232:109319.