RESUMEN
BACKGROUND: The US National Institutes of Mental Health Research Domain Criteria (RDoC) seek to stimulate research into biologically validated neuropsychological dimensions across mental illness symptoms and diagnoses. The RDoC framework comprises 39 functional constructs designed to be revised and refined, with the overall goal of improving diagnostic validity and treatments. This study aimed to reach a consensus among experts in the addiction field on the 'primary' RDoC constructs most relevant to substance and behavioural addictions. METHODS: Forty-four addiction experts were recruited from Australia, Asia, Europe and the Americas. The Delphi technique was used to determine a consensus as to the degree of importance of each construct in understanding the essential dimensions underpinning addictive behaviours. Expert opinions were canvassed online over three rounds (97% completion rate), with each consecutive round offering feedback for experts to review their opinions. RESULTS: Seven constructs were endorsed by ≥ 80% of experts as 'primary' to the understanding of addictive behaviour: five from the Positive Valence System (reward valuation, expectancy, action selection, reward learning, habit); one from the Cognitive Control System (response selection/inhibition); and one expert-initiated construct (compulsivity). These constructs were rated to be related differentially to stages of the addiction cycle, with some linked more closely to addiction onset and others more to chronicity. Experts agreed that these neuropsychological dimensions apply across a range of addictions. CONCLUSIONS: The study offers a novel and neuropsychologically informed theoretical framework, as well as a cogent step forward to test transdiagnostic concepts in addiction research, with direct implications for assessment, diagnosis, staging of disorder, and treatment.
Asunto(s)
Conducta Adictiva/fisiopatología , Trastornos Relacionados con Sustancias/fisiopatología , Asia , Australia , Conducta Adictiva/diagnóstico , Conducta Adictiva/psicología , Conducta Adictiva/terapia , Conducta Compulsiva , Toma de Decisiones , Técnica Delphi , Europa (Continente) , Hábitos , Humanos , Inhibición Psicológica , Aprendizaje , National Institute of Mental Health (U.S.) , América del Norte , Recompensa , América del Sur , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Estados UnidosRESUMEN
Being under the influence during choice between drug and nondrug options can have a dramatic effect on choice outcomes. When rats face a choice between cocaine and sweet water and are not under the influence, they prefer sweet water. In contrast, when they are under the influence of cocaine, this causes them to shift their choice to cocaine nearly exclusively. Here we sought to characterize the behavioral mechanisms underlying the influence of cocaine on choice. In theory, rats under the influence of cocaine should be in a mixed motivational state, at least temporarily, with both their motivation for cocaine and their motivation for the nondrug option suppressed by the drug satiating and anorexic effects of cocaine, respectively. For this mixed state to shift choice to cocaine, the satiated motivation for cocaine should recover before the suppressed motivation for the preferred nondrug option. The goal of the present study was to test this prediction in rats that expressed a preference for sweet water after extended access to cocaine self-administration. We measured their choice and response latencies to each option after pre-trial, passive administration of cocaine to estimate the duration of its drug satiating and anorexic effects. As expected, pre-trial cocaine caused most rats to shift their choice to cocaine. Though this shift was not simply due to a longer latency to respond for sweet water than for cocaine after pre-trial cocaine, it nevertheless occurred while rats' motivation for the nondrug option was still partially suppressed. Thus, cocaine seems to bias choice toward more cocaine mainly via suppression of the nondrug option.