Neurocognitive Disorders in Substance Use Disorders

Chronic use of different substances is associated with neural dysfunctions and related cognitive deficits. Neurocognitive disorders encompass reward, negative affect and control deficits underlying core addiction symptoms, and broader cognitive sequela affecting everyday functioning. In the first part of this chapter, we summarise the theoretical models posited to understand the nature and course of addiction-related cognitive deficits, with special emphasis on dual and tripartite models and recent international consensus. Then, we review the specific neurocognitive disorders associated with chronic use of different drugs, including alcohol, cannabis, opioids and stimulants, while acknowledging the role of premorbid cognitive alterations and polysubstance use. In the last part of the chapter, we analyse the neural dynamics underlying these deficits, including development-related changes underpinning the transition between recreational and chronic use and neuroplasticity-related changes that can be achieved via pharmacological enhancement, cognitive remediation and neuro-stimulation. We conclude by providing a critical view of the strengths and weaknesses of current frameworks and assessment and intervention approaches and a perspective of future horizons for neurocognitive research and clinical applications in addiction medicine.