Demonstrating that impulsivity is a factor underlying the tendency to escalate drug intake and to relapse after abstinence leaves open the important issue of whether impulsivity is also a vulnerability marker for drug addiction and the compulsive drug seeking this entails. There are relatively few accepted models of compulsive drug seeking, or indeed compulsive behaviour in general, in animals. Perseverative responding in reversal learning tasks may provide one interesting example because this form of compulsion is persistently enhanced following even relatively brief periods of cocaine treatment (
Jentsch et al. 2002;
Calu et al. 2007). In theoretical terms, we have suggested (
Everitt & Robbins 2005) that compulsive drug seeking can be characterized as a maladaptive S–R habit in which the ultimate goal of the behaviour has been devalued, perhaps through tolerance to the rewarding effects of the drug. Instead, drug seeking is increasingly controlled by a succession of drug-associated discriminative stimuli, which also function as conditioned reinforcers when presented as a consequence of instrumental responses, as in the second-order drug-seeking schedule described above. Central to drug addiction, then, is the persisting quality of these habits, which we have suggested (
Everitt & Robbins 2005) may correspond to the subjective state of ‘must do!’—the persistent reinitiation of habitual acts—not least to distinguish it from the subjective state of excessive ‘wanting’ embodied in the incentive salience sensitization view of addiction (
Robinson & Berridge 1993; see
Robinson & Berridge 2008).
In attempting to model drug addiction in animals, we have tried to capture the
compulsive quality of drug seeking by measuring its persistence despite negative or aversive outcomes, as in the DSM-IV. In developing such behavioural procedures, we have shown that compulsive drug seeking only emerges following an extended, or chronic, history of cocaine taking (
Deroche-Gamonet et al. 2004;
Vanderschuren & Everitt 2004;
Pelloux et al. 2007). In the study by
Deroche-Gamonet et al. (2004), three addiction-like behavioural criteria were measured in rats, namely (i) increased motivation to take the drug, (ii) inability to refrain from drug seeking, and (iii) maintained drug use despite aversive consequences. After approximately 40 days of cocaine self-administration, but not at earlier times, some 17% of subjects developed these addiction-like criteria showing increased break points under a progressive ratio of cocaine reinforcement, persistent responding during signalled periods of drug unavailability and, perhaps most importantly, persistence of the instrumental nose-poke response for cocaine even when it was punished by mild footshock. In the study by
Pelloux et al. (2007), rats were trained on the seeking–taking chained schedule with intermittent punishment of the seeking response (i.e. on 50% of the seeking bouts, randomly occurring) to achieve suppression of drug seeking, or abstinence, as described previously. In this study too, whereas all rats suppressed their cocaine seeking after a limited history of cocaine self-administration, after an extended history 17–20% of subjects were completely resistant to punishment, continuing to seek and take drugs despite the ongoing, daily experience of the negative outcome. The proportion of rats compulsively seeking drugs, then, was similar both to that in the Belin study and to the addiction-vulnerable subgroup of human subjects, often estimated to be less than 20% of the population that initially use drugs (
Anthony et al. 1994).
However, the origins of this propensity to seek cocaine
compulsively have not been established. We hypothesized that impulsivity, which we have shown to be associated with low D
2/3 dopamine receptor availability in the ventral striatum and to predict the escalation of cocaine intake (
Dalley et al. 2007), might also confer a vulnerability to develop compulsive drug seeking and addiction following extended access to cocaine. Rats were screened both for impulsivity in the 5-CSSRT and also for the sensation-seeking phenotype of high locomotor responsiveness to novelty (HR rats) which has earlier been suggested to be an addiction vulnerability phenotype (
Piazza et al. 1989). The resultant groups were then studied in the acquisition of cocaine self-administration, and for the emergence of the three addiction-like behavioural criteria identified by
Deroche-Gamonet et al. (2004), but particularly persistent responding for the drug in the face of punishment. As expected, and as reported previously (
Piazza et al. 1989), the HR rats more readily acquired cocaine self-administration and showed an upward shift in the cocaine dose–response curve as compared both with rats with low responses to novelty and also high impulsivity (
Belin et al. 2008). We also confirmed our earlier finding that impulsivity is not associated with more rapid acquisition of cocaine self-administration, but instead with the escalation of cocaine intake. However, and in marked contrast, it was high impulsivity, but not high reactivity to novelty, that predicted the switch (
Leshner 1997) from controlled to compulsive cocaine taking (
Belin et al. 2008). Highly impulsive rats displayed higher addiction scores and much greater resistance to punishment than rats with high or low responses to novelty or low impulsivity (electronic supplementary material, figure S1). In fact, highly impulsive rats did not differ from rats showing the three addiction-like behavioural criteria in any of their addiction-like behaviours after the extended period of cocaine self-administration. Therefore, it seems, perhaps counter-intuitively, that the propensity to acquire cocaine self-administration when first encountering the drug and the vulnerability to develop compulsive cocaine intake (addiction), depend upon distinct and seemingly orthogonal behavioural characteristics—novelty/sensation-seeking versus impulsivity, respectively—each of which might have a genetic or environmental basis. The results of this study also provide experimental evidence that high levels of impulsivity can antedate the onset of compulsive drug use, thereby emphasizing the importance of pre-existing impulsivity seen in individuals addicted to drugs (
Jentsch & Taylor 1999;
Dom et al. 2006).
Now that we have established models of compulsive drug seeking and addiction, it will be possible to investigate not only predisposing factors, such as impulsivity, but also the underlying neurobiological mechanisms. There are several current views about the origins of compulsion within the brain, which are often thought of as being, but in reality are not, mutually exclusive. The neuroadaptations occurring during behavioural sensitization to stimulant drugs have been argued to underlie an extreme incentive motivational state of drug ‘wanting’ (
Robinson & Berridge 1993). According to this view, addicts experience this state especially when exposed to drug-associated cues, which leads to over-activation of the sensitized dopaminergic innervation of the nucleus accumbens, in which plasticity-associated structural changes in dendritic spines have also been observed (
Ferrario et al. 2005). This hypothesis is discussed in detail by
Robinson & Berridge (2008). One interpretation of compulsive drug seeking, then, is that it is a behavioural manifestation of this potentiated motivational state, which has been demonstrated in some studies as an increased break point under progressive ratio schedules of reinforcement (for a review, see
Vezina 2004). However, as noted above, a sensitization treatment regimen with amphetamine also leads to the more rapid instantiation of S–R habits (
Nelson & Killcross 2006) and it is not easy at the behavioural level to differentiate between an increased tendency to repeat drug-seeking responses elicited and maintained by drug-associated stimuli—the ‘must do!’ of
compulsive habits discussed above—from an increased desire for a drug, which might also seem counter-intuitive given the development of tolerance to its rewarding or reinforcing effects.
Perhaps more directly related to the notion of drug seeking as a compulsive habit, however, is the observation of reductions in dopamine D
2 receptors in the dorsal striatum in abstinent alcoholics, cocaine, heroin and methamphetamine addicts (
Volkow & Wise 2005) and also following chronic, but not acute, cocaine self-administration in monkeys (
Moore et al. 1998;
Nader et al. 2002). The consequences of this change in striatal dopamine D
2 receptors for the plasticity underlying instrumental learning and performance is unclear, but an intriguing putative sequential mechanism within the striatum and involving its dopaminergic innervation might be considered. Thus, the early vulnerability to escalate cocaine intake seen in impulsive rats is predicted by low D
2/3 dopamine receptor levels in the
ventral, but not the dorsal striatum (
Dalley et al. 2007). However, this escalated intake may lead to more rapid neuroadaptations, including downregulated D
2 dopamine receptors, in the
dorsal striatum and mediated in part by aberrant engagement of the spiralling striato-nigro-striatal circuitry. This would lead to more rapid consolidation of drug-seeking habits that are difficult to relinquish, despite negative outcomes and are more readily reinstated after abstinence following exposure to response-eliciting drug-associated stimuli.
An alternative account may be provided by the impact of negative reinforcement, as has been suggested to underlie obsessive–compulsive disorder, whereby drug-seeking habits are maintained by the motivation to alleviate or avoid (self-medicate) the negative emotional state and dysregulation resulting from tolerance to, and withdrawal from, drugs taken in increasing amounts over time (
Koob & Le Moal 2001). These counter-adaptations are prevalent in the central and extended amygdala and their motivational impact on drug self-administration is described in detail by
Koob & Le Moal (2008). These mechanisms are not of course mutually exclusive. Addiction to drugs may reflect a combination of increased incentive motivation mediated by the upregulation of ventral striatal dopamine transmission, by ‘hyper-consolidated’ habit learning mediated by upregulated dorsal striatum, dopamine-dependent mechanisms and the drive engendered by negative emotional states in extra-striatal networks.
However, we and others have also hypothesized an additional neurobiological mechanism perhaps arising in part as the direct or indirect consequence of toxic drug effects. This mechanism may be implicated in a shift in balance of behavioural control processes from the prefrontal cortex to the striatum, thereby promoting
compulsive habitual behaviour. There are abundant data suggesting prefrontal cortical, especially orbitofrontal (OFC), dysfunction in addicts, which are also increasingly supported by experimental studies in animals (
Schoenbaum et al. 2006;
Everitt et al. 2007;
Olausson et al. 2007) and humans (see
Garavan et al. 2008). Thus, in cocaine and methamphetamine abusers, reduced activity of the OFC that correlates with reduced D
2/3 dopamine receptors in the striatum (
Volkow et al. 2001), and reduced grey matter volume in this region (
Matochik et al. 2003) have been reported. There are also growing numbers of reports of impaired behavioural and cognitive functions, including poor behavioural adjustment (
Bechara 2005) and impaired probabilistic reversal learning in cocaine abusers (
Ersche et al. 2008), possibly due to reduced inhibitory control. Deficits have been reported in decision-making cognition on computerized versions of a gambling task, when stimulant abusers chose the most favourable option less frequently than control subjects and chose significantly against the odds in risky conditions, suggesting difficulties in estimating outcome probabilities (
Rogers et al. 1999;
Ersche et al. 2005). Similar changes in behaviour are seen in individuals with OFC damage (
Rogers et al. 1999) and this has encouraged the view that chronic drug taking may actually be a causal factor in inducing such prefrontal cortex-dependent deficits. But suboptimal prefrontal cortical, including OFC and anterior cingulate cortex, function (
Volkow & Fowler 2000;
Kaufman et al. 2003;
Hester & Garavan 2004) may also represent a pre-existing vulnerability trait that results in poor decisions and/or a lack of sensitivity to the consequences of such decisions, and hence drug abuse leading to addiction.
Experimental studies primarily involving psychostimulant treatment of rats and monkeys even after brief periods of exposure have supported the view that disrupted OFC function may indeed be a consequence of toxic drug effects during an addict's history of drug abuse (
Jentsch & Taylor 1999;
Schoenbaum et al. 2006). Short term, usually experimenter-, and not self-, administered cocaine or amphetamine enhanced the development of impulsivity (
Jentsch & Taylor 1999;
Roesch et al. 2007). Reversal learning was impaired by cocaine treatment in monkeys (
Jentsch et al. 2002) and rats (
Schoenbaum et al. 2004). Rats having self-administered and then been withdrawn from cocaine exhibited both increased extinction responding and a marked deficit in reversal learning during withdrawal (
Calu et al. 2007). Schoenbaum and colleagues have emphasized the similarity between OFC lesions and these apparently long-lasting effects of relatively short-term treatment with cocaine, and also showed that the deficit in reversal learning is reflected in a change in the properties of OFC neurons, which do not develop appropriate responses to cues predicting outcomes (
Stalnaker et al. 2006).
It is remarkable that even brief periods of drug exposure, whether experimenter administered or self-administered, can result in enduring changes in behaviour indicative of OFC dysfunction. However, in the great majority of imaging and neuropsychological investigations of addicts, there has been an exceptionally long history of drug abuse and often poly-drug abuse. These drug-addicted individuals must represent, therefore, a relatively small proportion of the much larger number of individuals in a population who have abused drugs over varying periods of time, but who have not made the transition to an addicted state as characterized by compulsive drug use. Thus, it would seem unlikely that experimental groups of rats receiving the fairly modest exposure to stimulant drugs in the experiments described above would in any sense fulfil the criteria for addiction, yet the changes in behaviour indicative of OFC dysfunction are seen in the entire population of treated experimental animals. It will be important, therefore, to investigate neurobiologically those models that capture chronic drug self-administration (
Dalley et al. 2005a,
b) and the compulsive drug seeking that develops in vulnerable sub-populations of rats if we are to understand the mechanisms underlying the interaction between predisposing behavioural traits and chronic drug exposure in the development of drug addiction.
The majority of the theorizing and evidence summarized above comes from studies of the neural and psychological basis of the seeking and taking of stimulant drugs such as cocaine. There is clearly a major need for studies of other drugs, especially opiates and alcohol, at both the psychological and neurobiological levels before the generalizability of the mechanisms so defined becomes clear and the gaps in our understanding are filled.