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作为学习行为而非疾病的成瘾中发生的脑部变化
Brain Change in Addiction as Learning, Not Disease


Marc Lewis ... 其他 • 2018.10.18

在过去30年中,成瘾是一种疾病或病态的假设已经形成了“成瘾的脑病模型”1。这种趋势的驱动因素包括:20世纪下半叶12步戒断法(12-step thinking)与入住戒瘾中心治疗(residential treatment)的融合2、20世纪90年代开始的神经影像技术的爆发,以及专业组织3和社区团体4的推动。根据脑病模型,成瘾是一种慢性疾病,由介导奖励体验和预期的脑部系统发生的变化,以及作为判断和认知控制基础的高阶系统发生的变化引起1,5。该模型的支持者提出,这些变化是由使用成瘾物质或滥用酒精引起,但也研究了行为成瘾的关系6

脑病模型是西方世界获得最广泛认可的成瘾模型。特别是在美国,脑病模型主导着关于预防、治疗、研究计划和政策问题的专业和公共讨论。由于疾病模型集中于脑部变化,因此有助于解释为什么成瘾者很难快速或轻易地改变他们的思维和行为6。因为疾病模型关注的是生物因素而不是道德争论,所以它至少在某些方面帮助减少了成瘾者及其家人所面临的污名(有关污名的广泛讨论,见表1)。脑病模型还使医师和其他医学专业人员在成瘾治疗中的作用合法化,并推动了用于对抗成瘾的新药的研究,该模型还被用于主张成瘾者获得治疗和护理,而不是被隔离和惩罚。





作者信息

Marc Lewis, Ph.D.
From the University of Toronto, Toronto. Address reprint requests to Dr. Lewis at Klingelbeekseweg 24, 6812DH Arnhem, the Netherlands, or at m.lewis@psych.ru.nl.

 

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