Research on the neural substrates of drug reward, withdrawal and relapse has yet to be translated into significant advances in the treatment of addiction. One potential reason is that this research has not captured a common feature of human addiction: progressive social exclusion and marginalization. We propose that research aimed at understanding the neural mechanisms that link these processes to drug seeking and drug taking would help to make addiction neuroscience research more clinically relevant.
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The writing of this article was supported in part by a grant from the Swedish Research Council (M.H.), the Intramural Research Program of the US National Institutes of Health and the US National Institute on Drug Abuse (D.H.E. and Y.S.) and grants DA010584 and DA017763 (M.A.N.). The authors are grateful to S. N. Haber at the University of Rochester, New York, USA, and her co-workers for producing and providing Figure 3. The authors apologize to their many friends and colleagues for not citing many reviews and empirical papers relevant to the topic of their paper, owing to format restrictions.
The authors declare no competing financial interests.
- Compulsive drug use
Continued use of a drug despite (known) adverse consequences.
- Contingency management
A treatment based on systematic reinforcement of a desired, clinically beneficial behaviour.
The subjective experience of a strong desire to consume a particular substance, to experience its effects or to avoid the symptoms of its withdrawal.
- Drug addiction
A clinical condition in which an individual knowingly continues to pursue and consume a chemical substance in a manner that is harmful to that individual or to others.
- Pain matrix
A term proposed for a set of brain structures, including the anterior insula and the dorsal anterior cingulate cortex, that are consistently shown by functional MRI to be activated during physical pain.
- Postdictive validity
The ability to retrospectively demonstrate an established human phenomenon in an animal model.
- Predictive validity
In the context of medications development, the extent to which a drug effect in laboratory animals prospectively predicts therapeutic effects of the same drug in humans.
- Protracted withdrawal
The affective symptoms of drug withdrawal — including low mood, elevated anxiety and increased sensitivity to stress — that persist beyond the time frame of acute physical withdrawal (which typically does not last beyond 3–7 days).
In the context of addiction research, the resumption of drug seeking after extinction of the drug-reinforced responding, induced by exposure to priming doses of drug, drug cues or stressors.
Resumption of drug taking after achieving abstinence.
- Social defeat
A type of social stress used in laboratory-animal studies that is typically induced by placing a rodent in a cage with an unfamiliar rodent that is expected to attack and defeat the intruder, owing to increased strength, aggression or established dominance.
- Social integration
A central concept of sociology, developed by the French sociologist Émile Durkheim, that refers to the web of relationships and interactions — family, kinship groups, traditions or economic activity — through which individuals are connected to each other to form a society; social exclusion is defined as a failure of this process.
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Heilig, M., Epstein, D., Nader, M. et al. Time to connect: bringing social context into addiction neuroscience. Nat Rev Neurosci 17, 592–599 (2016). https://doi.org/10.1038/nrn.2016.67
Characterization of operant social interaction in rats: effects of access duration, effort, peer familiarity, housing conditions, and choice between social interaction vs. food or remifentanil
Peer presence and familiarity as key factors to reduce cocaine intake in both rats and humans: an effect mediated by the subthalamic nucleus
An integrated multimodal model of alcohol use disorder generated by data-driven causal discovery analysis
Communications Biology (2021)