Executive functioning and substance use disorders

Executive functioning has been extensively studied over the past six decades and can be defined as a dynamic multifaceted construct that includes different but intercorrelated processes that aimed to self-regulate stress and cognitive engagement, enabling individuals to learn by experience. Substance-related disorders (SUD) are mainly characterized as a chronic self-regulatory disease where individuals engage in reward-seeking situations despite of the adverse consequences, shifting from impulsive to compulsive drug-seeking behaviors. It has been suggested that SUD are related to the failure to balance cognitive engagement (e.g., self-control, behavior inhibition, cognitive flexibility) over stressful demands (e.g., craving or coping with daily-stressful events). This imbalance leads to alterations on the main processes of decision-making (i.e. representation of adaptive behaviors, valuation of choices, goal-oriented action selection, feedback processing and updating), which are related to changes in both cortical and subcortical neural structures. This book chapter firstly highlight the concept of executive functioning and discuss how SUD are related to alterations in brain structures usually associated with executive performance. Additionally, we describe recent evidence on the role of dopaminergic system and how SUD can be described as a biopsychosocial executive functioning disorder.