Lighting the Darkness of Addiction Can Phototherapy Enhance Contingency-Management-Based Treatment of Substance-Related and Addictive Disorders?
Lighting the Darkness of Addiction Can Phototherapy Enhance Contingency-Management-Based Treatment of Substance-Related and Addictive Disorders?
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DOI：
10.1097/jan.0000000000000049
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发表时间：
2014-10-01
影响因子：
1.5
通讯作者：
Siporin, Sheldon
中科院分区：
文献类型：
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作者：
Siporin, Sheldon
药物使用的不适应模式是严重的社会问题。药物和非药物治疗都是可行的，但非药物治疗可能更可取，因为它们避免了精神药物的费用和不良副作用。应急管理（CM）和非药物社交和娱乐活动（NDSRA）是基于操作性条件反射原则，并寻求通过非药物奖励来减少物质使用。然而，当大脑奖励回路功能障碍时，它们的功效可能会受到阻碍。研究表明，药物滥用会使神经奖励系统偏向于药物诱导的兴奋，同时破坏基于昼夜节律的节律。昼夜节律系统也被发现影响人类的奖励途径。可能，昼夜节律紊乱和药物滥用效应之间存在双向关系。如果是这样的话，异常昼夜节律的修复可能有助于物质滥用者的奖励反应正常化，对CM或NDSRA治疗结果产生积极影响。光疗在修复季节性情感障碍和其他时间生物学条件的人的昼夜节律方面是有效的。本文提出，它同样可以修复物质滥用者的昼夜节律反应，从而使大脑奖励系统正常化。通过这样做，它将提高CM和NDSRA疗法的疗效，也可能有助于防止复发。鉴于其低成本和易于管理，光疗似乎是一个有前途的途径。
Maladaptive patterns of substance use are serious social problems. Both pharmacological and nonpharmacological treatments are available, but nondrug options may be preferable because they avoid the expense and adverse side effects of psychotropic medication. Contingency management (CM) and nondrug social and recreational activities (NDSRAs) are based on operant conditioning principles and seek to decrease substance use by means of nondrug rewards. However, their efficacy may be hindered where brain reward circuitry is dysfunctional. Research shows that substance abuse biases neural reward systems in favor of drug-induced highs, while disrupting circadian-based rhythms. Circadian systems also have been found to influence human reward pathways. Possibly, a bidirectional relationship exists between circadian disturbance and substance abuse effects. If so, repair of abnormal circadian rhythms might help normalize reward response in substance abusers, with positive effects on CM or NDSRA treatment outcomes. Phototherapy has been effective in repairing circadian rhythms in persons with seasonal affective disorder and other chronobiological conditions. This article proposes that it similarly may repair circadian response in substance abusers, thereby normalizing brain reward systems. By doing so, it would enhance the efficacy of CM and NDSRA therapies and may also help prevent relapse. Given its low cost and ease of administration, phototherapy seems a promising avenue to pursue.