http://umh1946.edu.umh.es/wp-content/uploads/sites/172/2015/04/Neurocircuitry-of-addiction1.pdf

Neurocircuitry of Addiction

This article offers a reformulation of the negative reinforcement model of drug addiction and proposes that the escape and avoidance of negative affect is the prepotent motive for addictive drug use. The authors posit that negative affect is the motivational core of the withdrawal syndrome and argue that, through repeated cycles of drug use and withdrawal, addicted organisms learn to detect interoceptive cues of negative affect preconsciously. Thus, the motivational basis of much drug use is opaque and tends not to reflect cognitive control. When either stressors or abstinence causes negative affect to grow and enter consciousness, increasing negative affect biases information processing in ways that promote renewed drug administration. After explicating their model, the authors address previous critiques of negative reinforcement models in light of their reformulation and review predictions generated by their model.

/pdf/addiction-motivation-reformulated-an-affective-processing-3dezd2dpj3.pdf

Addiction motivation reformulated: an affective processing model of negative reinforcement.

Contemporary urge models assume that urges are necessary but not sufficient for the production of drug use in ongoing addicts, are responsible for the initiation of relapse in abstinent addicts, and can be indexed across 3 classes of behavior: verbal report, overt behavior, and somatovisceral response. A review of available data does not provide strong support for these assumptions. An alternative cognitive model of drug use and drug urges is proposed that hypothesizes that drug use in the addict is controlled by automatized action schemata. Urges are conceptualized as responses supported by nonautomatic cognitive processes activated in parallel with drug-use action schemata either in support of the schema or in support of attempts to block the execution of the schema. The implications of this model for the assessment of urge responding and drug-use behavior are presented.

A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes.

Background and Methods Use of nicotine-replacement therapies and the antidepressant bupropion helps people stop smoking. We conducted a double-blind, placebo-controlled comparison of sustained-release bupropion (244 subjects), a nicotine patch (244 subjects), bupropion and a nicotine patch (245 subjects), and placebo (160 subjects) for smoking cessation. Smokers with clinical depression were excluded. Treatment consisted of nine weeks of bupropion (150 mg a day for the first three days, and then 150 mg twice daily) or placebo, as well as eight weeks of nicotine-patch therapy (21 mg per day during weeks 2 through 7, 14 mg per day during week 8, and 7 mg per day during week 9) or placebo. The target day for quitting smoking was usually day 8. Results The abstinence rates at 12 months were 15.6 percent in the placebo group, as compared with 16.4 percent in the nicotine-patch group, 30.3 percent in the bupropion group (P<0.001), and 35.5 percent in the group given bupropion and the nicotine patch (P<0.001). B...

https://www.nejm.org/doi/pdf/10.1056/NEJM199903043400903

A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation

The final, common pathway to alcohol use is motivational. A person decides consciously or uncon-sciously to consume or not to consume any particular drink of alcohol according to whether or nothe or she expects that the positive affective consequences of drinking will outweigh those of notdrinking. Various factors (e.g., past experiences with drinking, current life situation) help to formexpectations of affective change from drinking, these factors always modulated by a person's neuro-chemical reactivity to alcohol. Such major influences include the person's current nonchemicalincentives and the prospect of acquiring new positive incentives and removing current negative in-centives. Our motivational counseling technique uses nonchemical goals and incentives to help thealcoholic develop a satisfying life without the necessity of alcohol. The technique first assesses thealcoholic's motivational structure and then seeks to modify it through a multicomponent counselingprocedure. The counseling technique is one example of the heuristic value of the motiva-tional model.This article presents a motivational formulation of alcoholuse. The formulation is intended to incorporate advances madein understanding the inheritable constitutional factors (e.g.,Goodwin, in press; Schuckit, Li, Cloninger, & Deitrich, 1985)and the appetitive systems (T. B. Baker, Morse, & Sherman,1987) in alcohol-related behavior, and also the array of othermotivational factors that are increasingly recognized to play de-cisive roles in understanding and treating addictive behaviorpatterns (e.g., Klinger, 1977; Marlatt & Gordon, 1985; Miller,1985). The particular benefit of this formulation is to place al-coholic behavior in the context of contemporary theory of mo-tivation and emotion, as they relate both to alcohol use in thenarrow sense and to the life context in which the alcoholic con-tinually makes choices between drinking and alternative ac-tions. The formulation thereby suggests additional contributoryfactors, treatment strategies, and conceptual approaches.Despite the fact that there are multiple factors that influencedrinking, the final common pathway to alcohol use is, in ourview, motivational. The net motivation to drink, moreover, isclosely tied to people's incentives in other life areas and to theaffective changes that they derive from their incentives. We be-gin, therefore, by defining incentive motivation and affectivechange and showing how these two concepts are related to peo-ple's use of alcohol.

A Motivational Model of Alcohol Use

Traditionally, theories of addiction have stressed that drug urges are characterized by dysphoria, occur in response to decreasing levels of drug or drug effect, and are associated with withdrawal symptoms/signs or drug-antagonistic responses arising from a homeostatic mechanism. However, recent research has shown that urges, drug self-administration, and relapse all occur concomitant with both positive and negative affect, rising and falling levels of drug, and with drug-agonistic responses, as well as antagonistic/withdrawal responses. In keeping with recent theorizing about motivation and emotions, we believe that affective responding provides a readout of the motivational status of an organism (e.g., Buck, 1985). We conceive of urges as affects, whose activation mediates drug pursuit and self-administration. Moreover, we believe that affects are represented in neural networks comprising information on affect-relevant stimuli, responses, and meaning/expectancy. We believe that there are two types of urge networks. One, a "positive-affect" network, is activated, associatively and nonassociatively, by appetitive stimuli, especially appetitive drug actions that activate "GO" motivational incentive systems. Activation of this network is characterized by positive affect, drug isodirectional responding, attentional focus on a dominant response, and enhanced pursuit of appetitive stimuli--especially the drug. The operating characteristics of the positive-affect network, and the associated motivational systems, result in a drug's instating a positive feedback loop. Appetitive drug actions increase the likelihood of the pursuit of appetitive stimuli, and additional drug constitutes a prepotent candidate from among the available appetitive stimuli. This positive feedback loop may account in part for cardinal features of addiction: for example, the great relapse likelihood once any drug is sampled, the attainment of very high blood levels of a drug, and the pursuit of adjunctive appetitive stimuli while using a drug. The second type of urge network we have labeled a "negative-affect" network, and we believe it is activated, associatively and nonassociatively, by inappetitive stimuli or consequences (punishment, signals of punishment, frustrating lack of reward, etc.) and by withdrawal and signals of withdrawal (e.g., drug cues, which during the course of addiction are associated with both direct drug effects and withdrawal). Activation of the network is characterized by withdrawal symptoms and signs, negative affect, and drug seeking.(ABSTRACT TRUNCATED AT 400 WORDS)

Jack Edward Sherman

Papers

The motivation to use drugs: a psychobiological analysis of urges.

Subjective dimensions of heroin urges: influence of heroin-related and affectively negative stimuli.