The Addiction Cycle: Preoccupation Stage

The dorsal striatum does not appear to have a major role in the acute reinforcing effects of drugs abuse but appears to be recruited during the development of compulsive drug-seeking (Everitt et al, 2008). 6-Hydroxydopamine lesions of the dorsal striatum do not block cocaine-induced locomotor activity or cocaine self-administration (Roberts, 1992) but do block amphetamine-induced stereotyped behavior (Kelly and Iversen, 1976; Creese and Iversen, 1974). Using a second-order schedule (Table 1), lesions of the nucleus accumbens and basolateral amygdala blocked the acquisition of cocaine-seeking (Whitelaw et al, 1996). These results suggest that the dorsal striatum may have a minor role in the acute reinforcing effects of psychostimulant drugs but a key role in the transition to compulsive use (Everitt et al, 2008). Our understanding of the neurobiological substrates for the reinforcing effects of drugs of abuse can be traced to early work on the identification of a reward system in the brain with the discovery of electrical brain stimulation reward or intracranial self-stimulation by Olds and Milner (1954). Brain stimulation reward involves widespread neurocircuitry in the brain, but the most sensitive sites defined by the lowest thresholds involve the trajectory of the medial forebrain bundle that connects the ventral tegmental area (VTA) to the basal forebrain (Olds and Milner, 1954).

Whether (and how) such transcription factors influence the function of the brain stress systems, such as CRF and those described above, remains to be determined. A recent report highlighted the importance in addiction of the interoceptive circuit that most likely interfaces with the extended amygdala and ventral striatum. The study showed that smokers with damage to their insula (but not smokers with extrainsular lesions) were able to stop smoking easily and without experiencing either cravings or relapse (Naqvi et al, 2007).

Addiction and the humanities

Indeed, abstinence and effective relief of craving is expected to ameliorate brain damage caused by addictive substances. For example, He et al. found that white matter damage in the DLPFC could be improved in short- or long-term cocaine abstinence patients over 5 years (He et al., 2020). Chen et al. found that heroin abstinent patients had lower levels of evoked craving, stronger functional connectivities between the dorsal ACC, left DLPFC, and right posterior parietal cortex, which are positively correlated with duration of abstinence (Chen et al., 2021).

Here, trained professionals provide support through the early phases of discontinuing an addiction. For others, particularly those whose goals are around moderating or controlling behavior (rather than quitting completely), the action stage can be similar to normal life, but with greater restraint and perhaps a greater need for support and other ways of coping with stress. But with good preparation, it can also be an exciting time that gives way to new options. Addiction is a “chronic, relapsing brain disorder,” meaning there is no known cure for addiction, unfortunately. Because it is a chronic disease, it requires ongoing treatment in order to help people remain in recovery.

If Someone Relapses, Does That Mean Their Treatment Didn’t Work?

Such elements can be defined by models of different stages of the addiction cycle (see above; Table 2). Treatment options include psychotherapy and psychopharmacotherapy (i.e., medications) or a combination of both. Cognitive behavioral therapy (CBT) is the most common form of psychotherapy used in treating behavioral addictions; it focuses on identifying patterns that trigger compulsive behavior and making lifestyle changes to promote healthier behaviors. Because cognitive behavioral therapy is considered a short term therapy, the number of sessions for treatment normally ranges from five to twenty. During the session, therapists will lead patients through the topics of identifying the issue, becoming aware of one’s thoughts surrounding the issue, identifying any negative or false thinking, and reshaping said negative and false thinking.

If the rehab program is professional and solid, the addict should simply do everything they can to get back into a recovery mindset. That might mean adding a support group or making some changes in their life that will make it less likely that they will go back to using in the future. It’s a reflection of how powerful addiction is to conquer that positive and happy situations, such as birthdays and holidays, can be powerful relapse triggers, too. Our alcohol recovery program allows you to keep work and family commitments while focusing on your sobriety. Many studies have found that relapse rates within the first twelve weeks after the completion of intensive inpatient programs are about 50%.

Continued Use / Abuse

Therefore, new approaches to disrupt memory reconsolidation may help erode the strong associations between context and drug (Lee, 2008; Lee et al, 2005). Interestingly, β-blockers have already shown a promising capacity to inhibit conditioned responses to both natural reinforcers and aversive stimuli (Miranda et al, 2003). Moreover, results from a more recent study suggest that drug-induced conditioned responses may also be sensitive to β-blockade treatment (Milton et al, 2008).

• No molecular markers are sufficiently specific to predict the vulnerability to addiction, but changes in certain intermediate early genes with chronic drug exposure in animal models show promise of long-term changes in specific brain regions that may be common to all drugs of abuse.
• Oftentimes, tolerance becomes an issue with individuals who are struggling with severe addictions to substances, prompting them to turn to even more dangerous and high-risk drugs.
• In contrast, stress-induced reinstatement of drug-related responding in animal models appears to depend on the activation of both CRF and norepinephrine in elements of the extended amygdala (central nucleus of the amygdala and bed nucleus of the stria terminalis) (56, 57).

GABAergic stimulation, which can attenuate Pavlovian conditioning, appears to disrupt the response to drugs of abuse in animals (Volkow et al, 2004a) and may be a useful strategy to treat addiction in humans (Dewey et al, 1998). The pharmacokinetic properties of drugs, which influence the speed of delivery into the brain as well as the duration of their actions, are key elements of their addiction potential. Pharmacokinetic properties determine the doses, routes of administration, and frequency of drug use within a given binge episode. For example, comparison of the brain pharmacokinetics of cocaine and of methamphetamine reveals that both reach the brain very rapidly (although cocaine is somewhat faster than methamphetamine) but that cocaine clears out of the brain much faster than methamphetamine (Figure 3). This difference helps explain why cocaine is taken every 30–60 min during a binge, whereas methamphetamine is taken every couple of hours (Fowler et al, 2008).

Dependence / Addiction

New approaches to the study of memory reconsolidation may help elucidate the strong associations between context and drug. The importance in addiction of the interoceptive circuit involving the insula and other regions that most likely interface with the extended amygdala and ventral striatum remains to be determined. The reactivity of these brain circuits may serve as a biomarker to help predict relapse and help predict treatment efficacy. Human post-mortem studies, human laboratory studies, and neurocircuitry studies in parallel animal models will likely yield promising results in this domain.

After the questions, the DSM-5 criteria are used to identify the likelihood of the person having substance use disorder.[76] After these tests are done, the clinician is to give the “5 RS” of brief counseling. A “trigger” is an experience, event or even a person that causes you to stray from a life of sobriety back into substance abuse. Every person will have different triggers, but developing an awareness of your own and making a list how to break the addiction cycle of them can help you actively avoid them on a daily basis. Some examples of triggers might be visiting a place where you used to do drugs frequently, hanging out with a person you used to drink with, or even attending a holiday party where alcohol is present. Unfortunately, it’s not always possible to avoid these situations, so it’s wise to make a plan of specific strategies that will help you manage each of the triggers on your list.