Psychiatry and Addiction: A Multi-faceted Issue

Dear Colleagues,

The concept of addiction as a disease has developed in recent decades. In 1967, Vincent Dole proposed that addiction is a metabolic disease in order to somehow contrast the psychogenic theories of addiction. In 1980, the DSM-III started to consider addiction as not stemming from personality disorders and, since 1997, addiction has been defined as a chronic relapsing brain disease. Both the ICD-11 and the DSM5-TR classification systems offer a categorical distinction of disorders due/related to substance use and addictive behavior/disorders. Substance use includes both classical well-established psychoactive substances, novel psychoactive substances, as well as non-psychoactive medications. Other behavioral addictions (e.g., food addiction/compulsive eating, sex addiction, etc.) have not yet been included in such manuals, despite mounting evidence of their nosographic validity. Conversely, both substance-related and non-substance-related addictive disorders share a deficit of common pathological reward systems, which are involved in the reinforcement of behaviors.

Studies of prevalence demonstrate that both polysubstance misuse and behavioral addictions concomitant with substance misuse are common among people with addiction. It is of interest that some of the medications employed in the treatment of addiction exhibit translational anti-craving activities (e.g., varenicline, for both alcohol and tobacco dependence; bupropion, for compulsive eating and stimulant misuse; naltrexone, for both opiate and alcohol relapse prevention; topiramate, for both cocaine and alcohol dependence; and many other examples). Addiction exhibits dynamic clinical presentations, with phenomena such as addiction transfer, cross-addiction, and substitutive behaviors likely to be the result of pathological processes involving common reward pathways. Taken together, these data may suggest that the addiction of different clinical comorbid phenotypes, graded in quantitative symptomatology, may be viewed as a manifestation of a single and unique spectrum of disorders, namely addiction spectrum disorders.

The co-occurrence of addiction and mental disorders is common, with shared brain regions and neurotransmitter pathways being implicated. The disruption of salience attribution, a common feature of both addiction and psychotic disorders, is related to dopamine signaling activity. At the CNS level, the antipsychotic-related dopamine blocking activity may be associated with the induction of a reward deficit syndrome, which may in turn be related to the emerging/worsening of addictive symptoms/behaviors that increase the DAergic levels. Recent evidence may suggest that DA plays a role in controlling metabolism; at the peripheral level, the antipsychotic-related DA blocking activity is also directed at pancreatic DA receptors. This may well imbalance the glycemic homeostasis, hence facilitating the occurrence of a dysmetabolic related-syndrome. Conversely, recent data have suggested that some novel antidiabetic medications may also be effective in the treatment of antipsychotic-related weight gain, whilst their putative potential for prescription drugs misuse/nonmedical use may be a cause for concern. These molecules’ action may be also mediated by the gut–brain axis, which may be involved in both the development and treatment of addiction spectrum disorders.

The sub-topics and keywords of this Special Issue are as follows:

• Psychiatric comorbidity: the role of neurotransmitter imbalance, including dopamine/DA pathways.
• Salience and aberrant salience: pharmacological and clinical issues.
• Obesity associated with the prescription of antipsychotics: a reward deficit syndrome?
• Food and sex addiction: pharmacological and clinical issues.
• Gambling and internet gaming disorder: pharmacological and clinical issues.
• Novel antidiabetics and their interaction with the reward system.
• Novel psychoactive substances.
• Prescription drug misuse.

You may choose our Joint Special Issue in Brain Sciences.

Prof. Dr. Fabrizio Schifano
Prof. Dr. Norbert Scherbaum
Dr. Giovanni Martinotti
Guest Editors

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