Psychiatry and Addiction: A Multi-Faceted Issue—2nd Edition

Dear Colleagues,

Substance use disorders (SUDs) encompass classical psychoactive agents (e.g., ethanol, opioids, and stimulants), novel psychoactive substances (NPSs), and even certain non-psychoactive medications with abuse liability. In contrast, behavioral addictions—such as compulsive eating or hypersexuality—are excluded from common manuals despite converging clinical and neurobiological evidence supporting their inclusion.

At the neuropharmacological level, both substance-related and behavioral addictions are characterized by the dysregulation of meso-corticolimbic dopamine signaling, particularly within the ventral tegmental area (VTA), nucleus accumbens (NAc), and prefrontal cortex (PFC). These circuits mediate reward salience, motivation, and reinforcement learning, and their perturbation underlies compulsive drug seeking and loss of control. Several studies have demonstrated convergent alterations in D1/D2 receptor expression, dopaminergic tone, glutamatergic plasticity, and GABAergic modulation across diverse addictive phenotypes.

Prevalence data suggest frequent co-occurrence of poly-substance use and comorbid behavioral addictions, suggesting a shared neuropharmacological vulnerability.

Hence, it is conceivable to propose a transdiagnostic pharmacological profile supporting the construct of Addiction Spectrum Disorders (ASDs)—a dimensional model recognizing the shared pathophysiological mechanisms underpinning seemingly disparate addictive behaviors.

Finally, the gut–brain axis has emerged as a key regulatory pathway in addiction pathophysiology. Microbiota-derived metabolites, vagal afferents, and neuroendocrine signals converge on central structures implicated in reward and mood regulation. Pharmacological modulation of this axis—through agents affecting gut hormones, microbiota composition, or intestinal permeability—may offer novel strategies for the prevention and treatment of addiction spectrum disorders.

The sub-topics and keywords of this Special Issue are as follows:

• Psychiatric comorbidity: the role of neurotransmitter imbalance, including dopamine/DA pathways;
• Salience and aberrant salience: pharmacological and clinical issues;
• Obesity associated with the prescription of antipsychotics (a reward deficit syndrome?);
• Food and sex addiction: pharmacological and clinical issues;
• Gambling and internet gaming disorder: pharmacological and clinical issues;
• Novel antidiabetics and their interaction with the reward system;
• Novel psychoactive substances;
• Prescription drug misuse.

Prof. Dr. Fabrizio Schifano
Prof. Dr. Norbert Scherbaum
Prof. Dr. Giovanni Martinotti
Guest Editors

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