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Neuropathology of substance use disorders

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Abstract

Addictions to licit and illicit drugs are chronic relapsing brain disorders that affect circuits that regulate reward, motivation, memory, and decision-making. Drug-induced pathological changes in these brain regions are associated with characteristic enduring behaviors that continue despite adverse biopsychosocial consequences. Repeated exposure to these substances leads to egocentric behaviors that focus on obtaining the drug by any means and on taking the drug under adverse psychosocial and medical conditions. Addiction also includes craving for the substances and, in some cases, involvement in risky behaviors that can cause death. These patterns of behaviors are associated with specific cognitive disturbances and neuroimaging evidence for brain dysfunctions in a diverse population of drug addicts. Postmortem studies have also revealed significant biochemical and/or structural abnormalities in some addicted individuals. The present review provides a summary of the evidence that has accumulated over the past few years to implicate brain dysfunctions in the varied manifestations of drug addiction. We thus review data on cerebrovascular alterations, brain structural abnormalities, and postmortem studies of patients who abuse cannabis, cocaine, amphetamines, heroin, and “bath salts”. We also discuss potential molecular, biochemical, and cellular bases for the varied clinical presentations of these patients. Elucidation of the biological bases of addiction will help to develop better therapeutic approaches to these patient populations.

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Acknowledgments

This paper is supported by the Intramural Research Program of the National Institute on Drug Abuse (NIDA), NIH, and DHHS. V. Bisagno is a Fulbright Fellow, United States Department of State and is also supported by grants PIP11420100100072 and PICT 2012-0924, Argentina.

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Authors and Affiliations

  1. NIDA Intramural Research Program, Molecular Neuropsychiatry Research Branch, NIDA/NIH/DHHS, 251 Bayview Boulevard, Baltimore, MD, 21224, USA

    Jean Lud Cadet

  2. Instituto de Investigaciones Farmacológicas (ININFA-UBA-CONICET), Junín 956, piso 5, C1113, Buenos Aires, Argentina

    Veronica Bisagno

  3. Eastern Ontario Forensic Pathology, Unit of the Ontario Forensic Pathology Service, Division of Anatomical Pathology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K2A 2L4, Canada

    Christopher Mark Milroy

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Cadet, J.L., Bisagno, V. & Milroy, C.M. Neuropathology of substance use disorders. Acta Neuropathol 127, 91–107 (2014). https://doi.org/10.1007/s00401-013-1221-7

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