Kūkākūkā YBOP: ʻO ke kumumanaʻo o ka hoʻohaʻahaʻa maʻamau i nā mea hoʻoponopono a me nā sexologists. Eia nō naʻe, ke akāka nei i nā mea noiʻi ʻo nā ʻano lawehala hana ke kumu e loli ai ka lolo i ke aniani i nā lāʻau. Pono kēia, no ka mea hiki i nā lāʻau āpau ke hana ke hoʻonui a pale paha i kahi ʻano physiological maʻamau. Aia i loko o ka lolo nā ʻano hana hoʻoilina - he laʻana nui. No laila ke kū nei i ke kumu i ka lawena e pili ana i ka hoʻonāukiuki supranormal o kēlā mau ʻano hana i ka mana e alakaʻi ai i nā loli o ka lolo e pili ana i ka hoʻāʻo.
Ka Ike:
ʻO nā ʻano hana ʻē aʻe, ʻokoʻa ka hoʻokomo ʻana i ka lāʻau psychoactive, hana i ka uku pōkole e hoʻoulu ai i ka hana hoʻomau, ʻoiai ka ʻike o nā hopena maikaʻi ʻole, ʻo ia hoʻi, ua hoʻoliʻiliʻi ka kaohi ma luna o ka lawena. Ua noʻonoʻo ʻia kēia mau maʻi i nā ʻano like ʻole. Hoʻokahi kahi manaʻo i kēia mau maʻi e like me ka moe ʻana ma kahi speculsive-compulsive spectrum, me kekahi i hoʻonohonoho ʻia ma ke ʻano he mana hoʻomalu impulse. ʻO kahi ʻokoʻa, akā ʻaʻole kūlike ʻole, manaʻo ʻia ka manaʻo i nā maʻi me he mea lāʻaʻa ʻole a i ʻole nā ʻano "behavioral". N Object Pahuhopu: E hoʻomaopopo i ke kūkā kamaʻilio e pili ana i ka pilina ma waena o ka psychoactive a me nā hana lawena. Nā Papahana: Nānā mākou i nā ʻike e hōʻike ana i nā mea like a me nā ʻokoʻa ma waena o nā maʻi o ka impulse a i ʻole nā ʻano lawena a me nā mea hōʻalo. Pili pono kēia kumuhana i ka hoʻonohonoho kūpono loa o kēia mau maʻi i ka puka ʻelima e hiki mai ana o ka American Psychiatric Association Diagnostic and Statistics Manual of Mental Disorder (DSMV). Nā hopena: Hōʻike ka hōʻike hōʻike ʻana i ka pili ʻana i ke ʻano hana like me nā mea pili i ka waiwai ma ke ʻano he nui, e pili ana i ka mōʻaukala kūlohelohe, nā phenomenology, ka hoʻomanawanui, ka comorbidity, ka hoʻomaʻemaʻe ʻana i ka ʻatikala genetic, nā hana neurobiological a me ka pane ʻana i ka mālama ʻana, kākoʻo ana i ka DSM-V Task Force manaʻo hou i ka māhele hou o ka Addiction a me nā ʻeha pili. ka hoʻopuni ʻana a me ka waiwai a me nā hoʻohui ʻole. Hōʻike nā ʻikepili o kēia manawa i kūpono i kēia ʻahahui hui pū ʻia no ka petological judi a me kekahi mau mea hou e aʻo pono ʻia e pili ana i ka hoʻomaʻamaʻa, ʻano hoʻohālikelike. ʻAʻole lawa ka ʻikepili i kēia manawa e hōʻoia i kekahi kaila o nā hoʻohui ʻē aʻe i hāpai ʻia. He ʻuluʻulu ʻana a me nā mea ʻepekema koʻikoʻi: He ʻano kūpono o ka hoʻohui ʻana i nā hanana peʻa ʻole a i ʻole ke kīnā ʻole e hoʻomāhuahua i ka ulu ʻana o ka maikaʻi o ka pale ʻana a me nā hoʻolālā lapaʻau.
Palapala wā noho ma Dr. David A. Gorelick, 251 Bayview Boulevard, Baltimore, MD 21224, USA. I leka uila: [pale ʻia ka leka uila] Nā huaʻōlelo i hoʻohui ʻia, ka helu ʻana, ka maʻi, ka hoʻohālikelike ʻana i nā maʻi, nā mea hoʻonaninani i ka lāʻau
Introduction
ʻO nā ʻano hana ʻē aʻe, ʻokoʻa ka hoʻokomo ʻana i ka lāʻau psychoactive, hana i ka uku pōkole e hoʻoulu ai i ka hana hoʻomau ʻana me ka ʻike o nā hopena maikaʻi ʻole, ʻo ia hoʻi, ua hoʻoliʻiliʻi ka hoʻomalu ma luna o ka hana. ʻO ka kaohi hoʻopau ʻia kahi kumu nui e wehewehe ana i ka hilinaʻi ʻana o ka lāʻau psychoactive a i ʻole ka hōʻalo. ʻO kēia like ka mea i hāpai i ka manaʻo o nā kumuwaiwai ʻole a i ʻole nā ʻano "behavioral", ʻo ia hoʻi, nā syndrome i hoʻohālikelike ʻia me ka hoʻowaiwai lāʻau, akā me ka nānā ʻana i ka lawena ma mua o ka lawe ʻana i kahi lāʻau psychoactive. ʻO ke kumumanaʻo o nā hana lawena i loaʻa i kekahi waiwai ʻepekema a me nā maʻi heuristic, akā noho mau ʻo ia me ka hoʻopaʻapaʻa. Ke hoʻopaʻapaʻa ʻia nei nā pilikia e pili ana i nā hana lawena i ke ʻano o ka hoʻomohala ʻana i ka Diagnostic a me ka Statistic Statistic of Mental Disorder Fifth Edition (DSM-V) (1, 2)
ʻO nā mea hoʻohui e pili ana i ka hoʻohālikelike ʻia ua hoʻāliʻi ʻia e like me ka loaʻa ʻana o nā mea pili kino. Ke kuhikuhi nei ʻo Diagnostic and Statistical Manual, ʻehā Edition (DSM-IV-TR) i koho i ka hopena diagnostic maʻamau no kekahi o kēia mau pilikia (ka hoʻohālikelike ʻana, ka petological gaming, kleptomania), ka helu ʻana iā lākou e like me ke kīpē o ka hoʻokele lula, kahi māhele hoʻokaʻawale mai nā mea hoʻohana kino. Ua noʻonoʻo ʻia nā ʻano ʻē aʻe ʻē aʻe (a i ʻole nā mana o ke kaohi i ke ʻano) i ke komo ʻana i ka DSM-compulsive e kūʻai mai nei, ka ʻili ʻana o ka ʻili o nā pathologic, ka hana ʻana i nā moe kolohe (non-paraphilic hypersexuality), nā hana hōʻeha nui, ka pāʻani kamepiula / wikiō pāʻani, a me ka pili ʻana i ka pūnaewele. ʻO kēlā mau ʻano e hoʻohui ai me ka mea e pili ana i ka hoʻohui ʻana i ke ʻano no ka hoʻopaʻapaʻa (3). ʻAʻole ke kāʻei hoʻokaumaha āpau, a i ʻole nā pōʻino i hōʻike ʻia e ka impulsivity, pono e noʻonoʻo i nā hoʻohui lāʻau. ʻOiai ka hapanui o nā maʻi hoʻomalu o ka kuhi (ka hoʻohālike, ka petological gaming, kleptomania) e ʻike i nā hiʻohiʻona waiwai me nā mea e pili ana i ka pilaline, nā mea ʻē aʻe, e like me ke kikowaena kikowaena kikowaena, ʻaʻole paha. I ka hoʻomakaʻana o ka hāʻawi ʻana i kēia hoʻopaʻapaʻa, ua nānā kēia ʻatikala i nā hōʻike no nā mea like ʻole ma waena o nā mea hoʻohālikelike a me nā hana hōʻino mea koina, ko lākou ʻokoʻa mai ka ʻōpū o ka ʻāʻī, a me ka ʻike i nā wahi o ka kānalua ʻole i ka hōʻoia ʻana i ka noiʻi mua. Mālama ʻia ia i ka hoʻolako ʻana i nā ʻatikala i hiki mai i kēia pilikia, e loiloi ana i kekahi mau ʻano hana hoʻohālikelike putative.
Nā Koho Moho o nā Koho
ʻO ke ʻano nui o nā hoʻohui i ka hana kūpono ʻole o ka hōʻole ʻana i ka kuhi hewa, ka hoʻokele ʻana, a i ʻole e hoʻowalewale i ka hana e hōʻino ʻia ai ke kanaka a i ʻole kekahi (4). Hōʻike ʻia kēlā me kēia ʻano hana hoʻohālikelike e ka ʻano hoʻohuli o ke ʻano i loaʻa kēia ʻano nui i loko o kahi kāʻei kūikawā. ʻO ka hana hou ʻana i kēia mau ʻano hana i ka hopena o ka hana ma nā ʻāina ʻē aʻe. I ka hoʻohanohano ʻana, e like me nā mea pili i ke ʻano o nā hanana ʻeha. ʻO nā mea kūlohelohe me nā mea pili i ke kino e hōʻike i nā pilikia i ka pale ʻana i ka hoʻonāukiuki ʻana e inu a hoʻohana paha i nā lāʻau lapaʻau.
Loaʻa nā like like ʻole o ka lawena a me nā lāʻau i nā moʻolelo kūlohelohe, phenomenology, a me nā hopena maikaʻi ʻole. Ua hoʻomaka nā mea ʻelua i ka ʻōpio a me ke ʻōpio makua a me nā helu kiʻekiʻe ma kēia mau makahiki ma mua o nā poʻe ʻelemākule (5). He mau mōʻaukala kūlohelohe paha kā lāua ʻelua e hōʻike ai i nā lauana hoʻomau, hoʻi hou, akā me nā poʻe he nui e hoʻi ana iā lākou iho me ka ʻole o ka lapaʻau maʻamau (i kapa ʻia ʻo "spontaneous" quitting) (6).
Hoʻohui pinepine ʻia nā ʻano mea pili i ka lawena e nā manaʻo o "ke kūpikipiki a hoʻāla paha ma mua o ka hana ʻana i ka hana" a me "leʻaleʻa, ʻoluʻolu, a i ʻole ke kōkua i ka manawa o ka hana ʻana" (4). ʻO ke ʻano ego-syntonic o kēia mau ʻano hana e like me ka ʻike o ka hoʻohana ʻana i ka lāʻau. Hoʻohālikelike kēia me ke ʻano ego-dystonic o ka maʻi obsessive-compulsive. Eia nō naʻe, lilo nā ʻanoʻano a me nā mea hoʻowaiwai i mea hoʻoliʻiliʻi ego-syntonic a ʻoi aku ka ego-dystonic i ka manawa, ʻo ke ʻano (me ka lawe ʻana i nā mea) lilo i mea ʻoluʻolu ʻole a ʻoi aku ka nui o ka hana maʻamau a i ʻole ke koi ʻia (2, 7), a i ʻole lilo i mea hoʻonāukiuki e hoʻēmi ʻia e ka hoʻoikaika maikaʻi a me nā mea hou aku e ka hoʻoikaika maikaʻi ʻole (e laʻa, ke kōkua o ka dysphoria a i ʻole ka haʻalele ʻana).
Loaʻa nā ʻano like phenomenological i ka lawena a me nā lāʻau. Hōʻike ka hapa nui o nā kānaka me nā ʻano lawena i ka makemake a makemake paha i ka mokuʻāina ma mua o ka hoʻomaka ʻana i ka hana, e like me ka poʻe me nā maʻi hoʻohana maʻa ma mua o ka hoʻohana ʻana o ka lāʻau. Hoʻohui ʻia, hoʻoliʻiliʻi pinepine kēia mau hana i ka hopohopo a hopena i kahi kūlana maikaʻi a i ʻole "kiʻekiʻe," e like me ka ʻona o ka lāʻau. Hiki ke kōkua i ka dysregulation Emotional i ka ʻiʻini i nā maʻi ʻelua a me nā lāʻau hoʻohana (8). He nui ka poʻe me ka piliwaiwai pathological, kleptomania, ka moekolohe moekolohe, a me ke kūʻai koi koi e hōʻike i ka hōʻemi ʻana o kēia mau hopena ʻano maikaʻi me nā ʻano hana hou a i ʻole kahi pono e hoʻonui i ka ikaika o ka lawena e hoʻokō i ka hopena o ke ʻano like, e like me ke ahonui (9-11) . Hōʻike pū nā poʻe he nui me kēia mau ʻano lawena i kahi kūlana disphoric ʻoiai e hōʻole ana i nā ʻano, e like me ka haʻalele ʻana. Eia nō naʻe, ʻokoʻa ka huki ʻana o nā mea, ʻaʻohe hōʻike o ke kūlana koʻikoʻi koʻikoʻi a koʻikoʻi hoʻi o nā lāʻau mai nā hana lawena.
ʻO ka palaka pathological, ke aʻo aʻo maoli ʻana i nā pono pili kolohe, hāʻawi i ka ʻike hou i ka pili o nā mea pili i ke ʻano lāʻau a me nā pilikia hoʻohana. Hoʻomaka pinepine ka pā pāʻani pathological i ka wā kamaliʻi a me nā wā ʻōpio, me nā kāne e hoʻomaka ana e hoʻomaka i ka wā ma mua o ka makahiki (5, 12), ke kāʻei ʻia i ke ʻano o ka hana kino o ka maʻi kino. ʻIke ʻia nā kiʻekiʻe kiʻekiʻe o ka pāʻauwai pathological i nā kāne, me kahi ʻano telescoping i ʻike ʻia i nā wahine (ʻo ia hoʻi, ʻo ka wahine kekahi o ka mua o ke komo ʻana i ka hana hoʻohālikelike, akā no ka wīwī o ka manawa mai ka hoʻokūkū mua i ka hoʻohui) (13). ʻO ke kuhi telescoping i hōʻike nui ʻia i nā ʻano mea like ʻole o ka hoʻohana kino ʻana (14).
E like me ka mālama ʻana i nā pilikia, he pilikia nā pilikia kālā a me ka male i nā mea hoʻohui. ʻO nā mea kūwaho e pili ana i nā hana hoʻohālikelike, e like me ka poʻe me nā mea pili waiwai, e hana pinepine lākou i nā hana hewa, e like me ka ʻaihue, ka hoʻohemo ʻana, a me ka kākau ʻana i nā loiloi maikaʻi ʻole, e hoʻolilo i kā lākou ʻano hana hoʻohālikelike a i ʻole i ko nā hopena o ke ʻano (15).
laʻelaʻe
ʻO nā mea pilikino me nā mākau ʻai a me nā mea make me ka waiwai make ka ʻike kiʻekiʻe ma luna o nā hōʻike moʻo iho e pili ana i ka impulsivity a me ka ʻimi ʻana a me ka ʻimi ʻana a ma ka haʻahaʻa o ka pale ʻana i ka pōʻino (16-20). Eia nō naʻe, hiki i nā mea pākahi me kekahi mau mea pili i ke ʻano, e like me ka palaka pūnaewele a i ʻole ka petological gaming, hiki nō hoʻi ke hōʻike i nā kiʻekiʻe kiʻekiʻe o ka ʻalo ʻana (21) (e nānā pū iā Weinstein lāua ʻo Lejoyeux, kēia hihia). Ua hōʻike kekahi mau noiʻi ʻē aʻe nā ʻano o ka psychoticism, interpersonal conflict, a me ka nānā ponoʻī ʻana i nā mea a pau i ke pili ʻana i ka pūnaewele (e ʻike iā Weinstein lāua ʻo Lejoyeux, kēia). Ke hoʻohālikelike nei, ʻo ka poʻe me ka maʻi hoʻokūkū obsessive ka mea kiʻekiʻe loa i nā ana o ka hōʻalo ʻana a hoʻohaʻahaʻa ʻia i ka impulsivity (17, 21). ʻO nā mea kūlohelohe e pili ana i nā hana hoʻohiki, hiki ke kiʻekiʻe ʻia i nā hana koi, akā hiki ke palena ʻia i ka nānā ʻana i nā hana noʻonoʻo a me ka hopohopo e pili ana i ka nalowale ʻana i ka mālama ʻana i nā hanana motor (22). ʻO ka pale ʻana i nā pane o ka waika (impulsivity) ua loaʻa i loko o nā poʻe me ka maʻi compulsive compulsive a me ka ʻili ʻana o ka ʻili pathologic (ʻano hana hoʻomohala me kahi pili kokoke i ka phenomenological kokoke i ke kuʻikahi luhi ka hoʻokaumaha), ʻoiai hiki i ka cognitive inflexibility (manaʻo e hoʻomohala i ka compulsivity) i palena ʻia i ka obsessive hana ʻohiʻohi (23, 24).
MOKUNA 1. ʻO nā koho līlio o nā mea e hoʻohana ai i nā pilikia e pili ana i nā hoʻomehana kūpono.
ʻO ka pāʻani pūnaewele ʻo 35% -63%
Kleptomania 23% -50%
Ke koho nei i ka ʻili o nā pathologic 38%
Hoʻoikaika ka hana kūpono 64%
Hoʻohui pūnaewele 38%
Ke kūʻai nei ke kūʻai mai 21% -46% Punawai: (102).
ʻO Comorbidity
ʻOiai ʻo ka hapanui o nā haʻawina a ka lahui i komo ʻole i ka loiloi o nā pono pili kai, ua kākoʻo ʻia nā ʻikepili epidemiological i kahi pilina ma waena o ka palaka pathological a me nā pilikia hoʻohana, a me nā piʻi nui o ka hanana ʻana ma kēlā me kēia kuhikuhi (25, 26). Ua ʻike ʻia ka haʻawina ʻo St. Louis Epidemiologic Catchment Area (ECA) i ka nui o ka hui ʻana no ka hoʻopilikia ʻana i ka waiwai (e pili ana i ka hilinaʻi o ka nikotine) a me ka pelekikena pathological, me nā hopena kiʻekiʻe e ʻike pinepine ʻia ma waena o ka pili āpau, ka hoʻohana ʻana i ka wai ʻona, a me nā maʻi kūlohelohe antisocial ( 25). Ua ʻike ʻia kahi hoʻokolohua epidemiological Kanaka e ʻoi ka hopena pili i ka hopena ʻakaʻane i ke kino i ka nui o ka 3.8-lip i ka wā i hele ʻole ai ka pāʻani (27). I waena o nā mea pilikino me ka waiwai hilinaʻi, ʻo ka hōʻeha o ka hoʻoweliweli hōʻeha nui i ka hoʻoweliweli kiʻekiʻe ʻo 2.9 ka nui (28). Nā kuʻikahi o nā Odds e hele ana mai 3.3 a 23.1 i hōʻike ʻia ma waena o ka petological gaming a me ka hoʻohana ʻana i ka waiʻona i nā haʻawina ʻōlapa ma US (25, 29). Ua pili nā mea pili i ka pūnaewele me ka hoʻohana ʻana i ka wai ʻona (hewa ratio o 1.84) i kahi hoʻopaʻa haumāna haumāna 2,453, ma hope o ka pale ʻana i ka wahine, wahine a me nā kaumaha (30).
Ua hōʻike ʻia nā lāʻau lapaʻau i nā mea ʻē aʻe e pili ana i ka hanana ʻana me nā mea hoʻohana i ka maʻi maʻamau (Table 1). Hōʻike kēia mau mea loaʻa i ka hoʻohui ʻana e pili ana i ka hoʻohui ʻana i kahi pathophysiology maʻamau me nā pilikia hoʻohana.
Eia nō naʻe, e pili pono ka ʻikepili e pili ana i ka hoʻohana ʻana i nā mea hoʻonaninani. No ka mea, e ʻike ʻia nā hui kumu. hoʻomaka ka hoʻoulu ʻana i ke ʻano ma hope o ka mālama ʻana i ka inu wai, hiki iā ia ma ke ʻano he mea inu no ka inu). ʻO ka poʻe ʻo nā mea pāʻani pilikia me ka hoʻohana ʻana i ka ʻakaʻawa nui e loaʻa iā ia ka nui o ka ʻoi a me ka pilikia o ka psychosocial ma muli o ka pāʻani ma mua o ka poʻe i ʻole ka hoʻohana ʻana i ka moʻolelo o ka waiʻona (31), a me nā ʻōpio e kū aʻe nei i nā mea inu kiʻekiʻe he nui ka palaka pinepine ʻana i ka poʻe i ʻole (32). ke kuhikuhi ʻana i ka pilina pili pilikino ma waena o ka waiʻona a me ka pāʻani. Ke hoʻohālikelike nei, kahi ʻike like e pili ana i ka hoʻohana 'ana me ka nikotine pili i ka pilina o ka syndromal, e like me ka mea e ʻoi ai ka poʻe pākeke me ka petological gaming i kēia manawa a ma mua paha he mau mea puhaka ikaika loa i ke kīwī (33). ʻO nā mea pīpī pilikia e hoʻohana i nā tapaa i kēlā me kēia lā e ʻoi aku ka nui o ka inu wai a me nā pilikia make ʻana (34).
ʻO nā maʻi maʻi ʻē aʻe, e like me ke kaumaha nui loa, ka maʻi bipolar, ka pehu, a me ka nānā ʻana, a me ka nānā ʻana i nā maʻi lapaʻau, a ua ʻike ʻia i ka hoʻopili ʻana me nā mea pili i nā hanana (35, 36) (e nānā pū iā Weinstein a me Lejoyeux, kēia hihia). Eia nō naʻe, ua nui ka nui o kēia mau haʻawina comorbidity ma nā hoʻohālike lapaʻau. ʻO ka nui o ka huli ʻana i kēia mau ʻike i ka ʻike kaiāulu e hoʻomau ʻia.
Neurocognition
Hoʻohui kekahi i ke ʻano e pili ana i ka hoʻonaninani a me nā pilikia make. ʻO nā mea pīhoihoi a me nā mea pili i nā maʻi make me ka hōʻino ka hopena a hōʻemi i ka uku ma mua (37) a hana maikaʻi ʻole i ka hoʻoholo ʻana i nā hana hoʻoholo (38) e like me ka Iowa Gambling Task, kahi paradigma e nānā ana i ka hopena pane-ka hopena (39). Ma kahi hoʻohālikelike, kahi hōʻike o nā poʻe me ka addiction pūnaewele i hōʻike ʻole i nā hewa ʻole o ka hoʻoholo ʻana ma ka Iowa Gambling Task (40). Ke hōʻike ʻana me ka hoʻohana ʻana i ka pā pono neurocognitive piha i 49 poʻe papaʻi papaʻa, 48 ka poʻe ʻona e hilinaʻi ana i ka ʻona, a ua ʻike ʻia nā mana 49 ka poʻe ma ka poʻe ʻakaʻaka a me nā mea inu wai i hōʻike i nā hana haʻahaʻa o nā hoʻāʻo ʻana i ka hoʻokaʻawale ʻana, ʻike leʻaʻana a me nā hana hoʻolālā, akā ʻaʻole like hoʻokō lawelawe (41).
Nā Neurobiological Kūlohelohe
Ke ulu ʻana o ke kino kākau palapala hoʻopili i nā ʻōnaehana neurotransmitter lehulehu (e like me, serotonergic, dopaminergic, noradrenergic, opioidergic) i ka pathophysiology o ka pili pono i ka hana a me ka hoʻohana ʻana i nā mea pili (42). Pēlā ka serotonin (5-HT), ka mea i pili i ka keʻa ʻana o ka hoʻāla ʻana, a me ka dopamine, i pili pū me ka aʻo ʻana, hoʻoikaika, a me ke ʻano o ka hoʻoulu ʻana, me ka uku, hiki paha i nā mea āpau ke pili i nā ʻāpana like ʻole o ka maʻi (42, 43).
ʻO ka hōʻike no ka komo ʻana o serotonergic i ka pili ʻana i nā hana hoʻohālikelike a me nā hana hoʻonaninani mea i hele mai i kekahi ʻāpana mai nā haʻawina o ka hana platelet monoamine oxidase B (MAO-B), ka mea e hoʻoponopono me nā pae cerebrospinal (CSF) o 5-hydroxyindole acetic acid (5-HIAA, kahi metabolite o 5-HT) a ua manaʻo ʻia he māka peripheral o 5-HT hana. Pākuʻi ʻia nā pae CSF 5-HIAA kiʻekiʻe me ka nui o ka impulsivity a me ka nānā ʻana no ka sensation-a loaʻa iā ia i loaʻa i ka pāʻani pathological a me nā pilikia hoʻohana (44). ʻO nā haʻawina hoʻokolohua pharmacologic e ana i ka pane o ka hormonal ma hope o ka hoʻokele ʻana i nā lāʻau serotonergic e hāʻawi pū i nā hōʻike hōʻike no ka hana serotonergic i loko o nā hui hoʻohui ʻelua a me nā hana hoʻonaninani (45).
ʻO ka hoʻohana hou ʻana i nā mea waiwai a i ʻole ka komo ʻana i ka hana hoʻohālikelike e pili ana i ke koi ʻana e hōʻike i kahi kaʻina kūʻokoʻa. Ua hōʻike ʻia nā haʻawina mua a me nā lāʻau lapaʻau e pili ana i kahi hana hoʻomohala i lalo o ka maʻi i makemake ʻia i ka ʻōpū e pili ana i ka hoʻoili ʻana i ka helu komo uku e ka ventral tegmental area / nucleus accumbens / orbital frontal cortex circuit (46, 47). Loaʻa i ka wahi santralal ventralal e pili ana i nā neurons e hoʻokuʻu i ka dopamine i ka nucleus accumbens a me orbital frontal cortex. Ua hōʻike ʻia nā loli a me nā ala dopaminergic e like me ka lalo o ka ʻimi ʻana i nā uku (ʻoiʻa, ka lāʻau) nā mea e hoʻowalewale ʻia ai ka hoʻokuʻu ʻana o dopamine a loaʻa i nā manaʻo leʻaleʻa (48).
Hāʻawi ʻia nā hōʻike paʻa ʻana mai nā haʻawina neuroimaging i ka palu neʻeneʻe neʻeneʻe ʻana o nā mea pili i nā hanana a me nā pilikia hoʻonaninani (7). ʻO ka hana wehe ʻia o ka ventral cortex medial prefrontal cortex (vmPFC) i pili me ka hana hoʻonāukiuki i hoʻoholo i nā loiloi-hopena uku a me ka pane ʻana o nā kōkuhi ʻoi loa i nā mea pāʻani pathological (49). Pēlā nō, ua loaʻa ka hana maʻamau vmPFC i loko o nā poʻe me ka hōʻemi hoʻohana i ka waiwai (50). Hoʻokomo ʻia ka puʻuwai pili o ka lolo i ka poʻe ʻenehana pāʻani Pūnaewele i nā wahi like ʻole o ka lolo (orbitofrontal, dorsolateral prefrontal, anterior cingulate, nucleus accumbens) e like me ka lālani puʻuwai pili i ka lāʻau lapaʻau ʻokoʻa i nā mea hōʻeha lāʻau (51) (e nānā pū pū me Weinstein a me Lejoyeux, hoʻopuka).
Hōʻike ka noiʻi kiʻi ʻana i ka lolo i ke ala mesolimbic dopaminergic mai ka wahi tegmental ventral i ka nucleus accumbens i loko o nā maʻi hoʻohana lāʻau a me ka piliwaiwai pathological. Hōʻike nā kumuhana me ka piliwaiwai pathological i ka hana neuronal striatal ventral me ka fMRI i ka hana ʻana i ka piliwaiwai simulate ma mua o ka mālama ʻana i nā kumuhana (52), e like me ka nānā ʻana i nā kumuhana pili i ka ʻona i ka wā e hoʻoponopono ana i nā uku kālā (53). Hoʻohui pū ʻia ka hoʻoulu ʻana o ka striatal ventral ventral i loko o nā kuko e pili ana i ka lāʻau a me nā lawena behavioral (42). ʻO ke komo ʻana i kahi hana pāʻani kālā e ʻike ʻia ka hoʻokuʻu ʻia o ka dopamine nui aʻe i ka striatum ventral i kēlā me kēia kanaka me ka maʻi Parkinson (PD) a me nā piliwaiwai pathological ma mua o nā kānaka me PD wale nō (54), kahi pane e like me ka mea i hoʻopiʻi ʻia e ka lāʻau a i ʻole nā lāʻau i hoʻopili ʻia i nā mea hoʻōla lāʻau. (55).
Hoʻokomo ʻia ka Dopamine i ka hoʻohui ʻana i nā hana hoʻohālike e nā noiʻi o nā mea maʻi maʻi maʻi maʻi (56, 57). Ua loaʻa i ʻelua mau noiʻi o ka poʻe maʻi me PD ka ʻoi aku o ka 6% i loaʻa i kahi ʻano hoʻonaninani hou hou a i ʻole nā kuhi control control (e laʻa, ka lawaleʻa pathological, ke ʻano hana kolohe), me ka nui o nā kumukūʻai ma waena o ka poʻe e lawe ana i ka lāʻau agonist dopamine (58, 59). Ua pili ka nui o ka pālākiō levo-dopa i pili nui aʻe o ka loaʻa ʻana o kahi ʻano hana hana (59). Kūlike ʻole i ka mea e manaʻo ʻia mai ke komo ʻana o ka dopamine, nā antagonist i ka dopamine D2 / D3 ʻae e hoʻoikaika i nā mea pili e pili ana i ka pili ʻana i ka pili i ka pili o ka non-PD me ka petological gaming (60) a ʻaʻohe hopena i ka hoʻomohala ʻana i nā papa pelelo (61, 62) . ^ E Ha yM. ʻImi hou ʻia i mea e hoʻomaʻamaʻa ai i ka hana kūpono o ka dopamine i ka pāʻani pathological a me nā hoʻohui ʻē aʻe.
Nā Moʻolelo Pilina a me nā Genetics
Kekahi mau ʻohana ʻohana / genetics nā noiʻi pili ʻana i ka pili ʻana i ka hana hoʻohālikelike me nā pūʻulu mana kūpono (7). ʻO nā haʻahaʻa ʻohana liʻiliʻi o nā probima me ka petological gaming (63), kleptomania (64), a i ʻole e koi ʻana (65) i loaʻa i kēlā me nā ʻohana mua o nā kime ka nui loa o ke ola ʻana o ka wai inu wai a me nā mea waiwai ʻē aʻe e pili ana i ka pilikia, a me ke kaumaha nā maʻi psychiatric ʻē aʻe, ma mua o ka kāohi kumuhana i nā kumuhana. Kākoʻo kēia mau ʻohana ʻohana i ka manaʻo e pili ana i ka hoʻohui ʻana i ka pili ʻana i ke ʻano pili kino.
Hoʻomaopopo ka genetic versus kūlohelohe ʻano pili i nā ʻano kūpono a me nā pilikia o ka hoʻohālikelike ʻana i ko lākou concordance i mau like (monozygotic) a me fraternal (dizygotic) pālua pālua. I kahi noi ʻana o nā māhoe kāne e hoʻohana ana i ka Vietnam Era Twin Registry, ʻo 12% a i 20% o ka ʻano ʻano genetic i ka pilikia no ka petological gaming a me ka 3% a 8% o ka ʻano like ʻole nonshared i loko o ka pilikia no ka petological gaming. hoʻohana i nā pilikia (66). ʻO nā hapakolu ʻelua (64%) o ka hakakā ʻana ma waena o ka petological a me ke hoʻohana pono ʻana i ka waiʻona i hoʻowahāwahā ʻia i nā ʻano hanana e hoʻopilikia ai i nā maʻi ʻelua, e hōʻike ana i ka uhi ʻana i loko o nā ʻano o nā ʻano hoʻonaninani o nā ʻano ʻelua. Hoʻohālike kēia mau mea ʻike i nā mea ʻae e hāʻawi i nā kōkua genetic maʻamau i kahi nui o ka hoʻohana kino ʻana o nā mea make (67).
Heʻuʻuku liʻiliʻi nā haʻawina genetic molekepine o nā hanu makua. Hōʻike pinepine ka D2A1 allele o ka D2 dopamine receptor gene (DRD2) i ka maʻamau mai nā poʻe me ka pāʻani ʻole pilikia ma ka petological gaming a me ka hanana ʻana o ka petological a me nā hana hoʻonaninani make (68). Ua hui pū ʻia kekahi mau DRD2 gen single nucleotide polymorphism (SNPs) me nā ʻano pilikino o ka impulsivity a me nā kaʻina hana no ka pale ʻana i nā limahana olakino (69), akā, ʻaʻole i loiloi ʻia kēia i nā poʻe me nā mea pili i ka hanana. ʻO ka poʻe hoʻohana pūnaewele nui aku ka nui o nā alapine ākea o ka allele lima lima (SS) o ka hanana serporonin transporter (5HTTLPR) ma mua o nā kauā olakino, a pili pū kēia me ka pale ʻokoʻa nui (70) (e nānā pū iā Weinstein lāua ʻo Lejoyeux, kēia hopena).
ʻO ka pane i ka hōʻailona
Hoʻokomo maikaʻi ke hoʻoweliweli maikaʻi a me nā hana hoʻonaninani kino i nā ʻano like like ʻole, ʻo ka psychosocial a me ka pharmacological. Hoʻomaka ka hopena 12-step self-help, hoʻoikaika hoʻoikaika, a me ka ʻoluʻolu e hoʻomaʻamaʻa e pili ana i ka hōʻino ʻana i nā mea make a me ke ʻano e mālama pono ai i ka petological gaming, ka ʻano hana kolohe, kleptomania, ka ʻohi kino pathologic, a me nā mea e koi (71-74) . ^ E Ha yM. Nā pānaʻi Psychosocial no ka pili ʻana i ka pono a me ka hōʻino ʻana i nā mea e pili ai i ka hoʻonaninani ʻana i ke ʻano o ka hōʻeha ʻokoʻa e hoʻāliʻi i ka hana hoʻohālikelike ʻana i ka nānā ʻana i nā ʻano hōʻino maikaʻi ʻole, hōʻalo a pale ʻole paha i nā kūlana koʻikoʻi, a hana i nā loli o ke ʻano e hoʻoikaika ai i nā mea ola olakino. Ma ka hoʻohālikelike ʻana, kūleʻa nā maʻi psychosocial no ka maʻi obsessivecompulsive e hoʻomālamalama i ka ʻike a me nā hoʻolālā pale pale (2).
ʻAʻole he mau lāʻau lapaʻau i ʻae ʻia i kēia manawa no ka mālama ʻana i nā hoʻohui i nā ʻanoʻano, akā ʻo kekahi mau lāʻau lapaʻau i hōʻike ʻia i ka hoʻohiki ʻana i ka mālama ʻana i nā lāʻau pili kino ua hōʻike pū ʻia i ka hoʻohiki i ka mālama ʻana i nā mea e pili ana i ka hanana (75). ʻO Naltrexone, he antagonist receptor mu-opioid i ʻae ʻia e ka US Food and Drug Administration no ka mālama ʻana i ka ʻawaʻawa a me ka hilinaʻi opioid, ua hōʻike mai i ka hana pono ma nā hoʻokolohua paʻa i mālama ʻia no ka mālama ʻana i ka petological a me ke kleptomania (76-79), a ua hoʻohiki i ka poʻe ʻole. nā haʻawina o ke kūʻai kūpaʻa (80), ke ʻano hana hoʻomālamalama (81), ka hoʻohui pūnaewele (82), a me ka ʻili ʻana o ka ʻula pathologic (83). Hōʻike kēia mau ʻike i ka ʻeneka mu-opioid e like me nā hana i nā mea i hoʻohui ʻia e like me kā lākou hana ʻana i ka hana hōʻino, aia ma o ke ʻano o ke ala me ka mesolimbic dopaminergic. Ke hoʻohālikelike nei, ʻo ka mea hana mu-opioid receptor antagonist naloxone e hoʻomaʻalolu i nā hōʻailona i ka maʻi obsessive-compulsive (84).
ʻO nā lāʻau lapaʻau e hoʻololi ai i ka hana glutamatergic i hoʻohana ʻia no ka mālama ʻana i nā mea pili i nā hanana ʻelua a me nā mea hilinaʻi. ʻO Topiramate, kahi anticonvulsant e pani ana i ka AMPA subtype o ka mea hoʻopale glutamate (ma waena o nā hana ʻē aʻe) e hōʻike ana i ka ʻōlelo hoʻohiki ma ka noiʻi ʻana i ka pili ʻana i ka petological gaming, ke kūʻai kūleʻa, a me nā ʻili puʻupuʻu ʻula (85), a me ka hoʻomaʻamaʻa ʻana i ka hōʻemi ʻana i ka waiʻona (86) ), nā mea inu (87), a me ka cocaine (88) hoʻohana. ʻO ka cystine N-acetyl, kahi waikina amino e hoʻihoʻi i ka kukuna glutamate extracellular i loko o ka nucleus accumbens, hoʻemi hoʻohaʻaka i ke kōpaʻa a me ke ʻano i loko o ka noiʻi ʻana o nā mea pāʻani pathological (89), a me ka hōʻemi i ka caine caineini (90) a me ka hoʻohana ʻana i ka cocaine (91) i nā mea kokohiko. Ua hōʻike kēia mau haʻawina ʻo ka modus glutamatergic o ke kani dopaminergic i ka nucleus accumbens hiki paha i kahi ʻano maʻamau i ke ʻano o ke ʻano hana ona a me nā pilikia hoʻohana i nā pilikia (92).
Nānā diagnost
Hoʻokahi wale nō kuhi hewa, piliwaiwai pathological, kahi ʻike ʻike ʻia ma DSM-IV a me ICD-10. Kūlike like ke ʻano o kāna ana hoʻohālikelike me nā mea no ka hōʻino ʻana i ka lāʻau / kaukaʻi, ʻo ia hoʻi, ka hana mua ʻana me ka lawena, hoʻemi i ka hiki ke kaohi i ka lawena, ke ahonui, ka haʻalele ʻana, a me nā hopena psychosocial maikaʻi ʻole. Ua kuhi ka DSM-V Task Force i ka neʻe ʻana i ka piliwaiwai pathological mai kāna hoʻohālikelike ʻana i kēia manawa ma ke ʻano he mana hoʻomalu impulse i kahi papa inoa hou i kapa ʻia ʻo "Addiction and Related Disorder," kahi e hoʻopili ai i nā maʻi hoʻohana a me nā "nonsubstance addicts" (www.dsm5. org, kiʻi ʻia ma Pepeluali 10, 2010). ʻO ka loli nui wale nō i manaʻo ʻia e hoʻololi i nā pae hoʻohālikelike e waiho ana i kahi pae e pili ana i ke komisina o nā hana kū ʻole i ke kālā e pili kālā, ka mea i loaʻa he haʻahaʻa haʻahaʻa a liʻiliʻi iki ka hopena.
Ua noi aku kekahi mau ʻano hana ʻē aʻe e pili ana i nā hoʻokolohua diagnostic, ʻo ka pono me ke kūʻai ʻana (93), addiction pūnaewele (94), addition video wikiō (95), hoʻohui hūʻike (96), a me ka make kino (see Kouroush et al., Kēia hopena) . ^ E Ha yM. Pili ka maʻamau i kēia ma muli o ka mana o ka DSM-IV no ka hōʻino a me ka hilinaʻi ʻana, ka mea, ke ʻano nui ka manawa i loko o ka ʻano, a hoʻomāliʻi i ka hoʻāʻo ʻole e hōʻoki a mālama paha i ke ʻano, ʻae ʻia ka mana o ka lawena, ʻae ʻia, hoʻihoʻi, a me nā psychosocial i hōʻino. nā hopena. Ke noʻonoʻo nei ka pūʻulu hana hana DSM-V Hoʻonaʻauao e pili ana i kekahi o kēia mau mea hoʻohui ʻole no ka hoʻokomo ʻana i DSM-V, e hōʻike ana i ka hoʻohui ʻana ma ka pūnaewele (www.dsm5.org; i loaʻa iā Feb. 10, 2010). Eia nō naʻe, no nā maʻi he nui, heʻuʻuku a ʻaʻole hoʻi e hōʻoia i ka ʻikepili no kēia mau maʻi diagnostic; he kōkua nui lākou i kēia manawa e like me nā mea hana loiloi e koho i ka nui o ka pilikia.
ʻO hoʻokahi nīnau diagnostic i hāpai ʻia i loko o ka puke kahi e pili ai i nā hoʻohui lāʻau (a me nā waiwai hoʻohui) ka hāʻule ʻana o ka impulsivity-compulsivity dimension (97), ʻo ia hoʻi, he nui aʻe lākou e like me ka hōʻeha o ka impulse a i ʻole nā hana hoʻokalakupua obsessive? Ua kūpaʻa kekahi poʻe, he maʻalahi loa kēia ala o ke ʻano kūʻawale ʻole, a ʻo ka impulsivity a me ka hoʻokūkū e hōʻike ana i nā ʻāpana o nā orthogonal, ma mua o nā poloka e kū nei i kahi ʻāpana hoʻokahi (98). ʻO ka launa pū me ka hoʻopaʻapaʻa hope loa, ʻo ia nā ʻike e like me ka nui o ka nui o ka impulsivity ma waena o ka poʻe me kahi hoʻohui hoʻohālikelike, ʻano hoʻohālikelike e pili ana me ka pane ʻana i ka lāʻau lapaʻau lāʻau (48, 99).
I loko o DSM-IV, nā meaʻawaʻawa lāʻau (ka hoʻohanaʻana i ke kinona) heʻano hoʻokele kūikawā,ʻoiai ka manaʻo pāʻani pāpālua e nānāʻia he maʻi kaohiʻana, e like me, e like me ka pyromania a me ka kleptomania. Hoʻomaopopoʻo ICD-10 i ka pāʻani pīhoihoi e like me ka "maʻi a me ka manaʻo", akāʻikeʻo ia "ʻaʻole ka mana o ka hana ma keʻano loea,"ʻoiaiʻo ia i kapaʻia kekahi manawa "ka pāʻani pīhoihoi."
ʻO kahi pilikia pili ka hui, a i ʻole ka hoʻopili ʻana, inā he mea, i waena o nā ʻano lawena ʻokoʻa. ʻO kahi hōʻuluʻulu puʻupuʻu o nā heluna kanaka a me nā ʻano lāʻau lapaʻau i 210 mau maʻi me ka maʻi koʻikoʻi mua ʻole i ʻike ʻia ʻelua mau hui kaʻawale o nā mea maʻi me nā ʻano lawena (100): ʻo nā mea maʻi me ka piliwaiwai pathological a i ʻole ka hoʻomana kolohe ("hypersexual") he mau makahiki ma mua o ka hoʻomaka a ʻoi aku paha. kāne, ke hoʻohālikelike ʻia i nā mea maʻi me ke kūʻai koi. Pono e noiʻi hou e hōʻoia a hoʻolōʻihi i kēia loaʻa. ʻO kahi noiʻi noiʻi e hiki ai ke hāʻawi nui i ka māla kahi loiloi piha o kahi hui nui, heterogeneous, ʻano maikaʻi o nā poʻe me nā ʻano lawena a me nā mea ʻona i ka ʻōlelo o nā ʻāpana discrete o ka impulsivity a me ka compulsivity i loko o ka psychological (cognitive) a me ka behavioral ( moto) nā kāʻei, e laʻa, ʻike i ka hoʻolohi uku (hoʻoliʻiliʻi kūloko o ka uku), hoʻoholo hoʻoholo hoʻoweliweli, hoʻopaʻapaʻa manaʻo, pane anticipatory premature, pane hoʻomanawanui, kaohi ʻana i ka hopena, a me ka aʻo hoʻohuli ʻana.
KA HOʻOMAʻAU A ME KA HOʻOPIʻI
Kuhi nā hōʻike e ulu nei nā ʻano like ʻole o ka lawena i nā lāʻau ma nā kāʻei he nui, e like me ka mōʻaukala kūlohelohe (hoʻomau, hoʻi hou ʻana i ka papa me nā hanana kiʻekiʻe a me nā prevalence o nā ʻōpio a me nā ʻōpio), phenomenology (makemake nui i ka ʻona, ʻona ["kiʻekiʻe"], a me ka haʻalele ʻana), hoʻomanawanui , comorbidity, overlapping genetical hāʻawi, neurobiologicalʻano papa hana (me nā kuleana no ka lolo glutamatergic, opioidergic, serotonergic, a me ka dopamine mesolimbic ʻōnaehana), a me ka pane i ka lapaʻau. Eia nō naʻe, ʻoi aku ka nui o ka ʻikepili e kū nei no ka piliwaiwai pathological (e nānā iā Wareham a me Potenza, kēia pukana), me nā ʻikepili palena palena ʻole no ke kūʻai ikaika ʻana (e ʻike iā Lejoyeaux a me Weinstein, kēia pukana), ka hoʻopuka pūnaewele (e nānā iā Weinstein a me Lejoyeaux, kēia pilikia), a hōʻalo wikiō / pāʻani pāʻani kamepiula (ʻike iā Weinstein, kēia pukana), a ʻaneʻane ʻaʻohe ʻikepili no nā ʻano lawena e like me ke ʻano moekolohe (e ʻike iā Garcia a me Thibaut, kēia hoʻopuka), ke aloha i ke aloha (e nānā iā Reynaud, kēia pukana), ke ʻili ʻili pathologic (ʻike ʻO Odlaug a me Grant, kēia hoʻopuka), a i ʻole ke kāʻiliʻili nui ʻana (e nānā iā Kouroush et al., Kēia pukana).
Loaʻa nā hōʻike kūpono e hōʻoia i ka noʻonoʻo ʻana i nā moʻo pathological ʻoiai he mea waiwai ʻole a i ʻole ke kala ʻana; Ua hoʻolālā ka DSM-V Task Force e neʻe i ka hoʻokaʻawale ʻana i DSM-V mai kahi maʻi hōʻeuʻeu kolohe i kahi mea hoʻohui a me nā pilikia e pili ana (i kahi ʻano hou e hoʻopili ana i nā addancerelated a me nā mea ʻole hoʻohui). I ka manawa o ka ʻike i kēia manawa, inā paha i ka ʻole o nā loiloi maʻi hopena a me ka neʻe ʻana o ka lōʻihi, aʻo ia ka lōʻihi, e noʻonoʻo nō ia i nā ʻano hana ʻē aʻe e like me ka maʻi kūʻokoʻa kūʻokoʻa holoʻokoʻa, ʻoi aku ka hoʻokaʻawale ʻana iā lākou āpau me nā mea e like me nā mea pili i ka waiwai, ma mua o ka pae ʻana o nā mea hoʻohālikelike. me ka hoʻonāukiuki ʻana i nā maʻi maʻa. Pono ka noiʻi mua i ka wā e komo ai, a me nā ʻikepili kanaka a me nā holoholona (101), i lawe mai i kā mākou ʻike i ka pili ʻana i ka hoʻomaʻamaʻa ʻana i ke ʻano o ke ʻano o nā mea pili i ke ʻano mea nui, ʻoi aku hoʻi i nā kālena o nā genetics, neurobiology (me ka noʻonoʻo ʻana o ka noʻonoʻo) a me ka mālama ʻana.
ACKNOWLEDGMENTS
Ke kākoʻo ʻia e ka Polokalamu ʻimi noiʻi Intramural, National Institutes ofHealth, National Institute on Drug Abuse (DAG); Hāʻawi ʻo NIH (NIDA) iā R01 DA019139 (MNP) a me RC1 DA028279 (JEG); a me nā Minnesota ʻokoʻa a me Yale Centres of Excellence in Gambling Research, i kākoʻo ʻia e ke National Center for Responsible Gaming a me kāna Institute for Research on Gambling Dislines. ʻO ke kākoʻo ʻo Dr. Weinstein i kākoʻo ʻia e ka Israel National Institute for Psychobiology. Kūpono i nā mea i kākau ʻia no ke kuleana wale o nā mea kākau a ʻaʻole pono e kū i nā manaʻo no nā National Center for Responsible Gaming a i ʻole Institute of Research for Gambling Dislines a i ʻole nā mea kālā ʻē aʻe āpau.
Hōʻike o ka Pono
Ua hōʻike aku nā mea kākau a pau i hakakā ʻole o ka manaʻo e pili ana i nā manaʻo o kēia ʻatikala. Ua loaʻa i kā Dr. Grant nā noiʻi noiʻi mai NIMH, NIDA, National Center for Responsible Gaming a me kāna hui pili ʻana no ka Research for Gambling Dislines, a me nā lāʻau lapaʻau e mālama ai. Loaʻa iā Kauka Grant ka uku makahiki ʻana mai ʻo Springer Publishing no ka hana ma ka Luna Hoʻokele o ka Journal of Gambling Studies, ua hana i nā loiloi no ka NIH a me ka Hui Pūʻaka Kila ma Ontario, ua loaʻa nā huki mai ka Oxford University Press, American Psychiatric Publishing, Inc. , Nā Norton Press, a me McGraw Hill, i loaʻa i ka hoʻohanohano mai ka Kula Kauka ʻĀina Indiana, University of South Florida, the Mayo Medical School, California Society of Addiction Medicine, ka mokuʻāina o Arizona, ka mokuʻāina ʻo Massachusetts, ka mokuʻāina o Oregon, ʻIke o Nova Scotia, a me ka ʻāpana o Alberta. Ua loaʻa iā Dr. Grant ka uku uku ma ke ʻano he kūkākūkā no nā keʻena kānāwai e pili ana i nā pilikia e pili ana i nā maʻi ʻeha. Loaʻa iā Kauka Potenza i ke kākoʻo kālā a i ʻole ka uku ʻana no ka mea ma hope: i mea kūkā kūkākūkā no, a me ke kahu ʻōlelo no Boehringer Ingelheim; nā kālā kālā i Somaxon; noiʻi noiʻi ʻana mai ke National Institutes of Health, Keʻena ʻOihana Veterans Affairs, Mohegan Sun Casino, National Center for Responsible Gaming a me nā hui ʻoihana ʻĀpana nāna e noiʻi i nā Polokalamu Hoʻoweliweli, a me Laboratory Laboratory; ua komo i loko o nā noiʻi, leka uila a kūkākūkā paha kelepona e pili ana i ka hoʻohui ʻana o ka lāʻau lapaʻau, pilikia hōʻeha haki, a i ʻole nā kumuhana olakino ʻē aʻe; ua kūkākūkā no nā keʻena kānāwai e pili ana i nā pilikia e pili ana i ka hoʻohui a i ka hoʻomau ʻole paha. ua hoʻolako ʻia i ka mālama mālama kino ma ka ʻoihana ʻo Connecticut o ka Pūnaewele ʻo Mental and Addiction Services Problem Gambling Services Program; a ua hana i nā puke a i ʻole puke paha puke no nā mea paʻi o nā palapala olakino noʻonoʻo. Ua loaʻa iā Dr.Weinstein nā noi noiʻi mai ka Israel Anti-Drug Authority, ka Israel National Institute for Psychobiology, ke Keʻepekema Nui o ka Ministry of Health of Israel, a me ka Rashi Trust (Paris, Palani) a me nā uku no nā kūkākūkā ma ka hoʻohui lāʻau lapaʻau mai ka. ʻOihana Hoʻonaʻauao a ʻIseraʻela. ʻAʻole hōʻike ʻo Kauka Gorelick i waho kālā a me nā kū'ē ʻole i ka manaʻo
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