Passion’s Slave? Conscious and Unconscious Cognitive Processes in Alcohol and Drug Abuse

This chapter reviews the literature on cognitive processes in substance use disorders from a dual-process perspective. In dual-process models, behavior is viewed as the joint outcome of "impulsive" and "reflective" processes. Reflective processes rely on a single limited capacity mechanism and can be depleted, resulting in a stronger influence of impulsive processes. Recent studies confirmed this, both for state variables (e.g., reduced moderation of impulses after acute alcohol) and for trait variables (stronger prediction of addictive and related behaviors by impulsive processes in individuals with relatively weak executive control processes). In addiction, the balance between impulsive and reflective processes can become (further) disturbed as a result of the effects of the psychoactive substances on the cognitive processes involved. This is related to the notion of reduced "willpower," traditionally at the heart of definitions of addiction. A model on the cognitive processes involved in addiction is presented, along with implications for interventions.

Keywords: Dual-process model, addiction, substance use disorder, implicit cognitive processes, executive functions, craving, expectancies, motivation