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Drug withdrawal conceptualized as a stressor

Chartoff, Elena H.; Carlezon, William A. Jr

doi: 10.1097/FBP.0000000000000080
Review Articles

Drug withdrawal is often conceptualized as an aversive state that motivates drug-seeking and drug-taking behaviors in humans. Stress is more difficult to define, but is also frequently associated with aversive states. Here we describe evidence for the simple theory that drug withdrawal is a stress-like state, on the basis of common effects on behavioral, neurochemical, and molecular endpoints. We also describe data suggesting a more complex relationship between drug withdrawal and stress. As one example, we will highlight evidence that, depending on drug class, components of withdrawal can produce effects that have characteristics consistent with mood elevation. In addition, some stressors can act as positive reinforcers, defined as having the ability to increase the probability of a behavior that produces it. As such, accumulating evidence supports the general principles of opponent process theory, whereby processes that have an affective valence are followed in time by an opponent process that has the opposite valence. Throughout, we identify gaps in knowledge and propose future directions for research. A better understanding of the similarities, differences, and overlaps between drug withdrawal and stress will lead to the development of improved treatments for addiction, as well as for a vast array of neuropsychiatric conditions that are triggered or exacerbated by stress.

Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts, USA

Correspondence to Elena H. Chartoff, PhD, Department of Psychiatry, McLean Hospital, MRC 218, 115 Mill Street, Belmont, MA 02478, USA E-mail:

Received June 6, 2014

Accepted June 27, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins