ReMed 2018 ReMed N°6 - Addiction | Page 14

Sciences de la Santé Amygdala Hippocampus Pre-frontal cortex Ventral tegmental area Lateral Hypothalamus Nucleus accumbens Figure 1 - The reward circuit stimulus) that had not been predicted. In contrast, a decreased level of dopamine would signify that the reward is absent or less than expected. Finally, if the reward is just as expected, the dopamine neurons re- main at the basal firing rate. In terms of behavior, these results actually mean that, as long as there is no change in the envi- ronment (i.e. the reward is exactly as expected), there is nothing to learn and no need to change the behav- ioral response. In contrast, when the response is not as expected, the changes in dopamine level influence future responses to stimuli to focus on bigger rewards and avoid fruitless pursuits of non-rewarding situa- tions. Addictive drugs action fundamentally differs from that of natural reward as they cause DIRECT do- pamine release in the reward circuit, no matter what. Therefore, according to the theory above, the brain would always interpret this signal as a reward bet- ter than expected, or if you prefer, a really rewarding reward...Thus influencing behavior toward maximum drug-seeking and drug-taking. 14 Été 2018 This is just the beginning of the process. As the drug consumption continues for a long time, pro- gressive plasticity and changes in the neuronal cir- cuits occur, specifically in the prefrontal regions and their associated circuits. This results in a serious im- pairment of higher functions, like self-regulation, de- cision making, flexibility and error monitoring. Thus, the addicted person loses control over drug use and becomes focused only on drug taking, dominating all other pursuits despite serious negative consequences. These effects explain why the persons can be sincere in their desire and intention to stop their addiction and yet simultaneously unable to do that. Finally, memory also plays a major role in ad- diction. All the drug related cues, including environ- ments in which a drug has been taken, persons with whom it has been taken, and the mental state of a person before it was taken are stored in memory. Any exposure to these cues can awaken the crave of con- sumption even years after drug abstinence. Some- times, it can even reproduce the same euphoric state independently of drug consumption. This explains