Dackis C A, O'Brien C P
Treatment Research Center, University of Pennsylvania, 3900 Chestnut Street, Philadelphia, PA 19104, USA.
J Subst Abuse Treat. 2001 Oct;21(3):111-7. doi: 10.1016/s0740-5472(01)00192-1.
Cocaine addiction affects brain reward centers that have evolved to ensure survival. Cocaine euphoria is intensely pleasurable and results from mesolimbic dopamine (DA) neurotransmission. DA signal-receiving neurons in the nucleus accumbens synthesize endogenous opioids and project to numerous reward regions. Cocaine-induced neuroadaptations, including DA depletion, may underlie craving and hedonic dysregulation. Cue-induced craving is vigorously triggered by conditioned elements of the drug environment and associated with measurable limbic activation. Reduced frontal lobe metabolism in cocaine-addicted individuals could explain important clinical phenomena such as denial and the loss of control over limbic impulses. Cocaine addiction is rapidly progressive and associated with severe medical, psychiatric, and psychosocial consequences. Denial shields addicted individuals from their predicament and must be addressed in treatment. Lacking pharmacological options, clinicians must rely entirely on psychosocial approaches. Treatment principles, including engagement, motivational enhancement, abstinence strategies, and craving reduction are discussed in terms of biological rationales.
可卡因成瘾会影响大脑中为确保生存而进化的奖赏中枢。可卡因带来的欣快感极其愉悦，是由中脑边缘多巴胺（DA）神经传递产生的。伏隔核中接收DA信号的神经元会合成内源性阿片类物质，并投射到众多奖赏区域。可卡因诱导的神经适应性变化，包括DA耗竭，可能是渴望和享乐失调的基础。线索诱导的渴望会被药物环境的条件因素强烈触发，并与可测量的边缘系统激活相关。可卡因成瘾者额叶代谢降低可以解释诸如否认和无法控制边缘冲动等重要临床现象。可卡因成瘾进展迅速，并伴有严重的医学、精神和心理社会后果。否认使成瘾者对自身困境视而不见，在治疗中必须加以解决。由于缺乏药理学选择，临床医生必须完全依赖心理社会方法。从生物学原理的角度讨论了治疗原则，包括参与、动机增强、禁欲策略和减少渴望。
