Noël Xavier, Bechara Antoine, Brevers Damien, Verbanck Paul, Campanella Salvatore
Laboratory of Medical Psychology, CHU-Brugmann, Psychiatry Department, University of Brussels, Belgium.
J Psychophysiol. 2010 Jan 1;24(4):240-248. doi: 10.1027/0269-8803/a000037.
Like other addictions, alcoholism reflects the continuation of alcohol use despite negative consequences (e.g., an ulcer or family problems made worse by alcohol consumption). Recent cognitive theories suggest that optimal information processing related to the capacity to make decisions under uncertainty conditions is impaired either prior to the initiation of alcohol use, or it is related to the consequence of its repeated utilization. In this paper, we suggest that alcoholism may be the product of an imbalance between two separate, but interacting, cognitive registers that contribute to decision making: a reactive/automatic attentional and memory system for signaling the presence of alcohol cues in the environment and for attributing to such cues pleasure and/or excitement; and a reflective/nonautomatic system for regulating the dominant reactive/automatic response. Hyperactivity within the reactive system can override the reflective system and brain/cognitive changes induced by ethanol could lead to the disruption of self-regulation. We finally develop the idea that different patterns of imbalance between reactive and reflective systems could lead to distinct patterns of clinical impulsivity involved in the vulnerability to, the development of, and the relapse into alcoholism.
与其他成瘾行为一样，酗酒反映出尽管存在负面后果（例如，饮酒使溃疡或家庭问题恶化），但仍持续饮酒的情况。最近的认知理论表明，与在不确定条件下做出决策的能力相关的最佳信息处理，在开始饮酒之前就已受损，或者它与反复饮酒的后果有关。在本文中，我们认为酗酒可能是两种相互独立但又相互作用的认知机制之间失衡的产物，这两种机制有助于决策：一种是反应性/自动注意和记忆系统，用于在环境中识别酒精线索的存在，并将愉悦和/或兴奋归因于此类线索；另一种是反思性/非自动系统，用于调节占主导地位的反应性/自动反应。反应性系统的过度活跃可能会压倒反思性系统，而乙醇引起的大脑/认知变化可能会导致自我调节的破坏。我们最终提出这样的观点，即反应性和反思性系统之间不同的失衡模式可能导致与酗酒易感性、发展及复发相关的不同临床冲动模式。
