Heinz Andreas, Beck Anne, Halil Melissa Gül, Pilhatsch Maximilian, Smolka Michael N, Liu Shuyan
Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin (Campus Charité Mitte), 10117 Berlin, Germany.
Department of Psychiatry and Psychotherapy, Technische Universität Dresden, 01187 Dresden, Germany.
J Clin Med. 2019 Jul 24;8(8):1086. doi: 10.3390/jcm8081086.
Individuals with substance use disorders (SUDs) have to cope with drug-related cues and contexts which can affect instrumental drug seeking, as shown with Pavlovian-to-instrumental transfer (PIT) tasks among humans and animals. Our review addresses two potential mechanisms that may contribute to habitual or even compulsive drug seeking and taking. One mechanism is represented by Pavlovian and PIT effects on drug intake. The other is a shift from goal-directed to habitual drug intake, which can be accessed via model-based versus model-free decision-making in respective learning tasks. We discuss the impact of these learning mechanisms on drug consumption. First, we describe how Pavlovian and instrumental learning mechanisms interact in drug addiction. Secondly, we address the effects of acute and chronic stress exposure on behavioral and neural PIT effects in alcohol use disorder (AUD). Thirdly, we discuss how these learning mechanisms and their respective neurobiological correlates can contribute to losing versus regaining control over drug intake. Utilizing mobile technology (mobile applications on smartphones including games that measure learning mechanisms, activity bracelets), computational models, and real-world data may help to better identify patients with a high relapse risk and to offer targeted behavioral and pharmacotherapeutic interventions for vulnerable patients.
患有物质使用障碍（SUDs）的个体必须应对与药物相关的线索和情境，这可能会影响工具性药物寻求行为，正如人类和动物的巴甫洛夫到工具性转移（PIT）任务所显示的那样。我们的综述探讨了两种可能导致习惯性甚至强迫性药物寻求和使用的潜在机制。一种机制表现为巴甫洛夫效应和PIT对药物摄入的影响。另一种是从目标导向性药物摄入向习惯性药物摄入的转变，这可以通过各自学习任务中基于模型与无模型的决策来探究。我们讨论了这些学习机制对药物消费的影响。首先，我们描述巴甫洛夫学习机制和工具性学习机制在药物成瘾中是如何相互作用的。其次，我们探讨急性和慢性应激暴露对酒精使用障碍（AUD）中行为和神经PIT效应的影响。第三，我们讨论这些学习机制及其各自的神经生物学关联如何导致对药物摄入失去控制与重新获得控制。利用移动技术（智能手机上的移动应用程序，包括测量学习机制的游戏、活动手环）、计算模型和现实世界数据，可能有助于更好地识别具有高复发风险的患者，并为易患患者提供有针对性的行为和药物治疗干预措施。
