药物滥用预防与科学、文化和伦理道德问题的关联(英文)

近年来在脑与行为领域的科学进展和发现已经革新了我们对于物质滥用及其对人体思维和情绪作用的知识。与此同时,针对促进药物滥用和成瘾发展的人类行为和环境的大量心理学和社会文化方面的研究也在展开。文化因素也被认为在世界不同地区成瘾行为的发展和上升中起重要作用。要采取有效的策略解决全球非法药物滥用与成瘾问题,我们需要一种整合和统一的视角,这种视角不仅包括科学,还应包括文化,伦理道德和精神等社会组成部分。药物滥用是一个涉及多方面的问题。它可以是生物因素和基因缺陷的结果,也可以是由于社会影响,药物的易获得性,文化压力等因素导致的习惯性行为。因此,针对药物滥用或成瘾者进行预防、治疗和康复的任何成功的计划都应该考虑到多方面的因素。科学研究在解释分子生物学、脑影像学等在药物滥用形成耐受和依赖的发展过程中的重要性方面已经取得了一定进展,该领域的研究还阐释了基因发挥作用并将成瘾的特性传递给后代的途径。然而科学对于药物滥用预防的贡献是有限的,因为这是一个需要综合心理干预和咨询的领域。文化在指导人们的态度和形成成瘾或戒断的潜在动机中发挥了核心作用。个体的戒断和康复部分依赖于文化环境。事实上,对非法药物的界定在不同文化中也各不相同。每个社会都建立了控制人们接触药物和酒精的行为规范。因此,在对药物滥用多角度、综合的预防和干预措施中,理解不同的文化期待、态度和行为规范是至关重要的。伦理道德和精神文明也是药物滥用预防中重要的因素。非治疗用的处方药物就是药物滥用领域中存在的伦理问题。另外,关于非法药物滥用的立法问题也在各个国家引起了严重的争议。伦理和科学不是互斥的关系,两者都在为大多数人的利益努力寻求真理。统揽科学、文化、伦理道德和精神文明对于预防药物滥用和成瘾康复有重要的意义。主要文明体系的和睦关系将带来更为有效的策略,以克服由于药物滥用问题蔓延导致的全球性危机。     

澳门社会工作局防治药物依赖厅简介

防治药物依赖厅是社会工作局辖下的一个厅级部门 ,主要负责策划及执行预防药物依赖之教育及宣传活动 ,以及戒毒治疗和康复之工作 ;向社会大众提供禁毒信息和咨询服务 ,协调及促进其它公共或私人实体推行防治药物滥用工作。搜集和分析药物依赖领域内之重要数据及资料 ,提供制定及改善反吸毒措施建议 ,研究及发展防治药物依赖相关策略 ,并参与地区及国际性的合作。为履行有关职责 ,防治药物依赖厅设有预防药物滥用处及戒毒康复处两个附属工作单位。预防药物滥用处主要负责执行向学校、家庭及社区之预防滥用药物的教育活动 :提供有关预防讲座、…     

心理干预对药物滥用者自杀意念的影响

目的：探讨心理干预对预防药物滥用者自杀意念的影响。方法：对经住院脱瘾回归社区的药物滥用者48例进行每周3次，每次1小时，病人家属每周1次，每次2小时，共4周的心理干预治疗，并与48例对照组的自杀意念进行比较。结果：研究组自杀意念量表平均分（8．7±4．2），与对照组平均分（4．1±2．9）比较有显著差异性（P〈0．01）；试验组自杀发生率、自杀频度、治疗痊愈率、对治疗的依从性明显高于对照组。结论：对药物滥用者早期危机干预、急性期治疗和巩固维持治疗及回归家庭社会全过程的综合干预，能有效预防药物滥用者发生自杀的危险。     

五地区阿片类物质依赖者复发特点和原因调查

目的:了解我国阿片类物质依赖人群戒毒治疗后复发的一般情况和复发的影响因素,为复发的预防干预提供依据。方法:应用自行编制的《阿片类物质依赖复发情况问卷》,在调查人员指导下,对昆明、宜昌、珠海/中山、北京和上海市五地区戒毒机构收治的1085名阿片类物质依赖者进行问卷调查,问卷由被调查对象集体自行匿名填写完成。结果:回收问卷1085份,可进行统计分析的有效问卷1065份(占98.2%)。1065例调查对象的年龄35.1a±s7.1 a,滥用药物时间10.9 a±s4.4 a;经历"强制"和"劳教"的戒毒次数为4.4±s2.3次;出戒毒所后最易复发的时间段为"戒毒后的d1-5"(占40.2%);"躯体生理因素、心理因素、药物成瘾性因素和社会环境因素"等4个复发影响因子分值分别为720.8,1003.0,1019.5和1059.0;对4个因子的差异进行秩和检验,结果显示,差异具有统计学显著性(2χ=881.8,P<0.001);按照因子分排序为"社会环境因素"、"药物成瘾性因素"、"心理因素"和"躯体生理因素"。结论:阿片类药物依赖者在戒毒后复发的主要影响因素是社会环境因素,进行预防复发干预的关键时间段是"戒毒(出戒毒所)后的前5 d",提示预防复发的重要措施是在戒毒治疗后针对不同个体的具体情况,提供及时有效的社会支持和心理干预。     

应激与药物依赖相关性及其生物学机制研究

<正>药物依赖是一种慢性复发性脑病。大量研究发现,各种内、外环境刺激引起的应激与药物依赖的发生、发展及复吸密切相关,应激反应与药物依赖的生物学机制存在许多相互交叉作用,导致应激与药物依赖的形成、心理渴求及复吸密切相关[1]。本文就近年来有关导致应激与药物依赖密切相关的生物学机制方面的研究进行综述,希望对应激导致的药物依赖及复发进行更有效的预防及治疗提供一些启示。     

抗阿片依赖药物干预的研究进展

人类疾病谱正面临着重大的变化，21世纪上半叶将进入精神疾病时代。在众多的精神疾病中，精神活性物质依赖占有重要位置。其中以阿片类药物造成的滥用最为严重。精神活性物质依赖对国民经济、人口素质和社会安全的危害无法估量。毒瘾是一种病，吸毒者是一类特殊的病人。研究精神活性物质依赖的生物学基础和医学生物学干预手段反应了我国社会和科学发展的重大需求。阿片类毒品危害之所以如此严重主要原因是复发造成的难以戒除，复发主要是由精神依赖引起的，而精神依赖的神经生物学本质又是由于在阿片类毒品长期作用下机体的阿片受体作用系统在受体前、受体上和受体后发生了代偿性适应造成的。目前，在临床上用于脱毒和防复发的医学生物学干预手段主要包括药物干预手段，如激动剂美沙酮、部分激动剂丁丙喏啡和拮抗剂纳曲酮等；生理干预手段，如电针抗复发等。这些干预手段的共同特点都是通过影响阿片受体作用系统的功能实现的。近十多年来，人们逐渐认识到，阿片所导致的代偿性适应不仅和阿片受体作用系统相关，还和多类非阿片受体作用系统密切相关。这些系统至少包括单胺、兴奋性氨基酸、GABA、乙酰胆碱和咪唑啉等受体作用系统。干预这些非阿片受体作用系统的化合物能否成为有效的抗阿片复发药物已成为了本领域新的研究热点。     

海洛因依赖者戒毒期间心理干预对焦虑症状的疗效观察

对112例烫吸海洛因成瘾者进行焦虑自评量表(SAS)评定,结果表明:海洛因依赖者存在明显的焦虑情绪[1],而焦虑情绪往往是导致药物滥用者复吸的一个重要原因之一.在戒毒过程中,除做好戒断症状护理外,及时做好焦虑症状的心理干预与护理,消除或缓解患者的焦虑抑郁状态,对促进戒毒成功,延长操守时间、促进身心康复是至关重要的.本文对观察组68例海洛因依赖者实施系统的抗焦虑治疗的基础上进行心理干预与护理,在加速戒毒成功,缓解焦虑症状、延长操守时间及减少复吸,促进身心康复与对照组比较收效显著.     

宜昌市阿片类物质依赖者复发情况调查

目的:了解宜昌市阿片类物质依赖人群中戒毒治疗后复发的一般情况和复发影响因素,为复发的预防干预提供依据。方法:应用《阿片类物质依赖复发情况问卷》,在调查人员指导下,对宜昌市220名阿片类物质依赖者进行调查。问卷由被调查对象集体自行匿名填写完成,由调查员检查验收。结果:本次调查目标人群220例,回收问卷220份,可进行统计分析的有效问卷217份(98.6%)。217例调查对象的年龄33.3a±s6.0a,既往滥用药物时间8.8a±s3.7a;曾经戒毒的总次数范围2-108次;出戒毒所后最易复发的时间段为"戒毒后的d1-5"(43.4%);调查问卷将复发影响因素设计为"躯体生理因素、心理因素、药物成瘾性因素和社会环境因素"4个因子,因子分分别为185.3、219.0、234.8和242.7;对4个因子的差异进行秩和检验,结果显示差异具有统计学显著性(χ2=154.249,P<0.001);4个因子按照因子分排序为"社会环境因素"、"药物成瘾性因素"、"心理因素"和"躯体生理因素";保持操守不复发的前3位因素均为"社会环境因素"。结论:宜昌市阿片类物质依赖者在戒毒后复发的主要影响因素是社会环境因素,进行预防复发干预的关键时间段是"戒毒(出戒毒所)后的前5d",提示预防复发的重要措施是针对不同个体的具体情况,提供社会支持和心理干预。     

当前药物滥用的主要治疗模式

当前药物滥用的主要治疗模式汤宜朗（北京安定医院中国药物依赖治疗中心北京邮编１０００８８）药物滥用涉及的原因很多，其治疗也需从多方面着手。现今多数人承认，药物依赖是一种具有复发倾向的生物行为障碍（ｂｉｏ—ｂｅｈａｖｉｏｒａｌｄｉｓｏｒｄｅｒ）。目前，世...     

药物依赖的表观调控研究现状和应用前景

药物滥用是目前严重的社会问题之一,药物滥用导致特定大脑区域的基因表达异常,造成具有特定功能的脑区在分子、细胞乃至整体水平的改变,从而促进药物依赖和成瘾行为。表观遗传修饰是指在长期持续刺激下诱导产生基因的表达变化的调控方式,其在药物滥用的各阶段有不同的变化规律和调控作用,可能是导致药物滥用的重要因素。本文综述近年来药物成瘾和依赖相关的表观遗传研究,旨在探讨通过表观遗传调控系统抑制和逆转药物滥用的靶点和策略。     

Molecular genetic probing of dopamine receptors in drug addiction

Drug addiction is a brain disease with complex genetic, psychological and social factors. The dopaminergic system of the brain plays a central role in natural reward and motivation and is the main neural substrate for the actions of abusive drugs. The analysis of mice with mutations in their dopamine receptor genes has provided new information regarding the influence of individual dopamine receptors on drug actions. The use of genetic manipulation of dopamine receptors, and related intracellular signaling molecules, in mice will help to enhance our understanding of the molecular and cellular mechanisms underlying compulsive drug-seeking and drug-taking behaviors, reasons for relapse into drug addiction and persistent neuronal changes in response to repeated drug use. These studies will provide new insights for improved therapeutic strategies for the prevention and treatment of drug addiction.     

Addiction to and dependence on benzodiazepines. Diagnostic confusion in clinical practice and research studies.

Considerable confusion continues to surround basic concepts for abuse, addiction, tolerance, and dependence. Clinicians may be making decisions about prescribing these medications without clear definitions and distinctions. The terms are not equivalent in meaning and should not be used interchangeably in clinical application. Moreover, they may occur together or independently and are not etiologically related. Abuse is improper use outside the standard norms. Abuse implies a violation component and a control over the use of the drug. Addiction is a preoccupation with the acquisition and compulsive use of and a pattern of relapse to drugs is spite of adverse consequences. Pervasive to the criteria is a loss of control over drug use and a lack of volitional component in the drug use. In spite of problems in definitions, studies have clearly shown that abuse, addiction, tolerance, and dependence develop commonly in benzodiazepine use.     

Imaging the roles of the amygdala in drug addiction

The neurobiological processes that underlie initial use of drugs of abuse and the transition to drug abuse, addiction, and dependence are poorly understood. Intrinsic and drug-related alterations in complex brain functions such as motivation, learning, memory, reward, attention, and arousal seemingly underlie the process of drug abuse and addiction. This discussion focuses on the use of functional brain imaging techniques such as positron emission tomography and functional magnetic resonance imaging to define the roles of the amygdala in the sequence of behavioral processes that span initial drug use to addiction and its consequences. The functional images of the human amygdala demonstrate or implicate this limbic structure in the processes of reward learning and memory, conditioned reward and emotion dysregulation related to drug use, and the transition to addiction. While these roles of the amygdala reflect its involvement in the actions of large-scale neural systems comprising cortical and subcortical structures, its important roles as a neural substrate mediating or modulating behaviors related to initial drug use to addiction, and its personal and social consequences, are increasingly defined by functional brain imaging studies.     

The neurocircuitry of addiction: an overview

Drug addiction presents as a chronic relapsing disorder characterized by persistent drug-seeking and drug-taking behaviours. Given the significant detrimental effects of this disease both socially and economically, a considerable amount of research has been dedicated to understanding a number of issues in addiction, including behavioural and neuropharmacological factors that contribute to the development, loss of control and persistence of compulsive addictive behaviours. In this review, we will give a broad overview of various theories of addiction, animal models of addiction and relapse, drugs of abuse, and the neurobiology of drug dependence and relapse. Although drugs of abuse possess diverse neuropharmacological profiles, activation of the mesocorticolimbic system, particularly the ventral tegmental area, nucleus accumbens, amygdala and prefrontal cortex via dopaminergic and glutamatergic pathways, constitutes a common pathway by which various drugs of abuse mediate their acute reinforcing effects. However, long-term neuroadaptations in this circuitry likely underlie the transition to drug dependence and cycles of relapse. As further elucidated in more comprehensive reviews of various subtopics on addiction in later sections of this special issue, it is anticipated that continued basic neuroscience research will aid in the development of effective therapeutic interventions for the long-term treatment of drug-dependent individuals.     

抗阿片成瘾药物研究历史与现状

阿片成瘾是一种慢性复发性脑疾病,临床症状包括躯体依赖、稽延症状、精神依赖和复吸, 治疗的关键是防复吸。防复吸药物的研究包括以阿片受体和非阿片受体为靶标的药物。代表性药物分别为阿片受体激动剂美沙酮和受体阻断剂纳屈酮,新型阿片受体配体噻吩诺啡能够完全阻断吗啡等阿片类药物引起的躯体和精神依赖,防止阿片复吸。研究表明,参与调节阿片精神依赖和复吸的非阿片受体作用系统包括多巴胺受体、兴奋性氨基酸受体、γ-氨基丁酸受体、乙酰胆碱受体、5-HT受体、CB1受体和神经营养因子受体等。多巴胺D3受体阻断剂Y-QA14自身无致成瘾性,同时具有抗可卡因和海洛因成瘾及防复吸的作用。咪唑啉Ⅰ型受体激动剂胍丁胺具有抗阿片躯体和精神依赖、缓解稽延症状和防复吸的作用,机制与激活咪唑啉Ⅰ型受体后减轻阿片受体、多巴胺系统和谷氨酸系统的代偿性适应用关。本文将就阿片、阿片成瘾生物学基础、防阿片复吸药物研发展、作用机制、历史、现状和发展趋势加以综述。     

Personality, stress, and social support in cocaine relapse prediction

This study identified prospective psychosocial predictors of relapse status and drug abuse severity in male subjects in the first year after residential treatment for cocaine dependence. Personality, stress, and social support measures from an intake assessment, and stress and support measures reflecting status during the three-month period prior to the one in which relapse was identified were used as predictors. A number of hypotheses were confirmed. Detached personality and stress predicted both cocaine relapse and outcome drug abuse severity. Perceived social support quality and social network size predicted cocaine relapse. Implications for relapse prevention are presented.     

社会心理干预对戒毒后操守率的影响

目的·· :探讨海洛因依赖者脱毒后进行社会心理干预对其康复的作用。方法··:对90例躯体脱毒后的海洛因依赖者进行2 -2.5个月的心理康复训练 ,训练内容包括 :文体活动、认知疗法、动机强化治疗、生活技能训练等 ,回归社会后要求其定期到指定地点进行尿检、心理辅导、集体治疗和家庭治疗 ,并对其追踪监控。结果··:90例康复者中 ,出院后就脱失的38例 ,占42.2 % ;进行尿检随访52例 ,占57.8 %。52例随访者中保持操守12个月的5例 ,占随访人数的9.6 % ,占所有康复者的5.6 % ;操守6个月的19例 ,占随访人数的36.5 % ,占所有康复者的21.1 % ;操守3个月的37例 ,占随访人数的71.2 % ,占所有康复者的41.1 % ;操守1个月的45例 ,占随访人数的86.5 % ,占所有康复者的50 % ;在1个月内复吸的7例 ,占随访人数的13.5 % ,占所有康复者的7.8 %。结论··:海洛因依赖者躯体脱毒后进行有效的社会心理干预能在一定程度上提高操守率     

Gender and reported health problems in treated alcohol dependent Alaska natives.

OBJECTIVE: An ongoing study of phenotypes of alcohol dependence among Alaska Natives provides the opportunity to investigate gender differences in reported health-related problems among alcohol dependent clients in three residential programs in Anchorage, Alaska. METHOD: Clinical assessment information was obtained on 469 (263 male) subjects from consecutive admissions to each of three treatment programs. The average (SD) age of the sample was 33.7 (8.4) years. Patterns of substance use, comorbid psychopathology, overall health status, alcohol and other drug withdrawal symptoms, and psychological and physical consequences of alcohol and other drug use were examined. RESULTS: Male and female subjects reported similar experiences with alcohol-related health problems, including symptoms of withdrawal and the psychological and physical consequences of chronic alcohol abuse. However, women were significantly more likely to have lifetime diagnoses of major depression and cocaine dependence, whereas men were more likely to have lifetime diagnoses of antisocial personality disorder and marijuana dependence. Women reported a lower overall health status, more medication use and pain complaints, and more negative consequences of cocaine abuse and withdrawal than did men. CONCLUSIONS: Both men and women within this sample of inpatient alcohol-dependent Alaska Natives were found to have a similar early onset and rapid progression to DSM-III-R alcohol dependence, and to report a similar prevalence of alcohol-related psychological and physical problems. Reports by women of more pain symptoms, more medication use and more negative health consequences related to their cocaine abuse, compared with men in this alcohol dependent sample, suggests additional considerations for treatment planning and intervention.     

How does stress increase risk of drug abuse and relapse?

RATIONALE: The notion that stress leads to drug abuse in vulnerable individuals and relapse in addicts is not new. Most major theories of addiction postulate that stress plays an important role in increasing drug use and relapse. Several animal studies and some human laboratory studies have shown that stress exposure enhances drug self-administration. Although clinical observations suggest that exposure to stress increases drug use, and are associated with craving and relapse in addicts, human research in this area is largely correlational and at times contradictory. OBJECTIVE: Given the growing preclinical evidence that supports the key role of stress in substance abuse, careful examination of this research area in humans is warranted. This paper examines empirical evidence on how stress may increase the vulnerability to drug abuse, and explores whether chronic drug abuse alters the stress response and coping in addicts, thereby increasing the likelihood of drug seeking and relapse. Unanswered questions on the association between stress and substance abuse in humans are identified. CONCLUSION: Preclinical research has shown that stress, in addition to drug itself, plays a key role in perpetuating drug abuse and relapse. However, the mechanisms underlying this association in humans remain unclear. A greater understanding of how stress may perpetuate drug abuse will likely have a significant impact on both prevention and treatment development in the field of addiction.     

Treatment of methamphetamine abuse: research findings and clinical directions

Over the past few years, methamphetamine has appeared in mass quantities, in part, because of the ease and cost efficiency of manufacturing. With this increase in availability, the use of methamphetamine has increased significantly. The purpose of this article is to describe the existing treatment options for methamphetamine abuse and provide recommendations for practitioners and researchers. Methamphetamine abuse adversely impacts physical functioning, brain functioning and cognition, social support and social networks, and behavioral functioning. Negative consequences have also been documented to the environment and communities. In the studies reviewed on effective treatments, interventions consisted of aversion therapy, medication, psychosocial treatment, and case management. Each specific treatment is described as connected with an overall drug treatment program. If methamphetamine abuse continues to increase and the consequences continue to be so devastating, researchers and clinicians could advance the field by particular focus on the treatment of this type of drug use.