丘脑室旁核在物质成瘾中的作用机制研究进展

物质成瘾是一种慢性复发性脑疾病，作为全球范围的一个重大公共卫生问题，目前对其缺乏科学有效的针对性干预手段，这促使研究人员对物质成瘾的神经机制进行更深入的探索。近来研究发现丘脑室旁核可调节动机、奖赏及成瘾等多种行为，急性暴露于可卡因、吗啡和酒精可激活其神经元，提示丘脑室旁核可能是成瘾相关神经通路的关键核团。本文综述了丘脑室旁核的解剖特征、参与物质成瘾的神经通路及其具体机制，以期为物质成瘾神经机制后续研究提供参考。     

第四届酒精与药物滥用研讨会、第三届亚太酒精与成瘾学会会议

背景： 自2006年始,由中国药物滥用防治协会主办的全国酒精滥用防治研讨会已举办三届,一如既往,为了使全国从事酒精及药物成瘾相关问题工作者聚首一堂,互相学习与交流,藉此进一步提高酒精及药物成瘾相关问题的临床及研究水平,推动此项事业的发展,     

嗜酒大鼠落户北京

酗酒及其相关危害已成为严重的公共卫生问题之一。根据世界卫生组织2002年公布的“人类健康十大危机”报告，酒精是影响人类健康的第五大危险因素。自20世纪80年代起．我国酒精消费急剧增加，与酒精成瘾相关的问题日益突出。然而，与烟草、毒品等物质滥用相比，我国酒精滥用并未得到应有的重视。其滥用和依赖的神经生物学机制的研究亦较少见。究其原因，与我国缺乏嗜酒的动物模型有关。日前，北京大学中国药物依赖性研究所粱建辉教授在国家重点基础研究发展计划（973计划，2003CB515400），     

P物质与成瘾相关研究进展

<正>常见滥用药物有阿片类、可卡因、酒精、尼古丁等,这些药物长期使用会导致成瘾。在美国,每年大概花费7000亿美元以上用于社会上药物滥用的管理~([1])。药物成瘾与多巴胺和谷氨酸等神经递质相关。神经激肽属于肽类神经递质,与药物滥用也有着密切的联系~([2]),但是有关神经肽系统在成瘾中的作用机制还不十分清楚。     

我国酒精相关障碍的流行病学研究进展

酒精作为社会陛成瘾物质，具有高度成瘾性，应用非常普遍，严重影响了人类健康和经济发展。中国是人口大国，占世界人口总数的22％。经济的快速增长增加了酒的消耗量…。全国性或区域性流行病学调查均显示：改革开放后，酒精的生产和消费逐步增加，由酒精所导致的公共卫生问题日趋严重。本文对近年来国内酒精相关障碍的流行病学调查进行综述，了解其流行规律，以减轻酒精相关危害，减少酒精相关负担和成本。     

酒精成瘾与伏隔核内谷氨酸能突触传递及可塑性

目前临床上治疗酒精成瘾的难点在于降低酒精渴求程度和复饮率,充分阐明酒精渴求和复饮的神经生物学机制是解决这一难题的关键。中脑-皮层-边缘环路异常的神经适应是导致药物渴求以及复发的重要机制,其中伏隔核和内侧前额叶两个脑区是该环路中重要的组成部分。动物研究表明长期酒精暴露或摄取引起伏隔核内谷氨酸能传递及其突触可塑性异常,而这些异常适应性增加了饮酒行为复发的易感性。因此,本文将基于在动物模型上的电生理研究成果,重点讨论长期酒精暴露引起的伏隔核内谷氨酸能传递适应性相关的最新研究进展;其次,简单探讨内侧前额叶-伏隔核谷氨酸能传递在酒精渴求及其复发中的作用;最后,分析论证恢复伏隔核内谷氨酸能突触传递的异常适应,是否可以作为治疗酒精成瘾的潜在靶点。     

抗成瘾药物研究的最新进展

有关大脑成瘾机制的最新研究成果和新的药物作用靶点的发现为抗成瘾药物发展开辟了新的方法和思路,研发更有效、安全的抗成瘾药物成为一个研究热点。该文主要综述了当前在治疗阿片类、可卡因、甲基苯丙胺、大麻、酒精和尼古丁成瘾上具有潜力的药物。     

美国对酒精成瘾者子女研究的情况

<正> 酒精在一些国家如美国,已带来了严重的社会问题,例如个人健康的损害、道德沦落、刑事犯罪、意外事故等等。更令人担忧的是对儿童的影响。现就美国对酒精成瘾者子女研究的情况介绍如下。在美国有2860万儿童生活在酒精成瘾家庭中,占美国人口的1/8。18岁以下共650万人,这些孩子每天面临着不正常的家庭生活以及由于双亲滥用酒精而带来的种种问题。还有2200万成年人可能正在继续遭受由酒精成瘾家庭生活引起的各     

药物成瘾与睡眠障碍

药物成瘾已成为当今社会严重的公共健康和社会问题,引起了世界性的广泛关注和政府的高度重视。近年来,越来越多的研究者从社会、行为、环境、遗传等方面对药物成瘾的潜在机制进行了深入的探索,但目前关于药物成瘾的神经机制尚不完全清楚。已有研究表明,睡眠障碍在药物成瘾者中广泛存在,并且可能是影响药物成瘾者复吸的重要因素之一。此外,睡眠障碍也可能是药物成瘾发生的危险因素。为了深入理解药物成瘾与睡眠障碍之间的相互关系,本文将围绕药物成瘾者中广泛存在的睡眠障碍等问题进行系统综述,并且探讨了药物成瘾合并睡眠障碍的治疗措施,以期为药物成瘾相关的研究提供新思路。     

酒依赖治疗药物研究进展

酒精是成瘾性或依赖性物质之一。酒精成瘾特征表现为对获得酒精的强迫性渴望,无节制地饮酒,并且发展为酒精耐受和酒依赖。     

‘Alcohol short-circuits important part of the brain’: Swedish newspaper representations of biomedical alcohol research

The media has a central role in communicating and constructing health knowledge, including communicating research findings related to alcohol consumption. However, research on news reporting about alcohol is still a relatively small field; in particular, there are few studies of the reporting of biomedical alcohol and drug research, despite the assumed increasing popularity of biomedical perspectives in public discourse in general. The present article addresses the representational ‘devices’ used in Swedish press reporting about biomedical alcohol research, drawing on qualitative thematic analysis of the topics, metaphors, and optimist versus critical frames used in presenting biomedical research findings. In general, the press discourse focuses on genetic factors related to alcohol problems, on the role of the brain and the reward system in addiction, and on medication for treating alcohol problems. Metaphors of ‘reconstruction’ and ‘reprograming’ of the reward system are used to describe how the brain’s function is altered in addiction, whereas metaphors of ‘undeserved reward’ and ‘shortcuts’ to pleasure are used to describe alcohol’s effects on the brain. The study indicates that aspects of the Swedish press discourse of biomedical alcohol research invite reductionism, but that this result could be understood from the point of view of both the social organization of reporting and the intersection of reporting, science, and everyday understandings rather than from the point of view of the news articles only. Moreover, some characteristics of the media portrayals leave room for interpretation, calling for research on the meanings ascribed to metaphors of addiction in everyday interaction.     

Telling different stories,making new realities: The ontological politics of ‘addiction’ biographies

Personal narratives of alcohol and other drug addiction circulate widely in popular culture and they also have currency in professional therapeutic settings. Despite this, relatively little research has explored the conventions operating in these narratives and how they shape people’s experiences and identities. While research in this area often proceeds on the premise that addiction biographies are straightforwardly ‘true’ accounts, in this paper we draw on the insights of critical alcohol and other drug scholarship, and the concept of ‘ontological politics’ to argue that biographies produce normative ideas about addiction and those said to be experiencing it. Our analysis compares traditional addiction narratives with the biographies we reconstructed from qualitative interviews with 60 people in Australia who describe themselves as having an ‘addiction’, ‘dependence’ or drug ‘habit’. We track how addiction is variously enacted in these accounts and comment on the effects of particular enactments. By attending to the ways in which people cope, even thrive, with the kind of consumption that would attract a diagnosis of addiction or dependence, the biographies we produced disrupt the classic narrative of increasing drug use, decline and eventual collapse. Doing so allows for consideration of the benefits of consumption, as well as the ways that people carefully regulate it to minimise harms. It also constitutes individuals as active in managing consumption—an important move that challenges dominant understandings of addiction as a disorder of compulsivity. We conclude by considering the implications of our attempt to provide an alternative range of narratives, which resonate with people’s diverse experiences.     

The role of ghrelin in addiction: a review

Rationale

Ghrelin is a fast-acting hormone that is produced primarily by the stomach and by the brain although in smaller quantities. The regulation and the secretion of ghrelin are complex and not limited to aspects of feeding. Ghrelin exerts powerful effects on multiple processes, and it has been demonstrated that it mediates the rewarding properties of food as well as of drugs of abuse.

Objectives

The purpose of this review is to summarize the findings of preclinical and clinical studies related to ghrelin’s possible role in addiction for each specific class of substances. Questions related to ghrelin’s involvement in addiction are highlighted. Recurrent methodological issues that render the interpretation of the findings challenging are discussed. Also, the potential of targeting ghrelin as a pharmacologic treatment strategy for addiction is explored.

Results

Ghrelin signaling is implicated in the mediation of behavioral and biochemical effects of drugs of abuse that are cardinal for the development of addiction, especially for alcohol, nicotine, and stimulants. The available literature implicating ghrelin in opioid or cannabis use disorders is currently limited and inconclusive.

Conclusions

There is intriguing, although not always consistent, evidence for the involvement of ghrelin signaling in aspects of addiction, especially in the cases of alcohol, nicotine, and stimulants. Further research, particularly in humans, is recommended to replicate and expand on the findings of the current literature. Improved and novel methodologies that take into account the volatile and complex nature of ghrelin are required to clarify the inconsistencies of the findings.     

The emerging role of lawyers as addiction ‘quasi-experts’

This paper examines a discrete set of issues pertaining to the constitution of addiction in law. Based on qualitative interviews undertaken with lawyers in Australia and Canada, I examine how addiction figures in lawyers’ daily practice. Drawing on ideas from science and technology studies scholars Sheila Jasanoff, Michael Lynch and Bruno Latour, and building on recent research I undertook on legal addiction veridiction, I explore the constitution of addiction ‘facts’ in law. I examine how and when lawyers claim to make decisions about addiction in the course of their legal practice. Lawyers report playing a central role in the making of decisions about addiction, at multiple stages of the legal process including: before taking cases on, while running cases in court, and while negotiating and/or settling cases. I argue that these decisions can be properly described as ‘quasi-expert’ determinations with important parallels to scientific, technological and medical claims often made in legal settings by more conventional ‘expert witnesses’. I call these ‘quasi-expert’ decisions because they are decisions of the kind that might be assumed to be the purview of scientific or medical experts and because they have tangible implications for clients. Lawyers uniquely constitute addiction in unique ways, drawing on a combination of factors, including their own experience with and observations about addiction, the experiences of family members who have experienced alcohol and other drug problems, relevant legal concepts and frameworks, popular and scientific claims about addiction, emotions and values, including the gender politics of alcohol and other drug addiction. These addiction ‘facts’ can have a range of material and discursive effects, including potentially adverse implications for people characterised as ‘addicts’. I conclude the paper with a discussion of some implications of these practices, and with reflections on how we might address these issues in future research.     

食欲素在酒精依赖及复发中的研究进展

酒精依赖是长期过度饮酒导致中枢神经系统紊乱的一种慢性、复发性脑疾病,该疾病已给全球造成了巨大的社会和经济负担.但目前为止,酒精依赖形成的机制仍不明确,且缺乏相对有效的治疗手段,戒酒后的高复发率严重影响着酒依赖患者的身心健康.近年来研究发现,由下丘脑产生的食欲素除了参与调节机体的食物摄入、睡眠-觉醒和能量平衡外,在物质成...     

Addiction stigma and the biopolitics of liberal modernity: A qualitative analysis

Definitions of addiction have never been more hotly contested. The advance of neuroscientific accounts has not only placed into public awareness a highly controversial explanatory approach, it has also shed new light on the absence of agreement among the many experts who contest it. Proponents argue that calling addiction a ‘brain disease’ is important because it is destigmatising. Many critics of the neuroscientific approach also agree on this point. Considered from the point of view of the sociology of health and illness, the idea that labelling something a disease will alleviate stigma is a surprising one. Disease, as demonstrated in that field of research, is routinely stigmatised. In this article we take up the issue of stigma as it plays out in relation to addiction, seeking to clarify and challenge the claims made about the progress associated with disease models. To do so, we draw on Erving Goffman’s classic work on stigma, reconsidering it in light of more recent, process oriented, theoretical resources, and posing stigmatisation as a performative biopolitical process. Analysing recently collected interviews conducted with 60 people in Australia who consider themselves to have an alcohol or other drug addiction, dependence or habit, we explore their accounts of stigma, finding experiences of stigma to be common, multiple and strikingly diverse. We argue that by treating stigma as politically productive – as a contingent biopolitically performative process rather than as a stable marker of some kind of anterior difference – we can better understand what it achieves. This allows us to consider not simply how the ‘disease’ of addiction can be destigmatised, or even whether the ‘diseasing’ of addiction is itself stigmatising (although this would seem a key question), but whether the very problematisation of ‘addiction’ in the first place constitutes a stigma process.     

ADH2,ALDH2和CYP4502E1遗传多态性与云南汉族酒依赖综合征患者的关联研究

背景:酒精依赖综合征,也称为酒精中毒或者酒精成瘾,与遗传、生理、心理、社会环境等诸多因素有关。目前的研究揭示,酒依赖是一种多因子控制的复杂疾病,由多个基因共同控制,并且是遗传因素与环境因素以一种极其复杂的方式相互作用下的产物,而超过一半的饮酒风险度由遗传因素决定。与酒精依赖有关的基因主要包括两大类:一类是药物代谢动力学基因,这类基因编码的蛋白质是乙醇在体内代谢的重要酶类,包括乙醇脱氢酶(alcohol deydrogenase,ADH)基因,乙醛脱氢酶(aldehyde dehydrogenase,ALDH)基因,细胞色素P450第2家族E亚系多肽1(cytochromeP450,family2,subfamilyE,polypeptide1,CYP2E1);另一类是药物效应动力学基因,这类基因编码的蛋白质与乙醇在大脑的蓄积及随后产生的一系列精神依赖密切相关,主要包括儿茶酚氧位甲基转移酶(catechol-O-methyltransferase,COMT)基因、多巴胺受体D2(dopamine receptor D2,DRD2)基因、5-羟色胺受体(5-hydroxytryptamine receotor,5-HTR)基因、γ-氨基丁酸A受体β3(γ-aminobutyric acid Areceptor β3,GABAAβ3)基因、多巴胺转运体(dopamine transporter,DAT)基因和μ阿片受体基因(Mu opioid receptor gene,OPRM1)。目的:研究ADH2,ALDH2和CYP4502E1基因多态性与云南汉族酒依赖患者的相关性。本课题对云南汉族酒依赖患者组和非酒依赖对照组人群的ADH2、ALDH2和CYP2E1三个乙醇代谢相关基因多态性进行研究,探讨云南汉族ADH2、ALDH2和CYP2E1基因多态性和酒依赖的相关性,旨在从分子遗传学角度探讨酒精依赖综合征的发病机制,寻找其发生的潜在危险因素,为进一步开展酒精依赖综合征的病因学以及遗传学研究寻找理论依据。方法:选择2006-20083a来云南省精神病医院酒精依赖治疗科住院治疗患者80例。入组标准:(1)年龄21-65a,性别不限,汉族;(2)符合《精神疾病的诊断及统计手册》(DSMIV)酒依赖诊断标准;(3)饮酒10a以上,每天饮酒二两以上(白酒)或六瓶啤酒以上。排除标准:(1)精神分裂症、心理障碍、强迫症或其他严重精神障碍病史;(2)其他药物滥用史或成瘾史(烟草除外);(3)精神疾病阳性家族史。以及来自昆明医学院第一附属医院体检中心100例健康体检者作为对照组,其民族、年龄与上述病例组相匹配,既往无精神病史及精神疾病阳性家族史。结果:酒依赖患者组和健康对照组相比较,ADH2基因座ADH2*1/ADH2*1、ADH2*1/ADH2*2、ADH2*2/ADH2*2三种基因型的分布无显著差异(P>0.05),ADH2*1和ADH2*2两种等位基因分布有差异(P<0.05),在健康对照组ADH2*2等位基因频率高于酒依赖患者组;ALDH2基因座基因型及等位基因分布均差异有统计学意义(P>0.05),在健康对照组ALDH2*1/*2基因型及ALDH2*2等位基因频率高于酒依赖患者组;CYP4502E1基因座c1/c1和c1/c2两种基因型的分布差异具有统计学意义(P<0.05),c1/c2基因型在酒依赖患者组升高;c1和c2两个等位基因分布差异有统计学意义(P<0.05),c2等位基因在酒依赖患者组频率升高。结论:ADH2*2和ALDH2*2等位基因对于酒依赖发病有保护作用,而c2等位基因在酒依赖的发生中起一定的作用。     

Personality core dynamics and drug preference

The aim of this study is to investigate the possible link between Shoham's personality-core theory [1] and addiction to hard drugs. Basing ourselves on Kleinean premises, that the oral stage is critical in the formation of behavioural patterns, which are influential throughout life, we hypothesize that in the oral stage two opposing vectors, ‘separation’ and ‘participation’ are initiated. By ‘participation’ we refer to the identification of ego with an external object or symbol, and continuous tendency to lose the personal identity by fusion with this object or symbol. ‘Separation’ is the opposite vector and expresses ego's tendency to incorporate the external object or symbol. These vectors form two multidimensional personality axes, on which the different personality types and behavioral patterns can be anchored.This study aims at investigating the connection between these two vectors and drug addiction. We view drug addiction as a functional behaviour pattern, which brings the individual to a state of internal balance.Shoham's personality theory hypothesizes the derivation of behavioural patterns of different personality ‘types’, according to the strength of the two vector — the ‘separant’ and ‘participant’ types.It is hypothesized that the drug use and the experience gained by using the specific drug by different personality types will vary according to the prominence of the core personality vector. The potency of these vectors is related to an early oral (participant) or a later oral (separant) fixation. The main hypotheses of the study are: (a) There are two polar types of addicts, which may be placed at the extremes of the ‘separant-participant’ personality continuum. (b) The drug preference varies according to the strength of the ‘separant’ and ‘participant’ vectors. The ‘participant’ addicts will prefer depressant drugs, whereas ‘separant’ addicts will prefer stimulants. The results of the present study support these hypotheses.     

Innovative clinical addiction research training track in preventive medicine

Medical education related to identification, diagnosis and management of alcohol and other drug problems receives inadequate attention in the undergraduate curriculum and during residency training. This article describes the design, implementation, and evaluation of a new track in Clinical Addiction Research Training (CART) in a General Preventive Medicine (GPM) residency program. CART is comprised of a new course in Addiction Medicine, new practicum sites in addiction medicine research and treatment, and a CART‐designated resident. An Advisory Group of educators, researchers, scholars, and administrators in addiction medicine, has provided guidance and support for this new track. Evaluation of the CART track suggested improvements in residents’ knowledge and attitudes. Residents engaged in high caliber clinical addiction research projects. The development of the CART track within the GPM residency is an approach that can be integrated into other specialties, such as internal medicine, family practice, and adolescent medicine, to develop residents’ interest and expertise in the addictive behaviors.     

New narratives,new selves: Complicating addiction in online alcohol and other drug resources

Within the expansive qualitative literature on alcohol and other drug (AOD) use, knowledge of lived experiences of AOD addiction is limited. Much of the existing scholarship reifies addiction as a calamitous state, and pathologises those believed to be experiencing it. Such research discounts the many ways people live with regular AOD use and is unable to tell us much about how addiction emerges through, rather than precedes, people’s experiences and understandings of it. This article draws on the theoretical literature on the production of social problems and the concept of “ontological politics” to introduce an innovative approach to understanding lived experiences of AOD addiction. Applying this literature to a critical analysis of personal narratives from two Australian AOD websites, we demonstrate how addiction is conceived narrowly in these narratives as a disorder of compulsion, amenable to treatment. Not only does this conception reproduce unhelpful assumptions about addiction, it also reifies it as a stable, unified entity, the boundaries of which are fixed. Against this familiar account, we conceive addiction as an emergent, fiercely contested phenomenon, constituted in part through the very measures designed to treat it. This shift in focus allows an innovation in engaging with addiction, which is being pursued in a new Australian research project: the development of a public website presenting lived experiences of addiction that will be (1) a means of challenging existing public discourses, and (2) an intervention in the social production of addiction. The article concludes by considering the politics of this approach and how it might reshape addiction.