Department of Psychiatry, Yale University School of Medicine, Yale Stress Center, 2 Church Street South, Suite 209, New Haven, CT 06519, United States.
Curr Opin Neurobiol. 2013 Aug;23(4):649-54. doi: 10.1016/j.conb.2013.05.001. Epub 2013 Jun 10.
Drug craving has re-emerged as a relevant and important construct in the pathophysiology of addiction with its inclusion in DSM-V as a key clinical symptom of addictive disorders. This renewed focus has been due in part to the recent neurobiological evidence on craving-related neural activation and clinical evidence supporting its association with drug use, relapse, and recovery processes. This review covers the neurobiology of drug craving and relapse risk with a primary focus on cocaine addiction and a secondary emphasis on alcohol addiction. A conceptualization of drug craving on the continuum of healthy desire and compulsive seeking, and the associated neurobiological adaptations associated with the development of an increased craving/wanting state is presented. Altered dopamine neurochemistry as well as disrupted prefrontal control and hyperactive striatal-limbic responses in experiencing drug cues, stress, drug intake and in basal relaxed states are identified as neurobiological signatures that predict drug craving and drug use. Thus, the clinical and neurobiological features of the craving/wanting state are presented with specific attention to alterations in these cortico-limbic-striatal and prefrontal self-control circuits that predict drug craving and relapse risk. The methodological challenges that need to be addressed to further develop the evolving conceptual approach to the neuroscience of drug craving is presented, with a focus on identification and validation of biomarkers associated with the craving state and treatment approaches that may be of benefit in reversing the neurobiological adaptations associated with drug craving to improve treatment outcomes in addiction.
药物渴求作为成瘾病理生理学中的一个相关且重要的概念，已重新成为焦点，其在 DSM-V 中的纳入被视为成瘾障碍的关键临床症状之一。这种新的关注部分归因于最近关于与渴求相关的神经激活的神经生物学证据，以及支持其与药物使用、复发和恢复过程相关的临床证据。这篇综述涵盖了药物渴求与复发风险的神经生物学，主要关注可卡因成瘾，并次要强调酒精成瘾。提出了一种将药物渴求概念化在健康欲望和强迫寻求的连续体上，以及与发展增强的渴求/渴望状态相关的神经生物学适应的概念。改变的多巴胺神经化学，以及在经历药物线索、压力、药物摄入和基础放松状态时前额叶控制和纹状体-边缘反应的中断，被确定为预测药物渴求和药物使用的神经生物学特征。因此，呈现了渴求/渴望状态的临床和神经生物学特征，特别关注这些皮质-边缘-纹状体和前额叶自我控制回路的改变，这些改变预测了药物渴求和复发风险。提出了需要解决的方法学挑战，以进一步发展对药物渴求神经科学的不断发展的概念方法，重点是鉴定和验证与渴求状态相关的生物标志物，以及可能有助于逆转与药物渴求相关的神经生物学适应的治疗方法，以改善成瘾治疗的结果。
