from Section V - Substance Abuse
Published online by Cambridge University Press: 10 January 2011
Introduction
The use of substances for psychoactive effects dates to antiquity with evidence in archaeological finds of alcohol-related intoxication and possibly ritualistic use of Nymphaea caerulea in ancient Egypt and alcohol abuse in classic Greek and Roman culture. While a variety of legal and illicit substances are used for their mind-altering effects, the misuse of drugs and alcohol can result in a constellation of behavioral and physiologic consequences that comprise addiction, which is often considered to be a cyclic process associated with chronic relapse. Koob and Le Moal (2001) outlined a continuum of allostasis to pathology as an individual experiences the rewarding properties of drugs, transitions to dependence, develops addiction, and enters periods of protracted abstinence. Circuitry including cortical–thalamo-striatal loops, the reward system, and stress system contribute to a reward system allostatic state that reflects long-term deviation from normal brain states that ultimately can lead to pathologic change (Koob and Le Moal, 2001). While there are a number of potential individual and environmental differences associated with vulnerabilities in the transition to drug and alcohol-related brain pathology (allostatic load), a core neurobiological feature of the continuum is altered neurochemistry among neural pathways.
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