EMOTION AND ADDICTION Bio-Behavioral Indices of Emotion Regulation: Potential Targets for Treatment in Addiction Helen C. Fox 1 & Asif Karim 1 & Shariful A. Syed 1 # Springer Nature Switzerland AG 2020 Abstract Purpose of Review Emotion regulation and the manner in which it is comprised play a key role in the motivation for drugs and alcohol. As such, the bio-behavioral processes underpinning aspects of emotion regulation behavior may provide expedient targets for treatment development. This review will examine some of the robust emotional, psychophysiological, and neurobi- ological adaptations that sub-serve affect regulation behaviors during early abstinence from addiction and assess their potential as targets for treatment development. Recent Findings During early abstinence from addiction, individuals report problems with emotional awareness and impulse control during distress as well as enhanced, persistent negative mood in the face of acute psychological stress. In line with this, psychophysiological research studies have used non-affective indices of emotional awareness to show poor interoceptive accu- racy. Moreover, imaging research has highlighted hypofunctional prefrontal circuitry in regulatory brain regions and amygdala/ insula adaptations that are also compatible with decrements in emotional awareness, enhanced provoked dysphoria and decreased impulse control. There is also some evidence to suggest that targeting these indices of emotion regulation behavior using mindfulness-based meditation and medication therapies may be effective in improving outcome. Conclusions The biological construct of emotion regulation has helped to provide an important heuristic framework within which to develop novel treatment markers. However, there remains a need for more contextual and situational-based research to achieve a more holistic understanding of emotion regulation for improved clinical application. Keywords Emotion regulation . Addiction . Relapse . Stress . Craving . DERS Introduction Substance use disorders affect approximately 20 million peo- ple in the USA and may result in devastating consequences, with drug overdose leading to over 70,000 deaths in the USA in 2017 [1]. A key concept necessary for both clinicians and researchers to understand is what underlies the chronic, relaps- ing nature of the illness. Burgeoning research indicates that emotion regulation and the manner in which it is compro- mised may play a key role in the initiation, maintenance, and outcome of addictive disorders. As such, emotion regulation and the bio-behavioral processes underpinning emotion regulation may provide vital predictors of relapse vulnerability, and, hence, expedient targets for therapeutic development. Common definitions of emotion regulation relate to the way in which humans control their experience and expression of emotion under distress by employing strategies such as suppression, repression, and cognitive reappraisal [ 2]. Notably, these strategies are psychologically effortful and, during highly charged or stressful situations, may induce a conflict in regulatory goals, shifting attention towards more immediate and often pleasure-seeking goals [3–5]. This con- flict may in turn jeopardize volitional behavior through loss of impulse control [6] and is highly pertinent to processes under- lying compulsive drug use and alcohol-seeking behavior. For example, motivation for drugs and alcohol at various stages of the addiction cycle are impacted by aspects of emotion regu- lation which include sensitization of the core stress systems of the brain [7, 8], difficulty engaging in regulatory brain systems This article is part of the Topical Collection on Emotion and Addiction * Helen C. Fox helen.fox@stonybrookmedicine.edu 1 Department of Psychiatry, School of Medicine, Stony Brook University, 101 Nicolls Road, HSC, T-10, room 040B, Stony Brook, NY 11794-8101, USA https://doi.org/10.1007/s40429-020-00330-y Published online: 28 August 2020 Current Addiction Reports (2020) 7:333–343