Cocaine dependence: a disease of the brain’s reward centers

Cocaine addiction affects brain reward centers that have evolved to ensure survival. Cocaine euphoria is intensely pleasurable and results from mesolimbic dopamine (DA) neurotransmission. DA signal-receiving neurons in the nucleus accumbens synthesize endogenous opioids and project to numerous rewar...

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Bibliographic Details
Published in:Journal of Substance Abuse Treatment 2001-10, Vol.21 (3), p.111-117
Main Authors: Dackis, Charles A., O'Brien, Charles P.
Format: Article
Language:English
Subjects:
Addiction
Biological and medical sciences
Brain
Brain - drug effects
Brain - metabolism
Cocaine
Cocaine - pharmacology
Cocaine-Related Disorders - metabolism
Cocaine-Related Disorders - physiopathology
Cocaine-Related Disorders - therapy
Crack Cocaine - pharmacology
Disruptive, Impulse Control, and Conduct Disorders - metabolism
Dopamine
Dopamine Uptake Inhibitors - pharmacology
Drug Addiction
Drug addictions
Humans
Limbic System - drug effects
Limbic System - metabolism
Medical sciences
Models, Neurological
Psychotherapy - methods
Reward
Substance abuse treatment
Toxicology
Treatment
Treatment Methods
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Summary:Cocaine addiction affects brain reward centers that have evolved to ensure survival. Cocaine euphoria is intensely pleasurable and results from mesolimbic dopamine (DA) neurotransmission. DA signal-receiving neurons in the nucleus accumbens synthesize endogenous opioids and project to numerous reward regions. Cocaine-induced neuroadaptations, including DA depletion, may underlie craving and hedonic dysregulation. Cue-induced craving is vigorously triggered by conditioned elements of the drug environment and associated with measurable limbic activation. Reduced frontal lobe metabolism in cocaine-addicted individuals could explain important clinical phenomena such as denial and the loss of control over limbic impulses. Cocaine addiction is rapidly progressive and associated with severe medical, psychiatric, and psychosocial consequences. Denial shields addicted individuals from their predicament and must be addressed in treatment. Lacking pharmacological options, clinicians must rely entirely on psychosocial approaches. Treatment principles, including engagement, motivational enhancement, abstinence strategies, and craving reduction are discussed in terms of biological rationales.
ISSN:0740-5472
1873-6483
DOI:10.1016/S0740-5472(01)00192-1