Risky business: emotion, decision-making, and addiction.
Risky business: emotion, decision-making, and addiction.
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DOI：
10.1023/a:1021223113233
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发表时间：
2003-01-01
影响因子：
2.4
通讯作者：
Bechara, Antoine
中科院分区：
文献类型：
--
作者：
Bechara, Antoine
尽管在物质依赖个体(SDI)中观察到眼眶前额叶皮质的代谢异常已有数年，但很少有人注意到该脑区在成瘾中所起的作用。然而，前额叶皮质腹内侧部受损的患者和SDI患者表现出类似的行为。(1)他们经常否认，或者他们没有意识到他们有问题。(2)当面对冒着招致未来负面后果的风险追求立即回报的行动方案时，他们选择了直接回报，而忽视了未来的后果。对双侧前额叶皮质损害患者的研究支持这样的观点，即决策过程在许多重要方面依赖于调节动态平衡、情绪和感觉的神经底物。平行的研究表明，VM皮质功能障碍在对物质上瘾的亚群中也很明显。因此，了解决策的神经机制对于理解成瘾和病理性赌博的障碍，以及从受控行为向失控和强迫行为的转变具有直接意义。在临床方面，治疗成瘾障碍的方法一直被一种专注于行为、身体症状或药物选择的诊断系统所主导。文章强调了使用神经认知标准对成瘾障碍进行亚型划分的概念。这是一个重大的范式转变，对指导诊断和治疗具有重要意义。使用神经认知标准可能会导致对成瘾障碍进行更准确的亚型划分，并可能成为更具体、可能更成功的行为和药物干预的指南。
Although metabolic abnormalities in the orbitofrontal cortex have been observed in substance dependent individuals (SDI) for several years, very little attention was paid to the role of this brain region in addiction. However, patients with damage to the ventromedial (VM) sector of the prefrontal cortex and SDI show similar behaviors. (1) They often deny, or they are not aware, that they have a problem. (2) When faced with a choice to pursue a course of action that brings an immediate reward at the risk of incurring future negative consequences, they choose the immediate reward and ignore the future consequences. Studies of patients with bilateral lesions of the VM prefrontal cortex support the view that the process of decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion, and feeling. Parallel lines of study have revealed that VM cortex dysfunction is also evident in subgroups of individuals who are addicted to substances. Thus, understanding the neural mechanisms of decision-making has direct implications for understanding disorders of addiction and pathological gambling, and the switch from a controlled to uncontrolled and compulsive behavior. On the clinical front, the approach to treat addictive disorders has been dominated by a diagnostic system that focuses on behaviors, physical symptoms, or choice of drugs. The article emphasizes the concept of using neurocognitive criteria for subtyping addictive disorders. This is a significant paradigm shift with significant implications for guiding diagnosis and treatment. Using neurocognitive criteria could lead to more accurate subtyping of addictive disorders, and perhaps serve as a guide for more specific, and potentially more successful, behavioral and pharmacological interventions.