A 45-year-old man with a 20-year history of alcohol and stim…
A 45-year-old man with a 20-year history of alcohol and stimulant use disorders presents after a relapse triggered by cue exposure. Neuroimaging research performed during a university addiction study demonstrates reduced basal dopamine release in the ventral striatum, upregulated glutamatergic input from the prefrontal cortex to the nucleus accumbens, and elevated expression of ΔFosB in D1 receptor–expressing medium spiny neurons. Clinically, he reports intense craving, automatic “habit-like” drug-seeking behaviors, and difficulty inhibiting responses despite strong motivation to abstain. Based on these findings, which neurobiological process best explains the patient’s persistent vulnerability to relapse, even after periods of abstinence?