Value, drug addiction and the brain

• Published in: Addictive behaviors 2021-05, Vol.116, p.106816-106816, Article 106816
• Main Authors: Loganathan, Kavinash, Ho, Eric Tatt Wei
• Format: Article
• Language: English
• Subjects: Behavior, Addictive; Brain; Cycle of Addiction; Drug addiction; Humans; Motivation; Neurobiology; Neuroimaging; Reinforcement, Psychology; Reward; Substance-Related Disorders; Valuation
• ISSN: 0306-4603; 1873-6327
• DOI: 10.1016/j.addbeh.2021.106816

•Decision-making during dependency is functional but focused on drugs.•Drugs valued as reward of choice for pleasure seeking and pain avoidance.•Motivation for drugs may change but goal-directedness remains.•Dopaminergic system and brain-wide networks involved in drug valuation.•The cycle of addiction can be viewed as oscillations in hedonic set point. Over the years, various models have been proposed to explain the psychology and biology of drug addiction, built primarily around the habit and compulsion models. Recent research indicates drug addiction may be goal-directed, motivated by excessive valuation of drugs. Drug consumption may initially occur for the sake of pleasure but may transition to a means of escaping withdrawal, stress and negative emotions. In this hypothetical paper, we propose a value-based neurobiological model for drug addiction. We posit that during dependency, the value-based decision-making system in the brain is not inactive but has instead prioritized drugs as the reward of choice. In support of this model, we consider the role of valuation in choice, its influence on pleasure and punishment, and how valuation is contrasted in impulsive and compulsive behaviours. We then discuss the neurobiology of value, beginning with the dopaminergic system and its relationship with incentive salience before moving to brain-wide networks involved in valuation, control and prospection. These value-based neurobiological components are then integrated into the cycle of addiction as we consider the development of drug dependency from a valuation perspective. We conclude with a discussion of cognitive interventions utilizing value-based decision-making, highlighting not just advances in recalibrating the valuation system to focus on non-drug rewards, but also areas for improvement in refining this approach.