Neuroscience of Addiction: Relevance to Prevention and Treatment

Abstract

Addiction, the most severe form of substance use disorder, is a chronic brain disorder molded by strong biosocial factors that has devastating consequences to individuals and to society. Our understanding of substance use disorder has advanced significantly over the last 3 decades in part due to major progress in genetics and neuroscience research and to the development of new technologies, including tools to interrogate molecular changes in specific neuronal populations in animal models of substance use disorder, as well as brain imaging devices to assess brain function and neurochemistry in humans. These advances have illuminated the neurobiological processes through which biological and sociocultural factors contribute to resilience against or vulnerability for drug use and addiction. The delineation of the neurocircuitry disrupted in addiction, which includes circuits that mediate reward and motivation, executive control, and emotional processing, has given us an understanding of the aberrant behaviors displayed by addicted individuals and has provided new targets for treatment. Most prominent are the disruptions of an individual's ability to prioritize behaviors that result in long-term benefit over those that provide short-term rewards and the increasing difficulty exerting control over these behaviors even when associated with catastrophic consequences. These advances in our understanding of brain development and of the role of genes and environment on brain structure and function have built a foundation on which to develop more effective tools to prevent and treat substance use disorder.

Can neuroimaging help combat the opioid epidemic? A systematic review of clinical and pharmacological challenge fMRI studies with recommendations for future research

“…To synthesize existing knowledge and facilitate effective translation of findings to real-world clinical settings, we aim to build upon recent reviews focused more broadly on fMRI findings across different substance use disorders [36,37] and others focused more narrowly on resting-state fMRI in OUD [38][39][40] by examining published fMRI literature (both task-based and resting-state) relevant to OUD, with an emphasis on findings related to opioid medications and treatment outcomes, as well as proposing areas for further research. By delineating common and distinct neural mechanisms of OUD pathophysiology and treatment response, it may be possible to identify which individuals are most likely to benefit from different treatments, optimize existing therapeutic approaches to target neural and clinical features of OUD, and unveil novel neuroscience-informed interventions to combat the nationwide opioid epidemic [32,35,41].…”

Metabolic and Addiction Indices in Patients on Opioid Agonist Medication-Assisted Treatment: A Comparison of Buprenorphine and Methadone

“…Here we attempted to extend these findings and to examine the effects of the opposite hyperopioidergic state by employing comprehensive metabolic assessment including plasma lipids, hemoglobin A1C, body composition, the oral glucose tolerance test (oGTT) and the Sweet Taste Test (STT) in OUD patients on buprenorphine-or methadone maintenance. We hypothesized that given the differences in the opioid receptor binding properties, subjects treated with buprenorphine vs. methadone would display more favorable metabolic characteristics and considering the alterations in metabolic restraint on the reward centers 48,94 , subjects with-vs. without MetS would display a worse addiction severity. In an exploratory fashion, potential relationships between the MAT drugs' exposure duration with metabolic and addiction indices were assessed separately in each study group.…”

Deficient Functioning of Frontostriatal Circuits During the Resolution of Cognitive Conflict in Cannabis-Using Youth

“…Because substance use and relapse rates are associated with control processes, 65 interventions based on neural stimulation, such as transcranial magnetic stimulation, and behavioral interventions, such as cognitive training, that specifically target frontostriatal circuits could be helpful as adjunct intervention strategies to complement standard treatment programs for cannabis use disorder and SUDs in general. 66…”