Lewis Article on Addiction as Moral or Disease

Striatum

Locus of dopamine reception and synaptic restructuring, area responsible for pursuing rewards (nucleus accumbens here: shift in striatal activation from ventral to dorsal region as addiction becomes more compulsive)

Amygdala

Mediates emotional salience

Hippocampus

Directs memory encoding and retrieval

Incentive Sensitization

The increasing specificity with which dopamine flows from the ventral tegmental area (VTA) in the mid brain to the accumbens in response to drug cues. With secondary and even tertiary drug-related cues triggering dopamine release, which then increased activation in the accumbens and induce a more driven, even “frenzied” quality tto drug-seeking behavior

Dorsal Striatum

Increasingly important for addiction with the passage of time. As the period of addiction stretches over months and years, activation shifts from the ventral to the dorsal striatum in response to drug-associated cues, while drug-seeking behavior becomes more compulsive and less impulsive in character.

Dorsolateral Prefrontal Cortex (dIPFC)

Critical for reasoning, remembering, planning, and self-control. Becomes hyperactivated in the early stages of addiction, as it does in some eating disorders, perhaps when people try to control or maintain the rewardingness of this new experience. Disengage along with other prefrontal control centers from the striatum, amygdala, and other areas compromising the motivational core of the brain. (loss of grey matter, and reduced synaptic density)

Argument against the disease model

If the key premise of the disease model is that addiction changes the brain. Aren’t brains supposed to change, and are designed to change? Developement signals changes in the cortex and limbic regions.

Experience-dependent changes

The war we experience things changes synaptic configurations, and those changes shape the way we experience things subsequently.

Hebbian Synaptic Firing

Neurons that fire together wire together

Synaptogenesis and Normal Tendencies that relate to addiction

Brain development always balances the formation of new synapses with synaptic loss or pruning. With pruning far outweighing synaptogenesis over the years of childhood and adolescence. Infant brains have an overabundance of synapses, with one-third of which are pruned through competition. Pruning in the pre-frontal cortex increases effeciency in the processing and organizing of information—the essence of cognitive development from puberty onward. Emotional regulation skills, which continue to advance through childhood and adolescence, involve two-way communication between prefrontal control centers and sbcortical (e.g. striatal) regions that mediate emotions and impulses.

Developmental-Learning Model

Addiction is part of personal growth and change, emphasizing individual agency, social context, and neuroplasticity rather than medical pathology. Treatment should focus on positive growth instead of medical intervention entirely.

Delay Discounting

The tendency to overvalue immediate rewards and undervalue future rewards. Addicts focus heavily on short-term gains rather than long-term benefits.

Impaired Response Inhibition

Label for prefrontal dysfunction seen in addiction

What did Connolly find about prefrontal grey matter when practicing abstinence?

It has the ability to fully recover and can even exceed baseline function