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. Author manuscript; available in PMC: 2023 Sep 1.
Published in final edited form as: Psychiatr Clin North Am. 2022 Jul 31;45(3):321–334. doi: 10.1016/j.psc.2022.05.001

Figure 2:

Figure 2:

The three stages of addiction: Binge/Intoxication, the stage at which an individual consumes an intoxicating substance and experiences its rewarding or pleasurable effects, primarily involves basal ganglia structures; Withdrawal/Negative Affect, the stage at which an individual experiences a negative emotional state in the absence of the substance, involves stress hormone responses and the extended amygdala; and Preoccupation/Anticipation, the stage at which one seeks substances again after a period of abstinence, involving interactions of the prefrontal cortex, the extended amygdala, and the basal ganglia.

(Reproduced from U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, 2016.)

Notes: Blue represents the basal ganglia involved in the Binge/Intoxication stage. Red represents the extended amygdala involved in the Negative Affect/Withdrawal stage. Green represents the prefrontal cortex involved in the Preoccupation/Anticipation stage. Not shown is the neurotransmitter norepinephrine which is also activated in the extended amygdala during withdrawal. PFC - prefrontal cortex, DS - dorsal striatum, NAc - nucleus accumbens, BNST - bed nucleus of the stria terminalis, CeA - central nucleus of the amygdala, VTA - ventral tegmental area.