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Addiction : A Disease of Self-Control

Introduction Research on the neuroscience of substance use disorders (SUDs) has started to shed light on the ways in which chronic drug abuse changes the brain to cause the profound disruptions we see in the behavior of an addicted person. This is because drugs of abuse impact many neuronal circuits that are crucial for the orchestration of conscious experience and hence, for the proper (flexible) functioning in social environments. But the core impairments established during the addictive process have a particularly devastating impact on the interacting circuits of motivational drive (which is enhanced for drug-related stimuli) and of self-control (which is weakened by chronic drug exposure) (Kalivas and Volkow 2005). For many years, studies of addiction had focused mainly on the role of dopamine and the brain reward circuitry (Di Chiara 1999; Weiss and Koob 2001). However, the drug-induced DA boost fails to fully explain addiction since it happens in naïve animals and its magnitude is decreased in addiction (Volkow et al. 1997). Preclinical and clinical studies are revealing neuroad-aptations in frontocortical regions of the brain that are likely to underlie compulsive drug-seeking behaviors in addiction (for review, see (Goldstein and Volkow 2002)). Imaging studies have provided particularly compelling evidence for the involvement of the brain's cognitive system (i.e., prefrontal cortex [PFC], including orbitofrontal cortex [OFC], anterior cingulate gyrus [ACC]) in the addiction process (Volkow and Fowler 2000). More recent work has revealed that the PFC plays a crucial role in social cognition and emotions (Forbes and Grafman 2010), which are key to proper social integration including responses to social rewards and punishment. For example , damage to ventral areas, frontal, and striatal regions can interfere with the ability of a person to accurately distinguish right from wrong in a socially acceptable manner, which can lead to socially inappropriate behaviors (Koenigs et al. 2007). Similarly, such brain impairments decrease the sensitivity to social rewards or punishments that can lead a person to behave in ways that alienate others and result in social isolation or even incarceration. While repeated drug exposures impair the fronto-striatal circuit there is also evidence that genetics or social adverse environmental exposures during childhood/adolescence can also result in impairments in this circuit that increase the vulnerability of the individual for a substance use disorder.