Reconceptualizing addiction as metabolic-arousal dysregulation: a structured theory-synthesis across neurobiological, physiological and psychological domains

The authors aim to reconceptualize addiction by proposing a theory that frames it as a disorder of metabolic-arousal regulation, rather than solely focusing on reward dysregulation and stress neuroadaptation. By synthesizing evidence from neurobiology, physiology, and psychology, they introduce a model that identifies two interacting states—hyperarousal and hypoarousal—that correspond to different phases of the addiction cycle and can be measured through various biomarkers. This approach seeks to integrate existing theories while providing a framework for developing targeted interventions.