Abstract
Bipolar disorders (BDs) and addictions constitute reciprocal risk factors and are best considered under a unitary perspective. The concepts of allostasis and allostatic load (AL) may contribute to the understanding of the complex relationships between BD and addictive behaviors. Allostasis entails the safeguarding of reward function stability by recruitment of changes in the reward and stress system neurocircuitry and it may help to elucidate neurobiological underpinnings of vulnerability to addiction in BD patients. Conceptualizing BD as an illness involving the cumulative build-up of allostatic states, we hypothesize a progressive dysregulation of reward circuits clinically expressed as negative affective states (i.e., anhedonia). Such negative affective states may render BD patients more vulnerable to drug addiction, fostering a very rapid transition from occasional drug use to addiction, through mechanisms of negative reinforcement. The resulting addictive behavior-related ALs, in turn, may contribute to illness progression. This framework could have a heuristic value to enhance research on pathophysiology and treatment of BD and addiction comorbidity.
Highlights
Bipolar disorder (BD) is a severe, often chronic condition with lifetime prevalence rates of up to 6.5% for bipolar spectrum disorders in the general population [1]
The rates of alcohol and other substance-use disorder (SUD) are significantly higher in subjects with BD than in the general population [1, 6]
Several studies have aimed to identify the endophenotypical features predisposing to the development of addiction in the general population, as well as in the context of BD
Summary
Bipolar disorder (BD) is a severe, often chronic condition with lifetime prevalence rates of up to 6.5% for bipolar spectrum disorders in the general population [1]. Bipolar patients with comorbid conditions present with a more severe course of illness [8], characterized by an overall worse clinical picture [9], poorer treatment outcome [10,11,12], higher suicidality [13], and mortality [14]. Several studies have aimed to identify the endophenotypical features predisposing to the development of addiction in the general population, as well as in the context of BD. These studies focused on genetic vulnerability, impulsive traits, and decision-making impairment [15,16,17,18,19]
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