The Study

State of Research

Self-regulation as a key mechanism

Why does PSRT place self-regulation at its centre? Because research over the past two decades has identified it as a key to whether addiction treatment succeeds. Four findings are especially telling.

Self-regulation often precedes substance use

A long-term study that followed around 1,000 children into adulthood found a clear association: those who showed lower self-control early on had a higher risk of developing an addiction later, independent of intelligence and social background. The association was graded rather than tied to a fixed threshold — even small differences shifted the risk. That is an encouraging message: even moderate improvements can make a real difference.

The deficits are measurable and consequential

People with an addiction score lower than comparison groups across all domains of self-regulation, most markedly in the regulation of emotions.

This means that the very people who would benefit most from strengthening their self-regulation are also those for whom standard treatments work least well. A good training programme must therefore hold up even where difficulties are pronounced.

A pattern that spans substances

These patterns are not limited to a single drug. Genetic and neuroimaging studies point to a common basis. An analysis of around 1.5 million people found a shared factor behind behaviours as different as problematic alcohol and cannabis use, the onset of smoking, and heightened risk-taking. The brain regions most involved are those for planning, impulse control, and the appraisal of emotions. Because the underlying vulnerability is the same across substances, PSRT is designed as a transdiagnostic approach and is intended, in the longer term, to be evaluated across substances as well.

Changeable — and in a meaningful order

Most important for the training: this vulnerability is not fixed. Even genetically influenced differences can be shifted by the environment, so psychological interventions can indeed make a difference. Well-developed self-regulation can even buffer risks that stem from family history. The order matters: concrete anti-relapse strategies only work once basic self-regulation is in place. This is why PSRT first strengthens general self-regulation and then builds everyday strategies on top of it.

Sources (selection)

• Moffitt et al. (2011): Dunedin longitudinal study — childhood self-control and later addiction risk
• Bakhshani & Hosseinbor (2013): self-regulation in substance-dependent and non-dependent individuals
• Stellern et al. (2023): meta-analysis of emotion-regulation deficits in substance use disorders
• Verdejo-García et al. (2017): systematic review of executive deficits, treatment adherence, and relapse
• Karlsson Linnér et al. (2021): genome-wide analysis (~1.5 million people) of self-regulation and addiction
• Murray et al. (2015): cerebral blood flow in polysubstance use and self-regulation
• Quinn & Fromme (2010); Pearson et al. (2011): the protective, buffering function of self-regulation
• Tanksley et al. (2025): modifiability of genetically influenced self-regulation deficits (within-family design)
• D’Lima et al. (2012): global self-regulation as the basis for concrete protective strategies