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College Writing 161

Annotated Bibliography
Mark McLaughlin
University of California, Berkeley
7/19/22
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1.
Solinas, M., Belujon, P., Fernagut, P. O., Jaber, M., & Thiriet, N. (2019). Dopamine and
addiction: what have we learned from 40 years of research. Journal of neural transmission
(Vienna, Austria : 1996), 126(4), 481–516. https://doi.org/10.1007/s00702-018-1957-2

This literature review provides an excellent overview of the role of dopamine in addiction.
This matters because addiction at a neurological level begins as a result of reward processes.
The review explains many of the “knowns” which provide a basis of understanding for this topic.
The authors cover the three stages of the addiction cycle and highlight the role of different
cortical areas in each phase. Using results from brain imaging studies, they explain the
structural adaptations which occur at each stage of the addiction cycle. The authors then cover
vulnerability factors for addiction as well as potential paths for treatment at each stage.

This source offers a solid basis of understanding for this topic. In particular, plasticity in
different brain regions at each phase of the addiction cycle are especially relevant for my topic.
Beginning with a general overview of the cycle of addiction, highlighting effects on the brain at
each phase of the cycle, and concluding with recommendations for treatment protocols, this
source provides many avenues for further exploration. While the authors answer many
questions about the topic, reading the paper also stimulates several lines of questioning. With
this source as a framework, the rest of the sources can delve into the more specific questions I
have about the topic of addiction.

2.
Volkow, N. D., Michaelides, M., & Baler, R. (2019). The Neuroscience of Drug Reward and
Addiction. Physiological reviews, 99(4), 2115–2140. https://doi.org/10.1152/physrev.00014.2018

This review provides more information about the various neurotransmitter systems and
the role they play in substance use disorder. While the previous source focuses primarily on the
role of dopamine and reward in addiction, this source covers the part that other
neurotransmitters play. The authors explain the processes involved in salience attribution
(sensitivity to cues for drug use), as well as the process by which addicted individuals lose
control over their ability to regulate compulsive behavior. The review then covers the role of
habit and ritual, as well as why addicted individuals also show creativity in their methods of
obtaining their substance of choice when their habits are disrupted. The most interesting piece
of this review for me is the exposition of rates of addiction for different substances. The authors
present these percentages and then postulate why rates of addiction in a given population
exposed to heroin are higher than for cocaine, for example. This leads into a discussion of
vulnerability factors and finally implications for treatment.

This source expands upon the prior review in the following ways: the authors highlight
the importance of dopamine in the cycle of addiction, and also the role of other neurotransmitter
systems in reinforcing addictive behavior. Most interestingly, the authors cover how adaptations
within the glutamatergic system influence plasticity. Because my topic centers on neuroplasticity
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at different phases of addiction, this overview of how neurotransmitter systems combine to

affect plasticity is vital information. The first source recommends that treatment professionals
examine the role of other neurotransmitters at each stage of the addiction cycle; this review
does just that. One of the treatment recommendations the authors make involves developing a
mindfulness practice in order to strengthen emotional regulation. This is an interesting avenue
to explore further.

3.
Parvaz, M. A., Rabin, R. A., Adams, F., & Goldstein, R. Z. (2022). Structural and functional brain
recovery in individuals with substance use disorders during abstinence: A review of longitudinal
neuroimaging studies. Drug and alcohol dependence, 232, 109319.
https://doi.org/10.1016/j.drugalcdep.2022.109319

This meta-analysis of 45 longitudinal neuroimaging studies provides an overview of how

abstinence from addictive substances affects the brains of addicts in recovery. Longitudinal,
within-subject studies limit the impact of confounding variables that are present in cross-
sectional studies. The authors break down their methods for selecting and analyzing these
studies. The review examines changes in brain structure at varying lengths of abstinence and
compares these changes among different substances. Interestingly, there were far more studies
examining the effects of abstinence from alcohol, nicotine, cocaine and stimulants than there
were studies looking at opioid users. The references section of this review contains many
primary research studies and is an excellent springboard for further exploration of my topic.

This source answers the question: are the neurological changes that occur as a result of
the progression of addiction permanent? The answer, as suggested by the studies reviewed, is
no. This means that it is worth the time to research more into adaptations within the brain of
recovering addicts. Additionally, the Methods section of this source breaks down the search
criteria the authors used to find these 45 studies. This is highly relevant information, because
these are exactly the sorts of studies which may hold the answers to the questions I am asking
in my topic. The most interesting finding from this review is that the neurological changes which
occur as a result of addiction generally normalize; this implies that the changes which occurred
were a result of active addiction, not the result of pre-existing vulnerabilities. There is mention of
a study, my next source, which suggests that improved cognitive functioning as a result of
abstinence improves addiction treatment outcomes.

4.
Sofuoglu, M., Devito, E. E., Waters, A. J., & Carroll, K. M. (2013). Cognitive enhancement as a
treatment for drug addictions. Neuropharmacology, 64, 452-463.
https://doi.org/10.1016/j.neuropharm.2012.06.021

The first three reviews set the stage for this one: we now know that addiction causes
neurological changes, and that abstinence from substances can counter those changes. I am
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now curious if different treatment protocols can improve the rate of those structural adaptations.
The prior studies explain that the frontal cortex is a primary area impacted by addiction.
Therefore, executive functioning is a cognitive ability impacted by neurological changes due to
substance use disorder. This influences individuals’ ability to resist compulsive desires such as
using a substance when exposed to a drug-related cue. The authors of this review postulate
that treatment which aims to repair and improve executive functioning as quickly as possible
improves the odds of recovery from addiction. These types of treatment are referred to as
“cognitive-enhancement strategies.”

This is the first source which suggests a specific type of treatment for addicted
individuals. The authors review the components of cognition affected by addiction (working
memory, attention, etc.) and reference reports that test treatment protocols for each. I am now
interested in treatment strategies which aim to address the cognitive deficits measured in the
addicted brain. It seems that the more quickly and effectively these deficits are improved, the
higher likelihood that the individual can put space between substance-related cues in their
environment and the impulse to obtain and use their substance of choice. The following primary
research report examines some of these treatment protocols.

5.
Rezapour, T., Hatami, J., Farhoudian, A., Noroozi, A., Daneshmand, R., Sofuoglu, M., Ekhtiari,
H. (2021). Baseline executive functions and receiving cognitive rehabilitation can predict
treatment response in people with opioid use disorder. Journal of Substance Abuse Treatment,
131 doi:10.1016/j.jsat.2021.108558

Methadone maintenance treatment (MMT) is a common treatment for individuals with

opioid-use disorder. However, many people undergoing this treatment drop-out early. The
authors cite studies in the introduction which suggest that cognitive deficits in executive
functioning are a strong determinant of individuals’ success in treatment. They outline three
critical cognitive functions which substance use impairs: flexibility, inhibitory control, and working
memory. The researchers studied 113 male participants undergoing MMT to assess if Cognitive
Rehabilitation Training (CRT) improved tests of those three critical cognitive functions as well as
treatment outcomes. The authors conclude that the group which received CRT performed better
on tests of cognitive flexibility, inhibitory control, and working memory. The treatment group also
had lower rates of relapse compared with the control group.

This study makes a compelling case that cognitive rehabilitation training can improve the
likelihood of addicts staying sober. The study used three methods of training, one for each area
of executive functioning deemed critical. With this study as a backdrop, I can now look for
studies which look at the efficacy of different tests for working memory, shifting (cognitive
flexibility) and inhibitory control. This study suggests that the training for working memory and
inhibitory control had more significant impact than the training for cognitive flexibility. This study
does acknowledge several limitations, most blatantly only recruiting male participants, as well as
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not measuring IQ. Because of these limitations, I will reference this study mainly as being
indicative of the potential for cognitive training to improve treatment outcomes.

6.
Taren, A. A., Gianaros, P. J., Greco, C. M., Lindsay, E. K., Fairgrieve, A., Brown, K. W., Rosen,
R. K., Ferris, J. L., Julson, E., Marsland, A. L., & Creswell, J. D. (2017). Mindfulness Meditation
Training and Executive Control Network Resting State Functional Connectivity: A Randomized
Controlled Trial. Psychosomatic medicine, 79(6), 674–683.
https://doi.org/10.1097/PSY.0000000000000466

This study demonstrated that a structured mindfulness meditation training leads to

observable neurological changes. Most importantly, these changes are associated with
improved executive functioning. The three areas of executive functioning which were improved
were: attention, cognitive control, and working memory. The researchers exposed 35
participants with reported high levels of stress to a 3-day mindfulness training course. The
control group participated in non-mindfulness based “relaxation training.” The researchers
studied the dorsolateral prefrontal cortex because this is the region associated with executive
control. The researchers found that meditation strengthens the connection between this region
and the regions which coordinate functions of executive control.

This study is relevant because the participants identify as being in psychological stress.
This study clearly implies that mindfulness training strengthens neural pathways associated with
improved executive control. An important limitation to consider is that the brain imaging done in
this study was done during the actual task of meditation. It is vital to explore studies which use a
longitudinal approach to assess neurological changes over a period of time in which participants
practice mindfulness. The next source(s) look specifically at the impact of mindfulness training
on participants who identify as having addiction.

7.
Tang, Y. Y., Tang, R., & Posner, M. I. (2016). Mindfulness meditation improves emotion
regulation and reduces drug abuse. Drug and alcohol dependence, 163 Suppl 1, S13–S18.
https://doi.org/10.1016/j.drugalcdep.2015.11.041

This review focuses on self-control and emotion regulation and their role in relapse in
addiction. The authors look at whether mindfulness meditation increases activity in the anterior
cingulate cortex and other regions implicated in executive control. This is a review of several of
the authors’ randomized controlled trials, as well as other related studies. They hypothesize that
increased activity in the anterior cingulate cortex and adjacent prefrontal cortex as a result of
mindfulness training will lead to improved self-control and emotion regulation. Studies used
fMRI to study the functional/structural impact of mindfulness practices. The results are
illuminating: mindfulness training increased activity in the regions as hypothesized in both the
smoker and nonsmoker participants. Smoker (addicts) populations initially had lower activity in
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the regions compared to nonsmoker (non-addict) groups. However, following the training, the
difference in activity in those regions between groups disappeared. In other words, the training
“repaired” the addict groups’ activity in those regions.

This review of several studies builds upon the previous source because the researchers
look at the impact of mindfulness training on addicts. What I find to be most interesting from this
study is that the imaging done before the training indicated less activity in the cortical regions of
interest in the addict groups compared to the non-addict control groups. This corresponds to the
earlier reviews which showed cognitive deficits in individuals in active addiction. These cognitive
deficits impact executive function. And these deficits in one’s ability to regulate emotions and
control impulses play a part in susceptibility to relapse into active addiction. This review of
several studies shows that those deficits are actually made up as a result of mindfulness
training. Again, a limitation of these studies acknowledged by the authors is that the imaging
was only done during the training. That is why the next source looks at results of mindfulness
training on addicted individuals over a 12-month period.

8.
Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., Carroll, H. A.,
Harrop, E., Collins, S. E., Lustyk, M. K., & Larimer, M. E. (2014). Relative efficacy of
mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for
substance use disorders: a randomized clinical trial. JAMA psychiatry, 71(5), 547–556.
https://doi.org/10.1001/jamapsychiatry.2013.4546

Mindfulness training led to significantly lower relapse rates for 268 participants over a
12-month study. The researchers compared relapse rates for the treatment group compared to
control groups who underwent typical 12-step and relapse prevention treatment protocols. The
treatment group received 8 weeks of mindfulness-based relapse prevention training with one
group per week. Rate of relapse was measured after 3, 6, and 12 months for all groups. At the
12-month mark, the treatment group reported significantly lower rates of relapse compared to
the non-mindfulness groups. Also, individuals in the mindfulness group who did relapse reported
fewer days of heavy substance use. This means those who fell off the wagon got back on more
quickly than the other groups.

The results of this study certainly make a compelling case for mindfulness-based
strategies as a component of treatment for addiction. Especially the finding that participants in
the treatment who did relapse got back on the program more quickly than others. To me, this
illustrates the difference between what the literature calls a “slip” and a “relapse.” A relapse
looks like weeks or months of heavy use, after which the individual must effectively start their
treatment plan over. A slip, while still not ideal, looks like only a few days of moderate use
before the individual “comes to their senses” and returns to their treatment protocol. This study
also provides solid definitions of mindfulness, and operationalizes mindfulness training. This
study is the cornerstone of my topic so far; over a year-long period, mindfulness-based training
improved treatment outcomes for addicts. Interestingly, relapse-prevention training had slightly
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better (lower) relapse rates at the 3-month mark, while mindfulness-based training showed
lower rates over the longer 12-month period. This makes intuitive sense: Relapse-prevention
(RP) training involves identifying and avoiding environmental cues for relapse. MIndfulness-
based training focuses more on identifying, and then accepting, the internal states which such
cues trigger in the individual. RP is more about avoiding risky situations. Mindfulness training is
more about learning to live with the negative affect that those risky situations induce. Therefore,
it makes sense that mindfulness-based treatment is more effective in the long-term, because it
would be difficult to avoid all risky situations forever.

9.

Kamboj, S. K., Irez, D., Serfaty, S., Thomas, E., Das, R. K., & Freeman, T. P. (2017). Ultra-Brief
Mindfulness Training Reduces Alcohol Consumption in At-Risk Drinkers: A Randomized
Double-Blind Active-Controlled Experiment. The international journal of
neuropsychopharmacology, 20(11), 936–947. https://doi.org/10.1093/ijnp/pyx064

This study shows that even just 11 minutes of mindfulness practice lowered rates of
alcohol consumption in heavy drinkers for a week. The control group received an 11-minute
relaxation training session. The difference between the treatment and the control group is the
focus of mindfulness training on accepting whatever mental states arise, whereas relaxation
training aims to relax the physical body. The relaxation group reported lower substance craving
immediately following the experiment. However, a week later, only the treatment group showed
lower instances of substance use. In this case, that meant that at-risk drinkers drank less
alcohol in the week after the study. Importantly, none of the participants were instructed to
continue the training on their own. This suggests that even a little of this training can go a long
way.

This study illustrates the “lower bound of efficacy,” as the researchers write, of
mindfulness training in individuals deemed at-risk for addiction. Just an 11 minute session
impacting substance consumption for a week is fascinating. This study sparks more curiosity
about the topic: if this result can occur from such a brief session, what is the “bare minimum” of
mindfulness practice that can lower rates of relapse over the long term? Several of the studies
I’ve come across in my research for the topic mention the difficulty of getting participants to
keep up a consistent mindfulness practice on their own. Perhaps if all they needed was 11
minutes per week, better adherence would be possible?

10.
Roos, C. R., Bowen, S., & Witkiewitz, K. (2017). Baseline patterns of substance use disorder
severity and depression and anxiety symptoms moderate the efficacy of mindfulness-based
relapse prevention. Journal of consulting and clinical psychology, 85(11), 1041–1051.
https://doi.org/10.1037/ccp0000249
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This study analyzed data from two other studies (one of these is source #8, Bowen et
al., 2014). The researchers aimed to find out the extent to which the positive effects of
mindfulness-based relapse prevention training varied according to participants’ reported
psychological state at the onset of treatment. In other words, the researchers wanted to find out
if the mindfulness training was most helpful for individuals who started the treatment in high
levels of distress, or if participants with lower distress and substance use severity levels
received more benefit from the training. The researchers grouped the participants into 3 groups:
those who reported high levels of substance use, depression, and anxiety, called the high/high
group. Then there was the high/low group; participants with high levels of substance use, low
levels of depression and anxiety. The low/low group reported relatively low level substance use,
low levels of depression and anxiety. The researchers found that in the high/high group as well
as the high/low group, mindfulness training led to fewer instances of substance use over the 12-
month period. However, this difference was not significant in the low/low group. The implication
of these findings is that mindfulness-based treatment may be most effective for individuals with
higher levels of substance use disorder and/or high levels of depression and anxiety, whereas
treatment as usual is as effective for individuals with lower levels of substance use and co-
occurring disorders.

I find these results very interesting. The takeaway from this study is that mindfulness-
based treatment tools may be viewed as a serious tool in providers’ toolkits for addicted
individuals with high levels of substance abuse as well as co-occurring disorders. This means
that treatment providers can assess patients to determine their relative level of addiction and
mental health issues and decide from there if prescribing mindfulness-based relapse prevention
treatment might be beneficial. Of course, it seems unlikely to me that meditation would not
benefit everyone in some way. However, with limited time, staff, and resources, it is valuable for
treatment providers to know which population of patients might benefit the most from a
particular treatment modality. My takeaway from this study is that individuals’ initial condition
does impact the efficacy of mindfulness-based treatment. Neuroimaging of the participants in
these treatment groups, like the functional connectivity analysis done in source #6, would be
interesting and a good direction for a future study. Did the low/low group already have high
enough activity in those neural regions so that the mindfulness training was not necessary? Or
was the difference due solely to lower subjective levels of psychological distress? Incorporating
imaging into this study would be enlightening as to any impact of functional and structural
changes as a result of mindfulness training in an addicted population.