Addiction neurobiologists should study resilience

Abstract

The study of addiction has historically focused on identifying the differences which make susceptible individuals fall prey to drug use and abuse. This has resulted in a deep understanding of the learning, reward, and habit-formation circuits which drive initial drug reinforcement, as well as exploration of the cognitive control and anxiety systems which are important for craving and relapse to drug use. However, most human drug users and a smaller proportion of laboratory animals are resilient to addiction, meaning that they can use addictive drugs without developing substance use disorders. Evidence from the neurobiology of resilience in stress models suggests that the mechanisms of resilience are distinct from those of vulnerability, and thus may be missed if resilience is not investigated in a targeted manner. In this review, we briefly review the limitations in our knowledge which have resulted from a focus on addiction vulnerability. We next introduce the formal construct of resilience and its historical application in neurobiology and clinical research. Finally, we present evidence for the presence of resilience mechanisms in studies of addiction neuroscience and argue for an increase in the focused study of resilience to substance abuse. By intentionally identifying compensatory resilience mechanisms in addiction, rather than only focusing on mechanisms of susceptibility, more effective therapeutic approaches may be discovered.