From the National Institute on Drug Abuse, NIH, Bethesda, Md.
Am J Psychiatry. 2018 Aug 1;175(8):729-740. doi: 10.1176/appi.ajp.2018.17101174. Epub 2018 Apr 25.
Addiction, the most severe form of substance use disorder, is a chronic brain disorder molded by strong biosocial factors that has devastating consequences to individuals and to society. Our understanding of substance use disorder has advanced significantly over the last 3 decades in part due to major progress in genetics and neuroscience research and to the development of new technologies, including tools to interrogate molecular changes in specific neuronal populations in animal models of substance use disorder, as well as brain imaging devices to assess brain function and neurochemistry in humans. These advances have illuminated the neurobiological processes through which biological and sociocultural factors contribute to resilience against or vulnerability for drug use and addiction. The delineation of the neurocircuitry disrupted in addiction, which includes circuits that mediate reward and motivation, executive control, and emotional processing, has given us an understanding of the aberrant behaviors displayed by addicted individuals and has provided new targets for treatment. Most prominent are the disruptions of an individual's ability to prioritize behaviors that result in long-term benefit over those that provide short-term rewards and the increasing difficulty exerting control over these behaviors even when associated with catastrophic consequences. These advances in our understanding of brain development and of the role of genes and environment on brain structure and function have built a foundation on which to develop more effective tools to prevent and treat substance use disorder.
成瘾是物质使用障碍中最严重的形式,是一种由强烈的生物社会因素塑造的慢性大脑障碍,对个人和社会都有毁灭性的后果。由于遗传学和神经科学研究的重大进展以及新技术的发展,包括用于在物质使用障碍动物模型中检查特定神经元群体的分子变化的工具,以及用于评估大脑功能和神经化学的脑成像设备,我们对物质使用障碍的理解在过去 30 年中取得了显著进展。这些进展揭示了生物和社会文化因素如何有助于对药物使用和成瘾产生抵抗或易感性的神经生物学过程。成瘾中被打乱的神经回路的描绘,包括介导奖励和动机、执行控制和情绪处理的回路,使我们了解了成瘾者表现出的异常行为,并为治疗提供了新的靶点。最突出的是,个体将导致长期获益的行为优先于提供短期奖励的行为的能力被打乱,即使与灾难性后果相关,个体也越来越难以控制这些行为。这些在我们对大脑发育的理解以及基因和环境对大脑结构和功能的作用方面的进展为开发更有效的预防和治疗物质使用障碍的工具奠定了基础。