Why people change?: The role of cognitive-control processes in the onset and cessation of substance abuse disorders

Background: The current effectiveness of preventative and therapeutic interventions for substance use disorders (SUDs) is less than satisfying. Progress in understanding the processes related to the onset, course, and cessation of SUDs merits top priority, given the high prevalence and the severe negative consequences. Aims: This position Paper, after summarizing major factors related to onset and cessation processes, discusses the possible role of cognitive-control dysfunctions in the complex interaction between mechanisms of change (mediators) and risk factors (moderators). Findings: In past decades, research has expanded our knowledge about the impact of SUDs on human behaviour. Formal interventions are effective, but there is limited information about the mechanisms responsible for change during the onset and cessation of SUDs and for individual differences related to them. Preliminary results suggest that impairments in higher order control functions play a role in SUDs. Conclusions: Deficiencies in our understanding of behaviour-change processes during the onset and cessation of SUDs require that research have a different focus. A better understanding of the relevance of impairments in executive-control functions might help to improve formal preventative and therapeutic interventions and social conditions. Such interventions might reduce the chances that a SUD will develop or increase the likelihood of recovery from it. Copyright (C) 2008 John Wiley & Sons, Ltd.