Addiction as a brain disease revised: why it still matters, and the need for consilience.
Addiction as a brain disease revised: why it still matters, and the need for consilience.
复制标题
作为一种脑部疾病的成瘾修订：为什么它仍然重要，以及一致性的必要性。
DOI：
10.1038/s41386-020-00950-y
复制
发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Vanderschuren LJMJ
中科院分区：
文献类型：
--
作者：
Heilig M;MacKillop J;Martinez D;Rehm J;Leggio L;Vanderschuren LJMJ
物质成瘾是一种脑部疾病的观点，尽管在神经科学界得到了广泛的接受，但近年来也受到了尖锐的批评。这些批评指出，大脑疾病的观点是确定性的，未能解释缓解和康复的异质性，过于强调成瘾的强迫维度，并且尚未确定成瘾的具体神经特征。我们承认其中一些批评是有道理的，但我们断言，上瘾有神经生物学基础这一基本前提从根本上是合理的。我们还强调，否认上瘾是一种脑部疾病是一种有害的观点，因为它有助于减少获得医疗保健和治疗的机会，其后果是灾难性的。因此，在这里，我们解决了这些批评，并在这样做的同时，提供了对成瘾的大脑疾病观点的当代更新。我们提供了支持这一观点的论据，讨论了为什么表面上的自发缓解并不能否定它，以及表面上的强迫行为如何与成瘾中对替代强化的敏感性共存。最重要的是，我们认为大脑是产生成瘾和行为改变能力的生物底物，并主张加强对康复的神经科学研究。更广泛地说，我们认为这些分歧揭示了整合神经科学、行为、临床和社会文化视角的多学科研究的必要性。
The view that substance addiction is a brain disease, although widely accepted in the neuroscience community, has become subject to acerbic criticism in recent years. These criticisms state that the brain disease view is deterministic, fails to account for heterogeneity in remission and recovery, places too much emphasis on a compulsive dimension of addiction, and that a specific neural signature of addiction has not been identified. We acknowledge that some of these criticisms have merit, but assert that the foundational premise that addiction has a neurobiological basis is fundamentally sound. We also emphasize that denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing access to healthcare and treatment, the consequences of which are catastrophic. Here, we therefore address these criticisms, and in doing so provide a contemporary update of the brain disease view of addiction. We provide arguments to support this view, discuss why apparently spontaneous remission does not negate it, and how seemingly compulsive behaviors can co-exist with the sensitivity to alternative reinforcement in addiction. Most importantly, we argue that the brain is the biological substrate from which both addiction and the capacity for behavior change arise, arguing for an intensified neuroscientific study of recovery. More broadly, we propose that these disagreements reveal the need for multidisciplinary research that integrates neuroscientific, behavioral, clinical, and sociocultural perspectives.
登录
查看更多内容
影响因子：
10.6
作者：
Caprioli D;Venniro M;Zeric T;Li X;Adhikary S;Madangopal R;Marchant NJ;Lucantonio F;Schoenbaum G;Bossert JM;Shaham Y
通讯作者：
Shaham Y
影响因子：
26.1
作者：
Brody, Gene H.;Gray, Joshua C.;Yu, Tianyi;Barton, Allen W.;Beach, Steven R. H.;Galvan, Adrianna;MacKillop, James;Windle, Michael;Chen, Edith;Miller, Gregory E.;Sweet, Lawrence H.
通讯作者：
Sweet, Lawrence H.
影响因子：
1.4
作者：
Cahill, Kate;Stead, Lindsay F.;Polonio, Igor Bastos
通讯作者：
Polonio, Igor Bastos
影响因子：
4.2
作者：
Cohen, Emily;Feinn, Richard;Kranzler, Henry R.
通讯作者：
Kranzler, Henry R.
影响因子：
16.2
作者：
Fan, JJ;May, SJ;Barrett-Connor, E
通讯作者：
Barrett-Connor, E