Childress A R, Hole A V, Ehrman R N, Robbins S J, McLellan A T, O'Brien C P
Addiction Treatment Research Center, University of Pennsylvania School of Medicine, Philadelphia.
NIDA Res Monogr. 1993;137:73-95.
Despite a venerable history dating back to Pavlov and countless testimonials from patients such as those in the opening paragraphs of this chapter, there is much that remains to be learned about drug signals and, particularly, about ways of reducing their adverse effects on human drug users. There is a substantial amount of data showing increased craving and signs of physiological arousal to drug-related versus neutral cues in drug users for both drug classes reviewed here. Additional controlled studies will be useful in refining which responses among those studied are, in fact, conditioned in origin and therefore can be subjected reasonably to learning-based interventions. Most attempts to modify cue responsivity for clinical benefit have met with only modest success, and there is ample room for creative, but controlled, treatment-outcome studies. In recent years, several other groups have joined in the effort to understand drug-related cue reactivity, extending the research area to alcohol and nicotine (Monti et al. 1987; Niaura et al. 1988, 1989; Cooney et al. 1984; Hodgson and Rankin 1982; Drummond 1990; Laberg 1990). The interested reader is referred to several additional reviews of cue reactivity and cue exposure research related to alcohol and nicotine (Niaura 1988; Drummond 1990; Laberg 1990), opiates (Powell 1990), opiates and cocaine (Childress et al. 1988b; O'Brien et al. 1990), and all the preceding areas (Rohsenow et al. 1991).
尽管其历史可追溯到巴甫洛夫时代，且有无数患者的见证，比如本章开头段落中提到的那些患者，但关于药物信号，尤其是关于减少其对人类吸毒者不良影响的方法，仍有许多有待了解的地方。有大量数据表明，对于此处所回顾的两类药物，吸毒者对与药物相关的线索相较于中性线索会表现出更强的渴望以及生理唤起迹象。更多的对照研究将有助于明确所研究的哪些反应实际上是源于条件作用，因而能够合理地接受基于学习的干预措施。大多数旨在改善线索反应性以获得临床益处的尝试仅取得了有限的成功，仍有很大空间开展创新但可控的治疗效果研究。近年来，其他几个研究团队也加入到理解与药物相关的线索反应性的工作中，将研究领域扩展到了酒精和尼古丁（蒙蒂等人，1987年；尼亚乌拉等人，1988年、1989年；库尼等人，1984年；霍奇森和兰金，1982年；德拉蒙德，1990年；拉伯格，1990年）。感兴趣的读者可参考其他几篇关于与酒精和尼古丁（尼亚乌拉，1988年；德拉蒙德，1990年；拉伯格，1990年）、阿片类药物（鲍威尔，1990年）、阿片类药物和可卡因（奇尔德雷斯等人，1988b；奥布赖恩等人；1990年）以及上述所有领域（罗森诺等人，1991年）相关的线索反应性和线索暴露研究的综述。
