Allostasis as a conceptual framework linking bipolar disorder and addiction

Area of Science:

• Neuroscience
• Psychiatry
• Addiction Research

Background:

• Bipolar disorders (BD) and addiction are interconnected, sharing reciprocal risk factors.
• A unitary perspective is proposed to understand the complex relationship between BD and addictive behaviors.

Purpose of the Study:

• To explore the concepts of allostasis and allostatic load (AL) in understanding the neurobiological underpinnings of addiction vulnerability in BD patients.
• To hypothesize a progressive dysregulation of reward circuits in BD, leading to negative affective states and increased addiction risk.

Main Methods:

• Conceptualizing BD as an illness with cumulative allostatic states.
• Examining the role of allostasis in safeguarding reward function stability through neurocircuitry changes.
• Investigating the potential for negative reinforcement mechanisms in the transition to drug addiction.

Main Results:

• Allostasis involves changes in reward and stress systems to maintain function.
• Progressive dysregulation of reward circuits in BD may lead to anhedonia.
• Negative affective states increase vulnerability to rapid drug addiction development via negative reinforcement.

Conclusions:

• Allostatic load (AL) from addictive behaviors may exacerbate BD progression.
• The allostasis framework offers heuristic value for researching BD and addiction comorbidity.
• Understanding these mechanisms can enhance treatment strategies for co-occurring BD and addiction.