Seo Dongju, Sinha Rajita
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Handb Clin Neurol. 2014;125:355-68. doi: 10.1016/B978-0-444-62619-6.00021-5.
A major block to recovery from alcoholism is substantial alcohol craving and the chronic relapsing nature of the illness. This chapter reviews relevant structural and functional neuroimaging studies and discusses neural mechanisms underlying alcohol craving and relapse in the context of influential risk factors (i.e., alcohol, alcohol cue, and stress). Review of neuroimaging studies suggests that neuroadaptations in the cortico-striatal-limbic circuit encompassing the medial prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex, striatum, and amygdala significantly contribute to overwhelming alcohol craving and early relapse after a period of abstinence. The cortico-striatal-limbic circuit plays an important role in the modulation of emotion, reward, and decision making. As functional and structural chronic alcohol-related neuroadaptations are consistently reported in this circuit, it is likely that sensitization of this circuit from continued alcohol abuse may contribute to high alcohol craving and early relapse via impairments in the prefrontal executive function related to emotion regulation and decision making. This vulnerable neurobiologic state may be manifested as compulsive craving and intense urge to resume alcohol drinking in the face of environmental risk factors, including alcohol, alcohol cue, or stressful live events.
酗酒康复的一个主要障碍是对酒精的强烈渴望以及该疾病慢性复发性的本质。本章回顾了相关的结构和功能神经影像学研究，并在有影响的风险因素（即酒精、酒精提示物和压力）的背景下讨论了酒精渴望和复发背后的神经机制。神经影像学研究的回顾表明，包括内侧前额叶皮质、眶额皮质、前扣带回皮质、纹状体和杏仁核在内的皮质-纹状体-边缘回路中的神经适应性变化，在很大程度上导致了在一段时间的戒酒之后难以抑制的酒精渴望和早期复发。皮质-纹状体-边缘回路在情绪、奖赏和决策的调节中起着重要作用。由于在这个回路中持续报道了与慢性酒精相关的功能和结构神经适应性变化，持续的酒精滥用导致该回路的敏感化可能会通过与情绪调节和决策相关的前额叶执行功能受损，进而导致对酒精的强烈渴望和早期复发。这种脆弱的神经生物学状态可能表现为面对环境风险因素（包括酒精、酒精提示物或压力性生活事件）时，出现强迫性渴望和强烈的饮酒冲动。
