Noël Xavier, Brevers Damien, Bechara Antoine
Psychological Medicine Laboratory, Faculty of Medicine, Université Libre de Bruxelles , Brussels , Belgium.
Psychological Medicine Laboratory, Faculty of Medicine, Université Libre de Bruxelles , Brussels , Belgium ; Department of Psychology, Brain and Creativity Institute, University of Southern California , Los Angeles, CA , USA.
Front Psychiatry. 2013 Dec 27;4:179. doi: 10.3389/fpsyt.2013.00179.
According to the triadic neurocognitive model of addiction to drugs (e.g., cocaine) and non-drugs (e.g., gambling), weakened "willpower" associated with these behaviors is the product of an abnormal functioning in one or more of three key neural and cognitive systems: (1) an amygdala-striatum dependent system mediating automatic, habitual, and salient behaviors; (2) a prefrontal cortex dependent system important for self-regulation and forecasting the future consequences of a behavior; and (3) an insula dependent system for the reception of interoceptive signals and their translation into feeling states (such as urge and craving), which in turn plays a strong influential role in decision-making and impulse control processes related to uncertainty, risk, and reward. The described three-systems account for poor decision-making (i.e., prioritizing short-term consequences of a decisional option) and stimulus-driven actions, thus leading to a more elevated risk for relapse. Finally, this article elaborates on the need for "personalized" clinical model-based interventions targeting interactions between implicit processes, interoceptive signaling, and supervisory function aimed at helping individuals become less governed by immediate situations and automatic pre-potent responses, and more influenced by systems involved in the pursuit of future valued goals.
根据药物成瘾（如可卡因成瘾）和非药物成瘾（如赌博成瘾）的三元神经认知模型，与这些行为相关的“意志力”减弱是三个关键神经和认知系统中一个或多个系统功能异常的产物：（1）一个依赖杏仁核-纹状体的系统，介导自动、习惯性和显著行为；（2）一个依赖前额叶皮层的系统，对自我调节和预测行为的未来后果很重要；（3）一个依赖脑岛的系统，用于接收内感受信号并将其转化为感觉状态（如冲动和渴望），这反过来在与不确定性、风险和奖励相关的决策和冲动控制过程中发挥强大的影响作用。所描述的这三个系统导致决策能力差（即优先考虑决策选项的短期后果）和受刺激驱动的行为，从而导致更高的复发风险。最后，本文阐述了基于“个性化”临床模型的干预措施的必要性，这些干预措施针对内隐过程、内感受信号和监督功能之间的相互作用，旨在帮助个体减少受即时情境和自动优势反应的支配，更多地受参与追求未来有价值目标的系统的影响。
