The failing cascade: Comorbid post traumatic stress- and opioid use disorders

A Novel Precision Approach to Overcome the “Addiction Pandemic” by Incorporating Genetic Addiction Risk Severity (GARS) and Dopamine Homeostasis Restoration

“…We encourage clinicians to research and understand the importance of a molecular framework to explain the current underpinnings of endorphinergic/dopaminergic mechanisms related to opioid deficiency syndrome and a generalized reward processing deficiency [19,[78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97]. Along these same lines, many RDS subtypes have also been linked to hypodopaminergia using sophisticated imaging techniques [98][99][100][101][102][103][104][105][106][107][108][109][110][111][112]. Can we better combat SUD through early genetic risk screening enable early intervention by the induction of dopamine homeostasis?…”

Mechanisms Underlying Unconscious Processing and Their Alterations in Post-traumatic Stress Disorder: Neuroimaging of Zero Monetary Outcomes Contextually Framed as “No Losses” vs. “No Gains”

“…Differences in the framing function may determine whether an individual retains control of the symptoms or whether the symptoms attain control over the individual. The editing operation frames a prospect of continued illness or a successful recovery with respect to an endurable amount of disturbing symptoms to allow reformulation of the coping strategies in accordance with the amount of psychological suffering that a patient is capable of accepting, thus altering the reference (neutral) point (Elman and Borsook, 2019). All other things being the same, symptoms up to the limit of this new neutral state may not be perceived as an aversive experience.…”

“…Given that a partial opioid agonist, buprenorphine, has been successfully tried in PTSD patients (Seal et al, 2016;Lake et al, 2019) it would be of interest to test whether buprenorphine is able to normalize the abovementioned blunted responses. It has been proposed that some psychopathological conditions with excessive endogenous opioid function e.g., PTSD (Liberzon and Abelson, 2016;Elman and Borsook, 2019), schizophrenia (Elman et al, 2006) or addiction (Elman and Borsook, 2019) are associated with aberrant contextual processing (Waters et al, 2006;Anderson and Hanslmayr, 2014). Examination of neurocircuitries for these categories of mental illnesses reveals overlapping differences between patients and control groups in cortical and subcortical limbic structures implicated in re-experiencing and recall type of symptoms e.g., hallucinations-or craving-related memories (Waters et al, 2006;Elman and Borsook, 2016).…”

“…Examination of neurocircuitries for these categories of mental illnesses reveals overlapping differences between patients and control groups in cortical and subcortical limbic structures implicated in re-experiencing and recall type of symptoms e.g., hallucinations-or craving-related memories (Waters et al, 2006;Elman and Borsook, 2016). Such findings, however, do not yet conclusively demonstrate unitary nosology because PTSD entails manifestations of altered neurocircuitry in other domains be it reward function or motivational regulation (Elman and Borsook, 2019). An approach reflected in the Research Domain Criteria (Silveira et al, 2020) is to divide that kind of multidimensional constructs into domains based on the underlying circuitry or system.…”

Commentary on Higgins et al. (2020): How are chronic pain, psychological distress and opioid dependence related?

“…Opioids provide intrinsic reward, as well as reward associated with pain relief . The allure of opioids may be greatest in patients with post‐traumatic stress disorder, which is characterized by both enhanced anti‐reward and endogenous opioid activity . Our endogenous opioid system modulates not only physical pain, but also social stress, and supports social bonds .…”