The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors

Matthias Brand; Elisa Wegmann; Rudolf Stark; Astrid Müller; Klaus Wölfling; Trevor W Robbins; Marc N Potenza

doi:10.1016/j.neubiorev.2019.06.032

The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors

Neurosci Biobehav Rev. 2019 Sep:104:1-10. doi: 10.1016/j.neubiorev.2019.06.032. Epub 2019 Jun 24.

Authors

Matthias Brand¹, Elisa Wegmann², Rudolf Stark³, Astrid Müller⁴, Klaus Wölfling⁵, Trevor W Robbins⁶, Marc N Potenza⁷

Affiliations

¹ General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany. Electronic address: [email protected].
² General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Germany.
³ Department of Psychotherapy and Systems Neuroscience, Justus-Liebig-University of Giessen, Germany; Bender Institute of Neuroimaging, Justus-Liebig-University of Giessen, Germany.
⁴ Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.
⁵ Outpatient Clinic for Behavioral Addiction, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Germany.
⁶ Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, UK.
⁷ Departments of Psychiatry, Neuroscience and Child Study, Yale University School of Medicine, New Haven, USA; Connecticut Council on Problem Gambling, Wethersfield, USA; Connecticut Mental Health Center, New Haven, USA.

PMID: 31247240
DOI: 10.1016/j.neubiorev.2019.06.032

Abstract

We propose an updated version of the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, which we argue to be valid for several types of addictive behaviors, such as gambling, gaming, buying-shopping, and compulsive sexual behavior disorders. Based on recent empirical findings and theoretical considerations, we argue that addictive behaviors develop as a consequence of the interactions between predisposing variables, affective and cognitive responses to specific stimuli, and executive functions, such as inhibitory control and decision-making. In the process of addictive behaviors, the associations between cue-reactivity/craving and diminished inhibitory control contribute to the development of habitual behaviors. An imbalance between structures of fronto-striatal circuits, particularly between ventral striatum, amygdala, and dorsolateral prefrontal areas, may be particularly relevant to early stages and the dorsal striatum to later stages of addictive processes. The I-PACE model may provide a theoretical foundation for future studies on addictive behaviors and clinical practice. Future studies should investigate common and unique mechanisms involved in addictive, obsessive-compulsive-related, impulse-control, and substance-use disorders.

Keywords: Behavioral addictions; Buying-shopping disorder; Cue-reactivity; Gambling disorder; Gaming disorder; Inhibitory control; Problematic pornography use.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Amygdala / physiopathology*
Behavior, Addictive / physiopathology*
Decision Making / physiology*
Executive Function / physiology*
Humans
Inhibition, Psychological*
Models, Theoretical*
Prefrontal Cortex / physiopathology*
Ventral Striatum / physiopathology*