Cited by 315Stress Responses and CortisolNeurotransmitter Receptor Influence on BehaviorSubstance Abuse Treatment and Outcomes

The DOI matches its Crossref record; 204 of the 204 references it cites were found in a registry or an index.

Addiction and stress: An allostatic view

Koob, George F., Schulkin, Jay·2019·Neuroscience & Biobehavioral Reviews

Abstract

Allostasis, or stability through change, has most often been linked with challenges to homeostasis, in which repeated challenges or stressors produce sufficient allostatic load to generate an allostatic state that can ultimately lead to a disease state. The present review argues that the impact of stress on drug addiction fits with an allostatic model and represents a challenge to brain circuit regulatory mechanisms that underlie the emotional state of the animal. The central thesis is that stress leads to changes in corticotropin-releasing factor in the brain that impact addiction. Stress is further argued to impact all three stages of the addiction cycle-binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation-exposing the animal to an emotional allostatic load and allostatic state that forms the growing motivational pathology of addiction. Viewing addiction as an allostatic mechanism provides key insights into the ways in which dysregulated neurocircuitry that is involved in basic motivational systems can transition to pathophysiology.

Overview

Integrity signals

Registry

Crossref · 10.1016/j.neubiorev.2018.09.008

Cites

204 of 204 references verified0 citation errors · 0 not checkable

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  • Classically, with opioids and alcohol, individuals with a substance use disorder may start with recreational use during the binge/intoxication stage and progress to the withdrawal/negative affect stage as negative reinforcement evolves.

    “Classically, with opioids and alcohol, individuals with a substance use disorder may start with recreational use of the drug during the binge/intoxication stage and progress to the withdrawal/negative affect stage as negative reinforcement evolves (Koob et al., 2019; Fig. 2).”
  • A heuristic framework for addiction includes a three-stage cycle: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation.

    “A heuristic framework for addiction includes a threestage cycle-binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation-that provides a starting point for exploring the relatively new construct of hyperkatifeia in the context of drug withdrawal (Koob and Le Moal, 1997;Koob, 2019).”
  • Both somatic and psychologic symptoms of withdrawal are mediated by physiological changes in the body and brain, but symptoms associated with hyperkatifeia have significantly more motivational significance than somatic signs of withdrawal.

    “However, both somatic and psychologic symptoms are mediated by physiological changes in the body and brain, but the argument here is that the symptoms that are associated with hyperkatifeia have significantly more motivational significance than somatic signs of withdrawal (Koob, 2019).”
  • In OUD, a classic pattern evolves in which the individual must administer the drug to avoid severe dysphoria and discomfort associated with abstinence.

    “A classic pattern evolves in which the individual must administer the drug to avoid the severe dysphoria and discomfort that are associated with abstinence (Koob et al., 2019).”
  • Many individuals with AUD continue with a binge/withdrawal pattern for extended periods; for others, the pattern evolves into an opioid-like substance use disorder in which they must have alcohol available at all times to avoid consequences of abstinence.

    “Many individuals with AUD continue with a binge/withdrawal pattern for extended periods; for others, the pattern evolves into an opioid-like substance use disorder, in which they must have alcohol available at all times to avoid the consequences of abstinence (Koob et al., 2019).”

Citations

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Research works printed but not linked: 1

  1. Habib, 2000, CRH-1 receptor antagonism exerts antidepressant- and anxiolytic-like effects in attenuating stress ulcerogenesis, FASEB J., 14, A338

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Metadata

Authors
Koob, G. F., & Schulkin, J.
Affiliations
  • National Institute on Drug Abuse (US)
  • Georgetown University (US)
Corresponding author
Koob, George F.
Venue
Neuroscience & Biobehavioral Reviews
Publisher
Elsevier BV
Published
2019-11
Volume
106
Pages
245-262
ISSN
0149-7634 (ISSN-L)
OpenAlex
W2891830541
Cited by
315
References
204
Citations by year
2026: 36 · 2025: 53 · 2024: 32 · 2023: 47 · 2022: 31 · 2021: 50 · 2020: 40 · 2019: 26
FWCI
3.26
Type
journal article
Language
en
Open access
closed
Locations
  • Neuroscience & Biobehavioral Reviews (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
addiction, stress, allostasis, allostatic load, corticotropin-releasing factor, drug addiction, addiction cycle, withdrawal, emotion regulation, neurocircuitry
MeSH terms
Animals, Brain, Humans, Stress, Psychological, Substance-Related Disorders, Allostasis

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