School of Psychology, UNSW Sydney, Sydney, NSW, 2052, Australia.
Florey Institute of Neuroscience and Mental Health, Parkville, VIC, 3010, Australia.
Mol Psychiatry. 2023 Jun;28(6):2228-2237. doi: 10.1038/s41380-023-02040-z. Epub 2023 Mar 30.
The persistence of drug taking despite its adverse consequences plays a central role in the presentation, diagnosis, and impacts of addiction. Eventual recognition and appraisal of these adverse consequences is central to decisions to reduce or cease use. However, the most appropriate ways of conceptualizing persistence in the face of adverse consequences remain unclear. Here we review evidence that there are at least three pathways to persistent use despite the negative consequences of that use. A cognitive pathway for recognition of adverse consequences, a motivational pathway for valuation of these consequences, and a behavioral pathway for responding to these adverse consequences. These pathways are dynamic, not linear, with multiple possible trajectories between them, and each is sufficient to produce persistence. We describe these pathways, their characteristics, brain cellular and circuit substrates, and we highlight their relevance to different pathways to self- and treatment-guided behavior change.
尽管存在不良后果，但仍坚持吸毒，这在成瘾的表现、诊断和影响中起着核心作用。最终认识和评估这些不良后果是决定减少或停止使用的核心。然而，面对不良后果，最恰当的坚持方式仍不清楚。在这里，我们回顾了一些证据，表明尽管使用会带来负面后果，但至少有三种途径可以持续使用。一种是对不良后果的认知途径，一种是对这些后果的价值评估的动机途径，还有一种是对这些不良后果做出反应的行为途径。这些途径是动态的，不是线性的，它们之间有多种可能的轨迹，每一种途径都足以产生坚持。我们描述了这些途径，它们的特征，大脑细胞和电路基质，并强调了它们与不同的自我和治疗引导的行为改变途径的相关性。
