NDEMANGA: Iyi ndi nkhani yabwino kwambiri yokhudza kutulutsidwa kwa The American Society of Addiction Medicine mu Ogasiti 2011 kwa tanthauzo latsopano la kuledzera. Nkhaniyi, A Radical New View of Addiction Stir Scientific Storm inachokera patsamba lawebusayiti la "The Fix." Magawo olimba mtima omwe ali pansipa akukhudzana ndi mfundo zomwe zafotokozedwa pano pa YBOP.
- Lumikizani ku ndondomeko ya ASAM ndi ndondomeko ya ndondomeko: American Society for Addiction Medicine: Tanthauzo la Chizolowezi - Long Version
- Lumikizani ndi mafunso a ASAM pa tanthauzo: Tanthauzo la ASAM la Chizolowezi - Mafunso Ofunsidwa Kawirikawiri
- Lumikizani ku ASAM Press Release pa tanthauzo latsopano: ASAM Press Release
Nkhani ziwiri tinalemba:
- Gwiritsani Ntchito Mabuku Athu: Ma Docs Amachepetsa Kugonjetsa Khalidwe lachiwerewere (2011) American Society of Addiction Medicine amavomereza kusagwirizana ndi DSM
- Kodi Mumakopeka ndi Zolaula? Funsani ASAM (2011) Ogwiritsira ntchito zithunzi akufotokoza zomwe zimakonda kuti azigwedezeka
Kuledzera ndi matenda ake a ubongo. Koma kodi zidzakhazikitsidwa bwanji? Ndi Jennifer Matesa ndi Jed Bickman 08 / 16 / 11
Akatswiri apamwamba aku America adangotulutsa tanthauzo latsopano losokoneza bongo. Ikuyambitsa mikangano pazinthu zazikulu-kusokonezeka kwaubongo motsutsana ndi machitidwe oyipa, kudziletsa, chizolowezi chogonana, kupereka kena kake kwa aliyense - makamaka malo olimbikitsa odwala matenda amisala - oti angatsutsane nawo.
Ngati mukuganiza kuti chizolowezi ndi cha mowa, mankhwala osokoneza bongo, kugonana, kutchova juga, chakudya ndi zinthu zina zoipa, ganiziraninso. Ndipo ngati mukukhulupirira kuti munthu ali ndi mwayi wosankha kuchita chizolowezi choledzera kapena ayi, siyani zimenezo. Bungwe la American Society of Addiction Medicine (ASAM) linalengeza za malingaliro amenewa ndi kutulutsidwa kwake kovomerezeka kwa chikalata chatsopano chomwe chimafotokoza chizolowezi ngati matenda osatha amitsempha okhudzana ndi ntchito zambiri za ubongo, makamaka kusalinganika kwakukulu mu zomwe zimatchedwa circuitry ya mphotho. Kulephera kwakukulu kumeneku mu chisangalalo kumakakamiza munthu woledzerayo kuti atsatire mankhwala opangidwa ndi zinthu monga mankhwala osokoneza bongo ndi mowa komanso makhalidwe oledzera monga kugonana, chakudya ndi kutchova juga.
Tanthauzoli, lomwe linachokera ku ndondomeko ya zaka zinayi yokhudza akatswiri otsogola oposa 80 mu chizolowezi ndi matenda a mitsempha, likugogomezera kuti chizolowezi ndi matenda oyamba—mwanjira ina, sichimayambitsidwa ndi mavuto amisala monga kusokonezeka maganizo kapena umunthu, zomwe zimapangitsa kuti anthu ambiri asamaganize kuti makhalidwe oledzera ndi mtundu wa “mankhwala odzipatsa okha” kuti achepetse ululu wa kuvutika maganizo kapena nkhawa.
Zoonadi, malingaliro atsopanowa amatsindika debunks, kwathunthu kapena mbali, maganizo ambiri okhudzana ndi kuledzera. Kuledzera, mawu akuti, ndi "bio-psycho-socio-spirituality" matenda omwe amadziwika ndi (a) kupanga zolakwika (kukhudza kuphunzira, kulingalira, ndi chiweruzo) ndi (b) chiopsezo chokhazikika ndi / kapena kubwereza kubwereza; Zomwe zimakhala zovuta ndizo: (a) oledzera sangathe kulamulira makhalidwe awo ozunguza bongo ndipo (b) kudziletsa kwathunthu, ndiko kwachinyengo, cholinga chenicheni cha mankhwala.
Makhalidwe oyipa okhawo ndi zizindikilo zosokoneza bongo, osati matenda omwewo. "Mkhalidwe wosokoneza bongo si wofanana ndi kuledzera," ASAM ikuyesetsa kunena. M'malo mongokhala umboni wakulephera kwa chifuniro kapena chikhalidwe, mayeserowo amayesa kuthetsa kusakhazikika kwamalingaliro omwe amakhala mofanana ndi matendawa. Mwanjira ina, kusankha mozindikira kumasewera pang'ono kapena kulibe nawo gawo pakulowerera; Zotsatira zake, munthu sangasankhe kuti asakhale osokoneza bongo. Omwe amakonda kumwa mankhwala osokoneza bongo kwambiri ndikusankha kuti asagwiritse ntchito mankhwalawo kapena kuchita zinthu zomwe zimalimbitsa chiwonongeko chonse chodziwononga.
Komabe ASAM sinawombera zotsatila za zotsatira zovuta za kuledzera, kulengeza kuti ndi "matenda" omwe angayambitse kulemala kapena kufa msanga, makamaka ngati sanasamalidwe kapena kuti asamalidwe bwino. "
Kutanthauzira kwatsopano kumatsimikizira kuti zoledzera zonse-kaya mowa, heroin kapena kugonana, amati_ndizofanana mofanana. Dr. Raju Haleja, pulezidenti wakale wa Canadian Society for Addiction Medicine ndi mpando wa komiti ya ASAM yomwe inapanga tanthauzo latsopanoli, inauza The Fix kuti, "Tikuyang'ana kuledzera ngati matenda amodzi, mosiyana ndi omwe amawawona ngati osiyana matenda.
Kuledzera ndikoledzera. Zilibe kanthu kuti ubongo wanu ukugundana ndi njira yotani, ukasintha, umakhala pachiwopsezo chazovuta zonse. ” Kuti anthu adziwitse kuti ali ndi vuto logonana kapena kutchova juga kapena kuledzera monga momwe mankhwala alili monga kumwa mowa kapena heroin kapena crystal meth kungayambitse mikangano yambiri kuposa mawu ake obisika koma ofanana.
Tanthauzo latsopano likubwera ngati American Psychiatric Association (APA) ikuchita mwatsatanetsatane kwambiri, zaka khumi-mu-kupanga-kukonzanso za kutanthauzira kwake kwa kuledzera mu Kufufuza Kwake ndi Kuwerenga Masalimo a Mental Disorders-bible la ntchito ya umoyo wa maganizo. DSA ya DSM idzakhala ndi zotsatira zowonjezereka pa ndondomeko za umoyo waumphawi zomwe zimatsogolera chithandizo cha mankhwala osokoneza bongo, makamaka chifukwa chakuti makampani a inshuwalansi akulamulidwa ndi lamulo kugwiritsa ntchito zigawo za matenda a DSM komanso zoyenera kuti adziwe momwe angaperekere.
Dr. Haleja adauza The Fix kuti tanthauzo la ASAM linayamba pang'ono chifukwa cha kusamvana ndi komiti ya DSM; ngakhale DSM idzatanthauzira kuledzera ngati matenda, zizindikiro zake (ndipo motero njira zodziwira matenda) zidzawonedwabe ngati machitidwe osiyana. Komanso, DSM idzatanthauzira mtundu uliwonse wa kuledzera ngati matenda osiyana, m'malo mwa lingaliro limodzi komanso logwirizana la matenda lomwe ASAM ikupereka. "Ponena za chithandizo, zimakhala zofunika kwambiri kuti anthu asayang'ane mbali imodzi ya matendawa, koma matenda onse," akutero Haleja. M'malo molephera chifuniro kapena makhalidwe abwino, makhalidwe osokoneza bongo ndi kuyesera kwa munthu woledzera kuthetsa "mkhalidwe wosagwira ntchito bwino wamaganizo" womwe umayamba limodzi ndi matendawa. Mwanjira ina, kusankha mwanzeru sikuchita gawo lalikulu kapena silikugwira ntchito pa mkhalidwe weniweni wa kuledzera; chifukwa chake, munthu sangasankhe kusakhala woledzera.
Ngakhale osokonezeka sangathe kusankha kukhala osokoneza bongo, angathe kusankha chithandizo. Kubwezeretsa, ASAM ikunena, sikudziwike bwino ndi kudzipangira okha ndi magulu othandizana monga maubwenzi a 12, komanso ndi othandizira othandizira.
Akatswiri ena omwe amamwa mankhwala osokoneza bongo amatha kuona tanthauzo latsopanoli monga kutsimikizira kwa zomwe zilipo, kuyambira kufalitsa kwa Alcoholics Anonymous ku 1939, kumadziwika kuti "matenda a" matenda osokoneza bongo. Dr. Neil Capretto, wotsogolera zachipatala wa Gateway Rehabilitation Center ku Pittsburgh, ndi membala wa ASAM wothandizira. "Kwa anthu odziwa zambiri omwe amagwiritsa ntchito mankhwala osokoneza bongo kwa zaka, tikudziwa kuti ndi matenda a ubongo."
Kodi mawuwa akukakamiza masitepe 12, omwe ndi malo opitilira chithandizo, mapulogalamu ndi azachipatala, kuti atha msinkhu? Kupatula apo, vuto likanenedwa kuti ndi "lachipatala", kodi sizikutanthauza kuti yankho liyeneranso kukhala "lachipatala" - monga madokotala ndi mankhwala? "Njira ziwirizi zingagwire ntchito," akutero Dr. Marc Galanter, pulofesa wa zamisala ku New York University, woyambitsa wamkulu wa Division of Alcohol and Substance Abuse komanso wamkulu wa Fellowship Training Program in Addiction Psychiatry. "Kuledzera ndi matenda sizitanthauza kuti kumangotenga mankhwala osokoneza bongo." A Capretto akuti: "Kutanthauzira kwatsopano kumeneku sikukutanthauza kuti njira zamaganizidwe kapena zauzimu sizofunikira. Chodandaula changa ndikuti anthu ena omwe samamvetsetsa kuchuluka kwa zosokoneza amangoziona ngati matenda am'magazi amubongo. Sitikugwiritsa ntchito makompyuta, koma ndi anthu onse omwe, monga akutanthauzira, ndi cholengedwa cha 'bio-psycho-socio-socio -uzimu', ndipo adzafunikirabe thandizo kumadera amenewa. ”
Ndi mawu ake osasinthika (amasamba asanu ndi atatu, olembedwa m'malo amodzi, kuphatikizapo mawu apansi panthaka), ASAM yatchula—makamaka—mbali imodzi ya funso la nkhuku ndi dzira lomwe lakhala likusokoneza anthu omwe akufuna kuledzera, madokotala ndi omwe akuchira omwe: ndi chiyani chomwe chinayamba, matenda amitsempha kapena machitidwe okakamiza ndi kugwiritsa ntchito mankhwala osokoneza bongo? Tanthauzoli limati zolakwika mu kulumikizana kwa mphotho ya dongosolo la mitsempha—kulankhulana pakati pa madera a ubongo, makamaka omwe amakumbukira, kuyankha kwamalingaliro ndi chisangalalo—zimabwera poyamba, ndikupangitsa munthu woledzerayo kuchita zinthu zomwe zingamulepheretse kubweza kusalingana kwa mphotho ndi dongosolo kudzera mu khalidwe loledzera. Koma pambuyo pake, chikalatacho chikunena kuti machitidwe awa okha amatha kuwononga madera ozungulira mphotho ndikupangitsa kuti munthu asamayende bwino ndi chilakolako chake.
Mawuwa akugwirizana, m'mawu ake onse, ndi mfundo yomwe ilipo mu sayansi yamakono ya chizolowezi choledzera kuti njira yachilengedwe yopezera mphotho yopangidwira kuthandiza anthu kupulumuka imagonjetsedwa kapena kulandidwa ndi phindu la mankhwala omwe amaperekedwa ndi kugwiritsa ntchito mankhwala osokoneza bongo kapena machitidwe osokoneza bongo. "Magulu opezera mphotho amaika chizindikiro pazinthu zofunika: kudya chakudya, kulera ana, kugonana, kukhala ndi ubwenzi wapamtima," akutero Dr. Mark Publicker, mkulu wa zamankhwala wa Mercy Recovery Center ku Portland—malo ochiritsira odwala akuluakulu ku Maine—komanso wakale Chief of Addiction Medicine ku Kaiser Permanente Mid-Atlantic Region.
Tikamagwiritsa ntchito mowa kapena mankhwala osokoneza bongo, Publicker akuti, mphotho ya mankhwala - "yapamwamba" - imakhala yamphamvu kwambiri nthawi zambiri kuposa mphotho ya oyang'anira zachilengedwe, ndipo dongosolo la mitsempha limazolowera kusefukira kwa ma neurotransmitters. “Koma chifukwa sitinasinthe ngati mtundu wa OxyContin kapena crack cocaine, makinawo amasinthasintha. Chifukwa chake kumakhala kosatheka kukhala ndi chisangalalo chabwinobwino, ”akupitiliza. "Kugwiritsa ntchito mankhwalawa kumachitika pokhapokha ngati zomwe zingalimbikitse kupulumuka. Mukazilingalira motere, zimayamba kuyambitsa matenda komanso kufa msanga. ” Wokonda kugwiritsa ntchito mankhwala osokoneza bongo ali pachiwopsezo chachikulu chomwalira msanga kudzera kudwala kapena kudzipha.
Mawuwa akubweretsa madandaulo mobwerezabwereza okhudza kuopsa komwe achinyamata ndi achinyamata akukumana nako chifukwa cha kukula kwa zizolowezi zogwiritsa ntchito mankhwala osokoneza bongo chifukwa ubongo wawo udakali mkati mwa kukula, ndipo "kuba" kwa mankhwala a dongosolo lopereka mphotho kungayambitse machitidwe oyamba komanso owopsa a chizolowezi. Ngakhale kuti akuchokera mu chitsanzo cha matenda amitsempha cha chizolowezi, tanthauzoli silimatsutsa majini (limatanthauza pafupifupi theka la chifukwa chake ndi cholowa chanu cha DNA). Ndikosamala kunena kuti zinthu zachilengedwe zimakhudza ngati majini adzapereka phindu komanso kuchuluka kwa chibadwa. Mawuwa akunena kuti "kulimba mtima" komwe kumapezeka kudzera mu kulera ana ndi zomwe zachitika pamoyo kumatha kuletsa chizolowezi cha majini. "Majini ndi chizolowezi, osati tsogolo," akutero Capretto.
Zinthu zamaganizidwe ndi zachilengedwe, monga kuwonongedwa ndi zovuta kapena kupsinjika kwakukulu, malingaliro olakwika ponena za tanthauzo la moyo, kudzidalira, ndi kuwonongeka kwa kulumikizana ndi ena komanso ndi "wopitilira muyeso (wotchedwa Mulungu ndi ambiri, Mphamvu Yapamwamba pofika 12 magulu opondereza, kapena kuzindikira kwa ena) ”amadziwikanso kuti ali ndi mphamvu.
Kuonjezera apo, ASAM imanenanso kuti kumvetsetsa mphotho kumangokhala gawo lakumvetsetsa za mankhwala osokoneza bongo. Asayansi akuyesetsabe kumvetsa momwe ena oledzera amatanganidwa ndi mankhwala ena kapena makhalidwe ena ndi ena omwe amamwa mankhwala ena; momwe ena omwe amamwa mowa amayamba kuyambitsa kugwiritsa ntchito ndi zochitika zina zomwe sizikukhudza ena; komanso momwe zilakolako zingapitirire kwa zaka zambiri pambuyo poti athetsa.
Mawuwo amayesa kufotokoza zizindikilo zozindikiritsa, zomwe zonse ndizo khalidwe: kusakhoza kudziletsa; kusokoneza maganizo; zilakolako; kuchepetsa kumvetsa mavuto anu; komanso kukhumudwa maganizo.
Kodi ndizovuta kuti tanthawuzolo silingathe kuwonetsa chizindikiro chodziŵika cha matendawa? "Ndingakhale ndikufotokoza zoonekeratu, apa," Publicker akuti, kuusa moyo, "koma simusowa kuchita ubongo kuti muzindikire mowa mwauchidakwa."
M'malo mwake limatsindika kuti "kuchuluka komanso kuchuluka" kwa zizolowezi zosokoneza bongo - monga kuchuluka kwa omwe amamwa mowa patsiku kapena kuchuluka kwa maola omwe mumathera kuseweretsa maliseche - sichizindikiro chochepa chabe kuposa "njira yoyeserera [komanso] matenda" chizolowezi chimayankha kupsinjika ndi malingaliro mwa kupitiliza kuchita izi ngakhale kukumana ndi zovuta zomwe zikukula.
Ndondomeko yatsopano ya ASAM inayamba kusagwirizana ndi komiti ya DSM, yomwe idzafotokozera mtundu uliwonse wa chizolowezi chokhala ngati matenda osiyana. "Potsata chithandizo, ndikofunikira kuti anthu asamangoganizira mbali imodzi ya matenda, koma matenda onsewo," anatero Haleja.
Kusindikiza, wogwira ntchito yogwira ntchito ASAM kwa zaka 30 ndi wothandizira mankhwala othandizidwa ndi mankhwala osokoneza bongo, amanenanso kuti mankhwala osokoneza bongo amachokera ku chithandizo cha maganizo, chikhalidwe ndi zauzimu za matenda-osati zowonjezera zokhazokha. "Amatchedwa mankhwala othandizira mankhwala, osati mankhwala othandizira mankhwala," akutero. "Mankhwala okha amalephera. Ndaziwona izi pa ntchito yayitali kwambiri. Koma zingathandize kwambiri anthu omwe akuvutika kuti ayambirane. "
Iye akupanga kufanana ndi kupsinjika maganizo: "Ngati muwafunsa anthu ambiri momwe matendawa aliri, iwo adzayankhira kuti ndi vuto la serotonin ndi vuto lakutsekera ndi kumuika wina pa SSRI [mankhwala ochepetsa kupanikizika]. Koma ndi njira yophweka komanso yosagwira ntchito yothetsera kuvutika maganizo. Mankhwala angakhale othandiza, koma amafunika kuphatikizidwa ndi zokambirana. Tikukhala mu nthawi tsopano pamene zokambirana sizibwezeredwa. "Zikuwonekeratu ngati chithunzithunzi chatsopano cha ASAM chokhala ndi matenda ochiritsira wodwalayo chidzathandiza oledzera kupeza ndalama zobwezeretsera kuchipatala. Ponena za inshuwalansi, kufotokoza kuti matendawa ali ndi "mizu ya chilengedwe" -kutseka kuti si vuto la wodwalayo kapena ali ndi matenda-akhoza kuthetsa mabotolo obwezera.
Capretto akuvomereza kuti: "Zinthu monga tanthawuzo limeneli zimabweretsa chizoloŵezi kukhala ndi matenda ena, kotero kuti m'tsogolomu zidzatanthauza zolepheretsa zochepa za anthu ofuna thandizo."
Chimodzi mwazolinga zomwe ASAM sananene chinali chodziwikiratu polimbana ndi manyazi omwe anthu ambiri amakhala nawo. "Palibe funso lomwe adapanga kuti athetse vuto loledzera," anatero Publicker. “Palibe amene amasankha kukhala osokoneza bongo. Kuda nkhawa komwe ndili nako ndikudzudzula wodwalayo. Zimatenga nthawi yayitali kuti ubongo uzolowere. Pomwe zikuyembekezera kuti zichitike, mukumva chisoni, malingaliro anu ali operewera, ndipo ndi njira yoti mubwererenso. Odwala amatha kudzudzulidwa chifukwa chobwerera m'mbuyo, ndipo mabanja amawawona ngati opanda chidwi komanso ofooka. Koma amenewo ndi matenda osokoneza bongo. ”
Jennifer Matesa akulemba za mankhwala osokoneza bongo komanso zovuta pa blog, Guinevere Gets Sober. Iye ndi mlembi wa mabuku awiri osasamala okhudza zaumoyo, kuphatikizapo magazini yopambana mphoto ya mimba yake, Kutsegulira Mitsinje: Masiku ndi Maso a Mayi Akupanga.
Jed Bickman adapereka malipoti owonjezera pankhaniyi. Walembera The Nation, The Huffington Post, ndi Counterpunch.com ndipo adzalengeza chidutswa chake choyamba cha The Fix sabata yamawa pa tanthauzo latsopanoli pakukonzanso kwa DSA ya APA ndi zomwe zimakhudza ndale ndi mfundo zake kwa anthu.