Cognitive Dysfunction in Addictions

In the last 50 years, progress in research on drug abuse has allowed us to better understand the cellular and molecular basis of both positive and negative reinforcing effects. Several reinforcement models based on the primary hedonic effect generated by the consumption of addictive substances have been described, such as paradigms of self-administration, intracranial self-stimulation, those related to associative learning, and the cognitive ability to make predictions about obtaining future rewards (paradigm of conditioned place preference), among others. Most neurobiological descriptions of addiction are based on animal models, and therefore subject to criticism, given their inherent limitations (reductionist models, evolutionary distance of brain structures, failure to capture relevant human risk genotypes, compulsive and controlled use of drugs). Transferring scientific developments made in the lab to daily medical practice is a challenge that must be overcome to improve our understanding of addiction, and attain not only adequate patient care, but also the best possible clinical outcome. We will specifically address the link between substance use disorders (SUD) and cognitive function. This has been studied in depth in the case of alcohol, but in the last decade, the need to understand the cognitive impact of other substances has arisen. We will describe the importance of an efficient evaluation of patient cognitive domains through, as well as the types of deficits encountered depending on consumption patterns and the influence exerted by these cognitive deficits at the functional level and on continued use.