Current drug abuse reviews最新文献

{"title":"The Need to Move from Describing to Evaluating the Effectiveness of Indigenous Drug and Alcohol Residential Rehabilitation Services: A Systematic Review.","authors":"Doug James,&nbsp;Anthony Shakeshaft,&nbsp;Alice Munro,&nbsp;Ryan J Courtney","doi":"10.2174/1874473711666180404123904","DOIUrl":"https://doi.org/10.2174/1874473711666180404123904","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite the importance of Indigenous drug and alcohol residential rehabilitation, the knowledge supporting these services is limited. This paper aims to: (i) identify the research output related to Indigenous drug and alcohol residential rehabilitation services; (ii) classify identified studies according to their methodology; and (iii) describe key characteristics of clients and services, and critique the research methods.</p><p><strong>Methods: </strong>A PRISMA compliant search of 10 electronic databases for studies of Indigenous drug and alcohol residential rehabilitation services from Australia, United States, Canada and New Zealand, published between 1 January 2000 and 28 March 2016, was conducted.</p><p><strong>Results: </strong>Of the 38 relevant studies, 20 were service descriptions, one was a thesis, 16 described treatment or client characteristics and one was a pre/post evaluation. No systematic reviews or the development or evaluation of measures was identified, with reviewed studies found to be of relatively low methodological quality.</p><p><strong>Conclusion: </strong>There are few published studies on Indigenous drug and alcohol residential rehabilitation services, an average of one paper per annum internationally, and only one treatment outcome evaluation. Three key features of the reviewed papers included (i) studied services were mostly located in regional areas; (ii) services provided multi-component programs, with little alignment between the models of care of other services; and (iii) the majority used qualitative, rather than quantitative methods. Client outcomes will likely improve if future research can establish best-practice, culturally acceptable models of care and increase the application of evidence-based, culturally validated quantitative evaluation measures to complement existing qualitative research.</p>","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"10 1","pages":"52-67"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36061511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thiamine and Alcohol for Brain Pathology: Super-imposing or Different Causative Factors for Brain Damage?","authors":"Rita Moretti,&nbsp;Paola Caruso,&nbsp;Matteo Dal Ben,&nbsp;Silvia Gazzin,&nbsp;Claudio Tiribelli","doi":"10.2174/1874473711666180402142012","DOIUrl":"https://doi.org/10.2174/1874473711666180402142012","url":null,"abstract":"<p><strong>Background: </strong>Drinking more than the recommended limits is a worldwide emerging problem, difficult to circumscribe, and alcohol-related brain damages are an under-recognized health problem. Alcohol-cognitive disruption can be considered as transient and recoverable if the alcohol consumption is limited and occasional; if not, it can progress to the so-called Alcohol-Related Dementia (ARD), or to the Wernicke encephalopathy, or it can even induce the Korsakoff syndrome, an irreversible and long-lasting medical condition. ARD still remains poorly diagnosed and addressed, despite having increased research interest being a frustrating condition, a relatively non-progressive, or even partially reversible condition in abstinent ex-drinkers. On the contrary, Wernicke encephalopathy, with its neurological symptoms (ocular coordination imbalance and gait ataxia), is a dramatic medical condition, potentially lethal which can lead towards Korsakoff dementia. The alcohol consumption is a strong reinforcing condition of the thiamine deficit, the main biochemical determinant factor that starts the cascade of the brain irreversible damaging events.</p><p><strong>Conclusion: </strong>Our review focuses on the possible common neural pathways of this three condition, on the biochemical basis of the damages, and tries to underline the strong need of better understanding the pathogenesis of the brain lesions, including epigenetics and the nutritional aspects of the problem.</p>","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"10 1","pages":"44-51"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36061512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Prevalence of Abandoned Needlesticks from Injecting Drug Users in Milton Keynes, UK: Analysing Access to Needle Exchange Centres and Drug Dependency Services.","authors":"Dushyant Mital,&nbsp;Steve Conway,&nbsp;Joanne Trueman","doi":"10.2174/1874473711666180418164130","DOIUrl":"https://doi.org/10.2174/1874473711666180418164130","url":null,"abstract":"<p><strong>Background: </strong>In 2015, Milton Keynes (MK) Council waste management team shows an increase in the numbers of abandoned used needles being found across MK. MK is an area of high Human Immunodeficiency Virus (HIV) prevalence and high Hepatitis C (HCV) in People Who Inject Drugs (PWID), the overriding concern was for the safety of the public.</p><p><strong>Methods: </strong>Analysis of data collection to understand the scale and spread of the problem, preventing/ reducing the incidence of abandoned needles and looking at access to the designated Drug Dependency Unit (DDU) and the Blood Borne Virus (BBV) service. Through data mapping, hotspot areas of used needles abandonment were analysed.</p><p><strong>Results: </strong>Peak needle stick finds were in March and June 2015 mainly in areas of social deprivation and marginalisation where designated needle exchange points were identified. 174 reports of abandoned needles were reported between January 2015 and November 2015 with a total of 2379 individual needles. 87% of the total numbers of needles were found in just 8 estates.</p><p><strong>Conclusion: </strong>Tackling the issue of abandoned needles effectively should be done through a targeted, multi-agency approach. Reductions in needlestick abandonment can be strengthened through improving access to needle exchange points, DDU and BBV services, delivering high-quality harm reduction interventions and using data mapping in order to identify and target hot spot areas.</p>","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"10 1","pages":"76-80"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36061513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Asleep at the Wheel: Concerning Driving after Co-Consumption of Alcohol and Benzodiazepines.","authors":"Luke A Downey,&nbsp;Talitha Ford,&nbsp;Amie Hayley","doi":"10.2174/187447371001180611082250","DOIUrl":"https://doi.org/10.2174/187447371001180611082250","url":null,"abstract":"","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"10 1","pages":"4-5"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2174/187447371001180611082250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36241374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Administration of Antipsychotic Drugs in Schizophrenia and Influence of Substance and Drug Abuse on the Disease Outcome.","authors":"Felix-Martin Werner,&nbsp;Rafael Covenas","doi":"10.2174/1874473710666171020104524","DOIUrl":"https://doi.org/10.2174/1874473710666171020104524","url":null,"abstract":"<p><strong>Background: </strong>Many schizophrenic patients with a long-term administration of antipsychotic drugs do not regularly adhere to the prescribed pharmacotherapy. Antipsychotic drugs constitute a palliative, but not a curative treatment, and the long-term effect of these drugs is not secure. Patients tend to consume nicotine and alcohol, as well as some patients consume drugs such as cannabis and amphetamines.</p><p><strong>Objective: </strong>The objective of this mini-review is to examine the reasons for the high tendency of schizophrenic patients to consume alcohol, nicotine and drugs and in addition to suggest measures to reduce the abuse of substances and drugs. The effects of substances such as alcohol and nicotine and drugs such as cannabis and amphetamines on the disease outcome will be mentioned.</p><p><strong>Method: </strong>Previous reviews on the psychotic disorders and the pharmacological treatment were used to examine the effects of substances and drugs on schizophrenic symptoms and to investigate appropriate measures to improve medication adherence and the renouncement of consuming substances and drugs.</p><p><strong>Results: </strong>A possible coherence between the function of single susceptibility genes and the alteration of neurotransmitters is mentioned. The mechanism of action of the most important secondgeneration antipsychotic drugs and their indications are described. The tendency of schizophrenic patients to consume alcohol and nicotine and in addition the effect of both substances to possibly worsen psychotic symptoms are pointed out. The effect of nicotinergic agonists to support smoking cessation is described. The different compounds of cannabis, tetrahydrocannabidiol (a psychotomimetic) and cannabidiol (exerts antipsychotic actions), are mentioned. Because a reduced adherence to the pharmacotherapy is frequently combined with the abuse of substances, additional drugs, psychoeducation and the administration of long-acting injectable antipsychotic drugs could reduce the abuse of substances and drugs; these strategies could help to maintain the antipsychotic administration.</p><p><strong>Conclusion: </strong>The abuse of drugs and substances might be combined with a reduced adherence to the antipsychotic pharmacotherapy. Drugs and substances might in some cases worsen the psychotic symptoms. Appropriate measures to reduce substance and drug abuse as well as to improve the adherence to the antipsychotic pharmacotherapy are cognitive behavioral therapy, psychoeducation and the administration of long-acting injectable antipsychotic drugs. Some new drugs, for example the cannabis compound cannabidiol that shows antipsychotic properties and ß-varenicline, a nicotinergic cholinergic agonist, might be administered when substance abuse (cannabis, nicotine) occurs.</p>","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"10 1","pages":"19-24"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35479989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Repetitive Transcranial Magnetic Stimulation (rTMS) in Treatment of Addiction and Related Disorders: A Systematic Review.","authors":"Ramkrishna Makani,&nbsp;Basant Pradhan,&nbsp;Umang Shah,&nbsp;Tapan Parikh","doi":"10.2174/1874473710666171129225914","DOIUrl":"https://doi.org/10.2174/1874473710666171129225914","url":null,"abstract":"<p><strong>Background: </strong>Addiction and related disorders are devastating with their tremendous social, psychological, and physical consequences for which development of optimally effective treatments is long overdue. Repetitive Transcranial Magnetic Stimulation (rTMS) is relatively safe and is becoming an emerging therapeutic tool for these conditions.</p><p><strong>Methods: </strong>This systematic review was conducted using PubMed, PsycINFO, PsychiatryOnline and Cochrane Library ranging from year 2001 to 2017.</p><p><strong>Results: </strong>Our search selected 70 related articles of which, based on the Strength of Recommendation Taxonomy (SORT) guidelines, 11 indicated Level-1 study quality and class-B strength of recommendation for rTMS in nicotine addiction (effective in 218/289 subjects who received rTMS as found in 11 studies). Level-2/Class-B evidence was found for alcohol and cocaine addictions (Alcohol: effective in 126/193 subjects who received rTMS as found in 8 studies; Cocaine: effective in 86/128 subjects, as found in 5 studies). For food cravings, Level-3/Class-B evidence was noted (effective in 134/169, found in 7 studies). However, the evidence was limited to Level-3/Class-C for heroin (10/20 subjects received active rTMS, effective in 1 study), methamphetamine (33/48 subjects received active rTMS, effective in 2 studies), cannabis (18/18 subjects received active rTMS, effective in 1 study), and pathological gambling (31/31 subjects received active rTMS, effective in 2 studies).</p><p><strong>Conclusion: </strong>rTMS may serve as an emerging therapeutic option for addiction and related disorders. The major lacunae include important methodological limitations and dearth of knowledge about precise mechanism of action that need to be addressed in the future studies.</p>","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"10 1","pages":"31-43"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35648884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug-Drug Interactions in Cocaine-users and their Clinical Implications.","authors":"Luca Gallelli,&nbsp;Santo Gratteri,&nbsp;Antonio Siniscalchi,&nbsp;Erika Cione,&nbsp;Sabrina Sirico,&nbsp;Paolo Seminara,&nbsp;Maria Cristina Caroleo,&nbsp;Giovambattista De Sarro","doi":"10.2174/1874473710666170920143344","DOIUrl":"https://doi.org/10.2174/1874473710666170920143344","url":null,"abstract":"<p><strong>Background: </strong>Drug-Drug Interactions (DDIs) represent a common problem in clinical practice during drug treatments. DDIs can both induce the development of adverse drug reactions or reduce the clinical efficacy of each drug.</p><p><strong>Objectives: </strong>The main objective of this review was to analyze the pharmacokinetic and pharmacodynamic DDIs in cocaine consumers, focusing the interest on their clinical implications.</p><p><strong>Methods: </strong>The PubMed, Embase and Cochrane library databases were searched for articles published until January 10, 2017. Secondary search included articles cited in reference lists identified by the primary search. Papers were deemed eligible if they included any form of words: \"adverse drug reaction\", \"drug interactions\", \"poly-therapy\", \"cocaine\", \"systemic diseases\".</p><p><strong>Results: </strong>In this review, the nodal points treated concern: i) cocaine biochemical metabolism described for both, inactive benzoylecgonine and ecgonine methyl esters and norcocaine active metabolites. We provided evidences of concepts deriving from rat/mice experimental studies speculating a translation approach to human in order to treat cocaine overdose. ii) Drug-drug interactions, which come out from clinical evidences as the case of CYP450 family enzyme inhibitors or inductors modulating cocaine toxicity. Particularly, we highlighted the lack of knowledge concerning cocaine and CYP3A4 inhibitors (such as ketoconazole, nefazodone, erythromycin, and clarithromycin). We recorded the worst association of cocaine and beta-blockers by direct and indirect action, particularly at postsynaptic levels on dopamine and norepinephrine reuptake, sympathetic activation and increase of heart rate, blood pressure and cardiovascular toxicity. Cocaine also induces increase in serotonin synaptic activity leading to the development of a serotoninergic syndrome when used with drugs that affect serotonin pathway. Genetic (i.e. glutathione peroxidase-1 deficiency) and epigenetic factors (i.e. microRNAs) may be involved in drug-drug interactions in cocaine-users are also being introduced.</p><p><strong>Conclusion: </strong>DDIs represent an important potential complication in cocaine users in clinical setting. The knowledge of DDIs can also be used to select treatments for patients, thus optimizing clinical response and minimizing toxicity.</p>","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"10 1","pages":"25-30"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35294178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain and Opioid Addiction: A Systematic Review and Evaluation of Pain Measurement in Patients with Opioid Dependence on Methadone Maintenance Treatment.","authors":"B. Dennis, M. Bawor, James Paul, C. Plater, Guillaume Paré, A. Worster, M. Varenbut, J. Daiter, David C. Marsh, D. Desai, L. Thabane, Z. Samaan","doi":"10.2174/187447370901160321102837","DOIUrl":"https://doi.org/10.2174/187447370901160321102837","url":null,"abstract":"BACKGROUND\u0000While chronic pain has been said to impact patient's response to methadone maintenance treatment for opioid dependence, the reported findings are inconsistent. These discrepancies may be a direct result of variations in the measurement of chronic pain or definitions of response to methadone treatment. The goal of this study is to evaluate the association between pain and substance use behaviour to determine the real impact of comorbid pain in the methadone population. We also aim to examine sources of variation across the literature with a specific focus on the measurement of pain.\u0000\u0000\u0000METHODS/DESIGN\u0000We performed a systematic review using an electronic search strategy across CINAHL, MEDLINE, Web of Science, PsychINFO, EMBASE, and the Cochrane Library including Cochrane Reviews and the Cochrane Central Register of Controlled Trials databases. Title, abstract, as well as full text screening and extraction were performed in duplicate. Studies evaluating the association between chronic pain and methadone maintenance treatment response were eligible for inclusion in this review. Using a sample of 297 methadone patients from the Genetics of Opioid Addiction (GENOA) research collaborative, we assessed the reliability of patient self-reported pain and the validated Brief Pain Inventory (BPI) assessment tool.\u0000\u0000\u0000RESULTS\u0000After screening 826 articles we identified five studies eligible for full text extraction, of which three showed a significant relationship between the presence of pain and the increase in substance abuse among patients on methadone for the treatment of opioid dependence. Studies varied largely in the definitions and measurement of both pain and response to treatment. Results from our validation of pain measurement in the GENOA sample (n=297) showed the use of a simple self-reported pain question is highly correlated to the use of the BPI. Simply asking patients whether they have pain showed a 44.2% sensitivity, 88.8% specificity, 84.4% PPV and 53.6% NPV to the BPI. The area under the ROC curve was 0.67 and the Pearson χ(2) was 37.3; (p<0.0001).\u0000\u0000\u0000DISCUSSION\u0000The field of addiction medicine is at a lack of consensus as to the real effect of chronic pain on treatment response among opioid dependent patients. Whether it be the lack of a single \"gold standard\" measurement of response, or a lack of consistent measurement of pain, it is difficult to summarize and compare the results of these relatively small investigations. In comparison to the BPI, use of the simple self-reported pain has lower sensitivity for identifying patients with pain, suggesting the inconsistencies in these studies may result from differences in pain measurement. Future validation studies of pain measurement are required to address the predictive value of self-reported pain.","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"18 1","pages":"49-60"},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82625776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial Predictors of Relapse Among Patients with Alcohol Problems.","authors":"Dana D. Al Abeiat, A. Hamdan-Mansour, S. Hanouneh, Bushra M. Ghannam","doi":"10.2174/187447370901160318153019","DOIUrl":"https://doi.org/10.2174/187447370901160318153019","url":null,"abstract":"BACKGROUND\u0000Alcohol abuse is a common problem that is socially, psychologically and economically devastating to health of individuals.\u0000\u0000\u0000OBJECTIVES\u0000the purpose of this study was to examine the interrelationship between alcohol relapse, self efficacy, perceived social support, and perceived stress among individual diagnosed with alcohol dependence.\u0000\u0000\u0000METHODS\u0000A cross-sectional descriptive correlational design was utilized to collect data using self-administered questionnaire from a purposeful sample of 111 Jordanians diagnosed with alcohol dependence. Data collected in regards to self efficacy, perceived social support, and perceived stress.\u0000\u0000\u0000RESULTS\u0000patients reported moderate to severe psychological distress, moderate level of self-efficacy, and moderate perception of social support. The analysis also showed that self-efficacy and perceived social support from other and from friends have negative and not significant correlation with relapse. Also age had significant and positive correlation with relapse. Marital status and duration of alcohol dependence were significant predictors of relapse.\u0000\u0000\u0000CONCLUSION\u0000Stress and socio-demographic characteristic are significant factors to be considered while planning for alcohol relapse prevention.","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"76 1","pages":"19-25"},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74237943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining Stress and Dopamine Based Models of Addiction: Towards a Psycho-Neuro-Endocrinological Theory of Addiction.","authors":"James H. Johnston, D. Linden, M. V. D. van den Bree","doi":"10.2174/1874473709666151209113913","DOIUrl":"https://doi.org/10.2174/1874473709666151209113913","url":null,"abstract":"The literature on the two main models of addiction (dopamine-based positive reinforcement and stress-based negative reinforcement models) have made many important contributions to understanding this brain disorder. However, rarely has there been a comprehensive critique of the limitations of both models. This article seeks to resolve theoretical issues inherent to each model, as well as propose a more comprehensive psycho-neuro-endocrinological theory of addiction which reconciles important elements of both. We suggest that there is not only direct interaction of dopaminergic and stress systems throughout the addiction cycle, from initial use, via the abusing stage, to the endpoint of addiction, but that this interaction is present prior to initial use. A combination of genetic factors and/or experiences of adversity may result in a stress-triggered sensitisation of dopaminergic networks which is present before the onset of substance use, which cannot be explained solely in terms of dopaminergic (positive) reinforcement. Rather these processes are best explained by an allostatic model which reconciles aspects of both models of addiction and shows how dopamine/stress interactions become increasingly pathological in the addiction cycle. Our model suggests that chronic stress eventually creates baseline hypodopaminergic activity, but also prompts dopaminergic hyperactivity in cue reactivity. This is the neural marker of allostatic mechanisms observed at endpoint addiction. We propose a multi-circuit explanation of how this cumulative effect of stress increasingly impacts on dopaminergic networks of reward, affect, attention, memory and behavioural control. This revised model provides a useful frame of reference for further research and ultimately clinical practice.","PeriodicalId":72730,"journal":{"name":"Current drug abuse reviews","volume":"130 1","pages":"61-74"},"PeriodicalIF":0.0,"publicationDate":"2016-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89110617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}