Potential vulnerabilities of neuronal reward, risk, and decision mechanisms to addictive drugs

How do addictive drugs hijack the brain's reward system? This review speculates how normal, physiological reward processes may be affected by addictive drugs. Addictive drugs affect acute responses and plasticity in dopamine neurons and postsynaptic structures. These effects reduce reward discrimination, increase the effects of reward prediction error signals, and enhance neuronal responses to reward-predicting stimuli, which may contribute to compulsion. Addictive drugs steepen neuronal temporal reward discounting and create temporal myopia that impairs the control of drug taking. Tonically enhanced dopamine levels may disturb working memory mechanisms necessary for assessing background rewards and thus may generate inaccurate neuronal reward predictions. Drug-induced working memory deficits may impair neuronal risk signaling, promote risky behaviors, and facilitate preaddictive drug use. Malfunctioning adaptive reward coding may lead to overvaluation of drug rewards. Many of these malfunctions may result in inadequate neuronal decision mechanisms and lead to choices biased toward drug rewards.