"Loss of control" in alcoholism and drug addiction: a neuroscientific interpretation.

Considerable neurological evidence indicates that the prefrontal cortex mediates complex "executive" functions including behavioral autonomy and self-control. Given that impairments of self-control are characteristic of alcoholism and other drug addictions, frontal lobe dysfunction may play a significant role in such compulsive behaviors. Consistent with this idea, recent research using brain imaging, neuropsychological testing, and other techniques has revealed that the frontal lobes are particularly vulnerable to the acute and chronic effects of addictive drugs, especially alcohol and cocaine. Evidence implicating a hyperdopaminergic mechanism of acute and chronic drug-induced frontal lobe dysfunction and interactions with premorbid factors and stress are discussed.