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Addictions neuroclinical assessment: a neuroscience-based framework for addictive disorders

Open access
Kwako, Laura E., Momenan, Reza, Litten, Raye Z., Koob, George F., Goldman, David·2016·Biological Psychiatry
DOI 10.1016/j.biopsych.2015.10.024PMC PMC4870153
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Abstract

This paper proposes a heuristic framework for an Addictions Neuroclinical Assessment (ANA) that incorporates key functional domains derived from the neurocircuitry of addiction. We review how addictive disorders (AD) 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 AD, challenges to current classification systems, and prior attempts to subtype individuals with AD are described. Complementary initiatives, including the Research Domain Criteria (RDoC) project, which 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 AD. 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 AD on the basis of process and etiology, an advance that can lead to improved prevention and treatment.

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Crossref · 10.1016/j.biopsych.2015.10.024

Cites

149 of 149 references verified0 citation errors · 0 not checkable

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  • Advances in diagnosis reflecting endophenotype or research domain criterion approach will synergistically combine with advances in neurobiology to promote novel pharmacotherapeutic, brain stimulation, and behavioural treatments.

    “Advances in diagnosis that reflect such an endophenotype or research domain criterion approach will synergistically combine with advances in neurobiology to promote novel pharmacotherapeutic, brain stimulation (ie, transcranial magnetic stimulation and direct electrical stimulation), and behavioural treatments.186”

    From Neurobiology of addiction: a neurocircuitry analysis (2016) · cites this paper as [186]

    The Introduction’s “Changes in Nosology” section says that a mechanistically informed approach to diagnosis may identify improved treatments and better match patients to them; it discusses both medications and behavioural treatments. It does not support the more definite prediction that diagnostic and neurobiological advances will synergistically produce novel treatments, and the passages found do not address brain stimulation. Page numbers are unavailable in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Using the Addictions Neuroclinical Assessment, five subdomains of negative emotional states that can be operationally measured in human laboratory settings and paralleled by animal models were outlined.

    “Using the Addictions Neuroclinical Assessment, five subdomains of negative emotional states that can be operationally measured in human laboratory settings and paralleled by animal models were outlined (Kwako et al., 2016).”

    From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Kwako et al., 2016

    The Introduction’s ANA Domains section identifies negative emotionality as one of three main domains and discusses measurable features such as dysphoria and hypohedonia. The Introduction also says the framework draws on humans and model organisms. Our copy does not outline five subdomains of negative emotional states or establish that each has a human-laboratory measure paralleled by an animal model (pages not provided). (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The Addictions Neuroclinical Assessment framework allows identification of individuals with phenotypes that signal dysregulation in the hyperkatifeia domain.

    “From a nosology perspective, the Addictions Neuroclinical Assessment framework allows the identification of individuals with phenotypes that signal dysregulation in this domain (Kwako et al., 2016).”

    From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Kwako et al., 2016

    The Introduction and ANA Summary propose assessing negative emotionality to distinguish individuals by their profiles of vulnerability. The paper describes ANA as a heuristic framework intended to enable this work, rather than demonstrating that it already identifies such phenotypes; our copy also does not call the domain “hyperkatifeia.” (LLM, conf=0.79)

    Experimental — accuracy not yet measured

  • Executive dysfunction is postulated to be relevant to early onset of risky alcohol use and to the development and maintenance of alcohol use disorders.

    “a neurofunctional domain that is postulated to be relevant to early onset of risky alcohol use and the development and maintenance of AUDs (15).”

    From Impact of Childhood Trauma on Executive Function in Adolescence—Mediating Functional Brain Networks and Prediction of High-Risk Drinking (2020) · cites this paper as [15]

  • ANA integrates measures for an understanding of the overall functioning of a domain.

    “third, it integrates measures for an understanding of the overall functioning of a domain”

    From Addiction Biomarkers: Dimensional Approaches to Understanding Addiction (2018) · cites this paper as [2]

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Cites

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2 of the 151 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [117]Sobell LC Sobell MB Timeline follow-back Measuring alcohol consumption 1992 41 72 Springer

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Authors
Kwako, L. E., Momenan, R., Litten, R. Z., Koob, G. F., & Goldman, D.
Affiliations
National Institutes of Health (US)
Corresponding author
Kwako, Laura E.
ORCID
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2016-08
Volume
80
Issue
3
Pages
179-189
ISSN
0006-3223 (ISSN-L)
DOI
10.1016/j.biopsych.2015.10.024
PMC
PMC4870153
OpenAlex
W2207035985
Semantic Scholar
621a35dbbd45d7e898e2999389a1fe6c88ac4688
Cited by
395
References
151
Citations by year
2026: 48 · 2025: 32 · 2024: 46 · 2023: 38 · 2022: 43 · 2021: 47 · 2020: 38 · 2019: 46 · 2018: 24 · 2017: 27 · 2016: 6
FWCI
2.47
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (Z99‐AA999999)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
  • Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
Keywords
addiction, executive function, incentive salience, negative affectivity, addiction classification, Research Domain Criteria, neuroimaging, clinical heterogeneity, causes of addiction
MeSH terms
Emotions, Humans, Models, Psychological, Motivation, Neuropsychological Tests, Behavior, Addictive, Substance-Related Disorders, Executive Function, Neuroimaging

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