Substance use disorder develops from complex interactions between socio-environmental and neurobiological factors. A neurocognitive model of addiction, the triadic model, proposes that Alcohol Use Disorder (AUD) is the result of an imbalance between the reflective and the impulsive subcomponents along with a disruption of the regulatory subcomponent. Physical activity is considered as an emerging treatment for severe AUD (sAUD). This short review examines the efficacy and mechanisms of action of physical intervention as an adjunctive treatment in severe AUD (sAUD) within the theoretical framework of the triadic model.

Physical activity is a feasible, safe, and less stigmatizing approach than classical treatments. It improves sAUD patients’ mental and physical comorbidities. The key finding of this short review is that physical activity could contribute to a rebalancing of the triadic model in sAUD patients by 1) improving neuroplasticity and cognitive functioning, 2) reducing impulsivity and urgency, and improving emotional regulation, and 3) reducing craving. This rebalancing could eventually reduce the risk of relapse. However, due to methodological issues, it remains difficult to observe an effect of physical activity on drinking outcomes. At best, a trend towards a reduction in alcohol consumption was noted. The mechanisms that could explain the benefits of physical activity in sAUD patients involve multiple physiological processes such as dopaminergic or glutamatergic transmission and signaling or neuroplasticity.

Future randomized controlled trials should include neuropsychological and impulsivity assessments, in more controlled environments. Physical activity could contribute to a personalization of sAUD treatment using each subcomponent of the triadic model as a therapeutic target. Physical exercise could be an adjunctive treatment for sAUD patients, favoring the benefit of more usual treatments such as cognitive behavioral therapies. It could also be a stand-alone intervention in less severe patients.

物质使用障碍是由社会环境因素和神经生物学因素之间复杂的相互作用所引起的。一种成瘾的神经认知模型，即三联症模型，提出酒精使用障碍（AUD）是反射性和冲动性子成分之间不平衡以及调节性子成分破坏的结果。身体活动被认为是重度AUD（sAUD）的新兴治疗方法。这篇简短的评论探讨了在三元模型的理论框架内，物理干预作为辅助治疗严重AUD（sAUD）的功效和作用机制。

与传统疗法相比，体育锻炼是一种可行，安全且少有污名的方法。它可以改善sAUD患者的心理和身体合并症。这篇简短评论的主要发现是，体育锻炼可以通过以下方法来重新平衡sAUD患者的三联症模型：1）改善神经可塑性和认知功能，2）降低冲动性和紧迫性，改善情绪调节，3）减少渴望。这种重新平衡最终可以减少复发的风险。但是，由于方法问题，仍然很难观察到体育锻炼对饮酒结果的影响。充其量，人们注意到减少酒精消费的趋势。

未来的随机对照试验应在更受控的环境中进行神经心理学和冲动性评估。身体活动可能有助于使用三重模型的每个子组件作为治疗目标的sAUD治疗的个性化。体育锻炼可能是sAUD患者的辅助治疗方法，有利于采用更多常规治疗方法，例如认知行为疗法。对于不太严重的患者，这也可以是独立的干预措施。