Verheul R, van den Brink W, Geerlings P
Amsterdam Institute for Addiction Research, Academical Medical Center, University of Amsterdam (Department of Psychiatry), The Netherlands.
Alcohol Alcohol. 1999 Mar-Apr;34(2):197-222. doi: 10.1093/alcalc/34.2.197.
In this article, by reviewing the psychological, psychophysiological, neurobiological, and psychopharmacological literature on craving for alcohol, it is argued that converging evidence from several disciplines suggests a three-pathway psychobiological model of craving. Essential to this model is the appreciation of the role of individual differences in affect regulation strategies or personality styles, conditionability, sensitivity to alcohol's effects, and related dysregulations in distinct neural circuitries or neurotransmitter systems. These factors are of crucial importance to a proper understanding of the nature of craving, its underlying mechanisms and different manifestations. As a first pathway, it is suggested that reward craving or desire for the rewarding, stimulating and/or enhancing effects of alcohol might result from either dopaminergic/opioidergic dysregulation or a personality style characterized by reward seeking or a combination of both. As a second pathway, it is suggested that relief craving or desire for the reduction of tension or arousal might result from either gamma-aminobutyric acid (GABA)ergic/glutamatergic dysregulation or a personality style characterized by stress reactivity or a combination of both. Obsessive craving, the result of the third pathway, can be defined as lack of control over intrusive thoughts about drinking resulting in impaired functioning. This type of craving might result either from a serotonin deficiency or a personality style characterized by low constraint or disinhibition or a combination of both. The putative implications of this three-pathway model for the assessment of alcohol craving, diagnosis and treatment of alcoholism, and future research on craving, are discussed.
在本文中，通过回顾关于酒精渴望的心理学、心理生理学、神经生物学和精神药理学文献，有人认为来自多个学科的汇聚证据表明了一种三通路的酒精渴望心理生物学模型。该模型的核心在于认识到个体在情感调节策略或人格风格、条件反射能力、对酒精作用的敏感性以及不同神经回路或神经递质系统中相关调节异常方面的差异所起的作用。这些因素对于正确理解渴望的本质、其潜在机制和不同表现至关重要。作为第一条通路，有人提出对奖励的渴望或对酒精奖励、刺激和/或增强作用的欲望可能源于多巴胺能/阿片样物质能调节异常，或源于以追求奖励为特征的人格风格，或两者兼而有之。作为第二条通路，有人提出缓解渴望或对减轻紧张或唤醒的欲望可能源于γ-氨基丁酸（GABA）能/谷氨酸能调节异常，或源于以应激反应性为特征的人格风格，或两者兼而有之。强迫性渴望是第三条通路的结果，可定义为对饮酒的侵入性想法缺乏控制，导致功能受损。这种类型的渴望可能源于血清素缺乏，或源于以低约束或抑制解除为特征的人格风格，或两者兼而有之。本文还讨论了这种三通路模型对酒精渴望评估、酒精中毒诊断和治疗以及未来渴望研究的潜在影响。
