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Substance use disorders (SUD) represent a pervasive and ongoing public health crisis responsible for many deaths and hospitalizations each year. Despite decades of research, we have yet to develop an effective cross-substance treatment model. Many who seek and enter treatment for SUD end up relapsing despite their intentions. Inconsistency in treatment success necessitates the identification of novel, universal therapeutic targets in the underlying core mechanisms of SUD. Determining the cognitive mechanisms which promote addictive behaviors is an essential first step to fully understand relapse and maintenance in SUD. The goal of the current review is to explore underlying cognitive processes which prolong SUD despite treatment. Through this, we propose a mechanistic model for how intrusive cognitions may jeopardize symptom improvement and SUD treatment success via risky decision making. Intrusive cognitions - images, words, memories, or impulses - demand little cognitive effort, and lend themselves to quick action and decisions. In the current paper, we present evidence which shows how intrusive cognitions, poorly inhibited, could impair the decision making process in SUD and lead to subsequent addictive behaviors.

Unheard risk: considering the role of intrusive cognitions in relapse