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The Journal of Neuroscience, May 1, 2002, 22(9):3303-3305
MINI REVIEW
A Behavioral/Systems Approach to the Neuroscience of Drug
Addiction
Francis J.
White
Department of Cellular and Molecular Pharmacology, Finch University
of Health Sciences, The Chicago Medical School, North Chicago, Illinois
60048
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ARTICLE |
Drug addiction is likely to affect all of our
lives, with any luck not through our own actions but probably because
of one or more of our family and friends. Now firmly entrenched as a brain disease (Leshner, 1999 ; Wise, 2000 ), drug addiction is among the
most costly such diseases in modern society. Drug addiction is most
often defined as a chronically relapsing disorder in which the addict
experiences uncontrollable compulsion to take drugs, while
simultaneously the repertoire of behaviors not related to drug seeking,
taking, and recovery, declines dramatically. What transpires to
lead the drug user into this cyclical, self-destructive pattern of
behavior? Through a rapid escalation of basic neuroscience research, we
have begun to answer this critical question at both the
cellular/molecular and behavioral/systems levels of analysis. There
have been many excellent recent reviews regarding the molecular mechanism of drug addiction (see references below). Such has not been
the case from a systems neuroscience perspective. The present set of
mini-reviews has been solicited to address issues concerning the brain
systems responsible for specific immediate behavioral consequences of
drug intake, how such systems are altered during the process of
repeated drug administration, and whether additional systems become
engaged during the process of drug dependence, withdrawal, and relapse
to drug-taking. The aim of these reviews is to provide the
nonspecialist neuroscientist with a contemporary yet comprehensible
overview of exciting recent developments in our understanding of brain
circuits related to specific aspects of drug addiction.
Drug addiction is presently viewed as a complex neuroadaptive process
through which drugs of abuse alter cellular and molecular aspects of
neural function in such a way as to render the brain circuits mediating
various behavioral effects of these drugs more, or less, responsive to
those effects. This process guides behavior in maladaptive directions
during which severe physical and social consequences engulf and disable
the addict. Cellular and molecular mechanisms of tolerance,
sensitization (reverse tolerance), and dependence are rapidly being
identified for almost all classes of abused drugs, and both established
and new molecules are being investigated intensively using the most
modern and advanced technologies available to neuroscience
(Nestler, 2001b ,d ). As the neurobiology of drug addiction has
advanced, the discovery of precise cellular and molecular adaptations
related to the addictive process has been substantial. Alterations in
many molecules have been newly implicated. From long-suspected
involvement of the cAMP pathway in tolerance to and dependence on
opiates (Sharma et al., 1975 ), we have identified a dedicated role of
cAMP-related molecules in the actions of several drugs of abuse. The
cAMP-dependent protein kinase and the cAMP response element-binding
protein are but two examples. Molecules that interact both
upstream and downstream of these effectors are also implicated and
include various neurotransmitter receptors, inhibitory and stimulatory
G-proteins, protein kinases and phosphatases, ion channels, immediate
early genes, and gene transcription factors (for review, see
Berke and Hyman, 2000 ; Nestler, 2001a ,b ). At the cellular level,
alterations in synaptic and whole-cell plasticity accompany
sensitization and withdrawal (Bonci and Williams, 1996 ; Zhang et al.,
1998 ; Thomas et al., 2001 ; Ungless et al., 2001 ), as do structural
changes in dendrites (Robinson and Kolb, 1997 , 1999 ).
Clearly, dopamine (DA) is the molecule most directly implicated in the
positive reinforcing (rewarding, pleasurable) effects of all drugs of
abuse. The ability of addictive drugs to enhance DA neurotransmission,
particularly within the mesocorticolimbic DA system, is a well
documented commonality among the various classes of abused drugs (for
review, see Wise and Bozarth, 1987 ; Koob, 1992 ; White, 1996 ; Spanagel
and Weiss, 1999 ). This DA reward system, which originates in the
midbrain ventral tegmental area (VTA; A10 DA neurons) and projects to
the nucleus accumbens (NAc), prefrontal cortex (PFC), and other limbic
areas, has long been the major focus of our attempts to identify
cellular and molecular mechanisms underlying addiction. However, the
past decade has witnessed an emerging willingness to place the
DA system within a broader context of neuronal circuitry engaged by
specific drugs and particular behavioral sequences involved in the acts
of drug seeking, drug taking, and recovery from drug actions
(withdrawal, relapse, etc.).
One critical component of this broader conceptualization of drug reward
circuitry is the glutamate neuronal system innervating and directly
influencing the mesocorticolimbic DA system. Glutamatergic inputs to
the VTA and NAc, arising from the PFC, hippocampus, and basolateral
amygdala, have all been implicated in addiction. Indeed, a recurring
theme in modern addiction research is the extent to which
neuroadaptations responsible for various aspects of the addiction
process are similar to those responsible for other forms of neural
plasticity studied in cellular models of learning, such as long-term
potentiation and long-term depression (Wolf, 1998 ; Berke and Hyman,
2000 ; Nestler, 2001c ); however, glutamate is not the only other system
under intense scrutiny. We have long been baffled by the role of other
monoamine transmitters in the actions of drugs of abuse. In recent
years, a new emphasis on both serotonin and norepinephrine has
reemerged, along with clear implications for various neuropeptide
systems, including the opioid peptides and the stress-related peptides
of the hypothalamus-pituitary-adrenal axis (Kreek and Koob, 1998 ).
Moreover, as will be seen in several of the mini-reviews, brain
GABAergic and cholinergic systems are fruitful avenues for continued
research. Finally, conceptualization of the role of DA pathways has
been enlarged to include the nigrostriatal system as it becomes engaged
in stereotypic responses that define the process of addiction (Everitt
and Wolf, 2002 ).
A concerted interplay between cellular/molecular and behavioral/systems
neuroscience with respect to the process of addiction has never been so
crucial. Identifying the systems involved in specific behaviors directs
cellular/molecular studies of both acute and chronic drug actions.
Similarly, identification of new molecules selectively altered by
repeated drug administration, perhaps in brain areas not
"routinely" considered with addiction circuits, can expand our
concepts of brain circuitry modulating the addiction process. We are
fortunate that the neuroscientists who have agreed to provide the six
mini-reviews in this series work at both levels of analysis, thereby
providing a comprehensive multidisciplinary perspective on the
neurobiology of addiction. In putting together the teams of scientists
to provide these reviews, I have specifically paired two investigators
who do not necessarily collaborate directly, so that they mold perhaps
different perspectives to provide a consensus as to the most important
new developments in drug addiction research. As these reviews
emphasize, our efforts to tie specific brain circuits to precise
aspects of behavioral changes has broadened considerably the number of
affected brain regions and highlighted the need to expand cellular and
molecular studies to these areas. This has been made possible by the
refinement of sophisticated behavioral approaches coupled to systems neuroscience.
When surveying the advances made with respect to the neuroscience of
drug addiction, it is easy for the nonspecialist to get the incorrect
impression that brain circuits have evolved to allow maladaptive
patters of behavior. Actually, brain reward circuits subserve a much
more critical evolutionary function: reward induced by natural
reinforcers such as food and sexual interactions. Accordingly, we begin
our series of reviews with a look at how the neuroscience of natural
rewards is related to addictive drugs. Kelley and Berridge (2002)
review current thinking of how the DA reward system encodes specific
aspects of the reward process and how such encoding is impacted by
natural rewards. They also provide compelling arguments for
commonalities in the actions of natural rewards and drugs of abuse
within both traditional reward areas and brain regions not normally
considered within such circuitry.
After considering natural rewards, the next three reviews focus on the
major classes of illicit drugs of abuse: psychomotor stimulants
(amphetamine, cocaine), opiates (morphine, heroin), and cannabinoids
(marijuana). In a somewhat expanded mini-review, Everitt and Wolf
(2002) summarize the rapidly expanding field of psychostimulant
addiction from a systems perspective. We have allowed this more
detailed treatment not only because more work has focused on this class
of drugs but also because these authors provide excellent descriptions
of most of the sophisticated behavioral procedures that are also
touched on in the other mini-reviews. The interested reader would be
well served by first reading this mini-review to become familiar with
the animal models used to study drug-seeking, conditioned
reinforcement, and behavioral sensitization.
As pointed out by De Vries and Shippenberg (2002) , in contrast to
psychostimulants, considerably less is known regarding the mechanisms
of opiate addiction and relapse to opiates after withdrawal. Their
commentary in this regard is well informed given that these authors
could just as easily have reviewed the psychostimulants. This is
another feature of the scientists whom I have chosen to participate in
this series; many of them work across different drug classes, giving
unique perspectives on the similarities and differences between various
drugs of abuse. In this case, De Vries and Shippenberg emphasize that
recent findings challenge previous notions regarding the role of one
neurotransmitter or brain region in opiate addiction and point to
activity of several neurotransmitter and neuropeptide systems in brain
circuits mediating mood and affect underlying the addiction process.
Maldonado and Rodriguez de Fonseca (2002) tackle the job of integrating
an explosive recent literature regarding the perhaps controversial
concept of cannabinoid addiction. As social issues swirl with respect
to the medical use and possible decriminalization of marijuana,
neuroscientists have taken advantage of the relatively recent cloning
of cannabinoid receptors, the identification of endogenous
cannabinoids, and the development of specific and potent cannabinoid
compounds to begin the identification of circuits involved in
cannabinoid reward, dependence, and withdrawal. Maldonado and Rodriguez
de Fonseca (2002) beautifully integrate discoveries at the
behavioral/systems level with those at the cellular/molecular level to
argue persuasively that addiction to cannabinoids shares common
features with other drugs of abuse. The remarkable interactions between
cannabinoid and opioid systems are particularly emphasized.
The last two mini-reviews turn to the two major licit drugs of abuse:
alcohol and nicotine. Weiss and Porrino (2002) describe the unique
challenges in alcohol addiction research that emerge from the multiple
molecular targets of ethanol in several brain circuits. We have come
far from the days of considering ethanol as a "modifier of membrane
fluidity." Specific binding sites for ethanol within GABA-A and NMDA
receptors provide particular challenges given the almost ubiquitous
expression of these receptors throughout the nervous system. Weiss and
Porrino (2002) clearly and concisely review the involvement of DA,
opioid, and other systems in ethanol motivation and reward, adaptations
relevant for the transition to dependence and relapse, and issues
relevant to the treatment of alcoholism.
Finally, Picciotto and Corrigall (2002) team up to review the neuronal
system involved in behaviors related to nicotine addiction and the
molecular genetics that have identified which subtypes of nicotinic
acetylcholine receptors are implicated in distinct brain regions.
Nicotine presents its own challenges given that one does not typically
identify this drug as exerting the profound euphoria associated with
other drugs of abuse. Yet the DA reward system is again clearly
implicated in the addictive properties of nicotine, but so are several
other neurochemical systems and brain circuits. One primary example is
the involvement of the pedunculopontine tegmental nucleus, a brain
region not traditionally linked to the actions of other drugs of abuse,
in the acquisition of nicotine self-administration [however, see
Bechara et al. (1998) ].
Although not addressed in this set of reviews, it is important to point
out that brain imaging studies have clearly indicated that many of the
brain structures related to drug reward systems are also engaged by
other rewards such as money (Knutson et al., 2001 ), romantic love
(Bartels and Zeki, 2000 ), and maternal attachment (Lorberbaum et al.,
1999 ). As one progresses through this series of mini-reviews, it will
become apparent that there are many commonalities between different
drugs with respect to the systems involved in similar aspects of
behaviors associated with the addiction process. Yet there are also
many important differences. I am hopeful that the reader will sense the
excitement that exists in the neurobiology of addiction and the need
for continued research to identify what some refer to as the molecular
"switch" (Leshner, 1998 ) and the various components of the
"spiraling distress-addiction cycle" (Kreek and Koob, 1998 ) that
underlies the transition from drug taking to drug addiction.
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FOOTNOTES |
Correspondence should be addressed to Francis J. White,
Department of Cellular and Molecular Pharmacology, Finch University of
Health Sciences, The Chicago Medical School, 3333 Green Bay Road, North
Chicago, IL 60048. E-mail: whitef{at}finchcms.edu.
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