1. Keimyung University, Yang-Tae Kim
Stress and Addiction
Keimyung University, Yang-Tae Kim

2. Stress in the perspective of allostasis
Addiction in the perspective of allostasis
Stress and addiction
Trier Social Stress Test(TSST)
Functional imaging studies

16. Stress in the perspective of allostasis
Addiction in the perspective of allostasis
Stress and addiction
Trier Social Stress Test(TSST)
Functional imaging studies

21. Stress in the perspective of allostasis
Addiction in the perspective of allostasis
Stress and addiction
Trier Social Stress Test(TSST)
Functional imaging studies

22. Stress is a critical factor in increasing alcohol craving and compulsive alcohol consumption (Breese et al. 2005; Koob 2009), as evidenced by both preclinical and clinical studies, including overconsumption of alcohol in male mice with prenatal stress (Campbell et al. 2009), early trauma associated with greater alcohol use and alcohol craving (Schumache et al. 2006), and increased alcohol use after the 9/11 terrorist attacks among New York City residents (Vlahov et al. 2006).
The brain’s stress response involves activation of the ANS and HPA axis systems to promote regulation of physiological arousal and also facilitate adaptive coping (Sinha 2008). Chronic alcoholism is associated with impaired autonomic regulation characterized by high basal heart rate, reduced heart rate variability, and increased blood pressure (Quintana et al. 2013; Sinha et al. 2009; Stormark et al. 1998; Thayer et al. 2006). Further, upregulated HPA axis function, including elevated levels of basal cortisol and adreno-corticotrophic hormone (ACTH), has been frequently found in people with AUD (Breese et al. 2011; Sinha 2008; Sinha et al. 2009).

23. Attachment problem ?

27. There is a harmful interaction between AODs(alcohol and other drugs) and the stress response that influences the transition through these three stages of addiction. AODs can “hijack” the stress and reward systems in three ways.
First, AODs directly activate the stress response, and the glucocorticoids released during this process can, at least initially, sensitize the reward pathways, leading to further AOD use. This may contribute to reward sensitization during the preoccupation stage.
Second, as the AOD user transitions to addiction, negative affect and withdrawal symptoms become a dominant force that also stimulates the release of anxiety-inducing (i.e., anxiogenic) stress peptides such as CRF. At this stage, AOD use escalates as the addict administers the AODs more for stress-dampening purposes than for pleasure.
Third, environmental stress (which often is caused or exacerbated by the chaotic lifestyle and negative consequences of AOD abuse) interacts with the negative-affect state created by withdrawal or abstinence to amplify the anxiety and dysphoria induced by the stress peptides. At each of these steps, allostatic mechanisms are initiated by the organism to try and maintain homeostasis in the presence of the AODs and the resulting stress.

31. Stress in the perspective of allostasis
Addiction in the perspective of allostasis
Stress and addiction
Trier Social Stress Test(TSST)
Functional imaging studies

32. The Trier Social Stress Test (TSST)
1. 준비기간 (3분) : 구직자가 면담하는 역할 준비
2. 자기소개 (5분)
3. 산수문제 (5분) :
The Trier Social Stress Test (TSST)

43. Stress in the perspective of allostasis
Addiction in the perspective of allostasis
Stress and addiction
Trier Social Stress Test(TSST)
Functional imaging studies

49. During stress, ANS and HPA axis function are under the regulatory control of the VmPFC (Figueiredo et al. 2003; Radley 2006).
Consistent with this hypothesis, a recent fMRI study (Seo et al. 2013) found lowered activity in the stress modulatory regions involving VmPFC/ ACC during stress exposure in 30 AUD patients engaged in inpatient treatment and abstinent for 4 weeks, compared with 30 matched healthy control subjects (figure 1A).
Interestingly, the researchers observed an opposite pattern when the subjects were relaxed: AUD patients showed hyperactive VmPFC/ACC compared with control subjects (figure 1A).
More importantly, to prospectively assess relapse and early recovery, these researchers followed the same 30 AUD patients, plus 15 others, after they completed inpatient treatment. Results indicated that lowered VmPFC activity in response to stress exposure relative to the response when patients were relaxed was significantly associated with stress-induced alcohol craving and also predicted a shorter time to future relapse (see figure 1B) (Seo et al. 2013). In addition, lower VmPFC activity and insula response to stress was significantly correlated with more days of alcohol use during subsequent followup, emphasizing the contribution of altered stress neural circuitry to relapse

52. Relaxed-state hyperactivity in the vmPFC/ACC, ventral striatum, and precuneus observed in the current study is consistent with our previous neuroendocrine study showing greater adrenal sensitivity during the neutral-relaxing condition associated with shorter time to relapse in AD patients.
overactive physiological and neuroendocrine reactivity at basal levels in early recovering AD patients, including chronic alcohol related upregulation of corticotropin-releasing hormone and noradrenergic signaling, high basal cortisol levels, heart rate, disrupted heart rate variability and reduced inhibitory feedback control, and neuronal hyperexcitability in the frontal region at resting state.
chronic alcohol use has a long-term excitatory effect on the central nervous system, leading to central nervous system hyperexcitability and gray matter volume reductions associated with multiple Detoxifications and alcohol withdrawal symptoms, alcohol craving, and relapse risk.
This altered vmPFC pattern could also reflect neuronal inflexibility in AD patients with difficulty in changing brain responses in the face of challenging external or internal contexts. A poorly responsive and inflexible vmPFC/ACC during challenge would be unable to keep in check high levels of provoked alcohol craving, increasing the risk for relapse as shown in our study.

61. Stress in the perspective of allostasis
Addiction in the perspective of allostasis
Stress and addiction
Trier Social Stress Test(TSST)
Functional imaging studies