Neurobiology, psychotherapeutic interventions, and emerging therapies in addiction: a systematic review

Substance use disorders (SUDs) represent a major challenge in psychiatric treatment, with significant relapse rates despite various psychotherapeutic interventions. This systematic review explores the neurobiological underpinnings of addiction and examines the efficacy of psychotherapies, such as Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), Mindfulness-Based Relapse Prevention (MBRP), and emerging therapies in treating SUDs. Additionally, the study assesses how emerging biomarkers and neuroimaging data could enhance therapeutic outcomes by guiding personalized treatments. Neurobiological markers, such as prefrontal-limbic connectivity, mesolimbic dopaminergic dysregulation, and glutamate transmission deficits, are shown to significantly influence treatment efficacy. For example, prefrontal cortex hypoactivity and amygdala hyperactivity correlate with poor impulse control and emotional regulation, making these individuals more responsive to CBT and EMDR. Similarly, dopaminergic dysfunction in the mesolimbic pathway is closely tied to reward-seeking behavior where Transcranial Magnetic Stimulation (TMS) may offer therapeutic benefits. Epigenetic modifications, primarily those affecting the glucocorticoid receptor (GR), highlight the role of stress in relapse suggesting that trauma-focused therapies can be effective for individuals with high stress vulnerability. This review finds that integrating neurobiological insights with clinically validated psychometric assessments could significantly improve treatment stratification. Future research should focus on aligning diagnostic systems, such as the DSM-5, with neurobiological markers and psychological tells to facilitate more precise and personalized interventions, potentially transforming addiction treatment outcomes.