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- W1857655303 abstract "The Personal View by Wayne Hall and colleagues 1 Hall W Carter A Forlini C The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises?. Lancet Psychiatry. 2015; 2: 105-110 Summary Full Text Full Text PDF PubMed Scopus (140) Google Scholar questions the value of the brain disease model of addiction (BDMA) and claims that it is not supported by animal or neuroimaging evidence, that it has not helped deliver more effective treatments, and that its impact on public policy has been modest. However, these claims are not supported by the evidence. First, preclinical and clinical studies have consistently delineated specific molecular and functional neuroplastic changes at the synaptic and circuitry level that are triggered by repeated drug exposure. These findings, along with ongoing research, are helping us understand the neurobiological processes associated with the loss of control, compulsive drug taking, inflexible behaviour, and negative emotional states associated with addiction (figure). Second, the uncovering of the molecular targets and circuits underlying addiction has already resulted in several effective medications (naloxone and acamprosate for alcoholism, buprenorphine-naloxone for opioid addiction, and varenicline for tobacco addiction) and ongoing clinical trials are taking advantage of this knowledge to test new targets. 2 Kalivas PW Volkow ND New medications for drug addiction hiding in glutamatergic neuroplasticity. Mol Psychiatry. 2011; 16: 974-986 Crossref PubMed Scopus (291) Google Scholar , 3 Koob GF Zorrilla EP Neurobiological mechanisms of addiction: focus on corticotropin-releasing factor. Curr Opin Investig Drugs. 2010; 11: 63-71 PubMed Google Scholar For the approved medications, the effect sizes are similar to those associated with standard antidepressant pharmacotherapies. This knowledge provided the basis for the use of stimulation techniques such as transcranial magnetic stimulation or transcranial direct current stimulation and its variants, to strengthen circuits impaired by addiction, with promising results. 4 Conti CL Moscon JA Fregni F Nitsche MA Nakamura-Palacios EM Cognitive related electrophysiological changes induced by non-invasive cortical electrical stimulation in crack-cocaine addiction. Int J Neuropsychopharmacol. 2014; 17: 1465-1475 Crossref PubMed Scopus (45) Google Scholar , 5 Dinur-Klein L Dannon P Hadar A et al. Smoking cessation induced by deep repetitive transcranial magnetic stimulation of the prefrontal and insular cortices: a prospective, randomized controlled trial. Biol Psychiatry. 2014; 76: 742-749 Summary Full Text Full Text PDF PubMed Scopus (209) Google Scholar It has also provided clinicians with a framework to guide targeted behavioural interventions to strengthen the impaired circuits (to enhance self-control, reduce stress reactivity, improve mood). Third, the statement that the effects of the BDMA framework on public policy are modest negates some major achievements, such as the passage in 2008 of the parity law (the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, driven by the BDMA model) that requires medical insurance for the first time in the USA to cover costs associated with the treatment of addiction. 6 Busch SH Epstein AJ Harhay MO et al. The effects of federal parity on substance use disorder treatment. Am J Manag Care. 2014; 20: 76-82 PubMed Google Scholar Finally, the mere framework of BDMA has benefits in treatment as it significantly diminishes the stigma attached with addiction and gives hope for recovery to those fighting this devastating disease. Brain disease model of addiction: misplaced priorities?We were disappointed by Nora Volkow and George Koob's response1 to our critique2 of the brain disease model of addiction (BDMA) from the US National Institute on Drug Abuse (NIDA), which simply repeats the promise of future treatment advances and puts the most favourable spin on modest treatments that have been used since Alan Leshner first promulgated the BMDA in 1997. Full-Text PDF" @default.
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- W1857655303 date "2015-08-01" @default.
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- W1857655303 title "Brain disease model of addiction: why is it so controversial?" @default.
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- W1857655303 doi "https://doi.org/10.1016/s2215-0366(15)00236-9" @default.
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