ABSTRACT
Addiction is viewed as a motivational problem with a cognitive solution. Drawing on findings from cognitive neuroscience, this chapter describes how these insights can focus and refine psychotherapeutic approaches to overcoming addiction. Identification of neural systems involved in alterations in reward processing and cognitive processing that characterize addiction are proposed as therapeutic targets. The model consists of four phases, or 4Ms, sequentially addressing: Motivation, Managing impulses, Managing emotions and Maintaining change. At each stage, motivational and cognitive strategies are applied in a broad cognitive behavioral framework. Specifically, therapeutic procedures that alter reward processing, for example by enhancing the perceived value of distant rewards, are described. Cognitive control strategies, such as maintaining a goal in working memory to influence attentional deployment in the context of appetitive cues, also feature. Emotional regulation strategies are deemed to be important as unregulated emotion reduces cognitive control. Resilience in the face of the chronicity of addiction is fostered through the promotion of acceptance, self-compassion and the practice of mindfulness.
