Besterwitch_whole_thesis.pdf (2.64 MB)
Top-down and bottom-up : cognitive mechanisms in drug dependence and treatment outcomes
thesisposted on 2023-05-27, 08:50 authored by Besterwitch, JLS
Particular cognitive deficits such as attentional biases toward drug related stimuli (driven by low-level 'bottom-up' processes) and problems with inhibiting actions (executive or 'top-down' processes), appear to be associated with substance use disorder. Study used two experiments (One: 7 participants with mean age of 41.7 years, two: 67 participants with mean age 34.3 years) to test the theoretical framework proposed by Manning et. al. (2017). Poorer 'top-down' inhibitory cognition and greater 'bottom-up' drives: (according to the model) should be related to severity of substance use disorder (predicted by the model) correlate with poorer treatment outcomes (early drop out; tested at week 4 and 12). The study findings showed mixed evidence to support the theory underpinning the framework with significant bottom-up compulsivity measure but not top-down response inhibition. The predictions made by the framework were not supported. Previous studies analyzing the relation between cognition and treatment outcomes failed to control for psychological distress and readiness to change. After controlling for other key correlates of treatment dropout (anxiety, and readiness to change), top-down (SST) measure was significantly associated with treatment outcomes. The findings highlight the multifaceted way in which people can remain stuck in substance use disorder.
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