National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
J Am Acad Child Adolesc Psychiatry. 2011 Apr;50(4):329-39. doi: 10.1016/j.jaac.2010.12.008. Epub 2011 Jan 26.
Scientific advances in the field of addiction have forever debunked the notion that addiction reflects a character flaw under voluntary control, demonstrating instead that it is a bona fide disease of the brain. The aim of this review is to go beyond this consensus understanding and explore the most current evidence regarding the vast number of genetic, developmental, and environmental factors whose complex interactions modulate addiction risk and trajectory.
Focusing on childhood and adolescent smoking as a paradigm, we review the important risk factors for the development of addictions, starting at the level of genetics and closing with a focus on sociocultural and policy factors.
A critical review of the pertinent literature provides a detailed view of the cumulative power of risk and protection factors across different phenomenological levels to modulate the risk of undesirable outcomes, particularly for young people. The result represents a compelling argument for the need to engage in comprehensive, multilevel approaches to promoting health.
Today, the field of medicine understands more about disease than about health; however it need not be that way. The view of drug addiction as a systems failure should help refocus our general approach to developing dynamic models and early comprehensive interventions that optimize the ways in which we prevent and treat a complex, developmental disorder such as drug addiction.
成瘾领域的科学进步彻底推翻了这样一种观念，即成瘾反映了可受意志控制的性格缺陷，相反，它是一种真正的大脑疾病。本综述的目的是超越这一共识，探讨大量遗传、发育和环境因素的最新证据，这些因素的复杂相互作用调节成瘾风险和轨迹。
本文以儿童和青少年吸烟为例，综述了成瘾发展的重要危险因素，从遗传学层面开始，最后关注社会文化和政策因素。
对相关文献的批判性回顾提供了一个详细的视角，了解不同现象学层面的风险和保护因素对调节不良结果风险的累积能力，特别是对年轻人而言。这一结果有力地证明了需要采取综合的、多层次的方法来促进健康。
如今，医学领域对疾病的了解多于对健康的了解；然而，情况不一定非得如此。将药物成瘾视为系统故障的观点，应该有助于重新调整我们开发动态模型和早期综合干预的总体方法，以优化我们预防和治疗药物等复杂发育障碍的方式。
