Dependence and addiction are most appropriately understood as chronic medical disorders, with frequent recurrences to be expected. The neurobiology of these disorders is becoming well understood, but much remains unknown about the genomic mechanisms that predispose to addictions and that are activated, perhaps irreversibly, by long-term drug use. The mesolimbic reward system appears to be central to the development of the direct clinical consequences of chronic abuse, including tolerance, dependence, and addiction. Other brain areas and neurochemicals, including cortisol, also are relevant to dependence and relapse. Pharmacological interventions for addiction are highly effective for opiates, and we have illustrated three different approaches using an agonist, an antagonist, or a partial agonist. However, given the complex biological, psycho logical, and social aspects of these diseases, they must be accompanied by appropriate psychosocial treatments. Clinician awareness of the neurobiologi-cal basis of drug dependence, and information sharing with patients, can provide insight into patient behaviors and problems, and clarify the rationale for treatment methods and goals.


This work was supported by Grant Nos. P50-DA-12762, K05-DA-00454, K12-DA-00167, R01-DA-13672, and R01-DA-14039 from the National Institute on Drug Abuse.


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