Shared and Distinct Neural Signatures of Cue-Induced Response in Substance and Behavioral Addictions: A Coordinate-Based Neuroimaging Meta-Analysis

As the global burden of addiction intensifies, the neurobiological commonalities and distinctions between substance use disorders (SUDs) and behavioral addictions (BAs) remain poorly characterized. This coordinate-based meta-analysis of 59 fMRI articles (n = 2,951) mapped the neural signatures of visual cue-reactivity across the addictive disorders. Our results revealed a universal core network shared by SUDs and BAs centered in the bilateral opercular inferior frontal gyrus, suggesting a shared disruption in inhibitory control. Distinctively, SUDs exhibited a stronger recruitment of a subcortical salience pathway, with greater involvement of the left thalamus ventral anterior nucleus than BAs, potentially reflecting pharmacologically amplified bottom-up salience attribution. Notably, recovery-related patterns diverged in the left medial superior frontal gyrus. Alcohol use disorder was associated with neural restoration, whereas heroin use disorder showed neural decompensation. These neural signatures establish a rigorous neurobiological basis for differentiating substance and behavioral phenotypes, supporting tailored circuit-based precision treatments.