The Neuroscience of Drug Reward and Addiction
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Neuroscience research has revealed that addiction is a chronic, relapsing disease of the brain triggered by repeated exposure to drugs in those who are vulnerable because of genetics and developmental or adverse social exposures. As a result, the reward circuit’s capacity to respond to reward and motivate actions that are not drug related is decreased, the sensitivity of the emotional circuits to stress is enhanced, and the capacity to self-regulate is impaired. The result is compulsive drug seeking and drug taking despite severe harms and an inability to control the strong urges to consume the drug, even when there is a strong desire to quit. The changes in the brain responsible for these maladaptive behaviors can persist for months or even years after drug discontinuation but are amenable to treatment. Treatment should be aimed at improving self-regulation; helping to control craving and the emergence of distressing emotions, including depression and anxiety; and improving the sensitivity to alternative reinforcers. Addiction is a chronic disease, so its treatment should follow a sustained model of intervention, the intensity of which should be adjusted to the stage of the disease. Treatment should also be personalized and calibrated to the severity of the addiction, the presence of comorbidities, and the individual’s support systems. Crucially, addiction can be prevented, and both universal as well as tailored strategies can significantly reduce substance use disorder in the individual and in a population.
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