Yücel Murat, Lubman Dan I
Department of Psychiatry, The University of Melbourne, ORYGEN Research Centre, and Melbourne Neuropsychiatry Centre, Melbourne, Victoria, Australia.
Drug Alcohol Rev. 2007 Jan;26(1):33-9. doi: 10.1080/09595230601036978.
Neuropsychological and neuroimaging studies have generated a wealth of data demonstrating structural and functional brain changes, as well as cognitive deficits in drug addicted populations. Despite this, it is often difficult to make generalisations or conclusive statements about the neuropsychological and neurobiological correlates of chronic drug use given variations in the nature or extent of deficits observed within or across different classes of drugs. In this review, we focus specifically on the evidence for impairments in prefrontally-mediated cognitive functions that underlie behavioural regulation, namely decision making and inhibitory control. We argue that impairments in these specific domains, which are often compounded by an earlier initiation of drug use, polydrug abuse, comorbid psychiatric conditions, previous head injury, and acute withdrawal effects can serve to increase the risk for making decisions that are impulsive, focussed on short-terms gains and lack inhibitory control. We further argue that these impairments of prefrontal functioning may underpin the compulsive and 'loss-of-control' pattern of drug-seeking and drug-taking that is characteristic of drug addiction. Finally, we consider the implications of these findings for diagnosis, treatment and prevention, suggesting that a comprehensive understanding of the nature and extent of these cognitive deficits should form a core part of the conceptualization and focus of effective treatment.
神经心理学和神经影像学研究已经产生了大量数据，这些数据表明了药物成瘾人群大脑的结构和功能变化以及认知缺陷。尽管如此，鉴于在不同类别药物内部或之间观察到的缺陷性质或程度存在差异，关于慢性药物使用的神经心理学和神经生物学相关性，往往很难进行概括或得出结论性陈述。在本综述中，我们特别关注前额叶介导的认知功能受损的证据，这些功能是行为调节的基础，即决策和抑制控制。我们认为，这些特定领域的损伤，往往因更早开始使用药物、多药滥用、共病精神疾病、既往头部受伤以及急性戒断效应而加剧，可能会增加做出冲动决策的风险，这些决策侧重于短期收益且缺乏抑制控制。我们进一步认为，前额叶功能的这些损伤可能是药物成瘾所特有的强迫性和“失控”的觅药和用药模式的基础。最后，我们考虑这些发现对诊断、治疗和预防的影响，表明对这些认知缺陷的性质和程度的全面理解应该成为有效治疗概念化和重点的核心部分。
