Baler Ruben D, Volkow Nora D
National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA.
Trends Mol Med. 2006 Dec;12(12):559-66. doi: 10.1016/j.molmed.2006.10.005. Epub 2006 Oct 27.
The nature of addiction is often debated along moral versus biological lines. However, recent advances in neuroscience offer insights that might help bridge the gap between these opposing views. Current evidence shows that most drugs of abuse exert their initial reinforcing effects by inducing dopamine surges in limbic regions, affecting other neurotransmitter systems and leading to characteristic plastic adaptations. Importantly, there seem to be intimate relationships between the circuits disrupted by abused drugs and those that underlie self-control. Significant changes can be detected in circuits implicated in reward, motivation and/or drive, salience attribution, inhibitory control and memory consolidation. Therefore, addiction treatments should attempt to reduce the rewarding properties of drugs while enhancing those of alternative reinforcers, inhibit conditioned memories and strengthen cognitive control. We posit that the time has come to recognize that the process of addiction erodes the same neural scaffolds that enable self-control and appropriate decision making.
成瘾的本质常常在道德与生物学的层面上被争论。然而，神经科学的最新进展提供了一些见解，可能有助于弥合这些对立观点之间的差距。目前的证据表明，大多数滥用药物通过在边缘区域诱导多巴胺激增来发挥其最初的强化作用，影响其他神经递质系统，并导致特征性的可塑性适应。重要的是，被滥用药物破坏的神经回路与那些构成自我控制基础的神经回路之间似乎存在密切关系。在与奖赏、动机和/或驱力、显著性归因、抑制控制和记忆巩固相关的神经回路中可以检测到显著变化。因此，成瘾治疗应试图降低药物的奖赏特性，同时增强替代强化物的奖赏特性，抑制条件性记忆，并加强认知控制。我们认为，现在是时候认识到成瘾过程会侵蚀那些实现自我控制和做出适当决策的相同神经支架了。
