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Addiction and stress: An allostatic view
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.
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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).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Koob et al., 2019
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).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as 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).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as 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).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as 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).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Koob et al., 2019
The focus of between-system neuroadaptations fell on understanding neurocircuitry within the extended amygdala and its role in opponent process, more specifically hyperkatifeia.
“Subsequently, the focus of between-system neuroadaptations fell on understanding neurocircuitry within the extended amygdala and its role in opponent process, more specifically hyperkatifeia (Koob and Bloom, 1988;Koob and Le Moal, 2008;Koob, 2019).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Koob, 2019
Much of the data show the recruitment of brain stress systems, including CRF, norepinephrine, hypocretin, dynorphin, and glucocorticoids, as major key substrates responsible for hyperkatifeia associated with drug withdrawal and thus compulsive-like drug seeking via negative reinforcement.
“Much of the data show the recruitment of brain stress systems, including CRF, norepinephrine, hypocretin, dynorphin, and glucocorticoids, as major key substrates that are responsible for hyperkatifeia that is associated with drug withdrawal and thus compulsivelike drug seeking via negative reinforcement (Koob and Bloom, 1988;Koob, 2019).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Koob, 2019
CRF in the extended amygdala may play an important role in hyperkatifeia driving compulsive-like drug seeking for opioids and alcohol via negative reinforcement.
“Thus, CRF in the extended amygdala may play an important role in the development of hyperkatifeia that drives compulsive-like drug seeking that is associated with opioids and alcohol via a negative-reinforcement process (Koob, 2019).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Koob, 2019
Activated GR recruits CRF signaling in the CeA.
“given that activated GR recruits CRF signaling in the CeA (Koob and Schulkin, 2019;Tunstall et al., 2017)”
From Alcohol dependence and withdrawal increase sensitivity of central amygdalar GABAergic synapses to the glucocorticoid receptor antagonist mifepristone in male rats (2022) · cites this paper as Koob and Schulkin, 2019
Withdrawal can produce elevated levels of GCs and increase release of CRF in the central nucleus of the amygdala.
“Withdrawal can produce elevated levels of GCs and increase release of CRF in the central nucleus of the amygdala [175].”
From Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications (2020) · cites this paper as [175]
Stress leads to changes in brain CRF that have a direct impact on addiction.
“The central thesis in Koob’s allostatic view of stress and addiction is that stress leads to changes in brain CRF that have a direct impact on addiction [175].”
From Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications (2020) · cites this paper as [175]
Behavioral economics is a conceptual system to understand how one's access and exposure predict demand and subsequent intake.
“The environment in which one resides is a known predictor of consumption behavior (39), thus behavioral economics is a conceptual system to understand how one's access and exposure will predict demand and subsequent intake (40–43).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [42]
In an ecological study of one Southern California county from 2010 to 2014 (n = 1,205), higher education and income were protective against opioid-related deaths.
“In an ecological study of one Southern California county from 2010 to 2014 (n = 1,205) higher education and income were protective against opioid-related deaths but the data suggests that no group is immune and there is dire need for public health interventions at all SES levels (42).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [42]
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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
- Semantic Scholar
- 81d0dcacfe6b2902b48e20cdfc79fb37ce6694bc
- 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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