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. Author manuscript; available in PMC: 2021 Jul 1.
Published in final edited form as: J Addict Med. 2020 Jul-Aug;14(4):272–274. doi: 10.1097/ADM.0000000000000575

Figure 1.

Figure 1.

Addiction reflects progressive dopamine system dysregulation and the sensitization of corticotropin-releasing factor and dynorphin brain stress systems, which interact, are subjectively experienced as hypohedonia, and support craving from a negative reinforcement perspective (Koob, 2013). We hypothesize that a neuromodulatory approach can restore these alterations, thus reversing the allostatic load of hedonic dysregulation. Dorsolateral prefrontal cortex stimulation with repetitive transcranial magnetic stimulation possibly produces a “craving downregulated” therapeutic interval, during which compulsivity phenomena (craving driven by hypohedonia) do not interfere with progress in rehabilitation programs. CRF, corticotropin-releasing factor; GABA, γ-aminobutyric acid; NPY, neuropeptide Y.