压力在药物成瘾中的作用。综合述评。

The role of stress in drug addiction. An integrative review.

机构信息

Department of Psychobiology, Methodology and Behavioral Sciences, Faculty of Psychology, University of Salamanca, Spain.

出版信息

Physiol Behav. 2019 Apr 1;202:62-68. doi: 10.1016/j.physbeh.2019.01.022. Epub 2019 Jan 31.

DOI:10.1016/j.physbeh.2019.01.022

PMID:30711532

Abstract

BACKGROUND

The high prevalence and burden to society of drug abuse and addiction is undisputed. However, its conceptualisation as a brain disease is controversial, and available interventions insufficient. Research on the role of stress in drug addiction may bridge positions and develop more effective interventions.

AIM

The aim of this paper is to integrate the most influential literature to date on the role of stress in drug addiction.

METHODS

A literature search was conducted of the core collections of Web of Science and Semantic Scholar on the topic of stress and addiction from a neurobiological perspective in humans. The most frequently cited articles and related references published in the last decade were finally redrafted into a narrative review based on 130 full-text articles.

RESULTS AND DISCUSSION

First, a brief overview of the neurobiology of stress and drug addiction is provided. Then, the role of stress in drug addiction is described. Stress is conceptualised as a major source of allostatic load, which result in progressive long-term changes in the brain, leading to a drug-prone state characterized by craving and increased risk of relapse. The effects of stress on drug addiction are mainly mediated by the action of corticotropin-releasing factor and other stress hormones, which weaken the hippocampus and prefrontal cortex and strengthen the amygdala, leading to a negative emotional state, craving and lack of executive control, increasing the risk of relapse. Both, drugs and stress result in an allostatic overload responsible for neuroadaptations involved in most of the key features of addiction: reward anticipation/craving, negative affect, and impaired executive functions, involved in three stages of addiction and relapse.

CONCLUSION

This review elucidates the crucial role of stress in drug addiction and highlights the need to incorporate the social context where brain-behaviour relationships unfold into the current model of addition.

摘要

背景

药物滥用和成瘾的高患病率和对社会的高负担是无可争议的。然而，将其概念化为一种脑部疾病存在争议，并且现有的干预措施也不足。研究压力在药物成瘾中的作用可能会弥合立场并开发更有效的干预措施。

目的

本文的目的是整合迄今为止关于压力在药物成瘾中作用的最具影响力的文献。

方法

从神经生物学的角度，对 Web of Science 和 Semantic Scholar 的核心集合进行了关于压力和成瘾的文献检索。最后，根据过去十年中发表的最常被引用的文章和相关参考文献，基于 130 篇全文文章重新起草了一篇叙述性综述。

结果与讨论

首先，简要概述了应激和药物成瘾的神经生物学。然后，描述了压力在药物成瘾中的作用。压力被概念化为适应负荷的主要来源，这会导致大脑发生进行性的长期变化，导致易成瘾状态，表现为渴望和复发风险增加。压力对药物成瘾的影响主要通过促肾上腺皮质释放因子和其他应激激素的作用来介导，这些激素削弱了海马体和前额叶皮层，增强了杏仁核，导致负面情绪状态、渴望和缺乏执行控制，增加了复发的风险。药物和压力都会导致适应负荷过载，这是与成瘾的大多数关键特征相关的神经适应的原因：奖励预期/渴望、负面情绪和执行功能受损，涉及成瘾和复发的三个阶段。