Addiction as a stress surfeit disorder

George F. Koob, Cara L. Buck, Ami Cohen, Scott Edwards, Paula E. Park, Joel E. Schlosburg, Brooke Schmeichel, Leandro F. Vendruscolo, Carrie L. Wade, Timothy W. Whitfield, Olivier George

Research output: Contribution to journalReview articlepeer-review

375 Scopus citations


Drug addiction has been conceptualized as a chronically relapsing disorder of compulsive drug seeking and taking that progresses through three stages: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. Drug addiction impacts multiple motivational mechanisms and can be conceptualized as a disorder that progresses from positive reinforcement (binge/intoxication stage) to negative reinforcement (withdrawal/negative affect stage). The construct of negative reinforcement is defined as drug taking that alleviates a negative emotional state. Our hypothesis is that the negative emotional state that drives such negative reinforcement is derived from dysregulation of key neurochemical elements involved in the brain stress systems within the frontal cortex, ventral striatum, and extended amygdala. Specific neurochemical elements in these structures include not only recruitment of the classic stress axis mediated by corticotropin-releasing factor (CRF) in the extended amygdala as previously hypothesized but also recruitment of dynorphin-κ opioid aversive systems in the ventral striatum and extended amygdala. Additionally, we hypothesized that these brain stress systems may be engaged in the frontal cortex early in the addiction process. Excessive drug taking engages activation of CRF not only in the extended amygdala, accompanied by anxiety-like states, but also in the medial prefrontal cortex, accompanied by deficits in executive function that may facilitate the transition to compulsive-like responding. Excessive activation of the nucleus accumbens via the release of mesocorticolimbic dopamine or activation of opioid receptors has long been hypothesized to subsequently activate the dynorphin-κ opioid system, which in turn can decrease dopaminergic activity in the mesocorticolimbic dopamine system. Blockade of the κ opioid system can also block anxiety-like and reward deficits associated with withdrawal from drugs of abuse and block the development of compulsive-like responding during extended access to drugs of abuse, suggesting another powerful brain stress/anti-reward system that contributes to compulsive drug seeking. Thus, brain stress response systems are hypothesized to be activated by acute excessive drug intake, to be sensitized during repeated withdrawal, to persist into protracted abstinence, and to contribute to the development and persistence of addiction. The recruitment of anti-reward systems provides a powerful neurochemical basis for the negative emotional states that are responsible for the dark side of addiction. This article is part of a Special Issue entitled 'NIDA 40th Anniversary Issue'.

Original languageEnglish (US)
Pages (from-to)370-382
Number of pages13
Issue numberPART B
StatePublished - 2014
Externally publishedYes

Bibliographical note

Funding Information:
The author would like to thank Michael Arends and Mellany Santos for their assistance with the preparation of this manuscript. Research was supported by National Institutes of Health grants AA006420 , AA020608 , and AA008459 from the National Institute on Alcohol Abuse and Alcoholism , DA010072 , DA004043 , DA023597 , and DA004398 from the National Institute on Drug Abuse , and DK26741 from the National Institute of Diabetes and Digestive and Kidney Diseases . Research also was supported by the Pearson Center for Alcoholism and Addiction Research . This is publication number 23022 from The Scripps Research Institute.


  • Abstinence or withdrawal
  • Compulsive
  • Corticotropin-releasing factor
  • Dynorphin
  • Extended amygdala
  • Impulsive
  • Opponent process
  • Prefrontal cortex
  • Reward
  • Sensitization


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