Neural Correlates of Emotion Regulation in Substance Use.

Purpose of Review: Emotion regulation (ER) is a central process implicated in the development, maintenance, and escalation of substance use (SU) and substance use disorders (SUDs). Advances in functional magnetic resonance imaging (fMRI) have enabled characterization of neural systems underlying emotional processing, inhibitory control under emotional conditions, and deliberate ER in individuals engaging in SU. This review synthesizes recent neuroimaging findings related to ER and SU across three primary paradigms: emotional Go/No-Go tasks, cognitive reappraisal tasks, and implicit ER paradigms. Recent Findings: Across paradigms, SU is associated with altered engagement of frontolimbic, salience, and frontoparietal control networks, particularly during negative emotional contexts. Emotional Go/No-Go studies suggest that SU-related differences are most pronounced when inhibitory demands intersect with emotional salience. Cognitive reappraisal findings indicate disrupted recruitment and coordination of prefrontal-limbic systems during deliberate ER associated with SU, though results remain limited and mixed. Implicit ER paradigms further demonstrate context-dependent alterations in limbic reactivity and prefrontal connectivity associated with SU, with developmental and sex-specific patterns emerging in adolescent samples. Longitudinal findings suggest that some neural differences may precede SU initiation, whereas others may reflect consequences of chronic substance exposure. Summary: Collectively, this literature indicates that altered coordination between emotional salience detection and cognitive control systems represents a key neurobiological mechanism linking ER and SU. Future work integrating longitudinal, ecologically valid, and intervention-based designs will be critical for clarifying directionality and identifying modifiable neural targets to inform prevention and treatment efforts.