Shared brain vulnerabilities open the way for nonsubstance addictions: Carving addiction at a new joint?

Authors

  • Joseph Frascella,

    1. Division of Clinical Neuroscience and Behavioral Research, National Institute on Drug Abuse, Rockville, Maryland, USA
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  • Marc N. Potenza,

    1. Department of Psychiatry and Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
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  • Lucy L. Brown,

    1. Saul R. Korey Department of Neurology and Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, New York, USA
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  • Anna Rose Childress

    1. Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
    2. VISN 4 MIRECC, Department of Veteran's Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Address for correspondence: Anna Rose Childress, Department of Psychiatry, University of Pennsylvania School of Medicine, 3900 Chestnut St., Philadelphia, PA 19104. childress_a@mail.trc.upenn.edu

Abstract

For more than half a century, since the beginning of formal diagnostics, our psychiatric nosology has compartmentalized the compulsive pursuit of substance (e.g., alcohol, cocaine, heroin, nicotine) from nonsubstance (e.g., gambling, food, sex) rewards. Emerging brain, behavioral, and genetic findings challenge this diagnostic boundary, pointing to shared vulnerabilities underlying the pathological pursuit of substance and nonsubstance rewards. Working groups for the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), are thus considering whether the nosologic boundaries of addiction should be redrawn to include nonsubstance disorders, such as gambling. This review discusses how neurobiological data from problem gambling, obesity, and “normal” states of attachment (romantic infatuation, sexual attraction, maternal bonds) may help us in the task of carving addictions “at a new joint.” Diagnostic recarving may have a positive effect on addiction research, stimulating discovery of “crossover” pharmacotherapies with benefit for both substance and nonsubstance addictions.

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