1 1677 158 DRUG ADDICTION: HYPERKATIFEIA/NEGATIVE REINFORCEMENT AS A FRAMEWORK FOR MEDICATIONS DEVELOPMENT. COMPULSIVE DRUG SEEKING THAT IS ASSOCIATED WITH ADDICTION IS HYPOTHESIZED TO FOLLOW A HEURISTIC FRAMEWORK THAT INVOLVES THREE STAGES (BINGE/INTOXICATION, WITHDRAWAL/NEGATIVE AFFECT, AND PREOCCUPATION/ANTICIPATION) AND THREE DOMAINS OF DYSFUNCTION (INCENTIVE SALIENCE/PATHOLOGIC HABITS, NEGATIVE EMOTIONAL STATES, AND EXECUTIVE FUNCTION, RESPECTIVELY) VIA CHANGES IN THE BASAL GANGLIA, EXTENDED AMYGDALA/HABENULA, AND FRONTAL CORTEX, RESPECTIVELY. THIS REVIEW FOCUSES ON NEUROCHEMICAL/NEUROCIRCUITRY DYSREGULATIONS THAT CONTRIBUTE TO HYPERKATIFEIA, DEFINED AS A GREATER INTENSITY OF NEGATIVE EMOTIONAL/MOTIVATIONAL SIGNS AND SYMPTOMS DURING WITHDRAWAL FROM DRUGS OF ABUSE IN THE WITHDRAWAL/NEGATIVE AFFECT STAGE OF THE ADDICTION CYCLE. HYPERKATIFEIA PROVIDES AN ADDITIONAL SOURCE OF MOTIVATION FOR COMPULSIVE DRUG SEEKING VIA NEGATIVE REINFORCEMENT. NEGATIVE REINFORCEMENT REFLECTS AN INCREASE IN THE PROBABILITY OF A RESPONSE TO REMOVE AN AVERSIVE STIMULUS OR DRUG SEEKING TO REMOVE HYPERKATIFEIA THAT IS AUGMENTED BY GENETIC/EPIGENETIC VULNERABILITY, ENVIRONMENTAL TRAUMA, AND PSYCHIATRIC COMORBIDITY. NEUROBIOLOGICAL TARGETS FOR HYPERKATIFEIA IN ADDICTION INVOLVE NEUROCIRCUITRY OF THE EXTENDED AMYGDALA AND ITS CONNECTIONS VIA WITHIN-SYSTEM NEUROADAPTATIONS IN DOPAMINE, ENKEPHALIN/ENDORPHIN OPIOID PEPTIDE, AND GAMMA-AMINOBUTYRIC ACID/GLUTAMATE SYSTEMS AND BETWEEN-SYSTEM NEUROADAPTATIONS IN PROSTRESS CORTICOTROPIN-RELEASING FACTOR, NOREPINEPHRINE, GLUCOCORTICOID, DYNORPHIN, HYPOCRETIN, AND NEUROIMMUNE SYSTEMS AND ANTISTRESS NEUROPEPTIDE Y, NOCICEPTIN, ENDOCANNABINOID, AND OXYTOCIN SYSTEMS. SUCH NEUROCHEMICAL/NEUROCIRCUITRY DYSREGULATIONS ARE HYPOTHESIZED TO MEDIATE A NEGATIVE HEDONIC SET POINT THAT GRADUALLY GAINS ALLOSTATIC LOAD AND SHIFTS FROM A HOMEOSTATIC HEDONIC STATE TO AN ALLOSTATIC HEDONIC STATE. BASED ON PRECLINICAL STUDIES AND TRANSLATIONAL STUDIES TO DATE, MEDICATIONS AND BEHAVIORAL THERAPIES THAT RESET BRAIN STRESS, ANTISTRESS, AND EMOTIONAL PAIN SYSTEMS AND RETURN THEM TO HOMEOSTASIS WOULD BE PROMISING NEW TARGETS FOR MEDICATION DEVELOPMENT. SIGNIFICANCE STATEMENT: THE FOCUS OF THIS REVIEW IS ON NEUROCHEMICAL/NEUROCIRCUITRY DYSREGULATIONS THAT CONTRIBUTE TO HYPERKATIFEIA, DEFINED AS A GREATER INTENSITY OF NEGATIVE EMOTIONAL/MOTIVATIONAL SIGNS AND SYMPTOMS DURING WITHDRAWAL FROM DRUGS OF ABUSE IN THE WITHDRAWAL/NEGATIVE AFFECT STAGE OF THE DRUG ADDICTION CYCLE AND A DRIVING FORCE FOR NEGATIVE REINFORCEMENT IN ADDICTION. MEDICATIONS AND BEHAVIORAL THERAPIES THAT REVERSE HYPERKATIFEIA BY RESETTING BRAIN STRESS, ANTISTRESS, AND EMOTIONAL PAIN SYSTEMS AND RETURNING THEM TO HOMEOSTASIS WOULD BE PROMISING NEW TARGETS FOR MEDICATION DEVELOPMENT. 2021 2 4631 38 NEUROGENETICS OF ACUTE AND CHRONIC OPIATE/OPIOID ABSTINENCE: TREATING SYMPTOMS AND THE CAUSE. THIS REVIEW BEGINS WITH A COMPREHENSIVE HISTORY OF OPIOID DEPENDENCE AND TREATMENT IN THE UNITED STATES. THE FOCUS IS AN EVIDENCE-BASED TREATMENT MODEL FOR OPIOID/OPIATE DEPENDENT INDIVIDUALS. THE ROLE OF REWARD GENETIC POLYMORPHISMS AND THE EPIGENETIC MODIFICATIONS THAT LEAD TO VULNERABILITY TO USE AND MISUSE OF OPIATES/OPIOID TO TREAT PAIN ARE REVIEWED. THE NEUROCHEMICAL MECHANISMS OF ACUTE OPIATE WITHDRAWAL AND OPIATE/OPIOID REWARD MECHANISMS ARE EXPLORED WITH A GOAL OF IDENTIFYING SPECIFIC TREATMENT TARGETS. ALTERATIONS IN FUNCTIONAL BRAIN CONNECTIVITY BASED ON NEUROBIOLOGICAL MECHANISMS IN HEROIN DEPENDENCE AND ABSTINENCE ARE ALSO REVIEWED. A NEW CLINICAL MODEL AN ALTERNATIVE TO MERELY BLOCKING ACUTE WITHDRAWAL SYMPTOMS AS IDENTIFIED IN THE DSM -5 IS PROPOSED. GENETIC DIAGNOSIS AT THE ONSET OF DETOXIFICATION, TO DETERMINE RISK STRATIFICATION, AND IDENTIFY POLYMORPHIC GENE TARGETS FOR PHARMACEUTICAL AND NUTRACEUTICAL INTERVENTIONS, FOLLOWED BY THE SIMULTANEOUS INITIATION OF MEDICATION ASSISTED THERAPY (MAT), TO ENABLE PSYCHOLOGICAL EXTINCTION, AND STEADY PRO-DOPAMINERGIC THERAPY WITH THE GOAL OF DEVELOPING "DOPAMINE HOMEOSTASIS" IS RECOMMENDED. THE OBJECTIVE OF THESE INTERVENTIONS IS TO PREVENT FUTURE RELAPSE BY TREATING ALL "REWARD DEFICIENCY SYNDROME" (RDS) BEHAVIORS AND EVENTUALLY MAKE AN ADDICTION-FREE LIFE POSSIBLE. 2017 3 636 39 BIOLOGICAL SUBSTRATES OF ADDICTION. THIS REVIEW IS AN INTRODUCTION TO ADDICTION, THE REWARD CIRCUITRY, AND LABORATORY ADDICTION MODELS. ADDICTION IS A CHRONIC DISEASE HALLMARKED BY A STATE OF COMPULSIVE DRUG SEEKING THAT PERSISTS DESPITE NEGATIVE CONSEQUENCES. MOST OF THE ADVANCES IN ADDICTION RESEARCH HAVE CENTERED ON THE CANONICAL AND CONTEMPORARY DRUGS OF ABUSE; HOWEVER, ADDICTIONS TO OTHER ACTIVITIES AND STIMULI ALSO EXIST. SUBSTANCES OF ABUSE HAVE THE POTENTIAL TO INDUCE LONG-LASTING CHANGES IN THE BRAIN AT THE BEHAVIORAL, CIRCUIT, AND SYNAPTIC LEVELS. ADDICTION-RELATED BEHAVIORAL CHANGES INVOLVE INITIATION, ESCALATION, AND OBSESSION TO DRUG SEEKING AND MUCH OF THE CURRENT RESEARCH IS FOCUSED ON MAPPING THESE MANIFESTATIONS TO SPECIFIC NEURAL PATHWAYS. DRUG ABUSE IS WELL KNOWN TO RECRUIT COMPONENTS OF THE MESOLIMBIC DOPAMINE SYSTEM, INCLUDING THE NUCLEUS ACCUMBENS AND VENTRAL TEGMENTAL AREA. IN ADDITION, ALTERED FUNCTION OF A WIDE VARIETY OF BRAIN REGIONS IS TIGHTLY ASSOCIATED WITH SPECIFIC MANIFESTATIONS OF DRUG ABUSE. THESE REGIONS PERIPHERAL TO THE MESOLIMBIC PATHWAY LIKELY PLAY A ROLE IN SPECIFIC OBSERVED COMORBIDITIES AND ENDOPHENOTYPES THAT CAN FACILITATE, OR BE CAUSED BY, SUBSTANCE ABUSE. ALTERATIONS IN SYNAPTIC STRUCTURE, FUNCTION, AND CONNECTIVITY, AS WELL AS EPIGENETIC AND GENETIC MECHANISMS ARE THOUGHT TO UNDERLIE THE PATHOLOGIES OF ADDICTION. IN PRECLINICAL MODELS, THESE PERSISTENT CHANGES ARE STUDIED AT THE LEVELS OF MOLECULAR PHARMACOLOGY AND BIOCHEMISTRY, EX VIVO AND IN VIVO ELECTROPHYSIOLOGY, RADIOGRAPHY, AND BEHAVIOR. COORDINATING RESEARCH EFFORTS ACROSS THESE DISCIPLINES AND EXAMINING CELL TYPE- AND CIRCUIT-SPECIFIC PHENOMENA ARE CRUCIAL COMPONENTS FOR TRANSLATING PRECLINICAL FINDINGS TO VIABLE MEDICAL INTERVENTIONS THAT EFFECTIVELY TREAT ADDICTION AND RELATED DISORDERS. WIRES COGN SCI 2014, 5:151-171. DOI: 10.1002/WCS.1273 CONFLICT OF INTEREST: THE AUTHORS HAVE DECLARED NO CONFLICTS OF INTEREST FOR THIS ARTICLE. FOR FURTHER RESOURCES RELATED TO THIS ARTICLE, PLEASE VISIT THE WIRES WEBSITE. 2014 4 3708 20 INFLUENCE OF PHARMACOLOGICAL AND EPIGENETIC FACTORS TO SUPPRESS NEUROTROPHIC FACTORS AND ENHANCE NEURAL PLASTICITY IN STRESS AND MOOD DISORDERS. STRESS-INDUCED MAJOR DEPRESSION AND MOOD DISORDERS ARE CHARACTERIZED BY BEHAVIOURAL ABNORMALITIES AND PSYCHIATRIC ILLNESS, LEADING TO DISABILITY AND IMMATURE MORTALITY WORLDWIDE. NEUROBIOLOGICAL MECHANISMS OF STRESS AND MOOD DISORDERS ARE DISCUSSED CONSIDERING RECENT FINDINGS, AND CHALLENGES TO ENHANCE PHARMACOLOGICAL EFFECTS OF ANTIDEPRESSANT, AND MOOD STABILIZERS. PHARMACOLOGICAL ENHANCEMENT OF KETAMINE AND SCOPOLAMINE REGULATES DEPRESSION AT THE MOLECULAR LEVEL, INCREASING SYNAPTIC PLASTICITY IN PREFRONTAL REGIONS. BLOOD-DERIVED NEUROTROPHIC FACTORS FACILITATE MOOD-DEFICIT SYMPTOMS. EPIGENETIC FACTORS MAINTAIN STRESS-RESILIENCE IN HIPPOCAMPAL REGION. REGULATION OF NEUROTROPHIC FACTORS BLOCKADES STRESS, AND ENHANCES NEURONAL SURVIVAL THOUGH IT PARALYZES LIMBIC REGIONS. MOLECULAR AGENTS AND NEUROTROPHIC FACTORS ALSO CONTROL BEHAVIORAL AND SYNAPTIC PLASTICITY IN ADDICTION AND STRESS DISORDERS. FUTURE RESEARCH ON NEURONAL DYNAMICS AND CELLULAR ACTIONS CAN BE DIRECTED TO OBTAIN THE ETIOLOGY OF SYNAPTIC DYSREGULATION IN MOOD DISORDER AND STRESS. FOR THE FIRST TIME, THE CURRENT REVIEW CONTRIBUTES TO THE LITERATURE OF SYNAPTIC PLASTICITY REPRESENTING THE ROLE OF EPIGENETIC MECHANISMS AND GLUCOCORTICOID RECEPTORS TO PREDICT DEPRESSION AND ANXIETY IN CLINICAL CONDITIONS. 2019 5 4469 33 MOLECULAR NEUROLOGICAL CORRELATES OF ENDORPHINERGIC/DOPAMINERGIC MECHANISMS IN REWARD CIRCUITRY LINKED TO ENDORPHINERGIC DEFICIENCY SYNDROME (EDS). THE CONSENSUS OF THE CURRENT LITERATURE STRONGLY SUPPORTS THE CONCEPT THAT BRAIN NEUROTRANSMITTERS, AND SECOND MESSENGERS INVOLVED IN THE NET RELEASE OF DOPAMINE IN THE MESOLIMBIC REGION, ESPECIALLY THE NUCLEUS ACCUMBENS (NAC), IS DIRECTLY LINKED TO MOTIVATION, ANTI-STRESS, INCENTIVE SALIENCE (WANTING), AND WELL-BEING. THE ROLE OF DOPAMINE IN TERMS OF ALCOHOL WITHDRAWAL SYMPTOMOLOGY, COCAINE CRAVING BEHAVIOR, DOPAMINE -CONDENSATION PRODUCTS (TIQS), AND MORE RECENTLY, THE GENETIC ASPECTS OF DRUG-SEEKING AND PRO-DOPAMINE REGULATION, PROVIDE COMPELLING EVIDENCE OF THE RELEVANT MOLECULAR NEUROLOGICAL CORRELATES OF DOPAMINERGIC /ENDORPHINERGIC MECHANISMS IN REWARD CIRCUITRY DUE TO GENETIC POLYMORPHISMS AND EPIGENETIC INSULTS. IN THE FACE OF AN AMERICANS OPIOID EPIDEMIC, THE CLINICAL CONSENSUS IS TO TREAT OPIOID USE DISORDER (OUD) WITH LIFE-LONG OPIOID SUBSTITUTION THERAPY. HOWEVER, THE AUTHORS SUGGEST A PARADIGM SHIFT INVOLVING NOVEL MODALITIES LIKE TARGETING THE ENDORPHINERGIC SYSTEM LINKED TO DOPAMINE RELEASE AT THE NAC, IN TERMS OF THE INDUCTION OF REQUIRED "DOPAMINE HOMEOSTASIS." UTILIZING THE KNOWN GENETIC - ENVIRONMENTAL INTERACTION THEOREM P = G +E, THE AUTHORS PROVIDE A CLEAR RATIONALE FOR THE ADOPTION OF GENETIC RISK TESTING COUPLED WITH ENDORPHINERGIC/DOPAMINE REGULATION TO ADDRESS DYSFUNCTION ACROSS THE BRAIN REWARD CIRCUITRY. THE GOAL OF ALTERING RESTING-STATE, FUNCTIONAL CONNECTIVITY MAY REQUIRE A GENTLE "NEUROTRANSMITTER FIX" VIS ENKEPHALINASE INHIBITION TO OVERCOME OR COMBAT - SELF-INDUCTION OF ACUTE DOPAMINE RELEASE VIA PSYCHOACTIVE SUBSTANCE MISUSE RESULTING IN CHRONIC DOPAMINE DOWN-REGULATION. AS SUBSETS OF REWARD DEFICIENCY, WE ARE POISED TO PROVIDE NOVEL, GENETICALLY GUIDED THERAPY FOR ENDORPHINERGIC, OPIOIDERGIC, AND DOPAMINERGIC DEFICIENCIES AND RELATED SYNDROMES, UTILIZING "PRECISION ADDICTION MANAGEMENT. 2020 6 4846 26 OPIATE ADDICTION AND COCAINE ADDICTION: UNDERLYING MOLECULAR NEUROBIOLOGY AND GENETICS. ADDICTIVE DISEASES, INCLUDING ADDICTION TO HEROIN, PRESCRIPTION OPIOIDS, OR COCAINE, POSE MASSIVE PERSONAL AND PUBLIC HEALTH COSTS. ADDICTIONS ARE CHRONIC RELAPSING DISEASES OF THE BRAIN CAUSED BY DRUG-INDUCED DIRECT EFFECTS AND PERSISTING NEUROADAPTATIONS AT THE EPIGENETIC, MRNA, NEUROPEPTIDE, NEUROTRANSMITTER, OR PROTEIN LEVELS. THESE NEUROADAPTATIONS, WHICH CAN BE SPECIFIC TO DRUG TYPE, AND THEIR RESULTANT BEHAVIORS ARE MODIFIED BY VARIOUS INTERNAL AND EXTERNAL ENVIRONMENTAL FACTORS, INCLUDING STRESS RESPONSIVITY, ADDICT MINDSET, AND SOCIAL SETTING. SPECIFIC GENE VARIANTS, INCLUDING VARIANTS ENCODING PHARMACOLOGICAL TARGET PROTEINS OR GENES MEDIATING NEUROADAPTATIONS, ALSO MODIFY VULNERABILITY AT PARTICULAR STAGES OF ADDICTION. GREATER UNDERSTANDING OF THESE INTERACTING FACTORS THROUGH LABORATORY-BASED AND TRANSLATIONAL STUDIES HAVE THE POTENTIAL TO OPTIMIZE EARLY INTERVENTIONS FOR THE THERAPY OF CHRONIC ADDICTIVE DISEASES AND TO REDUCE THE BURDEN OF RELAPSE. HERE, WE REVIEW THE MOLECULAR NEUROBIOLOGY AND GENETICS OF OPIATE ADDICTION, INCLUDING HEROIN AND PRESCRIPTION OPIOIDS, AND COCAINE ADDICTION. 2012 7 1676 34 DRUG ADDICTION: FROM BENCH TO BEDSIDE. DRUG ADDICTION IS RESPONSIBLE FOR MILLIONS OF DEATHS PER YEAR AROUND THE WORLD. STILL, ITS MANAGEMENT AS A CHRONIC DISEASE IS SHADOWED BY MISCONCEPTIONS FROM THE GENERAL PUBLIC. INDEED, DRUG CONSUMERS ARE OFTEN LABELLED AS "WEAK", "IMMORAL" OR "DEPRAVED". CONSEQUENTLY, DRUG ADDICTION IS OFTEN PERCEIVED AS AN INDIVIDUAL PROBLEM AND NOT SOCIETAL. IN TECHNICAL TERMS, DRUG ADDICTION IS DEFINED AS A CHRONIC, RELAPSING DISEASE RESULTING FROM SUSTAINED EFFECTS OF DRUGS ON THE BRAIN. THROUGH A BETTER CHARACTERISATION OF THE CEREBRAL CIRCUITS INVOLVED, AND THE LONG-TERM MODIFICATIONS OF THE BRAIN INDUCED BY ADDICTIVE DRUGS ADMINISTRATIONS, FIRST, WE MIGHT BE ABLE TO CHANGE THE WAY THE GENERAL PUBLIC SEE THE PATIENT WHO IS SUFFERING FROM DRUG ADDICTION, AND SECOND, WE MIGHT BE ABLE TO FIND NEW TREATMENTS TO NORMALISE THE ALTERED BRAIN HOMEOSTASIS. IN THIS REVIEW, WE SYNTHETISE THE CONTRIBUTION OF FUNDAMENTAL RESEARCH TO THE UNDERSTANDING DRUG ADDICTION AND ITS CONTRIBUTION TO POTENTIAL NOVEL THERAPEUTICS. MOSTLY BASED ON DRUG-INDUCED MODIFICATIONS OF SYNAPTIC PLASTICITY AND EPIGENETIC MECHANISMS (AND THEIR BEHAVIOURAL CORRELATES) AND AFTER DEMONSTRATION OF THEIR REVERSIBILITY, WE TRIED TO HIGHLIGHT PROMISING THERAPEUTICS. WE ALSO UNDERLINE THE SPECIFIC TEMPORAL DYNAMICS AND PSYCHOSOCIAL ASPECTS OF THIS COMPLEX PSYCHIATRIC DISEASE ADDING PARAMETERS TO BE CONSIDERED IN CLINICAL TRIALS AND PAVING THE WAY TO TEST NEW THERAPEUTIC VENUES. 2021 8 1651 37 DOPAMINE AND GLUCOSE, OBESITY, AND REWARD DEFICIENCY SYNDROME. OBESITY AS A RESULT OF OVEREATING AS WELL AS A NUMBER OF WELL DESCRIBED EATING DISORDERS HAS BEEN ACCURATELY CONSIDERED TO BE A WORLD-WIDE EPIDEMIC. RECENTLY A NUMBER OF THEORIES BACKED BY A PLETHORA OF SCIENTIFICALLY SOUND NEUROCHEMICAL AND GENETIC STUDIES PROVIDE STRONG EVIDENCE THAT FOOD ADDICTION IS SIMILAR TO PSYCHOACTIVE DRUG ADDICTION. OUR LABORATORY HAS PUBLISHED ON THE CONCEPT KNOWN AS REWARD DEFICIENCY SYNDROME (RDS) WHICH IS A GENETIC AND EPIGENETIC PHENOMENA LEADING TO IMPAIRMENT OF THE BRAIN REWARD CIRCUITRY RESULTING IN A HYPO-DOPAMINERGIC FUNCTION. RDS INVOLVES THE INTERACTIONS OF POWERFUL NEUROTRANSMITTERS AND RESULTS IN ABNORMAL CRAVING BEHAVIOR. A NUMBER OF IMPORTANT FACTS WHICH COULD HELP TRANSLATE TO POTENTIAL THERAPEUTIC TARGETS ESPOUSED IN THIS FOCUSED REVIEW INCLUDE: (1) CONSUMPTION OF ALCOHOL IN LARGE QUANTITIES OR CARBOHYDRATES BINGING STIMULATES THE BRAIN'S PRODUCTION OF AND UTILIZATION OF DOPAMINE; (2) IN THE MESO-LIMBIC SYSTEM THE ENKEPHALINERGIC NEURONS ARE IN CLOSE PROXIMITY, TO GLUCOSE RECEPTORS; (3) HIGHLY CONCENTRATED GLUCOSE ACTIVATES THE CALCIUM CHANNEL TO STIMULATE DOPAMINE RELEASE FROM P12 CELLS; (4) A SIGNIFICANT CORRELATION BETWEEN BLOOD GLUCOSE AND CEREBROSPINAL FLUID CONCENTRATIONS OF HOMOVANILLIC ACID THE DOPAMINE METABOLITE; (5) 2-DEOXYGLUCOSE (2DG), THE GLUCOSE ANALOG, IN PHARMACOLOGICAL DOSES IS ASSOCIATED WITH ENHANCED DOPAMINE TURNOVER AND CAUSES ACUTE GLUCOPRIVATION. EVIDENCE FROM ANIMAL STUDIES AND FMRI IN HUMANS SUPPORT THE HYPOTHESIS THAT MULTIPLE, BUT SIMILAR BRAIN CIRCUITS ARE DISRUPTED IN OBESITY AND DRUG DEPENDENCE AND FOR THE MOST PART, IMPLICATE THE INVOLVEMENT OF DA-MODULATED REWARD CIRCUITS IN PATHOLOGIC EATING BEHAVIORS. BASED ON A CONSENSUS OF NEUROSCIENCE RESEARCH TREATMENT OF BOTH GLUCOSE AND DRUG LIKE COCAINE, OPIATES SHOULD INCORPORATE DOPAMINE AGONIST THERAPY IN CONTRAST TO CURRENT THEORIES AND PRACTICES THAT UTILIZES DOPAMINE ANTAGONISTIC THERAPY. CONSIDERING THAT UP UNTIL NOW CLINICAL UTILIZATION OF POWERFUL DOPAMINE D2 AGONISTS HAVE FAILED DUE TO CHRONIC DOWN REGULATION OF D2 RECEPTORS NEWER TARGETS BASED ON NOVEL LESS POWERFUL D2 AGONISTS THAT UP-REGULATE D2 RECEPTORS SEEMS PRUDENT. WE ENCOURAGE NEW STRATEGIES TARGETED AT IMPROVING DA FUNCTION IN THE TREATMENT AND PREVENTION OF OBESITY A SUBTYPE OF REWARD DEFICIENCY. 2014 9 4701 38 NICOTINE AND THE ADOLESCENT BRAIN. ADOLESCENCE ENCOMPASSES A SENSITIVE DEVELOPMENTAL PERIOD OF ENHANCED CLINICAL VULNERABILITY TO NICOTINE, TOBACCO, AND E-CIGARETTES. WHILE THERE ARE SOCIOCULTURAL INFLUENCES, DATA AT PRECLINICAL AND CLINICAL LEVELS INDICATE THAT THIS ADOLESCENT SENSITIVITY HAS STRONG NEUROBIOLOGICAL UNDERPINNINGS. ALTHOUGH DEFINITIONS OF ADOLESCENCE VARY, THE HALLMARK OF THIS PERIOD IS A PROFOUND REORGANIZATION OF BRAIN REGIONS NECESSARY FOR MATURE COGNITIVE AND EXECUTIVE FUNCTION, WORKING MEMORY, REWARD PROCESSING, EMOTIONAL REGULATION, AND MOTIVATED BEHAVIOR. REGULATING CRITICAL FACETS OF BRAIN MATURATION ARE NICOTINIC ACETYLCHOLINE RECEPTORS (NACHRS). HOWEVER, PERTURBATIONS OF CHOLINERGIC SYSTEMS DURING THIS TIME WITH NICOTINE, VIA TOBACCO OR E-CIGARETTES, HAVE UNIQUE CONSEQUENCES ON ADOLESCENT DEVELOPMENT. IN THIS REVIEW, WE HIGHLIGHT RECENT CLINICAL AND PRECLINICAL DATA EXAMINING THE ADOLESCENT BRAIN'S DISTINCT NEUROBIOLOGY AND UNIQUE SENSITIVITY TO NICOTINE. FIRST, WE DISCUSS WHAT DEFINES ADOLESCENCE BEFORE REVIEWING NORMATIVE STRUCTURAL AND NEUROCHEMICAL ALTERATIONS THAT PERSIST UNTIL EARLY ADULTHOOD, WITH AN EMPHASIS ON DOPAMINERGIC SYSTEMS. WE REVIEW HOW ACUTE EXPOSURE TO NICOTINE IMPACTS BRAIN DEVELOPMENT AND HOW DRUG RESPONSES DIFFER FROM THOSE SEEN IN ADULTS. FINALLY, WE DISCUSS THE PERSISTENT ALTERATIONS IN NEURONAL SIGNALING AND COGNITIVE FUNCTION THAT RESULT FROM CHRONIC NICOTINE EXPOSURE, WHILE HIGHLIGHTING A LOW DOSE, SEMI-CHRONIC EXPOSURE PARADIGM THAT MAY BETTER MODEL ADOLESCENT TOBACCO USE. WE ARGUE THAT NICOTINE EXPOSURE, INCREASINGLY OCCURRING AS A RESULT OF E-CIGARETTE USE, MAY INDUCE EPIGENETIC CHANGES THAT SENSITIZE THE BRAIN TO OTHER DRUGS AND PRIME IT FOR FUTURE SUBSTANCE ABUSE. 2015 10 6097 14 THE EFFECTS OF STRESS ON GLUTAMATERGIC TRANSMISSION IN THE BRAIN. STRESS LEADS TO DETRIMENTAL EFFECTS ON BRAIN FUNCTIONS AND RESULTS IN VARIOUS DISEASES. RECENT STUDIES HIGHLIGHT THE INVOLVEMENT OF GLUTAMATERGIC TRANSMISSION IN PATHOGENESIS OF DEPRESSIVE BEHAVIORS AND FEARS. ACUTE STRESS GENERATES DIFFERENT IMPACTS ON THE EXCITATORY TRANSMISSION COMPARED TO CHRONIC STRESS. DIFFERENT NEUROMODULATORS AND EPIGENETIC FACTORS ALSO PARTICIPATE IN THE ALTERATION OF SYNAPTIC TRANSMISSION AND THE REGULATION OF SYNAPTIC PLASTICITY. RESTORATION OF THE GLUTAMATERGIC TRANSMISSION IN STRESS-AFFECTED BRAIN AREAS THEREFORE PROVIDES NOVEL DIRECTIONS OF THERAPEUTIC INTERVENTIONS AGAINST STRESS. 2015 11 4654 32 NEUROSTEROIDS (ALLOPREGNANOLONE) AND ALCOHOL USE DISORDER: FROM MECHANISMS TO POTENTIAL PHARMACOTHERAPY. ALCOHOL USE DISORDER (AUD) IS A MULTIFACETED RELAPSING DISORDER THAT IS COMMONLY COMORBID WITH PSYCHIATRIC DISORDERS, INCLUDING ANXIETY. ALCOHOL EXPOSURE PRODUCES A PLETHORA OF EFFECTS ON NEUROBIOLOGY. CURRENTLY, THERAPEUTIC STRATEGIES ARE LIMITED, AND ONLY A FEW TREATMENTS - DISULFIRAM, ACAMPROSATE, AND NALTREXONE - ARE AVAILABLE. GIVEN THE COMPLEXITY OF THIS DISORDER, THERE IS A GREAT NEED FOR THE IDENTIFICATION OF NOVEL TARGETS TO DEVELOP NEW PHARMACOTHERAPY. THE GABAERGIC SYSTEM, THE PRIMARY INHIBITORY SYSTEM IN THE BRAIN, IS ONE OF THE WELL-KNOWN TARGETS FOR ALCOHOL AND IS RESPONSIBLE FOR THE ANXIOLYTIC EFFECTS OF ALCOHOL. INTERESTINGLY, GABAERGIC NEUROTRANSMISSION IS FINE-TUNED BY NEUROACTIVE STEROIDS THAT EXERT A REGULATORY ROLE ON SEVERAL ENDOCRINE SYSTEMS INVOLVED IN NEUROPSYCHIATRIC DISORDERS INCLUDING AUD. MOUNTING EVIDENCE INDICATES THAT ALCOHOL ALTERS THE BIOSYNTHESIS OF NEUROSTEROIDS, WHEREAS ACUTE ALCOHOL INCREASES AND CHRONIC ALCOHOL DECREASES ALLOPREGNANOLONE LEVELS. OUR RECENT WORK HIGHLIGHTED THAT CHRONIC ALCOHOL-INDUCED CHANGES IN NEUROSTEROID LEVELS ARE MEDIATED BY EPIGENETIC MODIFICATIONS, E.G., DNA METHYLATION, AFFECTING KEY ENZYMES INVOLVED IN NEUROSTEROID BIOSYNTHESIS. THESE CHANGES WERE ASSOCIATED WITH CHANGES IN GABA(A) RECEPTOR SUBUNIT EXPRESSION, SUGGESTING AN IMBALANCE BETWEEN EXCITATORY AND INHIBITORY SIGNALING IN AUD. THIS REVIEW WILL RECAPITULATE THE ROLE OF NEUROSTEROIDS IN THE REGULATION OF THE NEUROENDOCRINE SYSTEM, HIGHLIGHT THEIR ROLE IN THE OBSERVED ALLOSTATIC LOAD IN AUD, AND DEVELOP A FRAMEWORK FROM MECHANISMS TO POTENTIAL PHARMACOTHERAPY. 2022 12 2670 36 ETHANOL ACTIONS ON THE VENTRAL TEGMENTAL AREA: NOVEL POTENTIAL TARGETS ON REWARD PATHWAY NEURONS. THE VENTRAL TEGMENTAL AREA (VTA) EVALUATES SALIENCE OF ENVIRONMENTAL STIMULI AND PROVIDES DOPAMINERGIC INNERVATION TO MANY BRAIN AREAS AFFECTED BY ACUTE AND CHRONIC ETHANOL EXPOSURE. WHILE PRIMARILY ASSOCIATED WITH REWARDING AND REINFORCING STIMULI, RECENT EVIDENCE INDICATES A ROLE FOR THE VTA IN AVERSION AS WELL. ETHANOL ACTIONS IN THE VTA MAY TRIGGER NEUROADAPTATION RESULTING IN REDUCTION OF THE AVERSIVE RESPONSES TO ALCOHOL AND A RELATIVE INCREASE IN THE REWARDING RESPONSES. IN SEARCHING FOR EFFECTIVE PHARMACOTHERAPIES FOR THE TREATMENT OF ALCOHOL ABUSE AND ALCOHOLISM, RECOGNITION OF THIS IMBALANCE MAY REVEAL NOVEL STRATEGIES. IN ADDITION TO CONVENTIONAL RECEPTOR/ION CHANNEL PHARMACOTHERAPIES, EPIGENETIC FACTORS THAT CONTROL NEUROADAPTATION TO CHRONIC ETHANOL TREATMENT CAN BE TARGETED AS AN AVENUE FOR DEVELOPMENT OF THERAPEUTIC APPROACHES TO RESTORE THE BALANCE. FURTHERMORE, WHEN EXPLORING THERAPIES TO ADDRESS REWARD/AVERSION IMBALANCE IN THE ACTION OF ALCOHOL IN THE VTA, SEX DIFFERENCES HAVE TO BE TAKEN INTO ACCOUNT TO ENSURE EFFECTIVE TREATMENT FOR BOTH MEN AND WOMEN. THESE PRINCIPLES APPLY TO A VTA-CENTRIC APPROACH TO THERAPIES, BUT SHOULD HOLD TRUE WHEN THINKING ABOUT THE OVERALL APPROACH IN THE DEVELOPMENT OF NEUROACTIVE DRUGS TO TREAT ALCOHOL USE DISORDERS. ALTHOUGH THE FUNCTIONS OF THE VTA ITSELF ARE COMPLEX, IT IS A USEFUL MODEL SYSTEM TO EVALUATE THE REWARD/AVERSION IMBALANCE THAT OCCURS WITH ETHANOL EXPOSURE AND COULD BE USED TO PROVIDE NEW LEADS IN THE EFFORTS TO DEVELOP NOVEL DRUGS TO TREAT ALCOHOLISM. 2018 13 2259 26 EPIGENETIC PRIMING IN DRUG ADDICTION. DRUG ADDICTION IS A CHRONIC RELAPSING BRAIN DISORDER THAT IS CHARACTERIZED BY COMPULSIVE DRUG SEEKING AND CONTINUED USE DESPITE NEGATIVE OUTCOMES. CURRENT PHARMACOLOGICAL THERAPIES TARGET NEURONAL RECEPTORS OR TRANSPORTERS UPON WHICH DRUGS OF ABUSE ACT INITIALLY, YET THESE TREATMENTS REMAIN INEFFECTIVE FOR MOST INDIVIDUALS AND DO NOT PREVENT DISEASE RELAPSE AFTER ABSTINENCE. DRUGS OF ABUSE, IN ADDITION TO THEIR ACUTE EFFECTS, CAUSE PERSISTENT PLASTICITY AFTER REPEATED USE, INVOLVING DYSREGULATED GENE EXPRESSION IN THE BRAIN'S REWARD REGIONS, WHICH ARE THOUGHT TO MEDIATE THE PERSISTENT BEHAVIORAL ABNORMALITIES THAT CHARACTERIZE ADDICTION. EMERGING EVIDENCE IMPLICATES EPIGENETIC PRIMING AS A KEY MECHANISM THAT UNDERLIES THE LONG-LASTING ALTERATIONS IN NEURONAL GENE REGULATION, WHICH CAN REMAIN LATENT UNTIL TRIGGERED BY RE-EXPOSURE TO DRUG-ASSOCIATED STIMULI OR THE DRUG ITSELF. THUS, TO EFFECTIVELY TREAT DRUG ADDICTION, WE MUST IDENTIFY THE PRECISE EPIGENETIC MECHANISMS THAT ESTABLISH AND PRESERVE THE DRUG-INDUCED PATHOLOGY OF THE BRAIN REWARD CIRCUITRY. 2018 14 2292 21 EPIGENETIC REGULATION IN SUBSTANCE USE DISORDERS. SUBSTANCE USE DISORDER IS A CHRONIC CONDITION OF COMPULSIVE DRUG SEEKING AND USE THAT IS MEDIATED BY STABLE CHANGES IN CENTRAL REWARD PATHWAYS. REPEATED USE OF ABUSED DRUGS CAUSES PERSISTENT ALTERATIONS IN GENE EXPRESSION RESPONSIBLE FOR THE LONG-TERM BEHAVIORAL AND STRUCTURAL CHANGES. RECENTLY, IT HAS BEEN SUGGESTED THAT EPIGENETIC MECHANISMS ARE RESPONSIBLE IN PART FOR THESE DRUG-INDUCED CHANGES IN GENE EXPRESSION. ONE OF THE ALLURING ASPECTS OF EPIGENETIC REGULATION OF GENE EXPRESSION IS THAT EPIGENETIC MECHANISMS MAY PROVIDE TRANSIENT AND POTENTIALLY STABLE CONDITIONS THAT IN TURN MAY ULTIMATELY PARTICIPATE IN THE MOLECULAR MECHANISMS REQUIRED FOR NEURONAL CHANGES SUBSERVING LONG-LASTING CHANGES IN BEHAVIOR. THIS REVIEW DESCRIBES EPIGENETIC MECHANISMS OF GENE REGULATION AND THEN DISCUSSES THE EMERGING ROLE OF EPIGENETICS IN DRUG-INDUCED PLASTICITY AND BEHAVIOR. UNDERSTANDING THESE MECHANISMS THAT ESTABLISH AND MAINTAIN DRUG-DEPENDENT PLASTICITY CHANGES MAY LEAD TO DEEPER UNDERSTANDING OF SUBSTANCE USE DISORDERS AS WELL AS NOVEL APPROACHES TO TREATMENT. 2010 15 1252 33 CURRENT PERSPECTIVES ON THE NEUROBIOLOGY OF DRUG ADDICTION: A FOCUS ON GENETICS AND FACTORS REGULATING GENE EXPRESSION. DRUG ADDICTION IS A CHRONIC, RELAPSING DISORDER DEFINED BY CYCLIC PATTERNS OF COMPULSIVE DRUG SEEKING AND TAKING INTERSPERSED WITH EPISODES OF ABSTINENCE. WHILE GENETIC VARIABILITY MAY INCREASE THE RISK OF ADDICTIVE BEHAVIOURS IN AN INDIVIDUAL, EXPOSURE TO A DRUG RESULTS IN NEUROADAPTATIONS IN INTERCONNECTED BRAIN CIRCUITS WHICH, IN SUSCEPTIBLE INDIVIDUALS, ARE BELIEVED TO UNDERLIE THE TRANSITION TO, AND MAINTENANCE OF, AN ADDICTED STATE. THESE ADAPTATIONS CAN OCCUR AT THE CELLULAR, MOLECULAR, OR (EPI)GENETIC LEVEL AND ARE ASSOCIATED WITH SYNAPTIC PLASTICITY AND ALTERED GENE EXPRESSION, THE LATTER BEING MEDIATED VIA BOTH FACTORS AFFECTING TRANSLATION (EPIGENETICS) AND TRANSCRIPTION (NON CODING MICRORNAS) OF THE DNA OR RNA ITSELF. NEW ADVANCES USING TECHNIQUES SUCH AS OPTOGENETICS HAVE THE POTENTIAL TO INCREASE OUR UNDERSTANDING OF THE MICROCIRCUITRY MEDIATING ADDICTIVE BEHAVIOURS. HOWEVER, THE PROCESSES LEADING TO ADDICTION ARE COMPLEX AND MULTIFACTORIAL AND THUS WE FACE A MAJOR CONTEMPORARY CHALLENGE TO ELUCIDATE THE FACTORS IMPLICATED IN THE DEVELOPMENT AND MAINTENANCE OF AN ADDICTED STATE. 2012 16 678 31 BRAIN DEVELOPMENT UNDER STRESS: HYPOTHESES OF GLUCOCORTICOID ACTIONS REVISITED. ONE OF THE CONUNDRUMS IN TODAY'S STRESS RESEARCH IS WHY SOME INDIVIDUALS FLOURISH AND OTHERS PERISH UNDER SIMILAR STRESSFUL CONDITIONS. IT IS RECOGNIZED THAT THIS INDIVIDUAL VARIABILITY IN ADAPTATION TO STRESS DEPENDS ON THE OUTCOME OF THE INTERACTION OF GENETIC AND COGNITIVE/EMOTIONAL INPUTS IN WHICH GLUCOCORTICOID HORMONES AND RECEPTORS PLAY A CRUCIAL ROLE. HENCE ONE APPROACH TOWARDS UNDERSTANDING INDIVIDUAL VARIATION IN STRESS COPING IS HOW GLUCOCORTICOID ACTIONS CAN CHANGE FROM PROTECTIVE TO HARMFUL. TO ADDRESS THIS QUESTION WE FOCUS ON FOUR HYPOTHESES THAT ARE CONNECTED AND NOT MUTUAL EXCLUSIVE. FIRST, THE CLASSICAL GLUCOCORTICOID CASCADE HYPOTHESIS, IN WHICH THE INABILITY TO COPE WITH CHRONIC STRESS CAUSES A VICIOUS CYCLE OF EXCESS GLUCOCORTICOID AND DOWNREGULATION OF GLUCOCORTICOID RECEPTORS (GR) IN THE HIPPOCAMPUS TRIGGERING A FEED-FORWARD CASCADE OF DEGENERATION AND DISEASE. SECOND, THE BALANCE HYPOTHESIS, WHICH TAKES ALSO THE LIMBIC MINERALOCORTICOID RECEPTORS (MR) INTO ACCOUNT AND PROPOSES THAT AN INTEGRAL LIMBIC MR:GR IMBALANCE IS CAUSAL TO ALTERED PROCESSING OF INFORMATION IN CIRCUITS UNDERLYING FEAR, REWARD, SOCIAL BEHAVIOUR AND RESILIENCE, DYSREGULATION OF THE HYPOTHALAMIC-PITUITARY-ADRENAL (HPA) AXIS AND IMPAIRMENT OF BEHAVIOURAL ADAPTATION. THE MR:GR BALANCE IS ALTERED BY GENE VARIANTS OF THESE RECEPTOR COMPLEXES AND EXPERIENCE-RELATED FACTORS, WHICH CAN INDUCE LASTING EPIGENETIC CHANGES IN THE EXPRESSION OF THESE RECEPTORS. A PARTICULAR POTENT EPIGENETIC STIMULUS IS THE MATERNAL ENVIRONMENT WHICH IS FUNDAMENTAL FOR THE MATERNAL MEDIATION HYPOTHESIS. THE OUTCOME OF PERINATAL GENE X ENVIRONMENT INTERACTION, AND THUS OF MR:GR-MEDIATED FUNCTIONS DEPENDS HOWEVER, ON THE DEGREE OF 'MATCHING' WITH ENVIRONMENTAL DEMANDS IN LATER LIFE. THE PREDICTIVE ADAPTATION HYPOTHESIS THEREFORE PRESENTS A CONCEPTUAL FRAMEWORK TO EXAMINE THE ROLE OF GLUCOCORTICOIDS IN UNDERSTANDING INDIVIDUAL PHENOTYPIC DIFFERENCES IN STRESS-RELATED BEHAVIOURS OVER THE LIFESPAN. 2010 17 1984 24 EPIGENETIC ALTERATIONS IN PRESCRIPTION OPIOID MISUSE: NEW STRATEGIES FOR PRECISION PAIN MANAGEMENT. PRESCRIPTION OPIOIDS ARE USED FOR SOME CHRONIC PAIN CONDITIONS. HOWEVER, GENERALLY, LONG-TERM THERAPY HAS UNWANTED SIDE EFFECTS WHICH MAY TRIGGER ADDICTION, OVERDOSE, AND EVENTUALLY CAUSE DEATHS. OPIOID ADDICTION AND CHRONIC PAIN CONDITIONS HAVE BOTH BEEN ASSOCIATED WITH EVIDENCE OF GENETIC AND EPIGENETIC ALTERATIONS. DESPITE INTENSE RESEARCH INTEREST, MANY QUESTIONS ABOUT THE CONTRIBUTION OF EPIGENETIC CHANGES TO THIS TYPOLOGY OF ADDICTION VULNERABILITY AND DEVELOPMENT REMAIN UNANSWERED. THE AIM OF THIS REVIEW WAS TO SUMMARIZE THE EPIGENETIC MODIFICATIONS DETECTED IN SPECIFIC TISSUES OR BRAIN AREAS AND ASSOCIATED WITH OPIOID PRESCRIPTION AND MISUSE IN PATIENTS WHO HAVE INITIATED PRESCRIBED OPIOID MANAGEMENT FOR CHRONIC NON-CANCER PAIN. THE REVIEW CONSIDERS THE EFFECTS OF OPIOID EXPOSURE ON THE EPIGENOME IN CENTRAL AND PERIPHERAL TISSUES IN ANIMAL MODELS AND HUMAN SUBJECTS AND HIGHLIGHTS THE MECHANISMS IN WHICH OPIOID EPIGENETICS MAY BE INVOLVED. THIS WILL IMPROVE OUR CURRENT UNDERSTANDING, PROVIDE THE BASIS FOR TARGETED, PERSONALIZED PAIN MANAGEMENT, AND THUS BALANCE OPIOID RISKS AND BENEFITS IN MANAGING CHRONIC PAIN. 2021 18 5649 21 SEX DIFFERENCES IN PSYCHOSTIMULANT ABUSE: IMPLICATIONS FOR ESTROGEN RECEPTORS AND HISTONE DEACETYLASES. SUBSTANCE ABUSE IS A CHRONIC PATHOLOGICAL DISORDER THAT NEGATIVELY AFFECTS MANY HEALTH AND NEUROLOGICAL PROCESSES. A GROWING BODY OF LITERATURE HAS REVEALED GENDER DIFFERENCES IN SUBSTANCE USE. COMPARED TO MEN, WOMEN DISPLAY DISTINCT DRUG-USE PHENOTYPES ACCOMPANIED BY RECOVERY AND REHABILITATION DISPARITIES. THESE OBSERVATIONS HAVE LED TO THE NOTION THAT SEX-DEPENDENT SUSCEPTIBILITIES EXIST ALONG THE PROGRESSION TO ADDICTION. WITHIN THIS SCOPE, NEUROADAPTATIONS FOLLOWING PSYCHOSTIMULANT EXPOSURE ARE THOUGHT TO BE DISTINCT FOR EACH SEX. THIS REVIEW SUMMARIZES CLINICAL FINDINGS AND ANIMAL RESEARCH REPORTING SEX DIFFERENCES IN THE SUBJECTIVE AND BEHAVIORAL RESPONSES TO COCAINE, METHAMPHETAMINE, AND NICOTINE. THIS DISCUSSION IS FOLLOWED BY AN EXAMINATION OF EPIGENETIC AND MOLECULAR ALTERATIONS IMPLICATED IN THE ADDICTION PROCESS. SPECIAL CONSIDERATION IS GIVEN TO HISTONE DEACETYLASES AND ESTROGEN RECEPTOR-MEDIATED GENE EXPRESSION. 2022 19 4424 33 MOLECULAR AND NEUROLOGIC RESPONSES TO CHRONIC ALCOHOL USE. THIS CHAPTER PROVIDES AN OVERVIEW OF CURRENT KNOWLEDGE ON THE MOLECULAR AND CLINICAL ASPECTS OF CHRONIC ALCOHOL EFFECTS ON THE CENTRAL NERVOUS SYSTEM. THIS DRUG IS ALMOST UBIQUITOUS, WIDELY ENJOYED SOCIALLY, BUT PRODUCES A DIVERSE SPECTRUM OF NEUROLOGIC DISEASE WHEN ABUSED. ACUTELY, ALCOHOL INTERACTS PREDOMINANTLY WITH GAMMA-AMINOBUTYRIC ACID-A (GABA-A) AND N-METHYL-D-ASPARTATE (NMDA) RECEPTORS, BUT TRIGGERS DIVERSE SIGNALING EVENTS WITHIN WELL-DEFINED NEURAL PATHWAYS. THESE EVENTS RESULT IN ADAPTIVE CHANGES IN GENE EXPRESSION THAT ULTIMATELY PRODUCE TWO MAJOR STATES: ADDICTION AND TOXICITY. EPIGENETIC MODIFICATIONS OF CHROMATIN COULD LEAD TO LONG-LIVED OR EVEN TRANSGENERATIONAL CHANGES IN GENE EXPRESSION, THUS PRODUCING ASPECTS OF THE HERITABILITY OF ALCOHOL USE DISORDERS (AUD) AND LONG-TERM BEHAVIORS SUCH AS RECIDIVISM. THE DIVERSE CLINICAL SYNDROMES PRODUCED BY CHRONIC ALCOHOL ACTIONS IN THE CENTRAL NERVOUS SYSTEM REFLECT THE MOLECULAR PATHOLOGY AND PREDOMINANTLY INVOLVE ASPECTS OF TOLERANCE/WITHDRAWAL, SELECTIVE VULNERABILITY (MANIFEST AS CENTRAL PONTINE MYELINOLYSIS, MARCHIAFAVA-BIGNAMI DISEASE), AND ADDITIONAL ENVIRONMENTAL FACTORS (E.G., THIAMINE DEFICIENCY IN WERNICKE-KORSAKOFF'S SYNDROME). ADDITIONALLY, DELETERIOUS ASPECTS OF CHRONIC ALCOHOL ON SIGNALING, SYNAPTIC TRANSMISSION, AND CELL TOXICITY LEAD TO PRIMARY ALCOHOLIC DEMENTIA. GENETICALLY DETERMINED ASPECTS OF MYELIN STRUCTURE AND ALCOHOL ACTIONS ON MYELIN GENE EXPRESSION MAY BE A PROMINENT MOLECULAR MECHANISM RESULTING IN A PREDISPOSITION TO, OR CAUSATION OF, AUD AND MULTIPLE OTHER NEUROLOGIC COMPLICATIONS OF CHRONIC ALCOHOL. THE DRAMATIC PROGRESS MADE IN UNDERSTANDING MOLECULAR ACTIONS OF ALCOHOL HOLDS GREAT PROMISE FOR OUR EVENTUAL TREATMENT OR PREVENTION OF AUD AND NEUROLOGIC COMPLICATIONS RESULTING FROM CHRONIC ALCOHOL ABUSE. 2014 20 677 22 BRAIN CIRCUITS AT RISK IN PSYCHIATRIC DISEASES AND PHARMACOLOGICAL PATHWAYS. THE MULTIPLE BRAIN CIRCUITS INVOLVED IN PSYCHIATRIC DISEASES MAY APPEAR DAUNTING, BUT WE PREFER TO CONCENTRATE ON A SELECT FEW, WITH A PARTICULAR SENSITIVITY TO STRESS AND NEURODEVELOPMENTAL ISSUES, WITH A CLEAR PHARMACOTHERAPY. THIS REVIEW IS STRUCTURED AROUND 1. THE KEY CIRCUITS, THEIR ROLE IN HEALTH AND DISEASE, AND THE NEUROTRANSMITTERS MAINTAINING THEM, 2. THE INFLUENCE OF UPBRINGING, STRESS, CHRONOBIOLOGY, INFLAMMATION AND INFECTION, 3. THE GENETIC AND EPIGENETIC INFLUENCE ON THESE CIRCUITS, PARTICULARLY REGARDING COPY NUMBER VARIANTS AND NEURONAL PLASTICITY, 4. THE USE AND ABUSE OF PHARMACOLOGICAL AGENTS WITH THE PARTICULAR RISKS OF STRESS AND CHRONOBIOLOGY AT CRITICAL PERIODS. A MAJOR EMPHASIS IS PLACED ON THE LINKS BETWEEN HIPPOCAMPUS, PREFRONTAL CORTEX AND AMYGDALA/PERIAQUEDUCTAL GREY WHICH CONTROL SPECIFIC ASPECTS OF COGNITION, MOOD, PAIN AND EVEN VIOLENCE. SOME OF THE RESEARCH FINDINGS WERE FROM THE INNOVATIVE MEDICINE INITIATIVE (IMI) NEWMEDS, A 22MEURO ACADEMIC/INDUSTRIAL CONSORTIUM ON THE BRAIN CIRCUITS CRITICAL FOR PSYCHIATRIC DISEASE. 2021