Addiction research has long focused on vulnerability – that is, understanding why some people are more susceptible to substance use disorders (SUDs). However, a recent critical review of the literature by Dr Alexandra Rogers and Professor Frances Leslie of the University of California, Irvine, suggests that a paradigm shift is needed. Rather than focusing solely on why people become addicted, the researchers argue that the field should also explore why many people do not, even when exposed to the same addictive substances. Their work, published in Addiction Neuroscience, argues for deeper investigation of resilience mechanisms that could pave the way for more effective addiction therapies.
Substance use disorders have plagued societies for centuries, but most drug users do not develop full-blown addictions. In fact, studies indicate that only 5–30% of regular drug users meet criteria for substance use disorders. This discrepancy highlights the need to study the neurobiological and psychological factors that protect against addiction. Rogers and Leslie note that while the neurobiology of vulnerability has been widely studied, resilience—the ability to maintain normal functioning despite exposure to addictive substances—remains underexplored.
The researchers suggest that mechanisms of resilience are distinct from those of vulnerability. “Resilience is not just the absence of vulnerability. It involves active compensatory brain changes that enable people to cope with the challenges posed by drug use,” explains Dr. Rogers. This perspective shifts the focus from attempting to reverse the brain changes associated with addiction to identifying and enhancing the brain’s natural resilience mechanisms.
Their research is based on evidence from stress models, where the concept of resilience has been most thoroughly investigated. In these models, certain individuals show remarkable resilience to stress, avoiding the negative consequences that are often associated with it. Similar protective mechanisms might be at play in addiction resilience. For example, studies have shown that resilient individuals may show enhanced neurogenesis in certain brain regions or possess specific genetic variants that confer protection against addiction.
Dr Rogers and Professor Leslie also highlight the potential for identifying new therapeutic targets by studying resilience. Traditional treatments for addiction often focus on reducing cravings or withdrawal symptoms, but do not address the underlying resilience that prevents most users from becoming addicted in the first place. By understanding how resilience works, researchers could develop therapies that bolster these protective factors, potentially offering stronger and longer-lasting treatment options.
The critical literature review underlines the importance of looking beyond addiction as a “brain disease” and considering it within a broader framework that includes both vulnerability and resilience. This dual approach could lead to a more comprehensive understanding of addiction and, ultimately, more effective treatments. “Future research should aim to uncover the full spectrum of responses to addictive substances, not just pathological ones,” says Professor Leslie. “By doing so, we can better support those at risk and help more people recover from addiction.”
Dr Rogers and Professor Leslie’s call for a renewed focus on resilience in addiction research is timely, given the current opioid crisis and rising rates of addiction around the world. Their work suggests that a more balanced approach, taking into account both vulnerability and resilience, could lead to advances in how we treat and prevent addiction.
Journal reference
Rogers, A., & Leslie, F. (2024). “Addiction Neurobiologists Should Study Resilience.” Addiction Neuroscience, 11, 100152. DOI: https://doi.org/10.1016/j.addicn.2024.100152
About the author
Alexandra Rogers Alexandra is a medical writer and neurobiologist with expertise in pharmacology and neurobiology. She completed her PhD in Pharmacological Sciences at the University of California, Irvine, where she was an NIH T32 and Vertex Pharmaceuticals Fellow. Her career path has taken her from cognitive science, studying the impact of music on memory recall, through retinal degeneration and glial functions in spinal cord injury recovery to identifying and characterizing the neural substrates of addiction resilience. Alexandra is currently a freelance medical writer, collaborating with academic institutions and industrial pharmaceutical companies. She excels in developing and refining scientific papers, including peer-reviewed publications and grant applications to national agencies such as NIH and HHMI.
Alexandra is a passionate advocate for mentoring and professional development. She co-founded a peer mentoring program at UC Irvine and several programs to support undergraduate excellence in her graduate research group. Alexandra resides in San Francisco with her partner and cats. She enjoys hiking, gardening, and reading, and finds inspiration in the endless possibilities of science and imagination.
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