Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications

Functional imaging studies have pointed to a key role for the prefrontal cortex (PFC) in addiction, both through its regulation of limbic regions and its involvement in higher-order executive function. Goldstein and Volkow review these studies, showing that disruption of the PFC in addiction not only underlies compulsive drug taking but also accounts for the disadvantageous behaviours that are associated with addiction and the erosion of non-drug related motivation and self-control. The loss of control over drug intake that occurs in addiction was initially believed to result from disruption of subcortical reward circuits. However, imaging studies in addictive behaviours have identified a key involvement of the prefrontal cortex (PFC) both through its regulation of limbic reward regions and its involvement in higher-order executive function (for example, self-control, salience attribution and awareness). This Review focuses on functional neuroimaging studies conducted in the past decade that have expanded our understanding of the involvement of the PFC in drug addiction. Disruption of the PFC in addiction underlies not only compulsive drug taking but also accounts for the disadvantageous behaviours that are associated with addiction and the erosion of free will.