Imaging studies also reveal that many substances of abuse are related to reduction in volume of specific areas of the cerebral cortex, reflecting a pruning of synapses to make the brain highly efficient in drug-seeking. The loss of synaptic density underlies a biologically based inability to respond to the wide range of other, more natural rewards. Ongoing research suggests that imaging studies measuring cortical thickness and brain response to a decision-making task may reveal who is most susceptible to relapse and could benefit from particular types of supportive treatment, such as cognitive therapies that strengthen executive control. But the disease model also wrongly suggests that the brain changes in addiction are permanent and that addiction is a chronic condition, that those who are addicted are unable to overcome it by themselves, and that relapse is an ever-present danger even to the recovered.
The importance of choice and agency in animal models of addiction
- As of March 1, 2020 registration will be required for all clinical trials (studies designed to examine the efficacy or effectiveness of a treatment or preventive intervention) reporting primary outcome findings.
- Fostering secure attachment bonds through sensitive parenting during childhood or through psychological interventions later in life may represent a unique opportunity to promote healthy socio-emotional and motivational growth across the lifespan.
- Addiction brings about changes in the brain, but those changes do not reflect a pathological process.
- Please refer to the Center for Open Science TOP guidelines for details, and contact the editor (Katie Witkiewitz, PhD) with any further questions.
Another particularly compelling argument describes the need for promotion of ‘empirically based pluralism’ when considering alcohol dependence aetiology (Kendler, 2012). Here, it is argued that alcohol dependence is influenced by ‘difference makers’ including but not limited to molecular and systems neuroscience; social, political, or cultural influence, and genetics. Addiction, generally, can be viewed from this comprehensive https://thecaliforniadigest.com/top-5-advantages-of-staying-in-a-sober-living-house/ vantage point, where appreciation of the contribution of multiple factors and theories are valued. Construing a universally accepted definition for addiction has been a controversial matter since deliberations arose over the first documented cases of substance abuse in the 17th century (Crocq, 2007). At this time, conflicting opinions existed on whether to categorise addiction as a sin or a disease (Nathan et al., 2016).
Social Model
The persistent negative state experienced during drug abstinence, colloquially known as ‘antireward’, is analogous with upregulation of the corticotropin-releasing factor (CRF) system within the extended amygdala (Koob and Le Moal, 2008). The result of hyperactive CRF-containing neurons in the amygdala is recruitment of the hypothalamic–pituitary–adrenal axis and brain stress systems (Nestler, 2005). Other stress-related neurotransmitters including noradrenaline, dynorphin, vasopressin and substance P are also overexpressed (Kwako and Koob, 2017). Activation of these stress systems correlate to the negative emotional state experienced during withdrawal (Koob, 2009). This results in a reduction in dopaminergic neurotransmission and therefore diminished positive response (Feltenstein, 2008). Heightened stress and depreciated reward pathways amalgamate during this stage and present as withdrawal and resulting compulsion.
Comment on Heilig et al.: The centrality of the brain and the fuzzy line of addiction
- It should be written in language that is easily understood by both professionals and members of the lay public.
- A person with an addiction uses a substance, or engages in a behavior, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences.
- When scientists began to study addictive behavior in the 1930s, people with an addiction were thought to be morally flawed and lacking in willpower.
- A recent example of image-based sexual abuse on social media highlights a need for broader public education about the harms caused by these kinds of behaviors.
- The opponent-process approach (Solomon & Corbit, 1974) suggests that the shift from substance use to substance abuse is generated by the transition from positive to negative reinforcement processes motivating continued substance use.
Inability to deal with external events (traumas) could lead to feelings of helplessness and powerlessness. Lacking the capability to cope with negative states, patients will erect powerful, sometimes intransigent, defenses in a desperate effort to avoid feeling them. The person using a defense is generally trying to accomplish the management of anxiety and maintenance of self-esteem. Keeping the unacceptable feelings out of awareness result in the development of a “false Sober House self.” The price for this protection is inability to develop resilience. The fact that significant numbers of individuals exhibit a chronic relapsing course does not negate that even larger numbers of individuals with SUD according to current diagnostic criteria do not. For instance, in many countries, the highest prevalence of substance use problems is found among young adults, aged 18–25 [36], and a majority of these ‘age out’ of excessive substance use [37].
Indeed, in the original Adverse Childhood Experiences (ACEs) study, Felitti et al. (1998) found that more ACEs increased the odds of subsequent drug and alcohol use. One explanation for this trend is that the toxic stress from trauma leads to a dysregulated stress response. An individual’s stress hormones (cortisol and adrenaline) are chronically elevated (Burke Harris, 2018; van der Kolk, 2014). The multifaceted disorder needs a multifaceted conceptualization, and we find that in the biopsychosocial model of addiction (Marlatt & Baer, 1988). Rather than pinpoint the one thing that causes addiction, we now understand that a constellation of factors contributes to a person being more or less at risk for addiction.