Allostasis and Addiction

The term addiction, in medical terminology means a psychiatric disorder manifested by unusual craving and compulsive indulgence of certain activities like drug addiction, alcohol addiction, gambling, video game, crime, money work addiction, overeating, nicotine or pornographic addiction. In fact there is no end of the list but since these substances or activities always brings negative impact on individual and social life; so they are specially earmarked. Addiction can also be described as a compulsive obsession and create excessive psychological dependence in addicts on their individual preference.

However, the term addiction is used commonly to mean psychological dependence and usually attached to drug or substance abuse problems. But it is also used for problems like compulsive overeating or alike; though medical communities do not recognize them as problems of addiction. There are addictions that are not substance related; like gambling and computer addiction. In these sorts of cases addiction means a recurring compulsion felt by individual to engage in some particular activity without considering its harmful consequences.

Different forms of addiction
In United States, the term “addiction” is not used in Diagnostic and Statistical Manual Disorders (DSM -IV TR) instead it uses “substance dependence” for physical dependence, abuse of or withdrawal from any substances or drugs. The section Substance dependence states “…. When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. These, along with substance abuse are considered substance use disorders……..” Terminology is divided between psychiatrists and physicians; as former call this problem or disease as psychological dependence or addiction and the later as physical or substance dependence.

Now there is trend to distinguish between physical dependence characterized by withdrawal symptoms and psychological dependence manifested by “compulsive, uncontrolled use” with no harm being suffered by user or any one. Clinically it is termed as “compulsive” but not necessarily addiction.

There is a lesser known factor called pseudo-addiction. This occurs when a patient seeks drugs after being treated with that for longer period. This reflects psychological dependence or addiction but sometime it may happen so that the patient might have been under treated as well. Such cases are numerous when patients are treated with opiates drugs to relieve them from pains. Treating them adequately tends to remove such dependence. More studies are required for the effectiveness or substitutes of addictive drugs like opiates.

Allostasis : What is it?
When a person is inclined to drug or substance addiction, he or she then appears to enter a new state called allostatic state departing from normal levels of change in ordinary condition. Allostasis is a process of maintaining stability while changing behavior and physiological features. Drug addiction causes harm to the addict’s brain and body due to pathological state caused by damage known as allostatic load. The result of allostatic load is a state of constant depression stemming from allostatic changes. This forces the drug abusers to seek drugs before their brain and body returns to normal allostatic levels; thus producing a constant state of stress. It is observed that the presence of circumstantial stressors induce acute drug seeking tendencies.

Allostasis is a new concept proposed by Sterling and Eyer in 1988. This is a process that establishes the stability in an emergency and occurs endogenously in our physiological system to maintain balance. The word allostasis and homeostasis derived from original Greek words; “homeo” means “same” and stasis means “stable”; so homeostasis means “remaining stable by staying the same”. So with the word allostasis; in Greek “allo” means “variable” and statis means “stable”; so allostasis means ” remaining stable by being variable”. Allostasis is a process to achieve stability through physiological or behavioral change and this can be done by altering HPA axis ( hypothalamic-pituitary-adrenal axis) hormones, cytokines, autonomic nervous system or many other systems and they are generally short term.

The process of allostasis is fundamental and this helps organisms to adjust or adapt actively to predictable or unpredictable events of life. Allostatic loads refer to the cumulative cost; the allostasis body pays to regain stability. Allostatic overload may result in serious pathophysiology. There are two types of allostatic overloads proposed which result in response of followings:

Type – I: This is when allostatic overload is caused due to increased demand of energy exceeds the supply and that result in emergency life history stage. When perturbation passes normalcy restored decreasing allostatic load.

Type – II: Allostatic overloads occur when demand of energy increases with social conflict or any type of social dysfunction. In these cases the normalcy restored by secretion of glucocorticosteroids and activities of other allostasis mediators like CNS neurotransmitters, autonomic nervous system, inflammatory cytokines wax. However if allostatic loads remain chronically high then pathologies develop. It is something like this, if a dehydrated individual continue to be stressed despite being helped then he fails to reinstate the body function. This will result in wearing out of individual’s body. Though human body is adaptable but fails to bear allostatic overload for a very longer period without hazards.

The adaptogens may come in help to curb allostatic load. Adaptogens are herbal or pharmaceutical substance; they are non-toxic in regular doses and produce defensive response of nonspecific nature to stress. They restore normalcy in HPA axis. Adaptogens are new class of metabolic regulators for homeostatic and allostatic changes, toning down the hyperfunctioning systems activity or increasing hypofunctioning systems.

Allostasis and Drug Addictions
Drug addiction or substance dependence is a chronic disorder manifested by a compulsive tendency to take and seek drugs or substances to manage the levels of compulsion and desires brought on by allostatic overload. Continuous increase of intake raises the hedonic level and overtakes the individual by a negative emotional state when without them. Allostatic changes helps to identify the effects and causes of drug addiction in the neurobiological and neuroadaptive systems. The reward system of the brain in the event of drug addiction implicates some key elements of amygdale basal forebrain macrostructure. The change in stress and reward system of the brain appears to maintain stability in allostatic state in contradiction to homeostatic state; so this shows the development of susceptibility and recurrence of addiction. The allostatic state of longer abstinence is the most useful target for treating drug addiction through pharmacological and behavioral therapies. When dealing with recovery from addiction it’s important for the patient to be cognizant of the brain functions occurring and by being fully aware of how the component of allostasis relates to ones addiction.