Haas Charles, Karila Laurent, Lowenstein William
Académie nationale de médecine.
Bull Acad Natl Med. 2009 Apr;193(4):947-62; discussion 962-3.
Cocaine addiction is an important public health problem worldwide, and use of this drug is growing in France. Cocaine produces its psychoactive and addictive effects primarily by acting on the brain's reward system--a set of interconnected regions that regulate pleasure and motivation. An initial short-term effect due to a build-up of the neurochemical dopamine gives rise to euphoria and to a desire to take the drug again. Cocaine's many longer-term effects include addiction, persistent craving and a high risk of relapse. Dysregulation of brain reward pathways is associated with a drastic escalation of drug-seeking behaviors and intake. Cocaine addiction is rapidly progressive and can have severe medical, psychiatric and psychosocial consequences. There are no proven pharmacotherapies for cocaine addiction. However, cocaine addiction being due to a pharmacologically induced reduction in the neuroplasticity of brain circuits mediating normal reward learning, novel pharmacotherapies directly targeting the biological pathology of addiction should be feasible. Progress in the neurobiology of cocaine dependence has enabled researchers to identify medications that might help patients initiate abstinence and avoid relapse. Several such medications, and a vaccine, have given encouraging results in controlled clinical trials with cocaine-dependent patients. Major behavioral therapies have also proven to be effective on cocaine addiction. Treatment approaches combining medication and behavioral intervention are likely to produce the best results.
可卡因成瘾是一个全球性的重要公共卫生问题，且在法国，这种毒品的使用正在增加。可卡因主要通过作用于大脑的奖赏系统——一组调节愉悦感和动机的相互连接的区域，来产生其精神活性和成瘾作用。由于神经化学物质多巴胺的积累而产生的最初短期效应会引发欣快感，并使人产生再次服用该药物的欲望。可卡因的许多长期影响包括成瘾、持续渴望以及高复发风险。大脑奖赏通路的失调与觅药行为和药物摄入的急剧升级有关。可卡因成瘾发展迅速，会产生严重的医学、精神和社会心理后果。目前尚无经证实的治疗可卡因成瘾的药物疗法。然而，由于可卡因成瘾是由药物诱导介导正常奖赏学习的脑回路神经可塑性降低所致，直接针对成瘾生物学病理的新型药物疗法应该是可行的。可卡因依赖神经生物学的进展使研究人员能够识别出可能有助于患者开始戒断并避免复发的药物。几种这样的药物以及一种疫苗，在针对可卡因依赖患者的对照临床试验中取得了令人鼓舞的结果。主要的行为疗法也已被证明对可卡因成瘾有效。药物治疗与行为干预相结合的治疗方法可能会产生最佳效果。
