Becker Howard C, Mulholland Patrick J
Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA; Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA; Department of Veterans Affairs RHJ Medical Center, Charleston, SC, USA.
Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA; Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.
Handb Clin Neurol. 2014;125:133-56. doi: 10.1016/B978-0-444-62619-6.00009-4.
Alcohol dependence encompasses a serious medical and societal problem that constitutes a major public health concern. A serious consequence of dependence is the emergence of symptoms associated with the alcohol withdrawal syndrome when drinking is abruptly terminated or substantially reduced. Clinical features of alcohol withdrawal include signs of central nervous system hyperexcitability, heightened autonomic nervous system activation, and a constellation of symptoms contributing to psychologic discomfort and negative affect. The development of alcohol dependence is a complex and dynamic process that ultimately reflects a maladaptive neurophysiologic state. Perturbations in a wide range of neurochemical systems, including glutamate, γ-aminobutyric acid, monoamines, a host of neuropeptide systems, and various ion channels produced by the chronic presence of alcohol ultimately compromise the functional integrity of the brain. These neuroadaptations not only underlie the emergence and expression of many alcohol withdrawal symptoms, but also contribute to enhanced relapse vulnerability as well as perpetuation of uncontrolled excessive drinking. This chapter highlights the hallmark features of the alcohol withdrawal syndrome, and describes neuroadaptations in a wide array of neurotransmitter and neuromodulator systems (amino acid and monoamine neurotransmitter, neuropeptide systems, and various ion channels) as they relate to the expression of various signs and symptoms of alcohol withdrawal, as well as their relationship to the significant clinical problem of relapse and uncontrolled dangerous drinking.
酒精依赖是一个严重的医学和社会问题，是主要的公共卫生关注点。依赖的一个严重后果是，当饮酒突然终止或大幅减少时，会出现与酒精戒断综合征相关的症状。酒精戒断的临床特征包括中枢神经系统过度兴奋的迹象、自主神经系统激活增强，以及一系列导致心理不适和负面影响的症状。酒精依赖的发展是一个复杂而动态的过程，最终反映出一种适应不良的神经生理状态。长期饮酒会导致多种神经化学系统紊乱，包括谷氨酸、γ-氨基丁酸、单胺、许多神经肽系统以及各种离子通道，最终损害大脑的功能完整性。这些神经适应性变化不仅是许多酒精戒断症状出现和表现的基础，还会导致复发易感性增加以及持续无节制的过度饮酒。本章重点介绍酒精戒断综合征的标志性特征，并描述各种神经递质和神经调质系统（氨基酸和单胺神经递质、神经肽系统以及各种离子通道）中的神经适应性变化，这些变化与酒精戒断的各种体征和症状的表现有关，以及它们与复发和无节制危险饮酒这一重大临床问题的关系。
