18 - Addiction and the Reward Pathway

Summary

Addictions are, fundamentally, disorders of the reward pathway. Clinicians, patients or family members are sometimes dissatisfied with the pronouncement that an addiction is its own diagnosis, preferring instead to search for additional psychiatric conditions (such as mood or anxiety disorders) from which addiction behaviors might be secondary offshoots – perhaps in part because of the more extensive range of pharmacotherapy options available to treat mood and anxiety disorders than addictions. True dual diagnoses certainly exist, in which mood or thinking problems occur as free-standing entities, but unless they chronologically antecede an addiction it becomes difficult if not impossible to discriminate them from the symptoms caused by repeated intoxication and withdrawal states. Still, intrinsic disorders of the reward pathway can be complex and often inherently involve problems with mood, thinking, perception, impulse control, self-regulation, compulsivity, and a host of psychopathology dimensions described in earlier chapters.