Molecular and Cellular Biology of Addiction
نویسندگان
چکیده
Addiction to alcohol, tobacco, and illegal drugs represents a substantial burden to societies worldwide. In terms of health-related outcomes, addiction results in enormous direct medical costs, premature mortality (tobacco alone may be responsible for 450,000 deaths yearly in the United States), and disability. In terms of broader social costs, addiction results in crime, negative impacts on families, derailed lives, and personal suffering. The major categories of drugs most likely to produce addiction are psychostimulants (including cocaine and amphetamines), opiates, ethanol, nicotine, marijuana, and phencyclidine-like drugs. Understanding the molecular and cellular actions of addictive drugs is obligatory if we are to better understand pathophysiology and develop potent pharmacotherapies to treat addiction. Of course, the molecular and cellular information presented in this chapter cannot be applied directly to the behavioral expression of addiction without putting it into the context of systems level neuroscience described in other chapters. Acutely, addictive drugs are both rewarding (i.e., interpreted by the brain as intrinsically positive) and reinforcing (i.e., behaviors associated with drug use tend to be repeated). With repeated use, however, addictive drugs produce molecular changes that, within a vulnerable brain, promote continued drug-taking behavior in a manner that becomes increasingly difficult to control. The central feature of addiction is compulsive drug use—the loss of control over the apparently voluntary acts of drug seeking and drug taking. Once it has taken hold, addiction tends to follow a chronic course with periods of abstinence (that may or may not follow treatment), followed by relapse to active drug use. Even after extended periods of drug abstinence, the risk of relapse remains high. From the point of view of developing treatments, a central problem in addiction research in-
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