A Comparative Synthesis of Cognitive Inflexibility and Self-Regulation in Substance Use Disorders

Drug addiction is a serious public health problem at the global level and is particularly prevalent among the young population. This phenomenon directly affects not only health, but also the economic and social development of the country. According to the World Health Organization (2023), diseases related to alcohol and illicit drug use account for 5.4% of the global disease burden and approximately 50 million people suffer from this problem (WHO, 2023). Executive function impairments are a central, debilitating feature of substance use disorders, with significant implications for treatment and recovery (Goldstein & Volkow, 2011). This research synthesizes evidence from neuropsychological and neuroimaging studies to examine the nature, specificity, and clinical impact of these cognitive deficits. Findings consistently demonstrate broad and significant executive dysfunction in individuals with drug dependence, encompassing domains of inhibitory control, working memory, cognitive flexibility, and decision-making, as evidenced by poor performance on standardized assessments like the Frontal Assessment Battery and Iowa Gambling Task (Bechara et al., 2001). Crucially, while alcohol abuse is robustly associated with deficits in verbal fluency and decision-making, illicit substances such as cocaine, cannabis, and opioids exhibit both shared and distinct patterns of impairment, moderated by the quantity and duration of use (Rogers & Robbins, 2001). Neurobiological models link these deficits to dysregulation in prefrontal and cingulate cortical networks, which are further implicated in heightened attentional bias towards drug-related cues (Volkow et al., 2012).