Tikuphunzira zambiri za chilakolako chomwe chimalimbikitsa zizolowezi zodzigonjetsa—ndi momwe zinthu zatsopano zopezedwa zingatithandizire kusiya chizolowezichi. [ Onerani kanema waufupi ]
Chizoloŵezi choledzeretsa chimapangira ubongo wa neural njira. Asayansi akutsutsa malingaliro akuti ndi kulephera kwa makhalidwe ndi kufufuza mankhwala omwe angapereke mpumulo kuchokera ku chikhumbo cha chilakolako, kulowerera, ndi kuchotsa komwe kumamangirira makumi amamiliyoni a anthu.
Janna Raine anayamba kugwiritsa ntchito mankhwala osokoneza bongo kwa heroin zaka makumi awiri zapitazo atatha kumwa mapiritsi ochepetsa kupweteka kwa ntchito. Chaka chatha anali kukhala mumsasa wopanda pokhala pansi pa sitima ya Seattle.
Patrick Perotti ananyoza pamene amayi ake anamuuza za dokotala yemwe amagwiritsa ntchito mafunde amphamvu kuti azitha kumwa mankhwala osokoneza bongo. "Ndinaganiza kuti anali wonyenga," anatero Perotti.
Perotti, yemwe ali 38 ndipo amakhala ku Genoa, Italy, anayamba kuyambitsa cocaine ku 17, mwana wolemera yemwe ankakonda kuchita phwando. Kuchita kwake pang'onopang'ono kunayamba kukhala chizoloŵezi cha tsiku ndi tsiku ndikukakamiza kwambiri. Anagwidwa m'chikondi, anali ndi mwana wamwamuna, ndipo anatsegula malo odyera. Pakulira kwake, banja lake ndi bizinesi zinatha.
Iye anachita miyezi itatu mu rehab ndipo anayambiranso maola a 36 atachoka. Anatha miyezi isanu ndi itatu pulogalamu ina, koma tsiku lomwe adabwerera kunyumba, adawona wogulitsa ndipo adakwera. Iye anati: "Ndinayamba kugwiritsa ntchito cocaine mokwiya. "Ndinachita mantha, ndinkangoganiza, ndachita zamisala. Sindinkaona njira iliyonse yothetsera. "
Mayi ake atamukakamiza kuti aitane ndi dokotala, Perotti adalowamo. Anaphunzira kuti atangokhala pampando monga dokotala wa dokotala ndikuwalola dokotala, Luigi Gallimberti, kugwiritsira ntchito chipangizo pafupi ndi kumanzere kwa mutu wake, pamutu zikanathetsa njala ya cocaine. "Pangakhale phokoso kapena Dr. Gallimberti," akukumbukira.
BREAKING CHAIN
Wovuta kwambiri wa cocaine amene anadutsanso kangapo katatha chithandizo, Patrick Perotti potsiriza anagwiritsira ntchito njira yowonetsera-kugwiritsa ntchito magetsi othamanga magetsi ku kampani yake yapamwamba ku Padua, Italy. Izo zinagwira ntchito. Psychiatrist Luigi Gallimberti wagwiritsanso ntchito maginito opatsa mphamvu odwala ena omwe ali ndi mphotho yomweyo. Iye ndi anzake akukonzekera chiyeso chachikulu. Njirayi tsopano ikuyesedwa kwa mitundu ina ya zakumwa ndi ofufuza padziko lonse lapansi.
Gallimberti, waubweya wa imvi, wodwala matenda opatsirana pogonana ndi wochita zauchidakwa amene wakhala akuledzera zaka 30, akuthamanga kuchipatala ku Padua. Chigamulo chake choyesa njirayi, yotchedwa transcranial magnetic stimulation (TMS), chifukwa cha kupita patsogolo kwakukulu mu sayansi ya chizoloŵezi-komanso chifukwa cha kukhumudwa kwake ndi mankhwala. Mankhwala angathandize anthu kusiya kumwa mowa, kusuta, kapena kugwiritsa ntchito heroin, koma kubwerezabwereza kumakhala kofala, ndipo palibe njira yothetsera mankhwala yothetsera vuto la cocaine. "Ndizovuta kwambiri kuchiza odwala awa," akutero.
Anthu oposa 200,000 padziko lonse amafa chaka chilichonse kuchokera ku mankhwala osokoneza bongo komanso matenda ozunguza bongo, monga HIV, malinga ndi bungwe la United Nations Office la Mankhwala Osokoneza Bongo ndi Chiwawa, ndipo ambiri amafa chifukwa cha kusuta ndi kumwa. Anthu oposa biliyoni akusuta, ndipo fodya imakhudzidwa ndi zifukwa zisanu zomwe zimayambitsa imfa: matenda a mtima, sitiroko, matenda opuma, matenda osokoneza bongo, ndi khansa ya m'mapapo. Pafupifupi mmodzi mwa anthu akuluakulu a 20 padziko lonse lapansi amamwa mowa mopitirira muyeso. Palibe amene adawerengera anthu otchova njuga ndi zinthu zina zomwe zimakakamizidwa kuti azitha kuthamanga.
Ku United States mliri wa opioid woledzera ukupitirirabe kuwonjezeka. Zomwe Zidzakhala Zosamalidwa ndi Kuteteza Matendawa zinalemba zochitika za 33,091 zakufa mopitirira muyeso ku 2015 kuchokera ku ma opioid, kuphatikizapo mankhwala opatsirana mankhwala ndi heroin-16 peresenti kuposa zaka zomwe zalembedwa kale, zisanafike chaka chimodzi. Poyankha vutoli, adokotala oyamba opaleshoni ya dokotala wamkulu wa ku United States adatulutsidwa mu November 2016. Zinamveka kuti anthu a ku America a 21 ali ndi mankhwala osokoneza bongo kapena moledzeretsa, zomwe zimachititsa kuti matendawa akhale osiyana kwambiri ndi khansa.
Atakhala zaka makumi angapo akufufuza ubongo wa nyama zokonda kugwiritsa ntchito mankhwala osokoneza bongo ndikusanthula ubongo wa anthu odzipereka, asayansi apanga chithunzi chatsatanetsatane cha momwe kusuta kumawonongera njira ndi njira zomwe zimakulitsa chikhumbo, kapangidwe kazizolowezi, chisangalalo, kuphunzira, kuwongolera malingaliro, ndi kuzindikira. Kuledzera kumapangitsa kusintha kwamitundu mu anatomy yaubongo, chemistry, ndi ma cell-to-cell signature, kuphatikiza mipata pakati pa ma neuron otchedwa synapses, omwe ndi makina ophunzirira. Pogwiritsa ntchito ubongo wodabwitsa wa ubongo, kuledzera kumabweretsanso maulendo a neural kuti apindule kwambiri ndi cocaine kapena heroin kapena gin, povulaza zinthu zina monga thanzi, ntchito, banja, kapena moyo weniweniwo.
"Kunena zoona, kumwa mowa mwauchidakwa ndi njira yophunzirira," anatero Antonello Bonci, katswiri wa zamagulu ku National Institute on Drug Abuse.
Gallimberti adachita chidwi kwambiri atawerenga nkhani ya m'nyuzipepala yokhudza zoyeserera za Bonci ndi anzake ku NIDA ndi University of California, San Francisco. Iwo anayeza ntchito zamagetsi mu ma neuron m'makoswe omwe akufuna cocaine ndipo adapeza kuti gawo la ubongo lomwe limakhudzidwa ndi kuletsa khalidwe linali losazolowereka. Pogwiritsa ntchito optogenetics, yomwe imaphatikiza fiber optics ndi majini kuti igwiritse ntchito ubongo wa nyama ndi liwiro komanso kulondola komwe sikunaganiziridwe, ofufuzawo adayambitsa maselo osalimba awa m'makoswe. "Chidwi chawo pa cocaine chinatha," akutero Bonci. Ofufuzawo adati kuyambitsa gawo la ubongo wa munthu lomwe limayang'anira kuletsa khalidwe, mu prefrontal cortex, kungathe kuletsa chilakolako chosatha cha munthu woledzera kuti aledzere.
Gallimberti amaganiza kuti TMS ikhoza kupereka njira yeniyeni yochitira izo. Ubongo wathu umayendetsa magetsi omwe amapanga pakati pa neuroni ndi lingaliro lililonse ndi kusuntha. Kulimbikitsana kwa ubongo, komwe kwagwiritsidwa ntchito kwa zaka kuti athetse kuvutika maganizo ndi migraines, matepi ozungulira. Chipangizocho sichina koma waya yophika mkati mwa wand. Pamene magetsi amatha kudutsa, makinawo amapanga magnetic pulse amene amasintha ntchito zamagetsi mu ubongo. Gallimberti amaganiza kuti mobwerezabwereza mapulesi angayambe kugwiritsa ntchito njira zopsereza mankhwala osokoneza bongo, monga kubwezeretsanso pa makompyuta ozizira.
Iye ndi mnzake, katswiri wamaganizo a maganizo, Alberto Terraneo, adagwirizana ndi Bonci kuti ayese njirayi. Anagwiritsira ntchito mankhwala osokoneza bongo: Omwe khumi ndi asanu ndi limodzi adakhala ndi mwezi umodzi wokondweretsa ubongo pamene 13 inalandira chisamaliro chonse, kuphatikizapo mankhwala okhudzidwa ndi nkhawa. Pamapeto pa chiyeso, anthu a 11 mu gulu lolimbikitsa, koma atatu okha mu gulu lina, anali opanda mankhwala.
Ofufuzawo adafalitsa zomwe adapeza mu magazini ya European Neuropsychopharmacology ya mu Januwale 2016. Izi zidapangitsa kuti anthu ambiri ayambe kufalitsa nkhani zawo, zomwe zidakopa anthu ambiri ogwiritsa ntchito cocaine kuchipatala. Perotti adabwera mokwiya komanso mokwiya. Atamaliza maphunziro ake oyamba, akuti, adakhala chete. Posakhalitsa adataya chilakolako cha cocaine. Chinali chitatha miyezi isanu ndi umodzi. "Chasintha kwambiri," akutero. "Ndikumva mphamvu komanso chikhumbo chokhala ndi moyo chomwe sindinachimvepo kwa nthawi yayitali."
Zidzatenga mayesero akuluakulu, omwe amayendetsedwa ndi malo omwe amatsimikizira kuti mankhwalawa amapindula ndi mapindu ake. Gululi likukonzekera kuti apitirize maphunziro, ndipo ofufuza padziko lonse akuyesa kukakamiza ubongo kuthandiza anthu kusiya kusuta, kumwa, kutchova njuga, kudya mowa, komanso kugwiritsa ntchito opioids molakwika. "Zimalonjeza," adatero Bonci. "Odwala amandiuza kuti, 'Cocaine wakhala mbali ya ine. Tsopano ndi chinthu chakutali chomwe sichimandiletsa. ' "
Posachedwapa , lingaliro lokonzanso mawaya a ubongo kuti alimbane ndi chizolowezi likadaoneka ngati losatheka. Koma kupita patsogolo kwa sayansi ya ubongo kwasintha malingaliro achikhalidwe okhudza chizolowezi—chomwe ndi chiyani, chomwe chingachiyambire, komanso chifukwa chake kusiya n'kovuta kwambiri. Mukadatsegula buku la zamankhwala zaka 30 zapitazo, mukanawerenga kuti chizolowezi chimatanthauza kudalira chinthu chomwe chimakula bwino, chomwe chimafuna kuti anthu ambiri amve zotsatira zake ndikupanga kusiya koipa akasiya kugwiritsa ntchito. Zimenezi zinafotokoza bwino mowa, nikotini, ndi heroin. Koma sizinafotokoze bwino za chamba ndi cocaine, zomwe nthawi zambiri sizimayambitsa kugwedezeka, nseru, ndi kusanza kwa kusiya heroin.
Mchitidwe wakalewo sunafotokoze mwinamwake mbali yonyansa kwambiri ya kuledzera: kubwereranso. Nchifukwa chiyani anthu amayembekeza kutentha kwa mowa pamphepete kapena kutentha kwa heroin pambuyo poti thupi silidalira thupi?
Lipoti la General Surgery limatsimikiziranso zomwe maziko a sayansi akhala akunena kwa zaka: Chizoloŵezi ndi matenda, osati chikhalidwe cholephera. Sichidziwikiratu ndi kudalira thupi kapena kuchotsedwa koma kubwereza kubwereza ntchito ngakhale kuti zotsatira zake zimawononga moyo. Lingaliro limeneli lachititsa asayansi ambiri kuvomereza lingaliro loyamba lachinyengo loti kuledzera n'kotheka popanda mankhwala osokoneza bongo.
Buku laposachedwa la Diagnostic and Statistical Manual of Mental Disorders, buku la American psychiatry, kwa nthawi yoyamba limazindikira chizolowezi cha khalidwe: kutchova juga. Asayansi ena amakhulupirira kuti zinthu zambiri zomwe zimakopa anthu masiku ano—chakudya chopanda pake, kugula zinthu, mafoni a m'manja—zingakhale zosokoneza chifukwa cha mphamvu zake pa dongosolo la mphotho la ubongo, lomwe ndi gawo la chilakolako.
"Tonsefe ndife opeza ndalama zambiri," anatero Anna Rose Childress, katswiri wa zamaganizo ku chipatala cha Pennsylvania ku Center for Studies of Addiction. "Ndilo gawo lathu la chisinthiko."
Kwa zaka zambiri Childress ndi asayansi ena adayesa kumasula zinsinsi za kuledzera powerenga mphoto. Kafukufuku wambiri wa Childress akuphatikizapo kusokoneza anthu omwe amamwa mankhwala osokoneza bongo mu chubu la makina a magnetic resonance imaging (MRI), omwe amachititsa kuti magazi aziyenda mu ubongo monga njira yofufuza zinthu zogonana. Kupyolera muzinthu zovuta kumvetsa komanso zojambulajambula, ubongo wa ubongo umasandulika kukhala mafano omwe amasonyeza maulendo omwe amakwera kumalo okwera pamene ubongo umafuna.
Childress, yemwe ali ndi tsitsi lofiira kwambiri ndi kuseka kwakukulu, akukhala pa kompyutayi yake, akudutsa kupyolera mu chithunzi cha zithunzi cha ubongo wa tsitsi ndi ziphuphu zofiira ngati mafilimu a Disney. "Zikumveka nerdy, koma ndimatha kuyang'ana zithunzi izi kwa maola, ndipo ndikutero," akutero. "Iwo ndi mphatso zazing'ono. Kuganiza kuti mungathe kuona momwe ubongo uliri wamphamvu komanso panthawi yomweyo. Zili ngati kuwerenga masamba a tiyi. Zonse zomwe timawona ndi mawanga omwe makompyuta amatembenukira kukhala opunduka komanso ofiira ndi obiriwira. Koma kodi akuyesera kutiuza chiyani? "
Gawo la mphotho, gawo loyamba la ubongo lomwe silosiyana kwambiri ndi makoswe, liripo kuti titsimikizire kuti tikufuna zomwe tikusowa, ndipo zimatichenjeza zozizwitsa, zomveka, ndi zowawa zomwe zimatifikitsa kumeneko. Zimagwira ntchito muzengereza komanso zowonongeka, zomangidwira pamene kupulumuka kumadalira kuthekera kupeza chakudya ndi kugonana musanafike mpikisano. Koma dongosololi likhoza kutitsogolera m'dziko lapansi ndi mwayi wa 24 / 7 kukwaniritsa zokhumba zathu.
Chilakolako chimadalira zovuta zochitika za ubongo, koma asayansi amakhulupirira kuti chiwongolero cha izi chikhoza kukhala chokhazikika mu neurotransmitter dopamine. Mtumiki wa mankhwala omwe amanyamula zizindikiro m'ma synapses, dopamine amakhala ndi ntchito zambiri mu ubongo. Zambiri zogwiritsira ntchito mankhwala ozunguza bongo, kutuluka kwa dopamine kumawongolera zomwe asayansi amachitcha kuti salience, kapena kukopa kokakamiza, monga kukumbukira, monga kukumbukira kwa ufa woyera. Mankhwala amodzi omwe amachitiridwa nkhanza amakhudza ubongo mwa njira yosiyana, koma onse amatumiza makina a dopamine akukwera kutali kuposa maonekedwe a chirengedwe. Wolfram Schultz, yunivesite ya Cambridge ya sayansi ya zamoyo, amachititsa maselo kuti apange dopamine "ziwanda zochepa mu ubongo wathu," kotero mphamvu imatero chi chemical.
Kodi ndi amphamvu bwanji? Taganizirani zotsatira zachilendo za mankhwala omwe amafanana ndi dopamine yachilengedwe ndipo amagwiritsidwa ntchito pochiza matenda a Parkinson. Matendawa amawononga maselo opanga dopamine, makamaka omwe amakhudza kuyenda. Mankhwala olowa m'malo mwa dopamine amathetsa zizindikiro, koma pafupifupi 14 peresenti ya odwala a Parkinson omwe amamwa mankhwalawa amakhala ndi zizolowezi zotchova juga, kugula zinthu, zolaula, kudya, kapena mankhwala okha. Lipotilo mu magazini ya Movement Disorders limafotokoza odwala atatu omwe adayamba kukonda "kupatsa mosasamala," omwe amangofuna kupereka ndalama kwa alendo ndi anzawo omwe amawaona kuti amafunikira.
Kudzera mu kuphunzira, zizindikiro kapena zizindikiro zokumbutsa mphotho zimabweretsa kuwonjezeka kwa dopamine. Ichi ndichifukwa chake fungo la snickerdoodles likuphika mu uvuni, kulira kwa uthenga wochenjeza, kapena kulankhula mokweza pakhomo lotseguka la bala kumatha kukopa chidwi cha munthu ndikuyambitsa chilakolako. Childress wasonyeza kuti anthu omwe ali ndi chizolowezi safunika kulemba chizindikiro mwadala kuti chidzutse njira yawo yopezera mphotho. Mu kafukufuku wofalitsidwa mu PLoS One adayang'ana ubongo wa anthu 22 omwe akuchira cocaine pomwe zithunzi za mapaipi a crack ndi zida zina zamankhwala zimaonekera pamaso pawo kwa ma millisecond 33, gawo limodzi mwa magawo khumi a nthawi yomwe imatenga kuti munthu aphethire. Amunawo sanawone chilichonse mwadala, koma zithunzizo zidayambitsa magawo omwewo a mphotho omwe zizindikiro zowoneka za mankhwala osokoneza bongo zimawasangalatsa.
Mu maganizo a Childress zomwe zapeza zikuthandiza nkhani zomwe anamva kwa odwala a cocaine omwe adabwerera koma sanathe kufotokoza chomwe chinayambitsa. "Iwo anali akuyendayenda mozungulira kumene nthawi zambiri chinthu chimodzi kapena china chinali chizindikiro cha cocaine," akutero. "Iwo anali kwenikweni akuyamikira, pokhala ndi mphoto ya kale yakale. Pomwe iwo adadziŵa, zinali ngati snowball ikukwera pansi. "
Ubongo, ndithudi, ndi woposa chiwalo chopezera mphotho. Uli ndi makina apamwamba kwambiri a chisinthiko kuti munthu aganizire, kuganizira zoopsa, komanso kulamulira chilakolako chothawa. N’chifukwa chiyani chilakolako ndi zizolowezi zimaposa kuganiza bwino, zolinga zabwino, komanso kuzindikira mavuto omwe amabwera chifukwa cha chizolowezi choledzera?
"Pali chiwanda cholimba chomwe chimakuvutitsani," akutero munthu wolemetsa yemwe ali ndi mawu akudzudzula amene amasuta nthawi zonse.
Iye akukhala pa mpando wakuda wakuda mu chipinda chaching'ono chopanda mawindo ku Ikahn School of Medicine ku Mount Sinai ku Manhattan, kuyembekezera MRI yake. Iye akugwira nawo phunziro mu labata la Rita Z. Goldstein, pulofesa wa matenda a maganizo ndi matenda a ubongo, ponena za udindo wa bungwe loyang'anira ubongo, loyendetsa bongo. Pamene scanner akulemba ubongo wake, ayang'ana zithunzi za cocaine ndi malangizo kuti aganizire zosangalatsa kapena zoopsa zomwe zithunzi zonse zimasokoneza. Goldstein ndi gulu lake akuyesera ngati neurofeedback, yomwe imalola anthu kuyang'ana ubongo wawo mukuchitapo kanthu, ingathandize othandizira kuti ayambe kulamulidwa kwambiri ndi zizoloŵezi zopanikiza.
"Ndimaganizabe, sindingakhulupirire kuti ndadula ndalama zonse zowonongeka pa mankhwalawa," adatero bamboyo pamene akutsogoleredwa ku makina a MRI. "Sizingatheke konse, zomwe mumapindula ndi zomwe mumasowa."
Maphunziro a Goldstein a neuroimaging adathandizira kumvetsetsa za mphoto ya ubongo pofufuza mmene chizoloŵezi chimagwirizanitsa ndi chigawo cha prefrontal ndi madera ena a cortical. Kusintha kwa gawo lino la ubongo kumakhudza chiweruzo, kudziletsa, ndi ntchito zina zamaganizo zokhudzana ndi kuledzera. "Mphoto ndi yofunika kumayambiriro kwa kayendetsedwe ka mankhwala osokoneza bongo, koma kuyankha kwa mphotho kumachepetsedwa ngati matendawa akupitirirabe," akutero. Anthu oledzera nthawi zambiri amapitiriza kugwiritsa ntchito mankhwala osokoneza bongo pofuna kuthetsa mavuto omwe amamva akamasiya.
Mu 2002, ndikugwira ntchito ndi Nora Volkow, yemwe tsopano ndi mkulu wa NIDA, Goldstein atasindikiza zomwe zakhala zizoloŵezi zowononga, zotchedwa iRISA, kapena kukhumudwa kuchitapo kanthu poyamika ndi kupatsidwa ulemu. Ndilo dzina lokhala ndi dzina lokhala ndi lingaliro losavuta. Monga momwe mankhwala osokoneza bongo amathandizira, malo osamalirako amakhala ochepa, ngati kamera ikulowera pa chinthu chimodzi ndikukankhira china chirichonse. Pakalipano ubongo uli ndi mphamvu zothetsera khalidwe poyang'anizana ndi zizindikirozo zimachepetsedwa.
Goldstein wasonyeza kuti monga gulu, odwala mankhwala osokoneza bongo amachepetsanso imvi pamtunda wamakono, omwe amalephera kugwira ntchito, ndipo amachita mosiyana ndi anthu omwe sagwiritsidwa ntchito mopitirira muyeso, kupanga, ndi kukonza zopindulitsa za nondrug monga ndalama. Kaŵirikaŵiri amachita zoipa, koma osati nthawi zonse. Zimadalira pa nkhaniyi.
Mwachitsanzo, pa ntchito yowonjezera yomwe imayesa kusinthasintha-ndizilombo zingati zomwe mungatchule mu miniti? -Anthu omwe ali ndi chizolowezi choledzeretsa akhoza kukumba. Koma pamene Goldstein akuwafunsa kuti alembe mawu okhudzana ndi mankhwala, amayamba kutulutsa ena onse. Ogwiritsa ntchito mankhwala osokoneza bongo nthawi zambiri amakhala okonzeka kupanga ndi kuchita ntchito zomwe zimaphatikizapo kugwiritsa ntchito mankhwala osokoneza bongo, koma izi zingapangitse kusokoneza malingaliro ena, kuphatikizapo kudziwa momwe angayimire ndi nthawi yanji. Zovuta za khalidwe ndi ubongo nthawi zina zimakhala zonyenga kusiyana ndi mavuto ena a ubongo, ndipo zimakhudzidwa kwambiri ndi vutoli.
"Ife tikuganiza kuti ichi ndi chimodzi mwa zifukwa zomwe zimachititsa kuti munthu akhale wovuta kwambiri ndipo akadali vuto linalake lodziwika kuti ndilo vuto la ubongo," akutero.
Maphunziro a Goldstein samayankha funso la nkhuku ndi lazira: Kodi kuledzera kumayambitsa vutoli, kapena kubvuta kwa ubongo chifukwa cha chibadwa, kupsinjika mtima, kupsinjika, kapena zinthu zina kumawonjezera chiopsezo chotayika? Koma labu la Goldstein lapeza umboni wochuluka wakuti ziwalo za ubongo zimayamba kuchira pamene anthu asiya kugwiritsa ntchito mankhwala osokoneza bongo. Kafukufuku wa 2016 anapeza odwala 19 a cocaine amene adasiya kapena akudula kwambiri miyezi isanu ndi umodzi. Anasonyeza kuwonjezeka kwakukulu kwa mutu wa imvi m'madera awiri omwe amachititsa kuti anthu asakhale ndi makhalidwe abwino komanso kuwonetsa mphoto.
Marc Potenza akuyenda mozungulira kasino wa ku Venetian ku Las Vegas. Masewera apakompyuta—makina olowetsa ndalama, roulette, blackjack, poker—akuyimba ndi kulira ndi kuvina. Potenza, dokotala wamaganizo wochezeka komanso wamphamvu ku Yale University komanso mkulu wa pulogalamu ya kafukufuku wa Impulsivity and Impulse Control Disorders ya sukuluyo, akuoneka kuti sakuzindikira. “Sindine wotchova juga,” akutero akugwedeza mapewa pang'ono ndi kumwetulira. Kuchokera mu palazzo yosangalatsa, akupita pansi pa escalator ndikudutsa m'chipinda chochezera chopumula ku Sands Expo Convention Center, komwe adzapereka kafukufuku wake wokhudza chizolowezi cha kutchova juga kwa asayansi ndi asing'anga pafupifupi zana.
Msonkhanowu umapangidwa ndi bungwe la National Gaming Responsible Gaming, gulu lothandizira makampani omwe athandiza kafukufuku wa njuga ndi Potenza ndi ena. Izi zimachitika madzulo a msonkhano wa mega, Global Gaming Expo. Potenza amaima pamsankhulo, akulankhula za zoyera zazingwiro ndi magazi amagazi othamanga njuga. Pambuyo pa chipindachi, owonetsa ma expo akukhazikitsa zojambula zomwe zimapangidwira kupanga dopamine yomwe ikuyenda m'zaka zikwizikwi. Kutsegula masewera a E-masewera. Masewera a Casino akuwonetsedwa pa Xbox. Anthu opanga masewera a 27,000, okonza mapulogalamu, ndi ochita masewera a casino.
Potenza ndi asayansi ena adakakamiza mabungwe amisala kuti avomereze lingaliro la chizolowezi chochita zinthu mopitirira muyeso. Mu 2013, bungwe la American Psychiatric Association linachotsa vuto la kutchova juga m'chaputala chotchedwa "Impulse Control Disorder Not Wherewhere Classified" mu Diagnostic and Statistical Manual ndikuyika mu chaputala chotchedwa "Substance-Related and Addictive Disorders." Izi sizinali nkhani yongopeka chabe. "Zimawononga kwambiri kuona makhalidwe ena ngati chizolowezi," akutero Judson Brewer, mkulu wa kafukufuku ku Center for Mindfulness ku University of Massachusetts Medical School.
Bungweli linaganizira nkhaniyi kwa zaka zosaposa khumi pamene kafukufuku anapeza momwe kutchova njuga kumafanana ndi mankhwala osokoneza bongo. Chikhumbo chosasunthika, nkhawa, ndi zofuna zosalamulirika. Kusangalatsa kofulumira ndi kufunika koti mupitirize kutulutsa ante kuti muzimva zozizira. Kulephera kuima, ngakhale malonjezo ndi kuthetsa. Potenza anachita zofufuza zoyambirira za ubongo za anthu otchova njuga ndipo anapeza kuti amawoneka ngati zovuta zowononga mankhwala osokoneza bongo, ndi ntchito zolemetsa m'magulu a ubongo omwe amachititsa kuti asayambe kudziletsa.
Tsopano popeza madokotala a maganizo avomereza lingaliro lakuti kuledzera n'kotheka popanda mankhwala osokoneza bongo, ofufuza akuyesera kudziwa mitundu ya makhalidwe omwe amaonedwa kuti ndi kuledzera. Kodi zochita zonse zosangalatsa zingakhale zoledzeretsa? Kapena kodi tikuyesa chizolowezi chilichonse, kuyambira kungoyang'ana imelo mpaka nthawi yopuma masana?
Ku United States, Buku Lofufuza ndi Kuwerengera tsopano likulemba matenda a pa intaneti ngati vuto lofunika kuliphunzira kwambiri, limodzi ndi chisoni chosatha, chofooketsa komanso vuto logwiritsa ntchito caffeine. Kuledzera pa intaneti sikunathe.
Koma zimapangitsa odwala matenda a maganizo a Jon Grant mndandanda wa zoledzeretsa. Choncho mumakonda kugula ndi kugonana, kudya zakudya komanso kleptomania. "Chilichonse chimene chimapindulitsa kwambiri, chirichonse chimene chimapangitsa kuti munthu azichita bwino kapena akuchepetsetsa, akhoza kumwa mankhwala," anatero Grant, yemwe amathamanga kuchipatala cha Addictive, Compulsive ndi Impulsive Disorders ku University of Chicago. Kaya zidzasokonekera zimadalira chiopsezo cha munthu, chomwe chikukhudzidwa ndi chibadwa, chipsinjo, ndi kupsinjika maganizo, pakati pa zina. "Sitife tonse timakhala oledzera," akutero.
Mwina vuto lalikulu kwambiri pa zizolowezi "zatsopano" ndi chakudya ndi kugonana. Kodi chilakolako choyambirira chingakhale choledzeretsa? Bungwe la World Health Organization lalimbikitsa kuti kugonana kokakamiza kuphatikizidwe ngati vuto lolamulira chilakolako mu kope lake lotsatira la International Classification of Diseases, lomwe likuyembekezeka kutulutsidwa pofika chaka cha 2018. Koma bungwe la American Psychiatric Association linakana kugonana kokakamiza chifukwa cha buku lake laposachedwa lothandizira matenda, pambuyo pa mkangano waukulu wokhudza ngati vutoli ndi lenileni. Bungweli silinaganizire za kuledzera ndi zakudya.
Nicole Avena, katswiri wa sayansi ya zamoyo pa Phiri la Sinai St. Luke Hospital ku New York, wasonyeza kuti makoswe adzapitirizabe kusakaniza shuga ngati mumawalola, ndipo amakula, amakhumba, ndi kuchotsa, monga momwe amachitira akamagwiritsira ntchito cocaine. Amati zakudya zamtengo wapatali ndi zakudya zopangidwa bwino kwambiri monga ufa wokonzedwanso zingakhale zovuta monga shuga. Avena ndi ofufuza pa yunivesite ya Michigan posachedwapa adafufuza akuluakulu a 384: makumi asanu ndi awiri mphambu makumi asanu ndi awiri aliwonse amafotokoza kuti akulakalaka kudya zakudya zina ndipo nthawi zambiri amayesetsa kusiya, zizindikiro ziwiri zoledzera. Ofunsidwawo amaika pizza-omwe amapangidwa ndi ufa wonyezimira ndi wofiira ndi tomato-monga chakudya chodwalitsa kwambiri, ndi chipsulo ndi chokoleti atamangiriza malo achiwiri. Avena alibe kukayikira kuti zakudya zakudya ndizoona. "Ndicho chifukwa chachikulu chimene anthu amachitira ndi kunenepa kwambiri."
Sayansi yakhala ikuchita bwino kwambiri pofufuza zomwe zimachitika muubongo wa munthu amene ali ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo kusiyana ndi kupeza njira zothetsera vutoli. Mankhwala ochepa angathandize anthu kuthana ndi zizolowezi zina. Mwachitsanzo, naltrexone idapangidwa kuti ithandize anthu kugwiritsa ntchito molakwika mankhwala a opioid, koma imaperekedwanso kuti ithandize kuchepetsa kapena kusiya kumwa mowa, kudya mopitirira muyeso, komanso kutchova juga.
Buprenorphine amachititsa opioid receptors mu ubongo koma kwa digiri yache kwambiri kuposa heroin amachita. Mankhwalawa amalepheretsa zizindikiro zoopsa zokhumba ndi kuchotsa kuti anthu athe kusokoneza. Justin Nathanson, mwiniwake wa mafilimu ndi wailesi yotchedwa Charleston, South Carolina anati: "N'zodabwitsa. Anagwiritsa ntchito heroin kwa zaka zambiri ndikuyesera kubwereza kawiri koma anabwereranso. Kenaka dokotala analamula buprenorphine. "Mphindi zisanu ndimamva kuti ndine wabwinobwino," akutero. Sanagwiritse ntchito heroin kwa zaka 13.
Mankhwala ambiri omwe amachiza mowa akhala akuzungulira zaka zambiri. Kupititsa patsogolo kwatsopano kwa sayansi ya sayansi sikukuthandizani kuchiritsa. Ochita kafukufuku ayesa mankhwala osiyanasiyana, koma pamene ambiri akuwonetsa lonjezo mu labu, zotsatira za mayesero a zachipatala zasokonezedwa bwino. Kulimbikitsana kwa ubongo chifukwa cha mankhwala osokoneza bongo, kuphatikiza kwa zowonjezereka zopezeka m'maganizo, zakhala zikuyesa.
Ngakhale mapulogalamu a 12, chithandizo cha kulingalira, ndi njira zina zamaganizo ndizo kusintha kwa anthu ambiri, sizimagwira ntchito kwa aliyense, ndipo kubwerera m'mbuyo kumawunikira.
Padziko lonse lapansi, pali zigawo ziwiri. Mmodzi amakhulupirira kuti mankhwala amapezeka pakukonzekera zojambula zolakwika kapena ubongo wa ubongo wovuta kwambiri kudzera mu mankhwala kapena njira monga TMS, ndi kuthandizira pazinthu zamaganizo monga chidziwitso. Winawo amawona mankhwala monga njira, kuchepetsa chilakolako ndi chisoni cha kuchoka pamene kulola anthu kuti azigwira ntchito ya maganizo kuti athetse vutoli. Makamu onse awiriwa amavomereza pa chinthu chimodzi: Chithandizo chamakono sichitha. "Panthawiyi odwala anga akuvutika," anatero Brewer, wofufuza kafukufuku wa ku Massachusetts.
Brewer ndi wophunzira wa maganizo a Buddhist. Iye ndi katswiri wa zamaganizo yemwe amadziwika kwambiri kuledzera. Amakhulupirira kuti chiyembekezo chabwino kwambiri chokhalitsa chizoloŵezi chazolowera ndi kusokoneza chizoloŵezi cha sayansi ndi kachitidwe ka nthawi zakale. Iye ndi mlaliki wa kulingalira, womwe umagwiritsa ntchito kusinkhasinkha ndi njira zina kuti tidziwitse zomwe tikuchita ndikumverera, makamaka zizolowezi zomwe zimayesa khalidwe logonjetsa.
Mu filosofi ya Chibuda, chilakolako chimawoneka ngati mzu wa mavuto onse. Buddha sanali kunena za heroin kapena ayisikilimu kapena zina zomwe zimabweretsa anthu ku mabungwe a Brewer. Koma pali umboni wochuluka wosonyeza kuti kulingalira kumatha kuthana ndi kusefukira kwa dopamine wa moyo wamasiku ano. Ochita kafukufuku ku yunivesite ya Washington anasonyeza kuti pulogalamu yochokera m'malingaliro inali yothandiza kwambiri popewera kugwiritsira ntchito mankhwala osokoneza bongo kuphatikizapo mapulogalamu a 12. Poyerekezera mutu ndi mutu, Brewer anasonyeza kuti kuphunzitsa mwachidziwitso kunali kogwira kawiri monga pulogalamu ya golide yowonetsera khalidwe.
Kulingalira kumaphunzitsa anthu kuti azisamala zofuna zawo popanda kuwayankha. Lingaliro ndikuthamangira chikhumbo chokhumba kwambiri. Kulingalira kumalimbikitsanso anthu kuzindikira chifukwa chake amanyengerera kuti azichita. Brewer ndi ena awonetsa kuti kusinkhasinkha kumapangitsa kuti phokoso likhale lopitirira, mphepo yamtunduwu imakhala yowonongeka yomwe ingayambitse kusokoneza.
Brewer akuyankhula mu mawu olimbikitsa amene mungafune kwa wodwala wanu. Chiganizo chake chimasintha pakati pa mawu a sayansi-hippocampus, insula-ndi Pali, chinenero cha ma Buddhist. Mmawa wam'mawa iye akuyima kutsogolo kwa 23 osadetsa nkhawa, omwe amakhala pansi mu mipando ya pulasitiki yokhala ndi beige, zofiira zofiira zozungulira zofiira.
Donnamarie Larievy, mlangizi wa zamalonda komanso wophunzitsi wamkulu, adalumikizana ndi gulu lalingaliro la mlungu ndi mlungu kuti amwetse ayisikilimu ndi chizolowezi cha chokoleti. Kwa miyezi inayi, amadya zakudya zathanzi ndipo nthawi zina amadya fudge koma samalakalaka. Iye akuti: "Wakhala wosintha moyo," akutero. "Kunena zoona, zilakolako zanga zatsika."
Nathan Abels wasankha kusiya kumwa mowa—kangapo. Mu Julayi 2016 anapezeka m'chipinda chodzidzimutsa ku Medical University of South Carolina ku Charleston, akugona tulo atamwa mankhwala a gin kwa masiku atatu. Pamene ankalandira chithandizo, anadzipereka kukaphunzira za TMS ndi katswiri wa za mitsempha Colleen A. Hanlon.
Kwa Abel, 28, katswiri wamapangidwe ojambula magetsi amene amamvetsa momwe dera limagwirira ntchito, chidziwitso cha sayansi ya sayansi chimapereka mpumulo. Sadzimva kuti ali ndi nkhawa chifukwa cha biology kapena alibe udindo woledzera. Mmalo mwake iye amamverera manyazi pang'ono. Iye anati: "Ndinkangokhalira kumwa mowa ngati kumwa. "Pali mphamvu zambiri mukumvetsa kuti ndi matenda."
Akuponya zonse zomwe achipatala amapereka pa machiritso ake, mankhwala a psychotherapy, magulu othandizira, ndi magetsi othamanga kupita kumutu. "Ubongo ukhoza kudzimanganso wokha," akutero. "Ndicho chinthu chodabwitsa kwambiri."