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World J Psychiatr. Jun 19, 2021; 11(6): 222-231
Published online Jun 19, 2021. doi: 10.5498/wjp.v11.i6.222
Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders
Timothy I Michaels, Emily Stone, Sonali Singal, Vladan Novakovic, Robert L Barkin, Stacy Barkin
Timothy I Michaels, Emily Stone, Sonali Singal, Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
Timothy I Michaels, Vladan Novakovic, Department of Psychiatry, The Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY 11004, United States
Robert L Barkin, Department of Anesthesiology, Rush University Medical College, Chicago, IL 60612, United States
Stacy Barkin, Private Practice, Scottsdale, AZ 85250, United States
Author contributions: Novakovic V conceived of the manuscript topic; all authors assisted with the literature review; Michaels TI and Stone E wrote a large portion of the manuscript although all authors contributed to the writing process with specific subsections written by Novakovic V, Stone E and Singal S; Barkin RL and Barkin S provided significant guidance as well as edits and revisions to the manuscript; Michaels TI and Stone E revised the manuscript prior to publication.
Conflict-of-interest statement: The authors have declared that no competing interest exists.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Timothy I Michaels, PhD, Postdoctoral Fellow, Research Fellow, Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY 11004, United States. timothy.michaels@uconn.edu
Received: February 28, 2021
Peer-review started: February 28, 2021
First decision: April 6, 2021
Revised: April 14, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: June 19, 2021
Abstract

Mental health symptoms secondary to trauma exposure and substance use disorders (SUDs) co-occur frequently in both clinical and community samples. The possibility of a shared aetiology remains an important question in translational neuroscience. Advancements in genetics, basic science, and neuroimaging have led to an improved understanding of the neural basis of these disorders, their frequent comorbidity and high rates of relapse remain a clinical challenge. This project aimed to conduct a review of the field’s current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD. A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders, and is summarized in detail, including evidence from both animal and clinical studies. Upon summarizing the relevant literature, this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues. It provides an overview of brain reward circuitry and its relation to the neurobiology, symptomology, and phenomenology of trauma and substance use. This review provides clinical insights and implications of the proposed theory, including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology. Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.

Keywords: Posttraumatic stress disorder, Substance abuse, Reward circuitry, Mesolimbic, Neurobiology

Core Tip: Traumatic stress disorders and substance use disorders are highly co-morbid in community and clinical samples. Recent findings from basic and clinical neuroscience support a shared neural basis of these disorders, specifically related to the processing of fear and reward cues. Understanding the overlapping neurobiology of these disorders will improve our understanding of disease aetiology and improve prevention and treatment efforts.