Scherbaum N, Bonnet U
Klinik für Abhängiges Verhalten und Suchtmedizin, LVR-Klinikum Essen, Kliniken der Universität Duisburg-Essen, Virchowstr. 174, 45147, Essen, Deutschland.
Abteilung Psychiatrie und Psychotherapie, EvK Castrop-Rauxel, Castrop-Rauxel, Deutschland.
Anaesthesist. 2019 Mar;68(3):179-190. doi: 10.1007/s00101-019-0557-3.
Opioid dependence is a chronic mental disease with multifactorial etiology. The neurobiological theory of addiction focuses on the manipulation of the dopaminergic reward system as a basic property of substances with addictive potential including opioids. With regular opioid intake, the manipulation of the reward system results in a cognitive bias towards drug-related stimuli. In addition, opioids inhibit the locus caeruleus, resulting in symptoms of sympathetic rebound during opioid detoxification. The pharmacokinetics of opioids also influence the risk of addiction. These biological factors are independent of the legal status of the individual opioid. Genetics also significantly influence the etiology. However, the assignment of this genetic influence is difficult because not only basic biological functions, but also personality traits and mental illnesses are genetically determined.
阿片类物质依赖是一种病因多因素的慢性精神疾病。成瘾的神经生物学理论聚焦于对多巴胺能奖赏系统的操控，这是包括阿片类物质在内的具有成瘾潜力物质的一种基本特性。随着阿片类物质的定期摄入，对奖赏系统的操控会导致对与药物相关刺激的认知偏差。此外，阿片类物质会抑制蓝斑，导致阿片类物质脱毒期间出现交感神经反跳症状。阿片类物质的药代动力学也会影响成瘾风险。这些生物学因素与个体阿片类物质的法律地位无关。遗传学也对病因有显著影响。然而，确定这种遗传影响很困难，因为不仅基本生物学功能，而且人格特质和精神疾病都是由基因决定的。
