Eventually the attenuation of aversive states eg

This preview shows page 5 - 7 out of 11 pages.

Eventually, the attenuation of aversive states (eg, cravings, withdrawal) associated with the addictive behavior becomes the primary driving force for continued engagement in the behavior. Interestingly, damage to a subregion of the insula, which is responsible for assessing internal mood and sensory states, eliminates the experience of craving. 57 In addition to the insula, another key neurobiological modulator of the anti-reward system is the HPA axis. This neuroendocrine pathway is disrupted with chronic exposure to substances, as well as during engagement in gambling, 58 which alters its ability to function effectively and efficiently. 52 The changes to the HPA axis resulting from repeated substance use include increases in circulating adrenocor- ticotropic hormone and corticosterone. These changes cause individuals with addictions to experience stress more intensely and for longer periods than others 36 and lead to a long-term increase in their susceptibility to the negative effects of stress. 59 Moreover, such modifications to the HPA axis are considered between-systems adaptations in the con- text of an addiction process, inasmuch as the recruitment of this stress response system partially mediates the experience of craving and predicts relapse. 59 Although Koob and Le Moal’s 36 model was structured around substances, emerging evidence links key constructs involved in drug dependency to GD as well. For example, the impulsive–compulsive spectrum shift that occurs in DUD also takes place in GD. 60 Additionally, on a molecular level, evidence indicates that dopamine D2 receptors underlie the experience of reward secondary to both gambling 61 and sub- stance use. 62 With respect to the dopaminergic influence on GD, dopamine agonists, often utilized as pharmacotherapy for individuals with Parkinson’s disease and restless leg Substance Abuse and Rehabilitation downloaded from by 5.189.201.158 on 16-Aug-2018 For personal use only. 1 / 1
Image of page 5

Subscribe to view the full document.

Substance Abuse and Rehabilitation 2016:7 submit your manuscript | Dove press Dove press 8 Rash et al syndrome, can lead to engagement in hedonic behaviors such as hypersexuality and gambling, ostensibly through dysregula- tion of the dopamine reward pathway. 63 Conversely, pharmaco- therapy with dopamine antagonists has shown some efficacy in treating alcohol dependence, 64 although evidence has yet to support the efficacy of this approach in GD. 65,66 Finally, as in DUD, the inability of individuals with GD to exhibit appropri- ate top-down impulse control may result from combinations of increases in sympathetic nervous system activity during gambling, 67 coupled with hyperactive stress systems, 58 as well as decreased activation in crucial PFC networks.
Image of page 6
Image of page 7

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern