Tobeña A, Fernández-Teruel A, Escorihuela R M, Núñez J F, Zapata A, Ferré P, Sánchez R
Department of Pharmacology and Psychiatry, School of Medicine, Autonomous University of Barcelona, Bellaterra, Catalonia, Spain.
Drug Alcohol Depend. 1993 May;32(3):209-17. doi: 10.1016/0376-8716(93)90085-5.
Problems in the application of exposure techniques to the management of long term dishabituation in addicts are discussed in the light of human and animal evidence. Extinction and habituation of responses to drug cues or drug aftereffects are unstable and strongly dependent on context, thus limiting the effectiveness of cue exposure treatments in the prevention of relapse. Several strategies are suggested to improve the stability of extinction and habituation in order to enduringly prevent relapse in addictions. (i) Warning patients about the episodic resurgence of unexpected urges or cravings precipitated by conditioned contexts and exposing them to such contexts. (ii) To obtain a maximum protection against relapse, extinction should 'recreate' all the original learning contexts (i.e. all possible drug cues). (iii) The behavioral chains involved in self administering drugs ought to be incorporated into cue exposure treatments (without permitting consummatory responses) in order to decrease their signal value as cues for drugs.
根据人类和动物研究证据，探讨了暴露技术在成瘾者长期去习惯化管理应用中的问题。对药物线索或药物后效应的反应消退和习惯化不稳定，且强烈依赖于情境，因此限制了线索暴露疗法在预防复发方面的有效性。文中提出了几种策略来提高消退和习惯化的稳定性，以持久预防成瘾复发。（i）警告患者注意由条件性情境引发的意外冲动或渴望的间歇性复发，并让他们接触此类情境。（ii）为了获得最大程度的防复发保护，消退应“重现”所有原始学习情境（即所有可能的药物线索）。（iii）自我给药所涉及的行为链应纳入线索暴露疗法（不允许有完成性反应），以降低其作为药物线索的信号价值。
