Drug addiction: updating actions to habits to compulsions ten years on
Open accessAbstract
A decade ago, we hypothesized that drug addiction can be viewed as a transition from voluntary, recreational drug use to compulsive drug-seeking habits, neurally underpinned by a transition from prefrontal cortical to striatal control over drug seeking and taking as well as a progression from the ventral to the dorsal striatum. Here, in the light of burgeoning, supportive evidence, we reconsider and elaborate this hypothesis, in particular the refinements in our understanding of ventral and dorsal striatal mechanisms underlying goal-directed and habitual drug seeking, the influence of drug-associated Pavlovian-conditioned stimuli on drug seeking and relapse, and evidence for impairments in top-down prefrontal cortical inhibitory control over this behavior. We further review animal and human studies that have begun to define etiological factors and individual differences in the propensity to become addicted to drugs, leading to the description of addiction endophenotypes, especially for cocaine addiction. We consider the prospect of novel treatments for addiction that promote abstinence from and relapse to drug use.
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Nonmedical use of prescription opioids may be influenced by thoughts and behaviors that become automatized through repetition and encoded in memory schemas.
“nonmedical use of prescription opioids may also be influenced by thoughts and behaviors that become automatized through repetition and encoded in memory schemas (Everitt & Robbins, 2016; Tiffany, 1990)”
From To be aware, or to accept, that is the question: Differential roles of awareness of automaticity and pain acceptance in opioid misuse (2023) · cites this paper as Everitt & Robbins, 2016
The Instrumental Learning and Addiction section says that, after much repetition, stimulus–response habits can dominate and behavior can become autonomous and occur outside conscious awareness. This supports the proposed automatization of drug-related behavior, but the paper does not specifically establish this for nonmedical prescription-opioid use or describe thoughts and behaviors as encoded in memory schemas. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn addition to moderating effects of general inhibitory control on relationships between cue-reactivity/craving and habitual behaviors, stimuli-specific inhibitory control may act as a mediator in later stages of addictive processes.
“In addition to the moderating e ff ects of general inhibitory control on relationships between cue-reactivity/craving and the habitual behaviors, we propose that stimuli-speci fi c inhibitory control may act as a mediator in the later stages of addictive processes (Everitt and Robbins, 2016).”
From The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors (2019) · cites this paper as Everitt and Robbins, 2016
The “ADDICTION AND TOP-DOWN CONTROL” section says inhibitory control may regulate compulsive behavior and that compulsive behavior may be partly habitual. It does not identify stimulus-specific inhibitory control as a mediator, or establish the stated moderating relationship between general inhibitory control, cue-reactivity/craving, and habitual behavior. The mediation claim is framed in the citing sentence as the citing authors’ proposal. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn later stages of addictive behaviors, stimuli-specific inhibitory control processes may be influenced by craving and urges related to encountering addiction-related stimuli, which may then make it more likely that an individual will behave habitually or seemingly automatically.
“Thus, in later stages of addictive behaviors (Fig. 2B), stimuli-speci fi c inhibitory control processes may be in fl uenced by craving and urges related to encountering addiction-related stimuli, which may then make it more likely that an individual will behave habitually or seemingly automatically (Everitt and Robbins, 2005, 2013, 2016).”
From The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors (2019) · cites this paper as Everitt and Robbins, 2016
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Experimental — accuracy not yet measuredWhile cue-exposure therapy may not extinguish existing associations, the intensity of experienced craving may be reduced, which is consistent with current neuroimaging findings on the reduction of cue-reactivity due to cue-exposure therapy in abstinent alcohol-dependent individuals, although its effectiveness is discussed controversially.
“While cue-exposure therapy may not extinguish existing associations, the intensity of experienced craving may be reduced (Pericot-Valverde et al., 2015), which is consistent with current neuroimaging findings on the reduction of cue-reactivity due to cue-exposure therapy in abstinent alcohol-dependent individuals (Vollstädt-Klein et al., 2011), although its effectiveness is discussed controvers”
From Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model (2016) · cites this paper as Everitt and Robbins, 2016
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe addiction process in general involves transitions from more voluntary and impulsive drug consumption to a more habitual or compulsive pattern of use, and within this process, the positive and recreational feelings linked to drug intake may become less important compared to experiencing the direct drug effects.
“The addiction process in general has been proposed to involve transitions from more voluntary and impulsive drug consumption to a more habitual or compulsive pattern of use, and that within this process, the positive and recreational feelings linked to drug intake may become less important compared to experiencing the direct drug effects (Everitt and Robbins, 2016;Piazza and Deroche-Gamonet, 2013”
From Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model (2016) · cites this paper as Everitt and Robbins, 2016
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Only ∼20% of the rats continue to respond for drug when delivery is paired with shock.
“Only ∼20% of the rats continue to respond for drug when delivery is paired with shock, which is consistent with the overall percentage of individuals who are likely to develop an addiction (Everitt and Robbins, 2016).”
From Sensitive periods of substance abuse: Early risk for the transition to dependence (2017) · cites this paper as Everitt and Robbins, 2016
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- Authors
- Everitt, B. J., & Robbins, T. W.
- Affiliations
- University of Cambridge (GB)
- Venue
- Annual Review of Psychology
- Publisher
- Annual Reviews
- Published
- 2016-01-04
- Volume
- 67
- Issue
- 1
- Pages
- 23-50
- ISSN
- 0066-4308 (ISSN-L)
- 1545-2085
- OpenAlex
- W1936785944
- Cited by
- 1,225
- References
- 202
- Citations by year
- 2026: 133 · 2025: 114 · 2024: 106 · 2023: 103 · 2022: 116 · 2021: 147 · 2020: 167 · 2019: 116 · 2018: 84 · 2017: 89 · 2016: 44 · 2015: 6
- FWCI
- 8.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annual Review of Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical Research Council (G1002231, G0701497, MR/N02530X/1, G0701500, G0802729)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- drug addiction, compulsive drug seeking, ventral striatum, dorsal striatum, prefrontal cortex, relapse, cocaine dependence, addiction treatment, abstinence
- MeSH terms
- Animals, Brain, Compulsive Behavior, Conditioning, Psychological, Habits, Humans, Substance-Related Disorders, Drug-Seeking Behavior
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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