Context-dependent Impulsivity in Substance Use Disorder: A Neuroscience-informed Framework

Due to various reasons including psychobiological states and psychopathological conditions, individuals may be more inclined toward choices or actions that are known as impulsive. This preference arises from either or both personality characteristics (trait), which are more stable, or impulsive tendencies that emerge in response to environmental factors and/or internal factors (e.g., mood) and fluctuate over time (state). Although both types of impulsivity are closely tied to addiction, particularly in terms of treatment outcomes (e.g., poor adherence, increased relapse risk), state impulsivity is susceptible to influences of context and the saliency of cues. One specific form of state impulsivity, known as context-dependent impulsivity, is evoked by contextual drug-related cues and could be conceptualized, monitored, and assessed using the cue-reactivity paradigm. In this paper, we aim to tease apart the neurocognitive mechanisms which are influenced or heightened by context-dependent impulsivity and explain how these mechanisms may interfere with addiction treatment. By integrating evidence from classic neuropsychological measures and the drug-cue reactivity paradigm in the field of addiction, we propose a neuroscience-informed conceptual framework explaining how relapse may occur due to the disruption of neurocognitive mechanisms in response to contextual cues. We introduce the term 'context-dependent impulsivity' in accordance with the cue-reactivity paradigm as a marker of addiction recovery and as a mechanistic target for cue-based interventions such as cognitive bias modification and mindfulness-based relapse prevention. Context-dependent impulsivity is a multi-faceted construct, which could be characterized by specific cognitive phenotypes. Parsing these different phenotypes into their constituent neurocognitive mechanisms and examining their interactions with relapse vulnerability could inform clinicians about optimized cognitive interventions and neuropsychological assessments tailored to individuals with specific impulsivity phenotypes within the trait or state levels.