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The British Journal of Psychiatry (2005) 187: 209-220
© 2005 The Royal College of Psychiatrists

REVIEW ARTICLES

Substance use disorders and the orbitofrontal cortex

Systematic review of behavioural decision-making and neuroimaging studies

G. Dom, MD

Psychiatric Centre Brothers Alexians, Boechout, Belgium

B. Sabbe, MD, PhD

Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Belgium

W. Hulstijn, PhD

Nijmegen Institute for Cognition and Information, Nijmegen, The Netherlands, and CAPRI, University of Antwerp, Belgium

W. van den Brink, MD, PhD

Department of Psychiatry, Academic Medical Centre, University of Amsterdam, and Amsterdam Institute for Addiction Research (AIAR), Amsterdam, The Netherlands

Correspondence: Dr G. Dom, Psychiatric Centre Brothers Alexians, Provinciesteenweg 408, 2530 Boechout, Belgium. Tel: +32 3455 7531; e-mail: geert.dom{at}fracarita.org

Declaration of interest None.

Background Orbitofrontal cortex dysfunctions have been frequently documented in people with substance use disorders. The exact role of this cortical region, however, remains unspecified.

Aims To assess the functionality of the orbitofrontal cortex in people with substance use disorders.

Method Reports of studies using behavioural decision-making tasks and/or neuroimaging techniques to investigate orbitofrontal cortex functioning in cases of substance misuse were reviewed. Studies focusing exclusively on tobacco-smoking and gambling were excluded.

Results Fifty-two research articles were evaluated. Most studies showed significant deficits in decision-making in people with substance use disorders. A consistent finding in the neuroimaging studies was hypoactivity of the orbitofrontal cortex after detoxification. The association between hyperactivity of this region and craving or cue reactivity was not consistent across studies.

Conclusions The orbitofrontal cortex has an important role in addictive behaviours. Further studies are needed to elucidate the underlying neuronal substrates of cue reactivity, craving and decision-making, and the implications for treatment and relapse prevention.


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