Lalanne L, Laprevote V, Danion J-M, Bacon E
Service de psychiatrie 1, clinique psychiatrique, CHU de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg cedex, France; Inserm 1114, CHU de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
Maison des addictions, CHU de Nancy, 54000 Nancy, France; CIC-Inserm 9501, centre d'investigation clinique, CHU de Nancy, 54000 Nancy, France.
Encephale. 2016 Jun;42(3):264-9. doi: 10.1016/j.encep.2014.10.027. Epub 2016 Feb 11.
Addictions can be regarded as cognitive disorders related to neurobiological impairments. On the one hand, some cognitive impairments occur as a result of substance intake and withdrawal upon stopping intake, while, on the other hand, cognitive mechanisms are responsible for initiating and maintaining addiction. In this review, we detail the memory and temporal mechanisms involved in this pathology.
We reviewed the literature dedicated to the mechanisms of conditioning association between a substance and a context, and the memory and temporal mechanisms involved in the maintenance of addiction. Cognitive impairments in this context are accompanied by both short-term and long-term neurobiological disorders.
Drug-context conditioning is dependent on learning abilities in rats and humans, and it is the first step towards the development of an addiction. In fact, with the beginning of an addiction, it is the context associated with the substance intake, which determines the reinforcing factors (such as pleasure in the case of drug consumption) for the development of an addiction. Maintenance of addiction is related to the persistence of this association between context and substance. Furthermore, the impulsiveness of patients renders them unable to delay their gratification. Consequently, even if delayed gratifications are more valuable, patients prefer immediate gratification such as substance use.
The memory and temporal mechanisms of addiction are central to the initiation and maintenance of drug addiction. They also affect patients' ability to develop projects for the future. The salience of the memory association between drug and context is accompanied by a decline in autobiographical memories, which become poor and lacking in detail. It is probably these impairments which are responsible for the difficulty that the patients have while investigating their story during psychotherapy. On the other hand, given that even though delayed gratification is greater patients prefer immediate gratification, they have difficulty making plans for the future and constructing their own personality. These cognitive impairments are sustained by neurobiological correlates such as dopamine dysregulation in the short-term and changes in neural plasticity in the cortico-meso-limbic system in the long term.
We reviewed full arguments which highlight that addiction is mediated by cognitive mechanisms which are related on the one hand to clinical symptoms and, on the other hand, to neurobiological alterations. According to the literature, memory and time mechanisms seem to be central to the initiation and maintenance of addictive behaviours. More research is needed to improve our knowledge of the cognitive mechanisms of addiction and to develop new tools for treating patients.
成瘾可被视为与神经生物学损伤相关的认知障碍。一方面，一些认知损伤是物质摄入以及停止摄入后戒断的结果，而另一方面，认知机制负责启动和维持成瘾。在本综述中，我们详细阐述了与这种病理状况相关的记忆和时间机制。
我们回顾了专门探讨物质与情境之间条件性关联机制以及成瘾维持过程中涉及的记忆和时间机制的文献。在这种情况下，认知损伤伴随着短期和长期的神经生物学紊乱。
药物 - 情境条件作用取决于大鼠和人类的学习能力，且是成瘾发展的第一步。事实上，随着成瘾的开始，与物质摄入相关的情境决定了成瘾发展的强化因素（如药物消费时的愉悦感）。成瘾的维持与情境和物质之间这种关联的持续存在有关。此外，患者的冲动性使他们无法延迟满足。因此，即使延迟满足更有价值，患者仍更喜欢即时满足，如使用物质。
成瘾的记忆和时间机制对于药物成瘾的启动和维持至关重要。它们还会影响患者规划未来的能力。药物与情境之间记忆关联的显著性伴随着自传体记忆的衰退，这些记忆变得贫乏且缺乏细节。可能正是这些损伤导致患者在心理治疗过程中讲述自己经历时存在困难。另一方面，鉴于即使延迟满足更大，患者仍更喜欢即时满足，他们在规划未来和塑造自身性格方面存在困难。这些认知损伤由神经生物学关联维持，短期来看是多巴胺调节异常，长期来看是皮质 - 中脑 - 边缘系统神经可塑性的变化。
我们全面回顾了相关论据，这些论据强调成瘾是由认知机制介导的，这些认知机制一方面与临床症状相关，另一方面与神经生物学改变相关。根据文献，记忆和时间机制似乎对于成瘾行为的启动和维持至关重要。需要更多研究来增进我们对成瘾认知机制的了解，并开发治疗患者的新工具。
