Bradley B P
Department of Experimental Psychology, University of Cambridge, UK.
Br J Addict. 1990 Nov;85(11):1417-9; discussion 1429-31. doi: 10.1111/j.1360-0443.1990.tb01622.x.
Marks' editorial is welcome in that is suggests common treatment approaches for chemical and behavioural addictions, namely, exposure and relapse prevention. There are other common features of addictive substances or activities which may explain their addictive potential: they act as operant reinforcers and as Pavlovian unconditioned stimuli, tolerance develops, an initial positive mood is followed by dysphoria and addictions are stimulated by common states (arousal, stress, pain). Most of Marks' features are not unique to addictions but apply to primary drive states (normal eating, sleeping, elimination, sex) and many apply to normal goal-orientated behaviour. Normal repetitive behaviour is more flexible than addictive behaviour, in allowing satisfactory substitution of alternatives. The restrictive range of activities which are satisfactory for the addict suggest that building up the behavioural repertoire may help in prevention and rehabilitation. Tics and Tourette's syndrome should not be regarded as addictions, since they involve simple, involuntary and non-goal-directed behavioural sequences. Considering addictions as goal-directed is important: addicts are often ambivalent about whether they want to give up or continue. This often underlies dropout and relapse. Treatment must address this issue.
马克斯的社论是受欢迎的，因为它提出了针对化学成瘾和行为成瘾的常见治疗方法，即暴露疗法和预防复发。成瘾物质或活动还有其他一些共同特征，这或许可以解释它们的成瘾潜力：它们可作为操作性强化物和巴甫洛夫式无条件刺激物，会产生耐受性，最初的积极情绪之后会出现烦躁不安，且成瘾会受到常见状态（兴奋、压力、疼痛）的刺激。马克斯所提到的大多数特征并非成瘾行为所独有，而是适用于基本驱力状态（正常饮食、睡眠、排泄、性行为），并且许多特征也适用于正常的目标导向行为。正常的重复行为在允许令人满意地替代其他行为方面比成瘾行为更具灵活性。成瘾者感到满意的活动范围有限，这表明增加行为技能储备可能有助于预防和康复。抽动和妥瑞氏综合征不应被视为成瘾，因为它们涉及简单、非自愿且无目标导向的行为序列。将成瘾视为目标导向行为很重要：成瘾者对于是否想要戒除或继续往往矛盾心理。这常常是治疗中断和复发的根本原因。治疗必须解决这个问题。
