Departments of Psychiatry and Pharmacology, University of Texas Health Science Center at San Antonio, United States.
Departments of Psychiatry and Pharmacology, University of Texas Health Science Center at San Antonio, United States.
Pharmacol Biochem Behav. 2018 Jan;164:62-70. doi: 10.1016/j.pbb.2017.05.002. Epub 2017 May 2.
Addiction is continued drug use despite its harm. As one always has alternatives, addiction can be construed as a decision to allocate behavior to drug use. While decision making is commonly discussed and studied as if it resulted from deliberative, evaluative processes, such processes are actually only rarely involved in behavior allocation. These deliberative processes are too slow, effortful and inefficient to guide behavior other than when necessary. Rather, most actions are guided by faster, more automatic processes, often labeled habits. Habits are mostly adaptive, and result from repeated reinforcement leading to over-learned behavior. Habitual behavior occurs rapidly in response to particular contexts, and the behavior occurring first is that which occurs, i.e., the behavior that is decided upon. Thus, as drug use becomes habitual, drug use is likely to be chosen over other available activities in that particular context. However, while drug use becoming habitual is necessary for addiction to develop, it is not sufficient. Typically, constraints limit even habitual drug use to safer levels. These constraints might include limiting occasions for use; and, almost always, constraints on amount consumed. However, in a minority of individuals, drug use is not sufficiently constrained and addiction develops. This review discusses the nature of these constraints, and how they might fail. These failures do not result from abnormal learning processes, but rather unfortunate interactions between a person and their environment over time. These accumulate in the maladaptive allocation of behavior to drug use. This Behavior Allocation Disorder (BAD) can be reversed; occasionally easily when the environment significantly changes, but more often by the arduous application of deliberative processes generally absent from decision making. These deliberative processes must continue until new more adaptive habits become the most probable behavior in the contexts encountered. As alternatives to drug use become the most probable behavior, relapse risk diminishes.
成瘾是指尽管明知有害仍继续使用药物。由于人们总是有其他选择，因此成瘾可以被理解为一种将行为分配给药物使用的决策。虽然决策通常被讨论和研究，好像它是由深思熟虑、评估性的过程产生的，但实际上，这些过程很少涉及行为分配。这些深思熟虑的过程太慢、太费力且效率低下，无法指导除必要时以外的行为。相反，大多数行为都是由更快、更自动的过程指导的，这些过程通常被标记为习惯。习惯主要是适应性的，是由于反复强化导致过度学习的行为而产生的。习惯性行为会迅速响应特定情境而发生，首先发生的行为就是发生的行为，即做出的决定。因此，随着药物使用变得习惯化，在特定情境下，药物使用可能会被选择，而不是其他可用的活动。然而，虽然药物使用变得习惯化是成瘾发展的必要条件，但这还不够。通常情况下，即使是习惯性药物使用也会受到限制，以保持在更安全的水平。这些限制可能包括限制使用的场合；而且，几乎总是限制消耗的数量。然而，在少数人中，药物使用没有受到足够的限制，因此成瘾发展了。本综述讨论了这些限制的性质，以及它们是如何失效的。这些失败不是由于异常的学习过程，而是由于一个人与他们的环境随着时间的推移而不幸的相互作用。这些相互作用导致行为习惯化分配到药物使用上的不良适应。这种行为分配障碍（BAD）是可以逆转的；在环境发生重大变化时，偶尔很容易逆转，但更常见的是通过通常不存在于决策中的深思熟虑的过程的艰苦应用。这些深思熟虑的过程必须继续，直到新的更适应的习惯成为在遇到的情境中最可能的行为。随着替代药物使用的行为成为最可能的行为，复发的风险会降低。
