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Heroin Addiction and Related Clinical Problems: 2013, 15, 2 (pages: 29 - 36)

Drug (heroin) addiction, bipolar spectrum and impulse control disorders

Bacciardi S., Maremmani A. G. I., Rovai L., Rugani F., Pani P. P., Pacini M., Dell'osso L., Akiskal H. S., and Maremmani I.

Summary: In most cases, interactions between the brain and the external environment are controlled by a system in which external inputs tend to satisfy internal inputs, so leading to the extinction of the behaviours triggered by internal needs. In this way, a loss of interest extinguishes the search for pleasure. In some individuals, however, the tendency to seek pleasure, and their hypersensitivity to the increased stimulus, sets up a self-perpetuating circuit where the incoming stimulus fails to satisfy internal needs. In the case of addiction, the search for the addictive substance is constantly repeated, without any equilibrium being reached. The same can be said about individuals with bipolar disorder in whom excitement elicits behaviours that aim to maintain a state of euphoria. Individuals with substance abuse and bipolar disorder share many clinical features, such as the strength and urgency of craving. Behaviours associated with substance dependence are very similar to those of hypomanic bipolar patients, where self-preservation and self-aggrandizement are the common features. In addition to their similar clinical psychopathology, mania and addiction are linked by a common background: excitement and impulsivity. For these reasons, and considering the high frequency of comorbidity, we can assume that the two conditions probably share a common biological substrate with a common reinforcement; substance dependence could then be viewed as belonging to the bipolar spectrum, and impulsivity could be viewed as the ‘bridge' between these two entities. If so, this would have a major impact on the management and treatment of patients with substance dependence who have other comorbid disorders, raising the probability that opioid medications could have a therapeutic role that extends beyond substance dependence disorders.