Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
Department of Psychology, The University of Memphis, 202 Psychology Building, Memphis, TN 38152, USA; Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 152 Merrimac St, Boston MA, 02135 USA.
Pharmacol Biochem Behav. 2023 Aug;229:173603. doi: 10.1016/j.pbb.2023.173603. Epub 2023 Jul 22.
While social context has long been considered central to substance use disorder prevention and treatment and many drug-taking events occur in social settings, experimental research on social context has historically been limited. Recent years have seen an emergence of concerted preclinical and human laboratory research documenting the direct impact of social context on substance use, delineating behavioral and neurobiological mechanisms underlying social influence's role. We review this emerging preclinical and human laboratory literature from a theoretical lens that considers distinct stages of the addiction process including drug initiation/acquisition, escalation, and recovery. A key conclusion of existing research is that the impact of the social environment is critically moderated by the drug-taking behavior and drug use history of a social peer. Specifically, while drug-free social contexts can reduce the likelihood of drug use initiation and act as a competitive non-drug alternative preventing escalation, drug-using peers can equally facilitate initiation and escalation through peer modeling as a contingent reward of use. Likewise, social context may facilitate recovery or serve as a barrier that increases the chances of a return to regular use. We conclude by discussing evidence-based treatments and recovery support services that explicitly target social mechanisms or that have identified social context as a mechanism of change within treatment. Ultimately, new areas for research including the expansion of drug classes studied and novel human laboratory designs are needed to further translate emerging findings into clinical practice.
虽然社会环境一直被认为是物质使用障碍预防和治疗的核心，许多药物使用事件发生在社会环境中，但历史上对社会环境的实验研究一直受到限制。近年来，越来越多的临床前和人体实验室研究集中在记录社会环境对物质使用的直接影响，阐明社会影响作用的行为和神经生物学机制。我们从一个理论视角回顾了这一新兴的临床前和人体实验室文献，该视角考虑了成瘾过程的不同阶段，包括药物开始/获得、升级和恢复。现有研究的一个关键结论是，社会环境的影响受到社交伙伴的药物使用行为和药物使用史的严格调节。具体来说，虽然无毒品的社会环境可以降低药物使用开始的可能性，并作为一种竞争性的非药物替代物来防止升级，但使用毒品的同伴同样可以通过同伴模仿作为使用的附带奖励来促进药物使用的开始和升级。同样，社会环境可以促进康复，也可以作为一个障碍，增加恢复后重新开始常规使用的可能性。最后，我们讨论了基于证据的治疗方法和康复支持服务，这些方法明确针对社会机制，或已经将社会环境确定为治疗过程中的一种变化机制。最终，需要新的研究领域，包括扩展研究的药物类别和新颖的人体实验室设计，将新兴发现进一步转化为临床实践。
