The neural basis of drug craving: An incentive-sensitization theory of addiction

Robinson, T

doi:10.1016/0165-0173(93)90013-p

Cited by 7,346Neurotransmitter Receptor Influence on BehaviorSubstance Abuse Treatment and OutcomesNeural and Behavioral Psychology Studies

The neural basis of drug craving: An incentive-sensitization theory of addiction

Robinson, T·1993·Brain Research Reviews

DOI 10.1016/0165-0173(93)90013-p

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Abstract

This paper presents a biopsychological theory of drug addiction, the 'Incentive-Sensitization Theory'. The theory addresses three fundamental questions. The first is: why do addicts crave drugs? That is, what is the psychological and neurobiological basis of drug craving? The second is: why does drug craving persist even after long periods of abstinence? The third is whether 'wanting' drugs (drug craving) is attributable to 'liking' drugs (to the subjective pleasurable effects of drugs)? The theory posits the following. (1) Addictive drugs share the ability to enhance mesotelencephalic dopamine neurotransmission. (2) One psychological function of this neural system is to attribute 'incentive salience' to the perception and mental representation of events associated with activation of the system. Incentive salience is a psychological process that transforms the perception of stimuli, imbuing them with salience, making them attractive, 'wanted', incentive stimuli. (3) In some individuals the repeated use of addictive drugs produces incremental neuroadaptations in this neural system, rendering it increasingly and perhaps permanently, hypersensitive ('sensitized') to drugs and drug-associated stimuli. The sensitization of dopamine systems is gated by associative learning, which causes excessive incentive salience to be attributed to the act of drug taking and to stimuli associated with drug taking. It is specifically the sensitization of incentive salience, therefore, that transforms ordinary 'wanting' into excessive drug craving. (4) It is further proposed that sensitization of the neural systems responsible for incentive salience ('for wanting') can occur independently of changes in neural systems that mediate the subjective pleasurable effects of drugs (drug 'liking') and of neural systems that mediate withdrawal. Thus, sensitization of incentive salience can produce addictive behavior (compulsive drug seeking and drug taking) even if the expectation of drug pleasure or the aversive properties of withdrawal are diminished and even in the face of strong disincentives, including the loss of reputation, job, home and family. We review evidence for this view of addiction and discuss its implications for understanding the psychology and neurobiology of addiction.

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Incentive sensitization theory has afforded insight into neurobiological and behavioral processes associated with individual vulnerability to addictive spectrum pathology, such as substance use disorders and gambling disorder.
“The incentive sensitization theory has afforded valuable insight into the neurobiological and behavioral processes that are associated with individual vulnerability to addictive spectrum pathology, such as substance use disorders (T. E. Robinson & Berridge, 1993) and more recently, gambling disorder (Linnet, 2014; M. J. F. Robinson, Fischer, Ahuja, Lesser, & Maniates, 2015b; Rømer Thomsen et al.,”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as T. E. Robinson & Berridge, 1993
The mesolimbic dopamine system is comprised of dopaminergic fibers that project from the ventral tegmental area in the midbrain, to limbic and cortical structures such as the nucleus accumbens, ventral pallidum, amygdala, and prefrontal cortex.
“This system is comprised of dopaminergic fibers that project from the ventral tegmental area in the midbrain, to limbic and cortical structures such as the nucleus accumbens, ventral pallidum, amygdala, and prefrontal cortex (Di Chiara & Imperato, 1988; T. E. Robinson & Berridge, 1993).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as T. E. Robinson & Berridge, 1993
Incentive salience is the psychological process by which rewards and the cues associated with them become imbued with subconscious motivational value and are transformed into objects of desire.
“Often referred to as incentive salience, it is the psychological process by which rewards and the cues associated with them become imbued with subconscious motivational value and are transformed into objects of desire (M. J. F. Robinson, Robinson, & Berridge, 2013; T. E. Robinson & Berridge, 1993; 2008).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as T. E. Robinson & Berridge, 1993
The incentive sensitization theory was initially proposed to distinguish between the different components of reward.
“The incentive sensitization theory (T. E. Robinson & Berridge, 1993; 2008) was initially proposed to distinguish between the different components of reward.”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as T. E. Robinson & Berridge, 1993
Incentive-sensitization theory specifies that repeated use of a drug produces neuroadaptations that sensitize motivational reward to drugs and associated drug stimuli ('wanting') distinct from the neurocircuitry mediating hedonic reward ('liking').
“The incentive-sensitization theory of addiction(16, 17) also emphasizes sensitization process, but specifies that repeated use of a drug produces neuroadapations that sensitize motivational reward to drugs and associated drug stimuli (i.e.., processes of “wanting”) distinct from the neurocircuitry mediating hedonic reward (liking) which may not sensitize over time.”
From A Prospective 5-Year Re-examination of Alcohol Response in Heavy Drinkers Progressing in Alcohol Use Disorder (2016) · cites this paper as [16]

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Neurocircuitry of Addiction
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Chronic stress, drug use, and vulnerability to addiction
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Food reward: brain substrates of wanting and liking
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Pleasure Systems in the Brain
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Problematic smartphone use: a conceptual overview and systematic review of relations with anxiety and depression psychopathology.
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Dopamine reward circuitry: Two projection systems from the ventral midbrain to the nucleus accumbens–olfactory tubercle complex
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Liking, wanting, and the incentive-sensitization theory of addiction
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Incentive-sensitization and addiction
Robinson, T. E., & Berridge, K. C. (2001) · Addiction · doi:10.1046/j.1360-0443.2001.9611038.x · Cited by 1,435 · see citing works
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Attentional bias in addictive behaviors: A review of its development, causes, and consequences
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The glutamate homeostasis hypothesis of addiction
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Adaptive Coding of Reward Value by Dopamine Neurons
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Motivation concepts in behavioral neuroscience
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Phasic Firing in Dopaminergic Neurons Is Sufficient for Behavioral Conditioning
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Multiple reward signals in the brain
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Drug addiction: updating actions to habits to compulsions ten years on
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Affective neuroscience of pleasure: reward in humans and animals
Berridge, K. C., & Kringelbach, M. L. (2008) · Psychopharmacology · doi:10.1007/s00213-008-1099-6 · Cited by 1,254 · see citing works
Neuronal Reward and Decision Signals: From Theories to Data
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“Liking” and “wanting” food rewards: Brain substrates and roles in eating disorders
Berridge, K. C. (2009) · Physiology & Behavior · doi:10.1016/j.physbeh.2009.02.044 · Cited by 1,147 · see citing works
Evidence for Addiction-like Behavior in the Rat
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Single cocaine exposure in vivo induces long-term potentiation in dopamine neurons
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Dopamine in drug abuse and addiction: results from imaging studies and treatment implications
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Neurobiology of addiction
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Dopamine responses comply with basic assumptions of formal learning theory
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Dopamine reward prediction-error signalling: A two-component response
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The psychology and neurobiology of addiction: an incentive–sensitization view
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A selective role for dopamine in stimulus-reward learning
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Nucleus accumbens shell and core dopamine: differential role in behavior and addiction
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Addiction: A Disease of Learning and Memory
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Neural mechanisms underlying the vulnerability to develop compulsive drug-seeking habits and addiction
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a neurobehavioral model of affiliative bonding: implications for conceptualizing a human trait of affiliation
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Imaginary Relish and Exquisite Torture: The Elaborated Intrusion Theory of Desire.
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Brain Reward Circuitry
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The tempted brain eats: Pleasure and desire circuits in obesity and eating disorders
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Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature
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“inson (Robinson and Berridge, 1993; Berridge and Robinson, 1998).”
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Drug Seeking Becomes Compulsive After Prolonged Cocaine Self-Administration
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Cue-induced activation of the striatum and medial prefrontal cortex is associated with subsequent relapse in abstinent alcoholics
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Peak Provoked Craving After Smoking Cessation
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Early Prediction of Initiation of Abstinence From Cocaine
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Authors: Robinson, T.
Affiliations: University of Michigan (US)
Corresponding author: Robinson, T
Venue: Brain Research Reviews
Publisher: Elsevier BV
Published: 1993-12
Volume: 18
Issue: 3
Pages: 247-291
ISSN: 0165-0173 (ISSN-L)
DOI: 10.1016/0165-0173(93)90013-p
OpenAlex: W2106862702
Semantic Scholar: 2993069cd29bb6b2cf86cba46b145119d2095bc9
Cited by: 7,346
References: 353
Citations by year: 2026: 173 · 2025: 199 · 2024: 165 · 2023: 222 · 2022: 239 · 2021: 245 · 2020: 327 · 2019: 318 · 2018: 239 · 2017: 264 · 2016: 286 · 2015: 306 · 2014: 324 · 2013: 325 · 2012: 302
FWCI: 25.06
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Brain Research Reviews (publishedVersion)
PubMed (publishedVersion)
Deep Blue (University of Michigan) (submittedVersion)
Funders: National Institutes of Health (5r01ns023959-06)
U.S. Public Health Service
National Institute on Drug Abuse
National Institute of Neurological Disorders and Stroke (NS-23959)
Topics: Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
Keywords: drug craving, incentive-sensitization theory, drug addiction, incentive salience, dopamine signaling, sensitization, neural adaptation, associative learning, drug-seeking behavior, drug liking, withdrawal, compulsive drug taking, abstinence
MeSH terms: Adaptation, Physiological, Animals, Brain, Conditioning, Psychological, Corpus Striatum, Dopamine, Humans, Models, Neurological, Motivation, Nucleus Accumbens, Recurrence, Reinforcement, Psychology, Substance-Related Disorders

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The neural basis of drug craving: An incentive-sensitization theory of addiction

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