Neural mechanisms of behavioral addiction: An ALE meta-analysis and MACM analysis

Li, Zhaolan and He, Quanxing and Elhai, Jon D. and Montag, Christian and Yang, Haibo (2025) Neural mechanisms of behavioral addiction: An ALE meta-analysis and MACM analysis. JOURNAL OF BEHAVIORAL ADDICTIONS, 14 (1). pp. 18-38. ISSN 2062-5871 (print); 2063-5303 (online)

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Abstract

Background and aims Behavioral addictions (BAs) represent complex and multifaceted disorders often associated with maladaptive neural alteration. To deepen our understanding of the essence of BAs, this study focuses on the neural mechanisms underlying its three stages: reward seeking, self-control, and decision-making. The aim of the current meta-analysis is to investigate the brain regions and neural networks involved in BAs. Methods Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched for relevant articles published before September 1, 2024, in the Web of Science and PubMed databases, and supplemented our search with Google Scholar. We conducted analyses using activation likelihood estimation (ALE) meta-analysis and meta-analytic connectivity modeling (MACM) analyses. Results A total of 50 functional magnetic resonance imaging studies involving 906 participants were included. The findings showed that individuals with BAs exhibited hyperactivation in the right inferior frontal gyrus (IFG), bilateral caudate and left middle frontal gyrus (MFG), and a high degree of connectivity was found between the right caudate, left caudate, and right IFG. These findings indicated that BAs were associated with the fronto-striatal circuits. Individuals with BAs demonstrate specific neural activation patterns in the reward seeking, self-control, and decision-making stages, characterized by differences in activation and functional connectivity of brain regions associated with these stages. Discussion and conclusions This study verifies the pivotal role of the fronto-striatal circuits in BAs and highlights the specific patterns of brain activity in different stages of addictive behavior. These findings expand our understanding of neural mechanisms underlying BAs and supports and provide partial support for the I-PACE model.

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