Negative affective states and cognitive impairments in nicotine dependence.
Negative affective states and cognitive impairments in nicotine dependence.
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DOI：
10.1016/j.neubiorev.2015.06.004
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发表时间：
2015-11
影响因子：
8.2
通讯作者：
Young JW
中科院分区：
文献类型：
--
作者：
Hall FS;Der-Avakian A;Gould TJ;Markou A;Shoaib M;Young JW
吸烟者在戒烟成功率方面有很大的个体差异，以应对目前的尼古丁依赖治疗。这一观察结果可能表明，不同个体持续使用烟草和戒烟的潜在动机不同，可能需要对不同个体进行不同的治疗。尽管大多数尼古丁依赖动物模型强调尼古丁的积极强化作用是尼古丁使用背后的主要动力，但吸烟者通常报告尼古丁使用的其他后果，包括尼古丁缓解负面情感状态或认知障碍的能力，是继续吸烟的原因。这些状态可能由尼古丁戒断引起，但也可能与情感和/或认知功能的病前差异有关。尼古丁对认知和情感的影响可能会减轻这些损害，无论其发病前或发病后的起源（例如，在尼古丁依赖发展之前或之后）。因此，尼古丁缓解这些症状的能力将负面地加强行为，从而维持随后的尼古丁使用，有助于开始吸烟，在戒烟尝试期间进展为依赖和复发。本文综述的人类和动物研究支持这样一种观点，即对发病前和戒断引起的损伤进行自我药物治疗可能是尼古丁成瘾和复发的更重要因素，而不是以前在尼古丁依赖的临床前研究中所认识到的。鉴于尼古丁在这些条件下的各种有益作用，个人可能会出于完全不同的原因吸烟。本综述表明，尼古丁与自我药疗和负强化相关的不同效应的个体间差异是试图了解尼古丁成瘾原因的研究中的一个重要考虑因素，也是开发有效的个性化尼古丁戒烟治疗的重要考虑因素。情感和认知障碍，无论是发病前的起源，或与尼古丁戒断（如上所述）有助于尼古丁依赖。更多地考虑这些过程，以及负强化的潜在作用，需要纳入尼古丁依赖的动物模型。
Smokers have substantial individual differences in quit success in response to current treatments for nicotine dependence. This observation may suggest that different underlying motivations for continued tobacco use across individuals and nicotine cessation may require different treatments in different individuals. Although most animal models of nicotine dependence emphasize the positive reinforcing effects of nicotine as the major motivational force behind nicotine use, smokers generally report that other consequences of nicotine use, including the ability of nicotine to alleviate negative affective states or cognitive impairments, as reasons for continued smoking. These states could result from nicotine withdrawal, but also may be associated with premorbid differences in affective and/or cognitive function. Effects of nicotine on cognition and affect may alleviate these impairments regardless of their premorbid or postmorbid origin (e.g., before or after the development of nicotine dependence). The ability of nicotine to alleviate these symptoms would thus negatively reinforce behavior, and thus maintain subsequent nicotine use, contributing to the initiation of smoking, the progression to dependence and relapse during quit attempts. The human and animal studies reviewed here support the idea that self-medication for pre-morbid and withdrawal-induced impairments may be more important factors in nicotine addiction and relapse than has been previously appreciated in preclinical research into nicotine dependence. Given the diverse beneficial effects of nicotine under these conditions, individuals might smoke for quite different reasons. This review suggests that inter-individual differences in the diverse effects of nicotine associated with self-medication and negative reinforcement are an important consideration in studies attempting to understand the causes of nicotine addiction, as well as in the development of effective, individualized nicotine cessation treatments. Affective and Cognitive impairments, either premorbid in origin, or associated with nicotine withdrawal (as described above) contribute to nicotine dependence. Greater consideration of these processes, and the potential role of negative reinforcement, needs to be incorporated into animal models of nicotine dependence.