Thus, intense focus is being placed on neural mechanisms driving drug “craving” sensation and initiation of relapse to intake after extinction. Relapse driven by learned associations (cue, context) as well as by mental state transitions (stress, anxiety) can occur long after obvious negative consequences of cessation of drug intake have stopped. Increasingly however, addiction is understood as a long-lasting change in brain function outlasting withdrawal. For many years research and rehabilitative medicine focused on the initial negative consequences of cessation of intake, withdrawal. This perhaps increases the frustration with this disorder where the apparent “cure” is simply to stop taking the abused substance. Thus addictive disorders are unique in being self-perpetuated by a conscious act. Addiction is relatively unique among psychiatric/neurological disorders in that the deleterious actions are brought on by the willful intake of a substance even under conditions where the abuser is aware of the negative consequences. Drug abuse and dependence are major public health issues worldwide.
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