Kakko Johan, Alho Hannu, Baldacchino Alexander, Molina Rocío, Nava Felice Alfonso, Shaya Gabriel
Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden.
Department of Public Health Solutions, The Alcohol, Drugs and Addictions Unit, National Institute of Health and Welfare, Helsinki, Finland.
Front Psychiatry. 2019 Aug 30;10:592. doi: 10.3389/fpsyt.2019.00592. eCollection 2019.
Opioid use disorder (OUD) is a major public health issue that has reached epidemic levels in some parts of the world. It is a chronic and complex neurobiological disease associated with frequent relapse to drug taking. Craving, defined as an overwhelmingly strong desire or need to use a drug, is a central component of OUD and other substance use disorders. In this review, we describe the neurobiological and neuroendocrine pathways that underpin craving in OUD and also focus on the importance of assessing and treating craving in clinical practice. Craving is strongly associated with patients returning to opioid misuse and is therefore an important treatment target to reduce the risk of relapse and improve patients' quality of life. Opioid agonist therapies (OAT), such as buprenorphine and methadone, can significantly reduce craving and relapse risk, and it is essential that patients are treated optimally with these therapies. There is also evidence to support the benefits of non-pharmacological approaches, such as cognitive behavioral therapy and mindfulness-based interventions, as supplementary treatments to opioid agonist therapies. However, despite the positive impact of these treatments on craving, many OUD patients continue to suffer with negative affect and dysphoria. There is a clear need for further studies to progress our understanding of the neurobiological basis of craving and addiction and to identify novel therapeutic strategies as well as to optimize the use of existing treatments to improve outcomes for the growing numbers of patients affected by OUD.
阿片类物质使用障碍（OUD）是一个重大的公共卫生问题，在世界某些地区已达到流行程度。它是一种慢性且复杂的神经生物学疾病，与频繁复吸吸毒相关。渴望，被定义为对使用毒品的极其强烈的欲望或需求，是阿片类物质使用障碍和其他物质使用障碍的核心组成部分。在本综述中，我们描述了支撑阿片类物质使用障碍中渴望的神经生物学和神经内分泌途径，并还关注在临床实践中评估和治疗渴望的重要性。渴望与患者再次滥用阿片类物质密切相关，因此是降低复吸风险和改善患者生活质量的重要治疗靶点。阿片类激动剂疗法（OAT），如丁丙诺啡和美沙酮，可以显著降低渴望和复吸风险，并且让患者接受这些疗法的最佳治疗至关重要。也有证据支持非药物方法的益处，如认知行为疗法和基于正念的干预措施，作为阿片类激动剂疗法的补充治疗。然而，尽管这些治疗对渴望有积极影响，但许多阿片类物质使用障碍患者仍继续遭受负面影响和烦躁不安。显然需要进一步研究，以增进我们对渴望和成瘾的神经生物学基础的理解，确定新的治疗策略，并优化现有治疗方法的使用，以改善越来越多受阿片类物质使用障碍影响的患者的治疗效果。
