How many times have you been told to “pay attention?” From those early days in the classroom to meetings on the job, paying attention is something we are often expected to do. In fact, we are commanded to do it as if we know what specific action we must take when in reality, few of us know how exactly to turn our brains toward something in a truly attentive way. Fascinatingly, even though we don’t quite know what it means to pay attention, we respond to these commands readily, as if “paying attention” is something we know exactly how to do. From a neurobiological perspective, paying attention involves a complex set of neuronal pathways that selectively ignore distractions and amplify the important stimuli in our environment that we are motivated to process (Higgins & George, 2013).
Some of us are much better at this task of “paying attention” than others. People who find it extremely difficult to pay attention may also be more prone to drug addiction. That’s because just like we have to inhibit our impulses in order to ignore appealing activities and pay attention to longer tasks, we must inhibit our impulses in order to ignore the appeal of addictive substances. People who are better at paying attention also seem to find longer tasks more gratifying, while people prone to addiction may only get that same gratification when they pursue short-term rewards (Kober et al., 2010).
Now if attention and addiction are closely related, then wouldn’t you think that there might be something to learn about paying attention from all the research on treatments that help curb drug addiction? In fact, the research on addiction is packed with lessons on improving attention, even in individuals without a substance use problem. Many of the interventions that enhance impulse inhibition in substance users also improve impulse inhibition more generally. Improving impulse control is bound to improve attention because attention demands controlling distracting impulses and instead focusing on the task at hand.
Mindfulness-based training is an example of an intervention that has been used to target alcohol use disorder, but that also seems to improve attention. Mindfulness is a practice of attending to one’s immediate surroundings with acceptance. Interestingly, one of the ways that mindfulness seems to help people avoid alcohol is by reducing their attentional bias to alcohol-related stimuli (Garland et al., 2010). Meaning, they become less likely to selectively pay attention to objects that have to do with drinking. Mindfulness not only helps drinkers ignore alcohol cues, but it also improves their attentional control more generally. Mindfulness improves performance on the Stroop task (Chan & Woollacott, 2007), which measures an individual’s ability to ignore distracting stimuli in order to pay attention to important information. More directly, mindfulness has been shown the brain’s neuronal response (P3a event-related brain potential) to distracting stimuli among experienced meditators (Cahn & Polich, 2009). Overall, meditation seems to help control alcohol use because enhances the brain’s capacity to ignore distractions and focus on what’s important.
Medications used to treat substance abuse disorders also seem to improve impulse inhibition. Opioid antagonists, like Naltrexone, are first line drugs for treating addiction. Simply, these drugs block the rewarding effects of drugs. But interestingly, these medications seem to dampen the rewarding effects of impulsive acts, even when these acts don’t involve drugs. For example, opioid antagonists have been shown to reduce impulsive stealing (kleptomania) and gambling, behaviors that don’t even involve substance use directly (Grant et al., 2006; Grant & Odlaug, 2009)! In rats, naltrexone also reduced their likelihood of choosing smaller immediate rewards over larger, delayed rewards (Kieres et al., 2004). Aside from blocking the actions of opioids, opioid antagonists seem to tamper the brain’s response toward impulsive choices and short-term gratification more broadly.
Cognitive Behavioral Therapy for individuals with cocaine use disorder also seems to enhance impulse control more broadly. During the Stroop task, CBT reduced the fMRI BOLD signal associated with cognitive interference from distracting stimuli (DeVito et al., 2012). In a related study, using CBT-based strategies increased activity in frontal brain regions compared to subcortical regions (Kober et al., 2010). These results suggest that in helping individuals resist substance use, CBT actually enhances the brain’s ability to self-regulate and ignore distracting stimuli, the key characteristics of maintaining attention.
In a number of meta-analyses, substance use rates were found to be higher among individuals with ADHD than the general population (Charach et al., 2011). Treatment of ADHD has also been associated with reduced rates of drug use in adulthood (van Emmerik–van Oortmerssen et al., 2013). The clinical link between ADHD and drug use reinforces the theoretical connection between attention and impulse control. When the brain is better able to inhibit ignore distracting stimuli and inhibit impulsive responses, it is then capable of attending to important cues.
The good news is that the brain’s capacity to pay attention seems somewhat malleable. Many treatments that were developed to treat addiction only also seem to be enhancing the brain’s general capacity to self-regulate and sustain attention. Improved performance on the Stroop task during treatment for addiction is a fascinating example of how managing addiction can have relevant implications for the many of us who want to attend successfully to the many challenging tasks we face every day.
There isn’t a single person who wouldn’t benefit from better attentional control. Every day, we are faced with millions of distractions that vie for our attention and offer us immediate thrills. Surprisingly, the research on drug addiction has some important lessons to teach us about improving our attention. Medications that reduce impulsivity, meditative practices that involve attending to one’s immediate experience, and CBT strategies that involve coping with one’s thoughts and feelings, all seem to directly affect our ability to pay attention to what’s important in our lives. Like exercising, practicing attention seems to strengthen our brain’s ability to filter out distractions. And for some of us, paying attention may be as difficult as shelving the bottle. But across the board, strategic interventions hold promise in providing us with some equipment to exercise those attentional biceps.
Cahn, B. R., & Polich, J. (2009). Meditation (Vipassana) and the P3a event-related brain potential. International Journal of Psychophysiology, 72(1), 51-60.
Chan, D., & Woollacott, M. (2007). Effects of level of meditation experience on attentional focus: is the efficiency of executive or orientation networks improved? The Journal of Alternative and Complementary Medicine, 13(6), 651-658.
Charach, A., Yeung, E., Climans, T., & Lillie, E. (2011). Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. Journal of the American Academy of Child & Adolescent Psychiatry, 50(1), 9-21.
DeVito, E. E., Worhunsky, P. D., Carroll, K. M., Rounsaville, B. J., Kober, H., & Potenza, M. N. (2012). A preliminary study of the neural effects of behavioral therapy for substance use disorders. Drug and Alcohol Dependence, 122(3), 228-235.
Garland, E. L., Gaylord, S. A., Boettiger, C. A., & Howard, M. O. (2010). Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: results of a randomized controlled pilot trial. Journal of psychoactive drugs, 42(2), 177-192.
Grant, J. E., Potenza, M. N., Hollander, E., Cunningham-Williams, R., Nurminen, T., Smits, G., & Kallio, A. (2006). Multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling. American Journal of Psychiatry. Robbins, T. W. (2002). ADHD and addiction. Nature Medicine, 8(1), 24-25.
Grant, J. E., Kim, S. W., & Odlaug, B. L. (2009). A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of kleptomania. Biological Psychiatry, 65(7), 600-606.
Higgins, E. S., & George, M. S. (2013). Neuroscience of Clinical Psychiatry: the pathophysiology of behavior and mental illness. Lippincott Williams & Wilkins.
Kober, H., Mende-Siedlecki, P., Kross, E. F., Weber, J., Mischel, W., Hart, C. L., & Ochsner, K. N. (2010). Prefrontal–striatal pathway underlies cognitive regulation of craving. Proceedings of the National Academy of Sciences, 107(33), 14811-14816.
Kieres, A. K., Hausknecht, K. A., Farrar, A. M., Acheson, A., de Wit, H., & Richards, J. B. (2004). Effects of morphine and naltrexone on impulsive decision making in rats. Psychopharmacology, 173(1-2), 167-174.
van Emmerik–van Oortmerssen, K., Vedel, E., Koeter, M. W., de Bruijn, K., Dekker, J. J., van den Brink, W., & Schoevers, R. A. (2013). Investigating the efficacy of integrated cognitive behavioral therapy for adult treatment seeking substance use disorder patients with comorbid ADHD: study protocol of a randomized controlled trial. BMC psychiatry, 13(1), 132.