Sinha Rajita
Department of Psychiatry, Yale University School of Medicine, 34 Park Street Room S110, New Haven, CT 06519, USA.
Curr Top Behav Neurosci. 2013;13:379-402. doi: 10.1007/7854_2011_150.
It is well known that alcoholism is a chronic relapsing illness. While stress significantly impacts alcoholism risk, there is also evidence that increasing levels of alcohol use affect peripheral and central stress and reward pathways thereby setting up a reciprocal relationship among the effects of alcohol consumption of the development, course of and recovery from alcoholism. This chapter reviews our efforts in assessing the integrity of stress pathways in alcoholism by examining whether altered responses of the stress pathways play a role in relapse risk. Using validated human laboratory procedures to model two of the most common situations that contribute to relapse risk, we review how such models in the laboratory can predict subsequent alcohol relapse. Empirical findings from human laboratory and brain imaging studies are reviewed to show that specific stress-related dysregulation accompanies the alcohol craving state in alcohol-dependent individuals, and such dysregulation along with increases in alcohol seeking are predictive of increased alcohol relapse risk. Finally, the significant implications of these findings for the development of novel treatment interventions that target stress processes and alcohol craving to improve alcoholism relapse outcomes are discussed.
众所周知，酒精成瘾是一种慢性复发性疾病。虽然压力会显著影响酒精成瘾风险，但也有证据表明，酒精使用量的增加会影响外周和中枢的压力及奖赏通路，从而在酒精消费对酒精成瘾的发生、发展过程及康复的影响之间建立一种相互关系。本章回顾了我们通过研究压力通路的改变反应是否在复发风险中起作用来评估酒精成瘾中压力通路完整性的工作。使用经过验证的人体实验室程序对导致复发风险的两种最常见情况进行建模，我们回顾了实验室中的此类模型如何预测随后的酒精复发。对人体实验室和脑成像研究的实证结果进行了综述，以表明在酒精依赖个体中，特定的与压力相关的调节异常伴随着酒精渴望状态，并且这种调节异常以及酒精寻求行为的增加预示着酒精复发风险的增加。最后，讨论了这些发现对开发针对压力过程和酒精渴望以改善酒精成瘾复发结果的新型治疗干预措施的重大意义。
