(L) Nyanzvi dzepamusoro dzeAmerica (ASAM) Vachangobva Kuburitsa Tsvairo Tsvairo Yekupindwa Muropa (2011)

ZVIMBVUNZO: Ichi ndicho chinyorwa chakanakisa chinofukidza iyo Nyamavhuvhu, 2011 kuburitswa kweAmerican Society yeAddiction Medicine tsananguro nyowani yekupindwa muropa. Ichi chinyorwa, Chirwere Chitsva Chekuona Kuwedzerwa Kunokanganisa Scientific Storm yakatanga kubva pawebhusaiti "The Fix." Izvo zvikamu zvakashinga pazasi zvine hukama nemifungo inokurukurwa pano paYBOP.

Nyaya mbiri takanyora:

Zvinodhaka ndezvezvirwere zvehupfungwa. Asi ichagadziriswa sei? NaJennifer Matesa naJed Bickman 08 / 16 / 11

Nyanzvi dzeAmerica dzepamusoro dzichangobva kuburitsa tsananguro itsva yekutsvaira. Inoburitsa makakatanwa panhau hombe-kusagadzikana kwehuropi zvichipesana nehunhu hwakaipa, kurega, kupindwa muropa nebonde, kupa chimwe chinhu kune wese munhu - kunyanya simba rezvepfungwa - kupokana nazvo.

Kana iwe unofunga kuti zvinodhaka ndezvese maererano nehuwandu, zvinodhaka, zvepabonde, kubhejera, zvokudya uye zvimwe zvisingakanganisiki, funga zvakare. Uye kana iwe uchidavira kuti munhu ane chisarudzo kana kana kuti haafaniri kuita zvekuita zvepabonde, pfuurira. Sangano reAmerican Society of Addiction Medicine (ASAM) rakaridza ruzha pamusoro pezvirevo izvi zvakanyatsoratidzwa nekubudiswa kwaro kwemashoko ehurumende itsva inotsanangura kusagadzikana sechirwere chisingaperi chepfungwa chinosanganisira maitiro akawanda europi, kunyanya kusagadzikana kunoparadza mune izvo zvinonzi mubairo circuitry. Uku kukanganiswa kwepfungwa mune ruzivo rwemufaro chaiwo kunomanikidzira mishonga yekudzinga makemikari highs inokonzerwa nezvinhu zvakadai semishonga uye doro uye kuzvibata zvakashata sekuita zvepabonde, zvokudya nekubhejera.

Iyo tsanangudzo, mugumisiro wemakore mana emubatanidzwa unosanganisira zvinopfuura hutungamiri hwe80 inotungamirira mukurwisa uye neurology, inosimbisa kuti kupindwa muropa nechirwere chikuru - mune mamwe mazwi, hazvikonzerwe nenyaya dzehutano hwepfungwa senge kushushikana kwepfungwa kana hunhu, kuisa zororo rakakurumbira rekuti maitiro ekurwisa inzira ye "kuzvirapa", toti, kurerutsa kurwadziwa kwekuora mwoyo kana kushungurudzika.

Zvechokwadi, mutsva hutsva hwepfungwa hunotsanangurwa kududzira debunks, yakazara kana kuti chikamu, huwandu hwemaonero akajairika pamusoro pemishonga. Kutadza, chirevo chinotsanangura, chirwere che "bio-psycho-socio-spiritu" chirwere chinoratidzwa (a) chinokanganisa kugadzirisa (chinokanganisa kudzidza, maonero, uye kutonga) uye ne (b) njodzi inoramba iripo uye / kana kudzokazve kudzokorora; izvo zvinoreva zvisingaverengeki ndezvokuti (a) kuvhiringidzika havagoni kudzora maitiro avo ekurwisa uye (b) kudzivisa zvachose, kune vamwe vanodhakwa, chinangwa chisingaiti chekurapa.

Maitiro akaipa pachezvowo zviratidzo zvekudhakwa, kwete chirwere chaicho. "Mamiriro ekudhakwa haana kufanana nehurumende yekudhakwa," ASAM inotora marwadzo kuratidza. Kure nekuva humbowo hwekukundikana kwekuda kana hunhu, maitiro ndiwo muyedzo wevapombwe kugadzirisa "kusanzwisisika kwemamiriro ezvinhu" anowanda pamwe chete nechirwere. Mune mamwe mazwi, sarudzo yekuziva inotamba zvishoma kana kusaita basa mune chaiyo mamiriro ekupindwa muropa; semhedzisiro, munhu haakwanise kusarudza kusave akapindwa muropa. Kunyanya kupindwa muropa kunogona kuitwa kusarudza kusashandisa chinhu kana kuita mutsika inosimbisa iyo yese yekuzviparadza mubairo-wedunhu loop.

Asi ASAM haibvumiri zvikwereti kana zvasvika pamigumisiro yakaipa yekudhakwa, ichizivisa chirwere chinogona "kukonzera kuremara kana kufa kusati kwasvika, kunyanya kana kusara kusatorwa kana kutorwa zvisina kukodzera."

Iyi tsanangudzo itsva inosiya pasina mubvunzo kuti zvose zvinodhaka-kana doro, heroin kana zvepabonde, vanoti-zvakangofanana. Dr. Raju Haleja, aimbova mutungamiriri weCanada for Addiction Medicine uye sachigaro wekomiti yeAAMAM yakashandura tsanangudzo idzva, yakaudza The Fix, "Tiri kutarisa kudhakwa sechirwere chimwe chete, kusiyana nevaya vanovaona sevakaparadzana zvirwere.

Kupindwa muropa kupindwa muropa. Hazvina basa kuti chii chinokanganisa uropi hwako munzira iyoyo, kana changochinja nzira, unokwanisa kupindwa muropa nezvinodhaka. ” Kuti nzanga yakadzvinyirira kuongororwa kwepabonde kana kubhejera kana kupindwa muropa nechikafu sezvinhu zvese sezvakakodzera pakurapa senge kupindwa muropa nedoro kana heroin kana kristall meth kunogona kukonzera mhirizhonga kupfuura kungwara kwayo asi zvirevo zvakaenzana zvinosvika kure.

Iyi tsanangudzo itsva inouya seAmerican Psychiatric Association (APA) iri kuita chiziviso chikuru, gumi-mu-ku-kugadziridza tsanangudzo yaro yekutsvaga muDainist and Statistical Manual ye Mental Disorders-bhaibheri rehutano hwepfungwa. IAAPA's DSM ichava nemigumisiro yakawanda pamitemo yehutano yevanhu inotungamirira kurapwa kwemishonga, kunyanya nokuti makambani einishuwarenzi anorayirwa nemutemo kushandisa shanduko dzeDMM yekuongorora uye nzira yekugadzirisa mishonga ipi yavanozobhadhara.

Dr Haleja vakataurira The Fix kuti sarudzo yeAASAM yakabva isingapindirani nekambani yeDMM; kunyange zvazvo DSM ichatsanangura kusagadzikana sechirwere, zviratidzo zvayo (uye naizvozvo zvirwere zvekuongorora) zvicharamba zvichionekwa semafungiro akajeka. Uyezve, DSM icharondedzera rudzi rwemhando yekudhakwa sechirwere chakasiyana, panzvimbo yeivo imwechete uye yakabatana yezvirwere izvo ASAM inotaura. "Panyaya yekurapwa, zvinova zvakakosha zvikuru kuti vanhu vasatarise pachinhu chimwe chete chechirwere ichi, asi chirwere chose," anodaro Haleja. Kure nekuva kukundikana kwechido kana hunhu, hunhu hwekupindwa muropa ndiko kuyedza kwevanopindwa muropa nekugadzirisa iyo "kusanzwisisika mamiriro" anouya achienderana nechirwere. Mune mamwe mazwi, sarudzo yekuziva inotamba zvishoma kana kusaita basa mune chaiyo mamiriro ekupindwa muropa; semhedzisiro, munhu haakwanise kusarudza kusave akapindwa muropa.

Kunyangwe kuvhiringidzika havakwanisi kusarudza kusapindwa muropa, vanogona kusarudza kuwana mishonga. Kudzoka, ASAM inoti, inonyanya kuonekwa kwete kungozvibata-kutarisira uye mapoka ekutsigira pamwe chete sehutano hweHNUMX-danho, asiwo nehutano hwepamhizha rubatsiro.

Dzimwe nyanzvi dzezvinodhaka-mishonga dzinoona tsanangudzo itsva yakajeka sechisimbiso chezvakave, sezvo bhuku reAlcoholics Anonymous mu1939, rinozivikanwa se "chirwere chechirwere" chekudhakwa. "Vanhu vazhinji vemuhuwandu vanhu vakawanda vanoona kusagadzikana sechinetso chetsika-'Nokuti havangomiri here? '" Anodaro Dr. Neil Capretto, mutungamiriri wezvechiremba we Gateway Rehabilitation Center muPittsburgh uye anoshanda ASAM nhengo. "Kune vanhu vane ruzivo vanoshanda mumishonga yekurapa kwemakore kwemakore, tinoziva kuti chirwere chepfungwa."

Chirevo ichi chinosundira matanho gumi nemaviri, musimboti wenzvimbo zhinji dzekurapa, zvirongwa uye vanachiremba, kuenda kuchinyakare? Mushure mezvose, kana dambudziko rikanzi inyaya ye "kurapwa", hazvireve here kuti mhinduro yacho inofanirawo kunge iri "yekurapa" - sekuvarapi nemishonga? "Maitiro ese ari maviri anoshanda," anodaro Dr. Marc Galanter, purofesa wezvepfungwa paNew York University, director wekutanga weDivision of Alcohol and Substance Abuse pamwe nemukuru weFellowship Training Program yayo muAddiction Psychiatry. "Chokwadi chekuti kupindwa muropa nechirwere hazvireve kuti chinongobatwa nemushonga." Anodaro Capretto: "Iyi dudziro nyowani hairevi kuti nzira dzepfungwa kana dzekunamata hadzina kukosha. Kunetseka kwangu ndekwekuti vamwe vanhu vasinganyatsonzwisisa huwandu hwakawanda hwekupindwa muropa vanozozviona chete sechirwere chemasero ehuropi. "Hatisi kurapa makomputa - zviri mumunhu chaiye uyo, sekutsanangurwa kwazvinoita, chisikwa 'chepfungwa-chezvemagariro uye chemweya,' uye ndiani acharamba achida rubatsiro munzvimbo idzodzo."

Nekutaura kwayo pasina-ibwe-risina kubviswa (rinomhanyira kumapfumbamwe masere, asina kusarudzwa, kusanganisira mashoko omuzasi), ASAM yakaburuka-kunyanya-kune rumwe rutivi rwemubvunzo wekuku-uye-yei yakagara yakanyanyisa vanhu vanoda kudikanwa, vanachiremba uye vanodzorera vanokanganisa zvakafanana: izvo zvakauya pakutanga, chirwere chepfungwa kana maitiro ekumanikidza uye kushandisa zvinhu? Iyo tsanangudzo inotaura kuti kusagadzikana muhutano hwemagariro ehutano-hutano-huri pakati penzvimbo dzeuropi, kunyanya avo vanoita chiyeuchidzo, manzwiro evanonzwa uye kufara-vauya pakutanga, uye vanokonzera mishonga mumatambudziko ekutsvaga kuti vatsivire mubairo- izvo zvinodhaka. Asi gare gare, iyo nyanzvi inotaura kuti maitiro aya pachake anogona kukuvadza muganhu wekufambisa uye kutungamirira kukanganisa kusagadzikana nekudzora.

Mashoko aya anoenderana, mumashoko aro ose, pamwe nechinzvimbo chakakosha mukucheka-kupindwa muropa nesayenzi kuti mibairo yepanyama yakagadzirirwa kutsigira kuponesa kwevanhu inowanikwa kana kukwidziridzwa nemakemikari ekubhadhara anopiwa nemishonga yemishonga kana kuti maitiro ekurwisa. "Mupiro wekufambisa zviratidzo zviratidzo zvezvinhu zvakakosha: kudya zvokudya, kubereka vana, kuita zvepabonde, kusimbisa ushamwari hwepedyo," anodaro Dr. Mark Publicker, mutungamiri wezvechiremba we Mercy Recovery Center muReenland rehabhi guru rePortland-uye aimbova Regional Chief of Addiction Medicine kwaKaiser Permanente Mid-Atlantic Region.

Patinoshandisa doro kana zvinodhaka, Publicker anodaro, mubairo wemakemikari - "wakakwirira" - une simba rakapetwa kazhinji kukunda mubairo wedunhu redunhu, uye hurongwa hwemitsipa hunoenderana nemafashama eanorotransmitter. “Asi nekuti isu hatina kushanduka sechisikwa neOxyContin kana crack cocaine, iyo michina inochinja. Saka zvinova zvisingaite kuti uwane mufaro wenguva dzose, ”anoenderera mberi. “Kushandiswa kwechinhu ichi kunoitika tichiregeredza izvo zvingasimudzira kurarama. Kana iwe ukafunga nezvazvo kubva ipapo maonero, inotanga kuverengerana nezvehurwere uye kufa nguva isati yakwana. ” Anodhakwa anoshanda ane njodzi yakanyanya yekufa kwekutanga kuburikidza nekurwara kana kuzviuraya.

Chirevo ichi chinomutsa ma alarm ekudzokororwa pamusoro penjodzi inounzwa nekuvandudzwa nevechidiki uye vechidiki miitiro yekushandisa zvinhu nekuti huropi hwavo huchiri mukukora, uye kemikari "kubiwa" kweiyo mibairo system inogona kukonzera kutanga uye nezvimwe zvakakomba kupindwa muropa nehunhu. Kunyange zvazvo wakasimba zvakasimba muhutano hwehutano hwehutano hwekutsvaira, tsanangudzo haisi iyo inokonzera kukanganisa majini (iyo inoratidza chikamu chechikonzero chinokonzera DNA yako nhaka). Inoshingaira kutaura kuti zvakatipoteredza zvinokonzera kana uye kuti yakawanda sei iyo inogadzirisa zviyero. Mashoko aya anotaura kuti "kusagadzikana" kunowanikwa kuburikidza nekurera vana uye hupenyu hwehupenyu hunogona kukanganisa mazwi ekutengesa. "Genetics ndiyo tsika, kwete chiitiko," Capretto anoti.

Zvepfungwa uye zvakatipoteredza, zvakadai sekuratidzwa nekushungurudzika kana kushungurudzika kwakanyanya, pfungwa dzakamonyoroka nezve zvinoreva hupenyu, pfungwa yekuzvikanganisa, uye kuparara kwekubatana nevamwe uye ne "anopfuura (anonzi Mwari nevazhinji, Simba repamusoro na12. -mapoka emapoka, kana kuziva kwakakwirira nevamwe) ”vanozivikanwawo sevane simba.

Mukuwedzera, ASAM inotaura zvakare kuti kunzwisisa maitiro emigumo inongova chikamu chekunzwisisa kusagadzikana kweeurobiology. Masayendisiti vachiri kuedza kunzwisisa kuti vamwe vanokanganisa vanoita sei kunyanya kune zvimwe zvinodhaka kana maitiro uye vamwe vanovhiringidzwa nevamwe; kuti vamwe vanokanganisa vanokonzerwa sei kushandisa zvimwe zviitiko zvisingaiti vamwe; uye kuti zvido zvinogona kuramba sei kwemakumi emakore mushure mekugadzirisa zvakakwana.

Mutsara unoedza kuisa zviratidzo zvekuongorora, izvo zvose zvirikuita: kusakwanisa kurega; kukanganisa kutora simba; chido; kuderedza kunzwisisa kwematambudziko ako; uye kunetseka mupfungwa mhinduro.

Icho chinetso here kuti tsanangudzo yacho isingakwanise kuratidzira kuverengera kuongororwa kwechirwere chechirwere ichi? "Ndingadaro ndiri kutaura pachena, pano," Publicker inoti, kugomera, "asi iwe haufaniri kuita ubongo imaging kuti uone doro rinodhaka."

Muchokwadi inosimbisa kuti "kuwanda uye kuwanda" kwezviratidzo zvekupindwa muropa - senge kuti kangani kunonwa iwe pazuva kana kuti maawa mangani aunopedza kuita bonyora - hakusi kana kumakisa kupfuura "nzira yehunhu uye yekurwara" muropa anopindura kunetseka uye cues nekuenderera mberi nekutsvaga mukutarisana nekukura kwakashata mhedzisiro.

Izwi idzva re ASAM rakabva risina kubvumirana nedare re DSM, iro richarondedzera rudzi rumwe rwemishonga sechirwere chakasiyana. "Nezvekurapa, zvakakosha kuti vanhu varege kutarisa pane chimwe chechirwere ichi, asi chirwere chacho chose," anodaro Haleja.

Kubvisa, anoshanda ASAM nhengo ye30 yemakore uye anotsigira mushonga-anobatsira kurapwa kwemishonga, anonyora kuti kushaya zvinodhaka kunotarirwa nekurapa kwepfungwa, zvehutano uye zvemweya zvehutano-kwete kungofanana nezvayo. "Inonzi mushonga-wakabatsira kurapwa, kwete remishonga-inobatsira mishonga," anodaro. "Mishonga chete inokundikana. Ndakaona izvi pamusoro pebasa rakareba. Asi zvinogona kuita kuti pave nekusiyana pakati pevanhu vanotambura kuti vadzoke zvakare. "

Anotora chimiro nekuora mwoyo: "Kana iwe ukakumbira vanhu vakawanda kuti kuora mwoyo chii, vanozopindura kuti serotonin inoshaiwa chirwere uye kuti mhinduro ndeyokuisa munhu kune SSRI [zvinodhaka zvinodhaka]. Asi iyo inzira isinganzwisisiki uye isina kukwana yekugadzirisa kuora mwoyo. Mishonga inogona kubatsira, asi inofanira kubatanidzwa nehurukuro. Tiri kurarama panguva ino iyo hurukuro isiri kubhadharwa. "Inoramba ichinyatsoonekwa kana kushandiswa kweAASAM kwekutsvaira sekuzara kwakakwana kwechirwere chechirwere kunobatsira kuvhiringidza kuwana kubhadharwa kwekurapa. Mukutaura kwevashandi vehurumende, kujekesa kuti chirwere chacho chine "midzi yezvisikwa" -kudzivisa kuti haisi mhosva yemurwere iye ane chirwere-kunogona kuputsa kubhadharwa kwemigwagwa.

Capretto anobvumirana achiti: "Zvinhu zvakadai sedudziro iyi zvinobatsira kubvisa zvinodhaka zvakanyanya muhuwandu hwehumwe zvirwere, saka munguva yemberi zvicharatidzika zvipingamupinyi zvishoma zvevanhu vanoda kuwana rubatsiro."

Chimwe chezvinangwa zvisina kutaurwa zveASAM zvaive pachena kuti vairwisa kusindimara kwevanhu mukusapindwa muropa nevanhu vakawanda vakapindwa muropa. "Hapana mubvunzo wavakagadzirira kubvisa kushorwa," anodaro Publicker. “Hapana munhu anosarudza kupindwa muropa. Kunetsekana kwandinako kuri kuisa mhosva kumurwere. Zvinotora nguva yakareba kwazvo kuti uropi hugadzirire. Ipo ichiri kumirira kuti chiitike, iwe uri kunzwa wakashata, kufunga kwako kwakakanganisika, uye iko setup kwekudzokazve. Varwere vanogona kupomerwa mhosva yekudzokazve, uye mhuri dzinovaona sevasina kufemerwa uye vasina simba. Asi ndicho chirwere chekupindwa muropa. ”

Jennifer Matesa anonyora nezvekudhakwa uye nyaya dzekudzorera pa blog yake, Guinevere Gets Sober. Iye ndiye munyori wemabhuku maviri asina chokwadi nezvehutano, kusanganisira bhuku rekupa mupiro rekuzvitora kwake, Navel-Gazing: Mazuva Nemazuva aamai Mukugadzira.

Jed Bickman akapa kumwe kuzivisa kwechinyorwa chino. Akanyorera Rudzi, Iyo Huffington Post, uye Counterpunch.com uye achashambadza chidimbu chake chekutanga cheThe Fix svondo rinouya pane dudziro nyowani yekupindwa muropa mukudzokororwa kweAPA's DSM uye nezvematongerwo enyika uye zvirevo zvevanhu.