Synergistic opportunities in combined interventions for addiction treatment

A key corollary of addiction neuroscience models is the imbalance between sensitization of the brain systems that code the reward value and the salience of drug-related stimuli (bottom-up) and deterioration of the systems that orchestrate cognitive control and decision-making (top-down). Decision-making can also be viewed as a complex and ubiquitously used ability that requires simultaneous consideration of the reward value of available options and the goal value of future desired states. In this final chapter, we articulate two approaches for exploiting this neuroscience knowledge to develop novel more comprehensive interventions for addiction treatment: (1) combined interventions blending bottom-up and top-down therapies and (2) decision-making interventions tapping into the inputs and the forecasting outputs of drug-taking decisions. We conclude that (1) combined interventions mixing cognitive control training and contingency management, inhibitory control training and exercise, and goal management training and mindfulness offer unique synergistic opportunities and (2) decision-making interventions combining episodic future thinking and mixed reality and novel forms of nudging are promising to address highly complex and ubiquitous decision-making deficits in addiction.