Dr. Arwen Podesta provides a foundational and clinically relevant overview of addiction's underlying mechanisms, connecting the dopamine reward system, genetic and epigenetic influences, and practical treatment strategies. Designed for clinicians and researchers, this session elucidates how addictive substances hijack the brain's reward circuitry, predisposing individuals to compulsive behaviors and chronic relapse.

Addiction is characterized by the overstimulation of the brain's reward system, primarily via dopamine in the nucleus accumbens. Substances like opioids, stimulants, and alcohol trigger unnaturally high dopamine surges, fostering reinforcement that leads to compulsive drug use even in the face of adverse consequences. Chronic use induces neuroadaptive changes, reducing dopamine receptor availability and diminishing the ability to experience pleasure from ordinary activities (anhedonia). This cycle drives further substance use and contributes to difficulties with abstinence.

The presentation explores how genetic and epigenetic mechanisms shape vulnerability to addiction. Differences in neural gene expression, mediated by DNA modifications and chromatin structure changes, underlie individual susceptibility. Both inherited and environmentally-driven epigenetic alterations — influenced by early life adversity or trauma — may predispose certain individuals to substance use disorders or alter their course of illness.

Evidence-based treatment interventions are highlighted, encompassing medications (FDA-approved and off-label with demonstrated efficacy), nutritional support, and trauma-informed care. Pharmacological strategies target cravings and withdrawal by modulating the reward circuitry and stress pathways. Nutrition, co-factor and trauma support address biological and psychosocial contributors, recognizing the multidimensional nature of addictive disorders.

Grounded in the latest neurobiological evidence and translational research, this presentation empowers clinicians to better understand the neurocircuitry underpinnings of addiction, and employ holistic, evidence-driven interventions for effective patient care.

To be updated shortly..