强迫性觅药行为与复发。神经适应性、压力及条件因素。
Compulsive drug-seeking behavior and relapse. Neuroadaptation, stress, and conditioning factors.
作者信息
Weiss F, Ciccocioppo R, Parsons L H, Katner S, Liu X, Zorrilla E P, Valdez G R, Ben-Shahar O, Angeletti S, Richter R R
机构信息
Department of Neuropharmacology, Scripps Research Institute, La Jolla, California 92037, USA.
出版信息
Ann N Y Acad Sci. 2001 Jun;937:1-26. doi: 10.1111/j.1749-6632.2001.tb03556.x.
The development of addiction and vulnerability to relapse following withdrawal is proposed to be the result of neuroadaptive processes within the central nervous system that oppose the acute reinforcing actions of drugs of abuse. These changes lead to impairment in the mechanisms that mediate positive reinforcement and the emergence of affective changes such as anxiety, dysphoria, and depression during withdrawal. Considerable evidence exists implicating perturbations in DA and 5-HT transmission in the nucleus accumbens--neurochemical systems that are activated by cocaine and ethanol self-administration and deficient during withdrawal--as potential substrates for these affective changes. In addition, growing evidence suggests that enhanced CRF release in the central nucleus of the amygdala represents a mechanism underlying the anxiogenic and stress-like consequences of withdrawal that are common to all drugs of abuse. A growing body of evidence also implicates dysregulation of the non-neuroendocrine CRF stress system within the central nucleus of the amygdala as a common factor in the anxiogenic and aversive consequences of withdrawal from drugs of abuse. Moreover, a possible link may exist between long-lasting abnormalities in CRF function in the CeA and vulnerability to relapse during protracted abstinence. Another presumably critical element contributing to the chronic relapsing nature of drug addiction is the learned responses to drug-related stimuli. The long-lasting efficacy of drug- and alcohol-associated contextual stimuli in eliciting drug-seeking behavior in animal models of relapse resembles the endurance of conditioned cue reactivity and cue-induced cocaine craving in humans and confirms a significant role of learning factors in the long-lasting addictive potential of cocaine. With cocaine, D1-dependent neural mechanisms within the medial prefrontal cortex and basolateral amygdala may be important substrates for the motivating effects of drug-related environmental stimuli. With ethanol, available data suggest a role for opioid receptors in the mediation of conditioned drug-seeking behavior. Finally, conditioning factors (i.e., exposure to drug-associated stimuli) and stress can interact to augment vulnerability to relapse. This finding emphasizes that it will be important to consider the simultaneous effects of multiple environmental triggers for relapse in the development of treatment and medication strategies.
成瘾的发展以及戒断后复发的易感性被认为是中枢神经系统内神经适应性过程的结果,这些过程与滥用药物的急性强化作用相反。这些变化导致介导正性强化的机制受损,并在戒断期间出现诸如焦虑、烦躁不安和抑郁等情感变化。有大量证据表明,伏隔核中多巴胺(DA)和5-羟色胺(5-HT)传递的紊乱——这些神经化学系统在可卡因和乙醇自我给药时被激活,而在戒断时功能不足——是这些情感变化的潜在基础。此外,越来越多的证据表明,杏仁核中央核中促肾上腺皮质激素释放因子(CRF)释放增加是戒断的致焦虑和应激样后果的一种机制,这是所有滥用药物共有的。越来越多的证据还表明,杏仁核中央核内非神经内分泌CRF应激系统的失调是滥用药物戒断的致焦虑和厌恶后果的一个共同因素。此外,杏仁核中央核中CRF功能的长期异常与长期禁欲期间复发的易感性之间可能存在联系。另一个可能对药物成瘾的慢性复发性起关键作用的因素是对与药物相关刺激的习得反应。在复发动物模型中,与药物和酒精相关的情境刺激在引发觅药行为方面的长期效力类似于人类中条件性线索反应性和线索诱导的可卡因渴望的持续性,并证实了学习因素在可卡因长期成瘾潜力中的重要作用。对于可卡因,内侧前额叶皮质和基底外侧杏仁核内依赖D1的神经机制可能是与药物相关的环境刺激的激励作用的重要基础。对于乙醇,现有数据表明阿片受体在介导条件性觅药行为中起作用。最后,条件因素(即接触与药物相关的刺激)和应激可以相互作用,增加复发的易感性。这一发现强调,在制定治疗和药物策略时,考虑多种环境复发触发因素的同时作用将很重要。