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From apathy to addiction: Insights from neurology and psychiatry


Kirschner, Matthias; Rabinowitz, Arielle; Singer, Neomi; Dagher, Alain (2020). From apathy to addiction: Insights from neurology and psychiatry. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 101:109926.

Abstract

The tendency to engage in addictive behaviors has long been tied to the actions of the dopamine system. Early theories were based on the fact that all addictive drugs and behaviors (such as gambling) increase dopamine levels in the striatum, and the evidence that dopamine signaled reward or reward prediction error. However, with a changing emphasis of addiction away from purely pharmacological models that emphasize tolerance and withdrawal, towards one of behavioral dyscontrol, is there still a place for abnormal dopamine signaling in addiction? Here we recast the dopamine theory of addiction based on the idea that tonic dopamine may index a continuous phenotype that goes from apathy to impulsivity and compulsivity. Higher tonic dopamine signaling would make individuals vulnerable to drug reinforcement and cue-induced craving. We relate this to computational models of dopamine signaling, and review clinical and neuroimaging evidence from Parkinson's Disease, schizophrenia and bipolar disorder in support of this model.

Abstract

The tendency to engage in addictive behaviors has long been tied to the actions of the dopamine system. Early theories were based on the fact that all addictive drugs and behaviors (such as gambling) increase dopamine levels in the striatum, and the evidence that dopamine signaled reward or reward prediction error. However, with a changing emphasis of addiction away from purely pharmacological models that emphasize tolerance and withdrawal, towards one of behavioral dyscontrol, is there still a place for abnormal dopamine signaling in addiction? Here we recast the dopamine theory of addiction based on the idea that tonic dopamine may index a continuous phenotype that goes from apathy to impulsivity and compulsivity. Higher tonic dopamine signaling would make individuals vulnerable to drug reinforcement and cue-induced craving. We relate this to computational models of dopamine signaling, and review clinical and neuroimaging evidence from Parkinson's Disease, schizophrenia and bipolar disorder in support of this model.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Psychiatry, Psychotherapy, and Psychosomatics
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Life Sciences > Pharmacology
Life Sciences > Biological Psychiatry
Uncontrolled Keywords:Biological Psychiatry, Pharmacology
Language:English
Date:1 July 2020
Deposited On:27 Jan 2021 18:30
Last Modified:27 Jan 2022 05:11
Publisher:Elsevier
ISSN:0278-5846
OA Status:Green
Publisher DOI:https://doi.org/10.1016/j.pnpbp.2020.109926
PubMed ID:32171904
Project Information:
  • : FunderSNSF
  • : Grant IDP2SKP3_178175
  • : Project TitleModulating the neural processing of internal and external rewards - a multimodal approach combining neuroimaging, TMS and pharmacological challenge

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