COMMENTS: Iyo itsva ASAM "tsananguro yekupindwa muropa" (Nyamavhuvhu 2011) inogumisa gakava pamusoro pehunhu hunhu hwekupindwa muropa, kusanganisira bonde uye kupindwa muropa nezvinonyadzisira Iyi dudziro nyowani yekupindwa muropa, iyo inosanganisira maitiro ekuzvibata, senge chikafu, kubhejera uye bonde, ASAM zvisina tsarukano inotaura kuti kupindwa muropa nehunhu kunosanganisira kushanduka kwehuropi hwakafanana uye nzira dzechiredzo sezvinoita zvinodhaka zvinodhaka. Isu tinotenda Internet kupindwa muropa kwepabonde hakufanirwe kunge kuri pasi pemaambura ekupinda muropa. Vazhinji varume vanova vakapindwa muropa nehupombwe vangadai vasina kumbobvira vapindwa muropa nepabonde dai vaigara munguva yepamberi peinternet. (Ndine italicized mareferenzi kune akasarudzika maitiro ehunhu.)
- UPDATE (2013) - National Institute of Mental Health (NIMH): DSM yakaipa uye haina nguva.
- ZVIMWE ZVAKAITIKA (2016) - Peer-rakadzokororwa bepa na DSM-5 nhengo yeboka reboka romuitiro Richard Krueger MD: Kuongororwa kwehutano hwepabonde kana kuita zvepabonde zvinogona kuitwa kuburikidza nekushandisa ICD-10 uye DSM-5 pasinei nokurambwa kweizvi kuongororwa neAmerican Psychiatric Association
- UPDATE (2018) - Chirwere chekuongorora chirwere? Nyika inonyanya kushandiswa kurapwa kwekurapa, The International Classification of Diseases (ICD-11), ine itsva yekuongorora yakakodzera kupindwa muropa nezvinonyadzisira kana kupindwa muropa nebonde: "Kunyanya Kuita Zvepabonde Zvirwere. "(2018)
- ASAM's FAQ's pane dudziro: Tsanangudzo yeASAM yeKupindwa muropa - Mibvunzo Inowanzo bvunzwa (2011)
- ASAM Press Release pachinotsva chitsva: ASAM Press Release (2011)
- Chinyorwa chakanakisa pane tsananguro uye mutemo chirevo: Nyanzvi dzepamusoro dzeAmerica (ASAM) Vachangobva Kuburitsa Tsvairo Tsvairo Yekupindwa Muropa (2011)
Zvinyorwa zviviri neYBOP kubva ku2011:
- Shandisai Mabhuku EpaMagwaro: Docs Dzochera Zvirwere Zvepabonde (2011). American Society of Addiction Medicine anobvumirana kusawirirana ne DSM
- Wakagumburwa paNotoni Here? Bvunza ASAM (2011). Vashandi veScott vanotsanangura kuti chii chakanaka kuti chigadzikane
Kuguma kwemutsara weDMM:
Chirevo chePublic Policy: Tsanangudzo yeKupindwa muropa (Nguva refu)
Kupindwa muropa ihosha, chirwere chisingaperi chemubairo weuropi, kukurudzira, ndangariro uye zvine chekuita nematunhu. Kupindwa muropa kunokanganisa neurotransmission uye kudyidzana mukati memubhadharo zvimiro zveuropi, zvinosanganisira nyonganiso inounganidza, anterior cingulate cortex, basal forebrain uye amygdala, zvekuti zvinokurudzira hierarchies zvinoshandurwa uye hunodhaka hunhu, hunhu hungangodaro kana hungasanganisira doro uye kumwe kushandiswa kwezvinodhaka, kuwedzera hutano. , kuzvibata kwakabatana nehunhu. [Uye] kupindwa muropa kunokanganisawo neurotransmission uye kudyidzana pakati pematunhu eucortical uye hippocampal maseketi uye mubhadharo wezvipiro zvehuropi, zvekuti kurangarira kwekubuditswa kwemubairo (zvakadai sekudya, zvepabonde, doro uye zvimwe zvinodhaka) zvinotungamira kune biological uye maitiro ekupindura kune ekunze cues, zvichikonzera kuchiva uye / kana kubatanidzwa mukupindwa muropa maitiro.
Irourobiology yekupindwa muropa inosanganisira yakawanda kupfuura iyo neurochemistry yemubairo. (1) Iyo yekumberi cortex yeuropi uye iri pasi chena nyaya kubatana pakati pemberi cortex uye maseketi emubairo, kurudziro uye ndangariro zvakakosha mukuratidzwa kwekushandurwa kwekumanikidza kwekudzora, kwakachinja kutonga , uye kushomeka kwekutsvaga mibairo (iyo inowanzo kusangana nemunhu akabatwa sechishuwo cheku "kuve akajairika") inoonekwa mukupindwa muropa- zvisinei nemhedzisiro inokwenenzverwa inokonzeresa kubva mukubata mukushandisa zvinodhaka uye mamwe maitiro ekurwisa.
Mberi mbichana dzakakosha mukudzivirira kukurudzira uye kubatsira vanhu kuti vanonoke kugutsikana. Kana vanhu vane kupindwa muropa vachiratidza matambudziko mukudzivirira kugutsikana, pane yemhasuru locus yezvinetso izvi kumberi cortex. Frontal lobe morphology, kubatana uye kushanda kwayo kuchiri mubato rekuvandudzwa panguva yekuyaruka uye kukura kwevechidiki, uye kuratidzwa kwekutanga kwekushandiswa kwezvinodhaka ndechimwe chinhu chakakosha mukukudziridza kupindwa muropa. Vazhinji vezvemagetsi vezvemagariro vanotenda kuti budiriro ye morphology ndiyo hwaro inoita kuti hupenyu hwepakutanga huonekwe nezvinhu zvakadaro chinhu chakakosha.
Nhengo dzedzinza dzinofunga nezve hafu yezvingaita kuti munhu ave nekukuvara. Zvinhu zvinokonzerwa nezvakatipoteredza zvinopindirana nehupenyu hwehupenyu hwevanhu uye hunochinja huwandu hunoshandiswa nehutachiona hunobatsira. Resilience iyo munhu anowana (kuburikidza nekuberekera vana kana zviitiko zvehupenyu zvekare) inogona kukanganisa kuwanda kwekuti genetic predispositions inotungamirira kune unhu hunoita uye zvimwe zviratidzo zvekudhakwa. Tsika inobatanidzwawo muhutano hwekuti kusvuta kunowanikwa sei kune vanhu vane hutachiwana hwehupenyu hwekugadzirwa kwekudhakwa.
Zvimwe zvinhu zvinogona kuita kuti chitarisiko chekupindwa muropa, zvichitungamira kune yayo hunhu bio-psycho-socio-pamweya kuratidzwa, zvinosanganisira:
a. Kuvapo kwekukanganisa kwehupenyu hwehupenyu mukushanda kwemasekete emubairo, zvekuti zvinodhaka uye maitiro anowedzera mubairo basa anosarudzwa uye anotsvakwa sevanosimbisa;
b. Kudzokororwa kubatanidzwa mukushandisa zvinodhaka kana mamwe maitiro ekupindwa muropa, zvichikonzera neuroadaptation mukusimudzira dunhu rinotungamira mukutadza kutonga pamusoro pekuwedzera kushandiswa kwezvinodhaka kana kubatanidzwa mukupindwa muropa maitiro;
c. Kukanganisa kwekuziva uye kunokanganisa, izvo zvinokanganisa maonero uye kukanganisa kugona kubata nemanzwiro, zvichikonzera kuzvinyengera kwakanyanya;
d. Kuvhiringwa kwerutsigiro rwemagariro ehutano uye matambudziko muhukama hwehukama hunokanganisa kusimudzira kana kukanganisa kwekusimba;
e. Kusangana nekushungurudzika kana zvinoshungurudza izvo zvinokurira kugona kwemunhu kugadzirisa;
f. Kutsveyamisa muchirevo, chinangwa nehunhu hunotungamira maitiro, kufunga nemaitiro;
g. Kukanganisa mukubatana kwemunhu nekwake, nevamwe uye neanopfuura (anonongedzerwa kwaari saMwari nevazhinji, Simba Repamusoro nemapoka-nhanho gumi nembiri, kana kuziva kwepamusoro nevamwe); uye
h. Kuvapo kwekubatana-kuitika kusagadzikana kwepfungwa muvanhu vanoita zvekushandisa zvinodhaka kana mamwe maitiro ekupindwa muropa.
Utachiona hunoratidzwa neABCDE (ona #2 iri pasi):
a. Kusakwanisa kuramba nguva dzose Bvisa;
b. Kuipa kwekutsika kwekuita;
c. Craving; kana kuwedzera “nzara” yezvinodhaka kana kuti zviitiko zvinopa mubayiro;
d. Kudzikira kucherechedzwa kwezvinetso zvakakosha nemaitiro emunhu uye hukama hwevanhu; uye
e. Kushanda kwepfungwa kusingaiti.
Simba rekunze kwekunze kukanganisa kushuva nekushandisa zvinodhaka, pamwe nekuwedzera nguva yekutaurirana mune dzimwe dzingangodaro maitiro ekurwisa, uyewo unhu hwekudhakwa, uye hippocampus ichikosha mukuyeuka kwemazuva apfuura kana kuitika kwechirwere, uye ne iyo amygdala ichikosha pakuve nekukurudzirwa kuisa pfungwa pakusarudza maitiro anobatanidza nezviitiko izvi zvakare.
Kunyangwe vamwe vachitenda kuti mutsauko uripo pakati peavo vakapindwa muropa, nevaya vasina, huwandu kana kuwanda kwekushandisa doro / zvinodhaka, kuita hunhu hwekupindwa muropa (zvakadai sekubhejera kana kushandisa) (3), kana kuratidzwa kune mamwe mibairo yekunze (sekudya kana zvepabonde), chimwe chinhu chinokonzera kukanganisa inzira inobatsira iyo munhu anopindura kune zvakadai, kushungurudzika uye zvakatipoteredza. Chimwe chinhu chinonyanya kukanganiswa nenzira iyo vanhu vane uroja vanoshandisa kushandiswa kwemishonga kana mibairo yekunze ndeyekuti kufunganya ne, kubata pamwe uye / kana kutsvaka mibairo (semuenzaniso, doro uye zvimwe zvinoshandiswa zvinodhaka) zvinoramba zvichiri pasinei nekuwedzerwa migumisiro yakaipa. Izvi zvinoratidzika zvinogona kuitika zvisinganzwisisiki kana zvisingatauriki, sechiratidziro chekushaya simba.
Ngozi inoramba iripo uye/kana kudzokazve kwekudzokazve, mushure menguva yekurega, chimwe chinhu chakakosha chekupindwa muropa. Izvi zvinogona kukonzereswa nekuratidzwa kune zvinhu zvinopa mubayiro uye maitiro, nekuratidzwa kune zvakatipoteredza cues zvekushandisa, uye nekusangana nezvinonetsa mupfungwa izvo zvinokonzeresa kuita kwakawedzera muuropi kushushikana maseketi.(4)
Mune zvinodhaka kune uwandu hwekuremera hukuru mukushanda, izvo zvinoratidzira mumatambudziko nekuona, kudzidzira, kutora pfungwa, kuvharidzira, uye kutonga. Vanhu vane utsotsi vanowanzoratidza kunonoka kwekushandura maitiro avo asina kunaka pasinei nekusimudza zvinetso zvinoratidzwa nevamwe vanokosha muupenyu hwavo; uye kuratidza kuonekwa kusakosha kwekuonga kwehukuru hwezvinetso zvakakonzera uye zvinetso. Izvo zvichiri kufambira mberi maziso evechiri kuyaruka zvinogona kuwedzera kukanganisa uku muhutungamiri nekushongedza vechidiki kuti vaite "mungozi huru" maitiro, kusanganisira kunwa doro kana zvimwe zvinoshandiswa nemishonga. Izvo zvinodhudhudisa kana chido chekushandisa zvinhu kana kuita muzviito zvinoratidzika zvinopa mubayiro, izvo zvinowanikwa kune vakawanda varwere vane uwandu, zvinotsigira kukanganisa kana kuregererwa kwechirwere ichi. Uku ndiko kuwirirana ne "kusina simba" pamusoro pokudhakwa uye "kusagadzikana" kwehupenyu, sezvinorondedzerwa muChitatu 1 yezvirongwa zve 12 Steps.
Kupindwa muropa kunopfuura kusazvibata. Zvimiro zvekupindwa muropa zvinosanganisira maitiro emunhu, kuziva, manzwiro, uye kudyidzana nevamwe, kusanganisira kugona kwemunhu kuwirirana nenhengo dzemhuri yavo, kunhengo dzenharaunda yavo, kumamiriro avo epfungwa, uye kune zvinhu zvinodarika zvavanoita zuva nezuva. ruzivo.
Kuratidzwa kwemaitiro uye matambudziko ekupindwa muropa, kunyanya nekuda kwekutadza kudzora, zvinogona kusanganisira:
a. Kushandisa zvakanyanya uye / kana kubatanidzwa mukupindwa muropa mafambiro, pamafafitera epamusoro uye/kana uwandu kupfuura hwakatarisirwa nemunhu, kazhinji hunobatanidzwa nechishuwo chinoramba chiripo chekuedza uye kusabudirira pakudzora maitiro;
b. Nguva yakawandisa yakarasika mukushandisa zvinodhaka kana kupora kubva kumhedzisiro yekushandisa zvinodhaka uye / kana kuita hunhu hwekupindwa muropa, zvine mhedzisiro yakaipa pamagariro uye basa rekushanda (semuenzaniso kukura kwezvinetso zvehukama hwehukama kana kuregeredza mabasa kumba, kuchikoro kana kubasa. );
c. Kuenderera mberi kwekushandisa uye / kana kubatanidzwa mukupindwa muropa maitiro, pasinei nekuvapo kwezvinetso zvemuviri kana zvepfungwa zvinoramba zviripo kana kuti zvepfungwa izvo zvingave zvakakonzerwa kana kuwedzerwa nekushandisa zvinodhaka uye / kana maitiro ane chokuita nemishonga;
d. Kudzikisira kwemaitiro erepertoire anotarisa pamubairo uri chikamu chekupindwa muropa; uye
e. Kushaikwa kuri pachena kwekugona uye / kana kugadzirira kutora nguva dzose, chiito chekusimudzira kunyangwe kucherechedzwa kwezvinetso.
Kuchinja kwekuziva mukupindwa muropa kunogona kusanganisira:
a. Kunyanya kunetseka nekushandisa zvinhu;
b. Kuongororwa kwakagadziridzwa kwehukama hunobatsira uye kukuvadza kwakabatana nezvinodhaka kana maitiro ane mubairo; uye
c. Kutenda kusina kururama kuti matambudziko anowanikwa muupenyu hwemunhu anokonzerwa nezvimwe zvikonzero pane kuva mugumisiro unofanotaurwa wekupindwa muropa.
Kushushikana kwekunzwa muropa kunogona kusanganisira:
a. Kuwedzera kunetseka, dysphoria uye kurwadziwa kwepfungwa;
b. Kuwedzera kunzwisisika kune zvinokonzera kushungurudzika kunobatanidza nekutsvaga kweuropi kushungurudza maitiro, zvakadai kuti "zvinhu zvinoita sezvinotambudza" semugumisiro; and
c. Kuoma mukuziva manzwiro, kusiyanisa pakati pemanzwiro uye manzwiro emuviri ekukurudzira manzwiro, uye kutsanangura manzwiro kune vamwe vanhu (dzimwe nguva inonzi alexithymia).
Mafungiro ekunyanya kukanganisa yakaoma zvikuru. Vamwe vanhu vanoshandisa doro kana mamwe madhiragi kana kuti pathologically vachiita mamwe mimwe mibayiro nokuti vari kutsvaga "kusimbiswa kwakanaka" kana kusikwa kwehupenyu hwakanaka ("euphoria"). Vamwe vanotsvaga kushandisa zvinhu kana mamwe mimwe mibayiro nokuti vakawana ruzivo kubva kune dzimwe nyika dzisina kunaka ("dysphoria"), iyo inomirira "kusimbisa kusina kunaka." Kunze kwezvakaitika zviitiko zvemubairo uye kuponeswa, kune hutano husina maturo hunovapo mune dzimwe nguva iyo inobatanidzwa nekutsungirira kwekubatana nemishonga yekurapa.
Mamiriro ekupindwa muropa haana kufanana nechimiro chokudhakwa. Kana chero munhu akadhakwa zvishoma kuburikidza nekushandisa doro kana zvimwe zvinodhaka, kana kana munhu achiita zvisiri-pathologically mune zvingangoita zvekupindwa muropa maitiro akadai sekubhejera kana kudya, munhu anogona kuwana "yakakwirira", inonzwa se "yakanaka" mamiriro epfungwa anoenderana nekuwedzera dopamine uye opioid peptide basa mumasekete emibayiro. Mushure mechiitiko chakadaro, kune neurochemical rebound, umo mubairo webasa haungodzokeri kune yekutanga, asi kazhinji inodonha pasi pemazinga ekutanga. Izvi hazviwanzo kunzwisiswa nemunhu uye hazvisi hazvo zvakabatana nekukanganisa kushanda.
Nekufamba kwenguva, zviitiko zvakadzokororwa nekushandiswa kwezvinodhaka kana maitiro ekupinda muropa hazvibatanidzwe nekuwedzera mubairo wedunhu basa uye hazvisi sezvakanaka mubayiro. Kana munhu angonzwa kubviswa kubva mukushandiswa kwezvinodhaka kana maitiro akafanana, pane kunetseka, kusagadzikana, kushungurudzika uye kunetseka kwemaonero, kwakanangana nekuwana mubairo nekutsiva kwehuropi uye mahormoni kushungurudzika masisitimu, ayo ane chekuita nekubviswa kubva kunenge kungangoita mamwe marudzi epamishonga zvinodhaka zvinodhaka. Nepo kushivirira kuchikwira kune "kwakakwirira," kushivirira hakukudziri kune kunetseka kwepasi kwakabatana nekutenderera kwekudhakwa uye kubvisa.
Nekudaro, mukupindwa muropa, vanhu vanowanzoedza kugadzira "yakakwira" - asi chavanonyanya kusangana nako kwakadzika uye kwakadzika "kwakadzika." Nepo chero munhu anga "achida" kukwira "kumusoro", avo vakapindwa muropa vanonzwa "kuda" kushandisa chinhu chinodhakwa kana kuita hunhu hwekupindwa muropa kuti vaedze kugadzirisa yavo yakashata yemanzwiro mamiriro kana avo ehupenyu zviratidzo zvekusiya. Vanhu vane kupindwa muropa nekumanikidza vanoshandisa kunyangwe zvingasavaita kuti vanzwe zvakanaka, mune dzimwe nguva nguva refu mushure mekutsvaga "mibairo" hakufadze. (5) Kunyangwe vanhu vanobva mutsika dzese vangasarudza "kukwira" kubva kune mumwe kana mumwe. chiitiko, zvakakosha kuti uzive kuti kupindwa muropa hakusi kungova basa rekusarudza. Zvichitaurwa zviri nyore, kupindwa muropa haisi mamiriro anodikanwa.
Sezvo kupindwa muropa chiri chirwere chisingaperi, nguva dzekudzokera shure, dzinogona kukanganisa nguva dzekuregererwa, chinhu chinozivikanwa chekupindwa muropa. Izvo zvakakoshawo kuziva kuti kudzokera kukushandisa zvinodhaka kana pathological kutsvaga mibairo hazvidzivisike.
Kupindira kwekliniki kunogona kuva kwakakosha mukuchinja mararamiro ekudhakwa. Kucherechedza kutarisa kwezviito zvehutungamiri wega uye wekutonga, dzimwe nguva kusanganisira zvinetso zvekuita zvezvezvekuita, zvinogona kuita kuti pave nemigumisiro yakanaka yezvipatara. Kubatana mune zvehutano zvinokurudzira izvo zvinokurudzira mutoro wega wega nekuzvidavirira, kushamwaridzana nevamwe, uye kukura kwomunhu pachako kunobatsira pakugadzirisa. Zvakakosha kuziva kuti kukanganisa kunogona kukonzera kuremara kana kufa kusati kwasvika, kunyanya kana kusara kusatorwa kana kuti kurapwa zvisina kukodzera.
Nzira dzehutano idzo huropi uye maitiro anopindura kune zvinodhaka zvinodhaka uye kubatanidzwa mukupindwa muropa maitiro akasiyana pane imwe nguva nhanho dzekupindwa muropa kupfuura mumatanho ekutanga, zvichiratidza kufambira mberi, izvo zvingave zvisinganyanyi kuoneka. Sezvazvakaita kune zvimwe zvirwere zvisingaperi, mamiriro acho anofanira kuongororwa uye kutarisirwa nekufamba kwenguva kusvika:
a. Kuderedza kuwanda uye kuwedzera kwekudzoka zvakare;
b. Nguva dzekuchengetedza kwekuregererwa; and
c. Natsiridza mwero wekushanda kwemunhu panguva dzekuregererwa.
Mune zvimwe zviitiko zvekudhakwa, kurapwa kwemishonga kunogona kuvandudza zvinogadzirwa nemishonga. Muzviitiko zvakawanda zvekudhakwa, kubatanidzwa kwekugadzirisa pfungwa dzepfungwa nekugadziriswa kwakasimba neuchapupu-based pharmacological therapy inopa mhinduro dzakanakisisa. Kurwara kwechirwere chisingaperi kunokosha pakugadzirisa zvikamu zvekudzoka zvakare uye zvinokonzera. Kurapa kwezvinodhaka kunoponesa upenyu †
Dhiyabhorosi vadzidzisi uye vanhu mukudzoka vanoziva tariro inowanika mukudzoka. Kudzorerwa kunowanikwa kune vanhu vangave vasati vatanga kuona iyo tariro, kunyanya apo chinonyanya kukoshesa nekubatanidza migumisiro yehutano kune chirwere chekudhakwa. Sezvimwe mune mamwe mararamiro, kuzvidzora, nekutsigirana, kunokosha zvikuru mukudzoka kubva pakudhakwa. Rutsigiro rwevezera rakafanana nerakawanikwa mumabasa akasiyana-siyana e "self-help" mabasa anobatsira mukugadzirisa hutano hwehutano uye kubudirira kwehutano mukugadzirisa. ‡
Kupora kubva mukupindwa muropa kunowanikwa zvakanyanya kuburikidza nemusanganiswa wekuzvitonga, kutsigirana, uye kutarisirwa kwehunyanzvi kunopihwa nenyanzvi dzakadzidziswa uye dzakasimbiswa.
ASAM Tsanangudzo yemuzasi:
1. The neurobiology yemubairo yakanzwisiswa zvakanaka kwemakumi emakore, nepo neurobiology yekupindwa muropa ichiri kuongororwa. Nyanzvi dzakawanda dzechiremba dzakadzidza nezvemubairo nzira dzinosanganisira zvirongwa kubva kune ventral tegmental nzvimbo (VTA) yeuropi, kuburikidza ne median forebrain bundle (MFB), uye kupedzisa mu nucleus accumbens (Nuc Acc), umo dopamine neurons inokurumbira. Iye zvino neuroscience inobvuma kuti neurocircuitry yemubairo inosanganisirawo pfuma yakawanda yezvikwata zvinotanha zvinosangana nucleus accumbens uye basal forebrain. Icho mufambiro wemubairo apo mubayiro unyoresa, uye uko mibairo yakakosha senge chikafu, hydration, bonde, uye kurera zvinopa simba rakasimba uye rinotsigira hupenyu.
Doro, nicotine, mamwe madhiragi uye pathological kubhejera maitiro anoita mhedzisiro yavo yekutanga nekuita pane imwechete mubairo wedunhu unoonekwa muuropi kuita chikafu uye zvepabonde, semuenzaniso, kusimbisa zvakanyanya. Zvimwe zvinokonzeresa, senge kudhakwa uye kufara kwemanzwiro kubva kumibairo, zvinobva mukushandiswa kwemubairo wedunhu. Kunyangwe kudhakwa uye kubviswa zvinonzwisiswa kuburikidza nekudzidza kwemararamiro ematunhu, kunzwisisa kwekudhakwa kunoda kunzwisisa kwepakati rese network ye-neural connections inosanganisira forebrain uye midbrain mizinda. Kusarudzwa kwemamwe maropafadzo, kufungisisa nezvimwe zvikomborero, mhinduro kune zvinokonzera kutsvaga mimwe mibayiro, uye zvinokurudzira zvinoshandiswa kushandisa doro nemamwe madhiragi uye / kana kuti pathologically kutsvaga mamwe mimwe mibayiro, inosanganisira dzakawanda dzimba dzehupi kunze kwemubayiro weurourocircuitry pachayo pachako.
2. Aya maficha mashanu haana kuitirwa neASAM kuti ashandiswe se "diagnostic maitiro" ekuona kuti kupindwa muropa kuripo here kana kuti kwete. Kunyange zvazvo zvinhu izvi zvinoratidzika zvinowanzovapo mune dzimwe nguva dzekudhakwa, pasinei nemasikiristiki ezvinoshandiswa zvinoshandiswa mukudhakwa kana mubayiro unoratidzirwa, chimwe nechimwe chingave chisingave chakakosha mumatambudziko ose. Kuongororwa kwemishonga inodhaka kunoda huwandu hwehupenyu, hwepfungwa, hwemagariro evanhu uye hwemweya hunongororwa nenyanzvi dzakadzidziswa uye dzakavimbiswa.
3. Murugwaro urwu, izwi rekuti "maitiro ekurwisa" rinoreva maitiro anowanzo kupa mubayiro uye ari chinhu chinowanzoitika muropa. Kujekesa kune aya maitiro, sezvazvinongoitika nekuratidzwa kune unopa mubayiro zvinodhaka, zviri nyore zvehurongwa hwekupindwa muropa pane kukonzeresa kupindwa muropa. Mamiriro ehuropi anatomy uye fizikisi ndiyo musiyano uri pasi unonyanya kunangana nekukanganisa. Nekudaro, mune ino gwaro, izwi rekuti "kupindwa muropa nehunhu" haireve maitiro asina hunhu kana ehunhu asingatenderwe, ayo anogona kuoneka mune dzakawanda dzekupindwa muropa. Maitiro, sekusatendeseka, kutyora hunhu hwemunhu kana hunhu hwevamwe, zviito zvematsotsi nezvimwe, zvinogona kuve chinhu chekupindwa muropa; izvi zvinonyanya kutaridzika sematambudziko anokonzeresa kubva pane kupa mupindwa muropa.
4. The anatomy ( brain circuitry inobatanidzwa) uye physiology ( the neuro-transmitters inobatanidzwa) mune idzi nzira nhatu dzekudzokera shure ( zvinodhaka- kana mubayiro-zvinokonzeresa kudzoka zvakare vs. cue-triggered relapse vs. stress-triggered relapse) zvakatsanangurwa. kuburikidza neuroscience research.
- Kudzokazve kunokonzerwa nekuratidzwa kune zvinodhaka / zvinokomborera zvinodhaka, kusanganisira doro, zvinosanganisira nucleus accumbens uye VTA-MFB-Nuc Acc neural axis (brain brain mesolimbic dopaminergic "incentive salience circry" -ona mashoko omuzasi 2 pamusoro). Mubairo-wakakonzeresa kudzokazve zvakare unopindirana ne glutamatergic maseketi anoratidzira kune iyo nucleus accumbens kubva kumberi kwekortex.
- Kudzokerazve kunokonzereswa nekuratidzwa kune akamisikidzwa cues kubva kwezvakatipoteredza kunosanganisira glutamate maseketi, anobva kumberi cortex, insula, hippocampus uye amygdala inofungidzira kune mesolimbic incentive salience circuitry.
- Kudzokorora kunokonzerwa nokutsvaga kune zvinetso zvinonetsa zvinosanganisira kuora kwepfungwa zvinotenderera kunze kwe hypothalamic-pituitary-adrenal axis iyo inozivikanwa senheyo ye endocrine stress system. Pane zviviri zvekudzokazve-kunokonzera hutano hwepfungwa dzepfungwa - imwe inotangira musayadrenergic nucleus A2 mu lateral tegmental nzvimbo yeuropi inosvika uye inopikira hypothalamus, nucleus accumbens, frontal cortex, uye nhovo yemubhedha we stria terminalis, uye inoshandisa norepinephrine seyourotransmitter; imwe yacho inotangira mukati rekati reamygdala, mapurojekiti kusvika kumubhedha webhedha we stria terminalis uye anoshandisa corticotrophin-releasing factor (CRF) seyourotransmitter yayo.
5. Pathologically kutsvaga mubayiro (unotaurwa muPfupi Dudziro yeiyi ASAM tsanangudzo) saka kune akawanda maficha. Haisi zvachose huwandu hwekuratidzwa kumubairo (semuenzaniso, dosage yemushonga) kana kuwanda kana kutaridzika kwekuratidzwa uku kuri kwepanyama. Mukupindwa muropa, kutsvaga mibairo kunoramba kuchiripo, kunyangwe matambudziko ehupenyu anounganidza nekuda kwehunhu hwekupindwa muropa, kunyangwe kana kuita hunhu kuchiguma kunakidza. Saizvozvovo, mumatanho ekutanga ekupindwa muropa, kana kana kuratidzwa kwekunze kwedzidziso yekudzvinyirira kuri pachena, kushandiswa kwezvinodhaka kana kuita hunhu hwekumanikidza kunogona kuve kuedza kwekutsvaga zororo kubva kune dysphoria; nepo mumatanho ekupedzisira echirwere, kuita hunhu hwekumanikidzira kunogona kupfuurira kunyangwe maitiro acho asisiri kupa zororo.
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