Addiction research has traditionally emphasized negative affect and the role of distress in the development and maintenance of substance use disorders (SUDs). However, a new review published in Current Addiction Reports examines evidence that positive emotion dysregulation may also play a fundamental role in how we understand addiction.

Findings  

The review synthesizes clinical, psychophysiological, neuroimaging, and neuropharmacological research examining positive emotion regulation in addiction, including blunted positive affect, reduced responsiveness to rewards, and difficulty increasing positive emotion. Evidence involving opioids, nicotine, cannabis, cocaine, and methamphetamine use suggests that chronic substance use is associated with diminished responsiveness to natural rewards and impaired capacity to experience or sustain positive emotion. These changes are linked to changes in brain circuits involved in reward, motivation, and emotion regulation.

One highlighted study, a secondary analysis of a randomized clinical trial involving 160 individuals using opioids, found that participants with opioid use disorder (OUD) showed impaired ability to intentionally increase positive emotion through savoring. Greater impairment was also associated with higher opioid craving.

The review also examines Mindfulness-Oriented Recovery Enhancement (MORE). In the cited study, eight weeks of MORE improved positive emotion regulation relative to supportive group therapy. Greater positive emotion regulation activity after treatment also predicted lower opioid craving.

Male therapist in session with a client.

However, the evidence does not support positive emotion regulation as a standalone treatment for addiction. The review notes that research on positive psychological interventions remains limited, and that more research is needed to understand how strengthening positive affect and responsiveness to rewards may influence craving and substance use.

Commentary and Clinical Takeaways from Dr. Judith Beck

The findings broaden how clinicians conceptualize the emotional processes involved in addiction. Rather than focusing exclusively on reducing distress, the review highlights the potential importance of building clients’ capacity to experience and notice positive emotions and develop healthy sources of rewards.

“For CBT clinicians, this review is particularly relevant to the broader question of what maintains unhelpful behavior and what therapeutic strategies may be effective,” said Beck Institute President Dr. Judith Beck. “We should be thinking about how we can interrupt a cycle in which lower levels of positive emotion may lead to continued substance use, which then further disrupts functioning.”

Positive emotion dysregulation may represent an important, historically underrecognized dimension of addiction. Further research is needed to determine how reliably interventions that strengthen positive emotion regulation can improve clinical outcomes, and what their role should be in addiction treatment.

Reference: 

Garland, E. L. (2026). Positive emotion regulation in addiction: A new frontier for recovery science. Current Addiction Reports, 13(1), 32.

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