Na bacha ba kotsing ea ho lemalla lithethefatsi ho feta batho ba baholo? Bopaki bo tsoang mehlaleng ea liphoofolo (2009)

Selelekela

Lithethefatsi tse kang cocaine, amphetamine, nikotini, joala le matekoane li tloaetse ho etsa lintho tse fetolang maikutlo le kelello. Lintho tsena le tsona li na le monyetla oa ho lemalla. Bathong ba bang, ts'ebeliso ea kamehla e lebisa ho "bokhoba" kapa "ho itšetleha", ke ho re, boitšoaro bo qobelloang le bo pheta-phetang ba ho batla lithethefatsi leha ho e-na le litlamorao tse mpe tsa bophelo bo botle. Leha ho le joalo, mofuta ona oa boitšoaro ha o hlahe ho basebelisi bohle (bona Feie. 1). Batho ba bangata ba lekang lithethefatsi ha ba fumane litlamorao ebile lia ba qoba nakong e tlang. Batho ba bang ba natefeloa ke litlamorao tsa lithethefatsi 'me ba li sebelisa ka boiketlo ntle le ha ba kile ba its'oara. Bakeng sa ba bang, leha ho le joalo, lithethefatsi li fumana taolo e matla maphelong a bona mme li ka nkela lintho tse ling tsohle tse loketseng bophelo bo botle (bona Feie. 1). Boholo ba batho ba ithaopisang ho sebelisa lithethefatsi tsa tlhekefetso bo qala nakong ea bocha. Boithuto ba Epidemiological bo bontšitse hore ho qaleha ha ts'ebeliso ea lithethefatsi ho amana le monyetla o moholo oa ntlafatso ea mathata a ts'ebeliso ea lithethefatsi. Leha ho le joalo, ho na le ngangisano ea hore na ho qala pele ka tsela e ikhethang ho ama tsoelo-pele ea boko ka tsela e ts'oereng ho khothaletsa boitšoaro ba methapo kapa hore na mabaka a tšoanang a liphatsa tsa lefutso le tikoloho a etsang hore motho a le mong a be le mathata a lithethefatsi le ona a etsang hore a khone ho qala kapele. Tlhahlobo ena e akaretsa sephetho ho tsoa ho mehlala ea liphoofolo moo phello ea lilemo tsa ho qala e kileng ea hlahlojoa.

Feie. 1

Liperesente tsa palo ea baahi ba US ho feta lilemo tse 12 ba kileng ba leka moriana o bontšitsoeng (palo e kaholimo, leseka le putsoa); ea sebelisang moriana o bontšitsoeng khoeling e fetileng (palo e bohareng, lebala le lefifi le letšo); ba fihlelang litekanyetso tsa ho itšetleha ka ...

Mantsoe "bokhoba," "tšebeliso e mpe ea lithethefatsi" le "ts'ebeliso ea lithethefatsi" a sebelisoa ka mokhoa o tšoanang puong ea batho ebile a na le litlhaloso tse fapaneng lithutong tsa kelello, tsa setso le tsa bongoli. Bakeng sa ho hlakisoa, re tla bua ka mathata a mabeli a tšebeliso ea lithethefatsi (SUDs), ts'ebeliso ea lithethefatsi le tšebeliso e mpe ea lithethefatsi, joalo ka ha li hlalositsoe ke Diagnostic and Statistical Manual of Mental Dis shida version IV (DSM-IV 1994).

Bakeng sa tlhahlobo ea ts'ebeliso e mpe ea lithethefatsi, mokuli o lokela ho hlahisa bonyane e 'ngoe ea litšobotsi tse latelang tse' ne:

1. Ts'ebeliso ea lithethefatsi tse etsahalang khafetsa e lebisang ho hloleha ho phethahatsa litlamo tse kholo mosebetsing, sekolong, kapa lapeng
2. Ts'ebeliso ea ntho e tloaelehileng khafetsa maemong ao ho leng kotsi ho 'ona
3. Mathata a tloaelehileng a amanang le lithethefatsi
4. Ts'ebeliso e tsoetseng pele ea lithethefatsi le ha e na le mathata a phehellang kapa a khafetsa a sechaba kapa a motho a bakoang kapa a mpefalitsoe ke litlamorao tsa ntho ena

Bakeng sa tlhahlobo ea ts'ebeliso ea ts'ebeliso ea lithethefatsi, mokuli o lokela ho hlahisa likarolo tse tharo ho tse latelang tse latelang:

1. mamello
2. Ho khaotsa
3. Ntho ena e nkuoa ka bongata kapa ka nako e telele ho feta kamoo e neng e reretsoe
4. Ho na le takatso e sa khaotseng kapa boiteko bo sa atleheng ba ho fokotsa kapa ho laola tšebeliso ea lithethefatsi
5. Ho sebelisoa nako e ngata mesebetsing e hlokahalang ho fumana ntho, ho sebelisa ntho eo, kapa ho hlaphoheloa liphellong tsa eona
6. Mesebetsi ea bohlokoa sechabeng, mosebetsing kapa boithabisong e ea fuoa kapa ea fokotsoa ka lebaka la ts'ebeliso ea lithethefatsi
7. Ts'ebeliso ea lithethefatsi e ntse e tsoela pele le ha o e-na le tsebo ea ho ba le bothata bo phehellang kapa bo etsahalang 'meleng kapa kelellong bo ka bakoang ke ntho eo kapa bo mpefalitsoe ke ntho eo

Mekhoa e 'meli ea ts'ebeliso ea ts'ebeliso ea lithethefatsi, ho tlosoa le ho mamella, e amana le liketsahalo tsa' mele tse hlahisoang ke ho sebelisa lithethefatsi khafetsa ebile ho bonolo ho li lekanya mehlaleng ea liphoofolo. Mekhoa e mecha ea boits'oaro e ntse e atamela katleho ho ho etsa mohlala oa ho ja haholo, ho ja lijo ntle le litlamorao tse mpe, le khetho pakeng tsa ho ja lithethefatsi le mesebetsi e meng, joalo ka ha ho hlalositsoe ka tlase.

Tlhahlobo ea DSM-IV e fana ka "setšoantšo se setle" seo lingaka li ka se sebelisang ha mokuli a hloka tlhahlobo kapa kalafo. Leha ho le joalo, ho itšetleha ka lithethefatsi ke lefu le tsoelang pele, le mehato e 'maloa e hlalositsoeng e atisang ho ba lilemong tsa bocha (Kreek le al. 2005;; bona Lifeiga. 1 'me and2).2). Ho itšetleha ka lithethefatsi ho hlile ho qala e le teko ea tšebeliso ea lithethefatsi; ha ho motho ea ka its'epahallang ntle le ho sebelisa moriana pele. Batho ba bangata ba leka lithethefatsi (bonyane joala kapa koae) ka nako e 'ngoe bophelong ba bona, hangata ba leka lilemong tsa bocha le lilemong tsa bo-20 tsa pele.Chen le Kandel 1995). Basebelisi ba bang ba pheta ts'ebeliso ea lithethefatsi tlas'a maemo a boithabiso. Ts'ebeliso ea lithethefatsi tsa boithabiso e ka fapana haholo empa e hlalosoa ke hore mosebelisi o na le taolo ho eona. Basebelisi ba boithabiso ba batla lithethefatsi bakeng sa thepa ea bona e ruisang eseng ka ho qobelloa (Kalivas le Volkow 2005). Ts'ebeliso e mpe ea lithethefatsi le ho its'etleha li qala ho hlaha ha ts'ebeliso e fetoha e qobelloang. Monyetla oa tsoelo-pele ho tloha teko ho ea ho ts'ebeliso ea boithabiso ho itšetleha ka lithethefatsi e fapana ka lithethefatsi. Setšoantšo sa 1 e fana ka pono ea pono ea ntlha ena ka ho bonts'a liperesente tsa palo ea baahi ba USA ba fetang lilemo tse 12 ba kileng ba nka moriana o itseng, ba o sebelisa khafetsa, kapa o its'episitse. Le ha liperesente tse nts'ets'ang ts'ehetso e fapana ka lithethefatsi mme e kanna ea susumetsoa ke mabaka a setso le molao, baahi ba its'epahalletseng ba emela karolo e nyane ea ba kileng ba sebelisa lithethefatsi. Potso ea bohlokoa ke hore na ke hobaneng batho ba bang ba sebelisang lithethefatsi ba e-ba le li-SUD, ha ba bang ba lula ba ithabisa?

Feie. 2

Mathata a ntseng a tsoela pele ho latela ts'ebeliso ea lithethefatsi (marang-rang) le mefuta ea liphoofolo e amanang le mohato ka mong (ovals; boinotšing-admin, boitaolo)

Lithuto tsa Epidemiological li fane ka leseli ho lintlha tse ling tse hlalosang phapang pakeng tsa basebelisi ba boithabiso le ba nang le SUD. Kamano e 'ngoe e hlokomeloang khafetsa ke hore batho ba qalang ho sebelisa ba sa le banyenyane ba na le menyetla ea ho ba le li-SUDs (Robins le Przybeck 1985; Meyer le Neale 1992; Lewinsohn et al. 1999; Prescott le Kendler 1999; DeWit et al. 2000; Lynskey le al. 2003; Brown et al. 2004; Patton et al. 2004) mme re tloaetse ho tsoela pele ka potlako ho tloha tekong ho ea ts'ebeliso ea mathata (Chen le Kandel 1995; Chen et al. 1997). Tlhabollo ena ke mohopolo oa tlhahlobo ea hajoale. Lintho tse ling tse kenyang letsoho li kenyelletsa nalane ea malapa ea li-SUD (Hoffmann le Su 1998; Hill le al. 2000) le psychopathology joalo ka khatello ea maikutlo, ho tšoenyeha, bokuli ba tlhokomelo, lefu la kelello le bokuli bo tsamaeang le boitšoaro (Deykin le al. 1987; Russell le al. 1994; Burke le al. 1994; Abraham le Fava 1999; Compton le ba bang. 2000; Shaffer le Eber 2002; Costello et al. 2003). Lintlha tsena kaofela ke e amanang ka kotsi e eketsehang ea nts'etsopele ea li-SUD, empa ho le thata ho e rarolla ka bongata ba batho. Thutong ena, re tla hlahloba liteko tsa mehlala ea liphoofolo ho araba potso ea hore na ho sebelisa lithethefatsi ho sa le monyane ho joalo ho etsa joalo kapa e iketsahalletseng feela kholisong ea SUD.

Ho bohlokoa ntlheng ena ho hlalosa hore na re bolela'ng ha re le "banyenyane." Teko ea joala, koae le matekoane hangata e qala lilemong tsa bocha.SAMHSA 2008). Tšebeliso ea lino tse tahang e feta lilemo tse 18 ho ea ho tse 20 'me ea theoha ho ba motho e moholo.Chen le Kandel 1995). Matekoane le koae li sebelisa litlhoro tse nyane hamorao, pakeng tsa lilemo tse 19 le 22 (Chen le Kandel 1995). Cocaine e sebelisa litlhoro tsa pele ho isa bohareng ba lilemo tsa bo-20 mme le eona e fokotseha hore e be motho e moholo.Chen le Kandel 1995). Mokhoa o tloaelehileng o amanang le tšebeliso ea lithethefatsi o kenyelletsa liteko nakong ea lilemong tsa bocha le lilemong tsa bo-20, kahoo ba lekang pele ho linako tsena tse tloaelehileng (joala le koae bongoaneng kapa lilemong tsa bocha kapa lithethefatsi tse seng molaong ho batjha) ke bona ba leng kotsing e kholo. . Le ha lithuto tse ngata li sebelisa lilemo tsa ho qala pele ho lilemo tse 15 e le ho qalella ha “ho qala,” ho na le moo ho lumellanang ka tsela e fapaneng: basebelisi ba banyane ba na le monyetla oa ho hlahisa li-SUD.

Le ha kamano e pakeng tsa lilemo tsa ho qala le mokoloto oa SUD li thehiloe hantle bathong, ha e re bolelle hore na tšebeliso ea pele ke lebaka. Lithuto tsa Epidemiological tsa ho lekola causality li hloka lithuto tsa mafahla kapa tsa malelele tse boima le tse sa tloaelehang. Liphuputso tse peli tsa mafahla li hlahisitse litholoana tse hananang, hammoho le lintho tse fapaneng. Phuputso e 'ngoe e kholo e neng e hlahloba kotsi ea ts'ebeliso e mpe ea joala le ts'ehetso ea maikutlo e boletse hore lilemo tsa ho qala li ne li tsamaellana le mathata a ts'ebeliso ea lino tse tahangPrescott le Kendler 1999). Ho fapana le hoo, patlisiso e nyane ea mafahla a neng a e-na le tšoaetso bakeng sa ts'ebeliso ea mathoasong a mathoasong a pelehi e tlaleha hore lilemo tsa ho qala li ne li baka ho nts'etsopele ea mathata a ts'ebeliso ea lithethefatsi hamorao le mathata a tlhekefetso (Lynskey le al. 2003). Kahoo, ho na le bopaki bo sa bonahaleng le ngangisano e sa khaotseng ka har'a lingoliloeng tsa mafu a tšoaetsanoang ka lebaka la tšusumetso ea ts'ebeliso ea lithethefatsi pele ho nako mabapi le mathata a morao-rao a lithethefatsi. Lithuto tsa batho li bontša hore nalane ea malapa le psychopathology ka bobeli li eketsa monyetla oa ho qaleha qalong (Tarter et al. 1999; Franken le Hendriks 2000; McGue le al. 2001a, b). Na litlamorao tse tsa tlhaho le tikoloho, li sebetsa ka ho qaleha ho eketsa tlokotsi ho li-SUD? Kapa basebelisi ba nang le nalane ea lelapa le / kapa psychopathology ba ne ba ka etsa li-SUD ho sa tsotelehe ha ba qala? Ho thata ho araba lipotso tsena. Ho sebetsana ka botlalo le lebaka la ho pepesetsoa hoa lithethefatsi pejana ho SUD ea morao, ho hlokahala mehlala ea liphoofolo.

Mefuta ea liphoofolo e na le monyetla o ikhethang oa taolo ea liteko. Litsebi li ka fana ka tumellano ea lilemo tsa tlhahiso ea pele, le lithethefatsi, tekanyetso, nako, le nako ea ho pepesetsoa, ​​athe, lithutong tsa batho, maemo ana a khethiloe ke mosebelisi. Ka lebaka lena, mehlala ea liphoofolo e fanne ka leseli la bohlokoa haholo. Leha ho le joalo, ntho e 'ngoe e busetsang tšebeliso ea liphoofolo ke hore ha ho mohlala o khethollang mehato ka botlalo ntlafatsong ea SUD. Ka lebaka lena, re tlameha ho kopanya sephetho ho tsoa ho mefuta e mengata ea boits'oaro le neurobiological ho fihlela kutloisiso e felletseng.

Ho pepesetsoa lithethefatsi kapele

Joalokaha ho bontšitsoe ho Feie. 2, mohato oa pele o hlokahalang bakeng sa nts'etsopele ea ts'ebeliso ea ts'ebeliso ea lithethefatsi ke tahi ea lithethefatsi. Boleng ba boiphihlelo ba pele ba lithethefatsi bo bohlokoa ho khetholla litekanyetso tsa nako e tlang: bakeng sa lithethefatsi tse ngata, batho ba natefeloang ke liphihlelo tsa bona tsa pele ba na le monyetla oa ho pheta tšebeliso ea lithethefatsi (Haertzen le al. 1983). Lithethefatsi tse sebelisang tlhekefetso li hlahisa melemo e tlisang melemo le litheko (Wise et al. 1976), le tekanyo e akaretsang lipakeng tsa liphihlelo tsena nakong ea ts'ebeliso ea lithethefatsi ea pele ea bongaka e bonts'a hore na motho o tla pheta ho nka lithethefatsi nakong e tlang. Literekeng, joalo ka ha ho hlalositsoe kaholimo, CPP, CPA, le CTA li sebelisoa ho lekola moputso oa pele le ho faposa taba 'me li fane ka leseli la bohlokoa mabapi le ts'epahalo ea lilemo tsa litlamorao tse joalo.

Liphello tse khotsofatsang

Ba bang ba nahana hore tšebeliso e phahameng ea lithethefatsi lilemong tsa bocha e etsahala hobane basebelisi ba banyenyane ba fumana lithethefatsi li putsa le ho feta (Vastola et al. 2002; Belluzzi et al. 2004; Badanich et al. 2006; O'Dell 2009). Ho na le bopaki bo bong ba hore batho ba banyenyane le litoeba ba fumana moputso o moholo ho tsoa linthong tsa tlhaho (Vaidya et al. 2004), e neng e ka akaretsa lintho tse lemalloang. Ha ho le joalo, basebelisi ba banyenyane ba kanna ba sebelisa lithethefatsi khafetsa kapa litekanyetso tse phahameng, tse ka hlalosang tsoelo-pele e potlakileng ho latela ts'episo e bonoang ho bacha. Bopaki ba ho arabela potso ena ea bohlokoa bo tsoakiloe empa bo supa hore bacha ba shebile haholo litholoana tse babatsang tsa bonyane lithethefatsi tse ling.

Nicotine e atleha kamehla ho bacha (Vastola et al. 2002; Belluzzi et al. 2004; Torrella et al. 2004; Shram et al. 2006; Kota et al. 2007; Brielmaier et al. 2007; Torres et al. 2008). Patlisiso e ngoe e bontšitse seo ethanol e atleha ho feta lilemong tsa bocha (Philpot et al. 2003). Lithuto tsa moputso oa psychostimulant (k'hok'heine, amphetamine, methamphetamine) li tsoakane empa li bonts'a teboho e kholo ea moputso ho bacha, haholoholo ka tekanyetso e tlase (Badanich et al. 2006; Brenhouse le Andersen 2008; Brenhouse et al. 2008; Zakharova et al. 2008a, b; empa bona Aberg le al. 2007; Adriani le Laviola 2003; Balda et al. 2006; Campbell et al. 2000; Schramm-Sapyta et al. 2004; Torres et al. 2008). Tetrahydrocannabinol (THC) ha e hlahise lithahasello tse nang le maemo a tiileng ka litoeba. Bona Lethathamo 1. Ka kakaretso, lithuto tse khethiloeng tsa sebaka se khethiloeng li bontša hore bacha ba ka fumana lithethefatsi tse ngata tsa tlhekefetso li le monate haholo, haholo litekanyetso tse haufi. Ho bapisa mokhoa o hlophisehileng haholoanyane oa lethathamo la litekanyetso hoa hlokahala ka har'a lingoliloeng.

Lethathamo 1

Ho itšetleha ka lilemo tsa moputso, ho hloea, ho itaola le ho tlosa chelete

Ho pepesetsoa lithethefatsi nako e telele

Karolo ea li-pharmacokinetics maemong a boitšoaro

Mekhahlelo e mengata ea pharmacokinetic ea lithethefatsi tsa tlhekefetso e ka kenya letsoho kholisong ea ho itšetleha. Sekhahla sa ponahalo le ho hlaka ha moriana o bokong (le lipakaneng tsa lona tsa limolek'hule), tlhaselo ea tlhoro, le nako ea ho pepeseha li ka ama litlamorao tsa lithethefatsi (Barekisi et al. 1989; de Wit le ba bang. 1992; Lesebo et al. 1992). Litholoana tsa Euphorigenic tsa lithethefatsi li matlafatsoa ke ho bokellana ka potlako bokong (de Wit le ba bang. 1992; Abreu et al. 2001; Nelson et al. 2006). Le ha a sa ithute hanyane, litla-morao tse matlafatsang, tse matlafatsang, le likelello tsa lithethefatsi tsa tlhekefetso li ka ameha ka mokhoa o ts'oanang ke litheko tsena tsa pharmacokinetic. Tekanyo ea phano ea lithethefatsi e khethoa ke sethethefatsi ka boyona, sebopeho, le tsela e khethiloeng ea tsamaiso. Boithuto bo bapisa li-pharmacokinetics tsa batho ba baholo le ba lilemong tsa bocha ba lithethefatsi tse tloaelehileng tsa tlhekefetso ha li na letho ebile ha li e-so phethehe mabapi le tekanyetso, tsela ea tsamaiso, le nako. Liphuputso tse nang le tsebo e ngata li hlahlobile litlamorao tsa boits'oaro le li-pharmacokinetics ka ho tšoana 'me ka kakaretso li bontšitse hore phapang ea lilemo mekhoeng ea boitšoaro ha e amane le litekanyetso tse fapaneng tsa lithethefatsi.

Nicotine le metabolite ea eona, k'habinine, eo hape e ka bang tšebetso ea bioloji (Terry le al. 2005), li na le metabolism ka potlako ho bongoaneng ho feta ho likhoto tse kholo (Slotkin 2002). Leha ho le joalo, lithutong tse peli tseo ho tsona dosing ea nicotine e ileng ea fetoloa ho fihlela maemo a lekanang a plasma, bacha ba ntse ba bonts'a matšoao a khaotseng a ho tlohela (O'Dell et al. 2006, b). Ethanol ho bonahala eka e kena bokong le maling ka litekanyetso tse ts'oanang le lits'oaetso ho bacha le batho ba baholo (ka makhetlo a 5-30 min; Varlinskaya le Spear 2006) empa e hlakisoa ka potlako ho tloha lilemong tsa bocha ho feta ho litoeba tsa batho ba baholo, ho feta 2-18 h (Doremus et al. 2003). Le ha ho le joalo, liphapang tsa phapang ha li na phapang ea phapang e hlakileng. Little et al. (1996) e bontšitse hore likhoto tsa bocha li lahleheloa ke ho hlaka nako e khuts'oanyane ho feta batho ba baholo empa, ha ba tsoha, ba na le litekanyetso tse phahameng tsa joala ba mali. Ka mokhoa o ts'oanang, phapang ea lilemo ho sensomization ea locomotor ho ethanol ha e na maemo a joala a mali (Stevenson le al. 2008). Methamphetamine e susumetsa ts'ebetso ea locomotor ho isa tekanyong e tlase lilemong tsa bocha ho feta litoeba tsa batho ba baholo leha ho e-na le katleho e kholo ea kelello ea (Zombeck et al. 2009). Bakeng sa k'hok'heine, sehlopha se seng se hlokometse hore litoeba tsa bocha li na le litekanyetso tse tlase maling le bokong ka metsotso e 15 ea postinjection ho feta batho ba baholo (McCarthy et al. 2004). Ka lehlakoreng le leng, sehlopha se seng se bontšitse maemo a holimo ho 5 min (Zombeck et al. 2009) leha a ntse a shebelletse ho ts'oaroa ha ts'oaro ea locomotor. Sehlopha sa rona se lekantse litekanyo tse lekanang liseleng tsa boko le maemo a tlase maling maling ho bacha ha a bapisoa le taba ea hore re hlokometse likarabo tsa locomotor likotong tsa bocha (Caster et al. 2005). Ka kakaretso, ho na le litlaleho tsa profiles tse fapaneng tsa pharmacokinetic ho litoeba tsa batho ba baholo lilemong, empa ha li ikarabelle ka liphapang tse amanang le lilemo.

Mehopolo ea Neurobiological

Boithuto ba boits'oaro bo hlalositsoeng ka holimo bo supa pheletsong ea hore bacha ba ka mamella litlolo tsa lithethefatsi tse phahameng le khafetsa, empa ha ho na lintlha tse lekaneng ho bonts'a hore na ba na le menyetla e matla ea ho nka lithethefatsi le boits'oaro bo joalo. Lithuto tse ling tse nang le mefuta e felletseng ea ts'ebeliso ea lithethefatsi li hlokahala ho netefatsa kapa ho hanyetsa mohopolo ona. Ntle le moo, kutloisiso ea molek'hule le methapo ea kutlo ea ts'ebeliso ea lithethefatsi ke senotlolo sa ho tseba hore na ts'ebetso e etsahala ka potlako kapa ka mokhoa o batsi ho bacha. Sehlopha se seholo sa lipatlisiso se etselitsoe ho utloisisa motheo oa 'mele oa ts'ebeliso ea lithethefatsi. Liphumano tsena li hlahlobiloe haholo libakeng tse ling (Robinson le Berridge 1993; 2000; Nestler 1994; Fitzgerald le Nestler 1995; Nestler et al. 1996; Volkow le Fowler 2000; Koob le Le Moal 2001; Hyman le Malenka 2001; Shalev et al. 2002; Winder et al. 2002; Goldstein le Volkow 2002; Kalivas le Volkow 2005; Yuferov le ba bang. 2005; Grueter et al. 2007; Kalivas le O'Brien 2008). Li fana ka moralo oa ho lekola mekhoa ea limolek'hule le li-neurophysiologic tse ka buisanang le ts'ebeliso e mpe ea tlhekefetso ea lithethefatsi ho bacha.

Boithuto bo 'maloa bo lekile hore na ho na le phapang ea limolek'hule le' mele pakeng tsa bacha le batho ba baholo tse ka bang kotsing e kholo ea ts'ebeliso ea lithethefatsi (bona (Schepis et al. 2008) bakeng sa tlhahlobo). Ka kakaretso, lithuto tsa limolek'hule le tsa 'mele li senotse mekhoa e ka amanang le phapang ea lilemo ka kutloisiso ea moputso oa lithethefatsi, empa bopaki bo mabapi le liketsahalo tsa neuroplastic tse amanang le phetoho ea ts'ebeliso e mpe ea lithethefatsi ha li e-so be teng. Litholoana tsa pele tse thabisang tsa lithethefatsi tsa tlhekefetso li its'etleha ho ho saena dopaminergic. Bacha ba na le "dopaminergic neurocircuitry" e potlakileng libakeng tse amanang le moputso oa lithethefatsi, mabapi le ts'ebetso ea presynaptic le postynaptic joalo ka dopamine transporter le polelo ea receptor (Seman et al. 1987; Palacios et al. Ka 1988; Teicher et al. 1995; Tarazi et al. 1998a, b, 1999; Meng et al. 1999; Montague et al. 1999; Andersen et al. 2002; Andersen 2003, 2005) le dopamine dikahare liseleng tsa boko (Andersen 2003, 2005). Lithuto tsena li bonts'itse hore ts'ireletso ea bokapele ba mmele e tsoela pele ho tloha lilemong tsa bocha, ka lipalo tsa matšoao a ho bolaea a kang dopamine, bafalli le li-enzyme tsa maiketsetso li fihla sehlohlolong lilemong tsa bocha. Linomoro tsa "receptor" tsa "postynaptic" li theoha ebe li fokotseha ho ea maemong a batho ba baholo ha bolulo bo fella. Boithuto bo bongata bo bonts'a hore maemo a basal a dopamine ea synaptic a tlase nakong ea karolo ena ea ntlafatso (Andersen le Gazzara 1993; Badanich et al. 2006; Laviola et al. 2001; empa bona Camarini et al. 2008; Cao et al. 2007b; Frantz et al. 2007) e tsamaellanang le bolulo bo sa phetheheng. Bacha ba boetse ba fapana le batho ba baholo ka tekanyo ea dopamine e hlahisitsoeng ho arabela amphetamine le cocaine: phetoho ea liperesente maemong a dopamine ea extracellular e kholo ho bacha ho feta batho ba baholo.Laviola et al. 2001; Walker le Kuhn 2008; empa bona Badanich et al. 2006; Frantz et al. 2007), mme sekhahla sa keketseho se ka potlaka ho batjha (Badanich et al. 2006; Camarini et al. 2008). Lithutong tsena, qeto e 'ngoe e hlakileng ea liphetho tsa liteko ke lilemo tseo teko e entsoeng ho tsona: Lits'ebetso tsa dopamine bongoaneng ba bocha (letsatsi la 28) li fapane haholo le tsa bonyenyaneng (ka letsatsi la 42) le qalong ea botsofali (letsatsi 60).

Liphapang tsena tsa neurobiologic pakeng tsa bacha le batho ba baholo hangata ha li lumellane le mehato ea boitšoaro. Mohlala, ts'ebetso ea kelello ea psychostimulant e fokotseha lilemong tsa bocha le ha ho e-na le keketseho e kholo ho dopamine (Laviola et al. 2001; Frantz et al. 2007), leha libaka tse ratehang li rata ho feta lilemong tsa bocha leha ho na le keketseho e lekanang ea dopamine (Badanich et al. 2006). Phuputso e 'ngoe e hlokometseng concordance lipakeng tsa ho lokolloa ha dopamine le tsamaiso ea methapo ea methapo e boletse hore ha ho na phapang ea lilemo ka tekanyo efe kapa efe (Frantz et al. 2007).

Phumano e tšoanang e sa khetholloe e boetse e tlalehiloe mabapi le karabo ea molek'hule le ea 'mele ea ho nka lithethefatsi nako e telele. Ho pepesetsoa nako e telele ho lebisa ho fokotseha ho kenngweng ha liphatsa tsa lefutso tsa pele-pele (joalo ka c-fos), ho ngolisoa ha mefuta e meng, le ho bokellana ha liprotheine tse telele joalo ka delta Fos B, tse phehellang matsatsi kapa libeke (Kalivas le O'Brien 2008). Liphetoho tsena li tsamaisana le ho kopanya phetiso ea methapo ea methapo ho li-cortical circry le dysregated glutamatergic signaling eo ho nahanoang hore e ne e batla ts'ebetso ea lithethefatsi tsa tlhaho. Boithuto bo 'maloa bo ithutile ho kenella ha li-c-fos ho arabela lithethefatsi tsa tlhekefetso ho bacha lilemong tsa batho ba baholo,' me liphetho li fapana haholo hape li its'etleha holima sebaka sa boko se hlahlobiloeng, se khothalletsoang, le litekanyetso. Shram et al. o hlokometse hore kamora ho ba le lethalinyana le tlase (0.4 mg / kg) empa eseng lethalinyana le phahameng (0.8 mg / kg) bokoali, bacha ba bontšitse li-c-fos tse kholoanyane mokokotlong oa medial nucleus accumbens (Shram le al. 2007a). Tekanyo e tšoanang ea litekanyetso tsa botsofali e tlalehiloe ka koae. Liphuputso tse tharo li bonts'itse hore batho ba baholo ba hlahisa mofuta oa c-fos ho feta lilemong tsa bocha maemong a fokolang a boikoetliso kamora ho nooa haholo (30- 40 mg / kg) k'hok'heine (Kosofsky le al. 1995; Cao et al. 2007b; Caster le Kuhn 2009). Ka lehlakoreng le leng, bacha ba na le likarabo tse kholo ho pholletsa le dorsal striatum le medial shell ea li-nucleus tse arabelang ka karabelo ho lethal dose ea cocaine e tlase (10 mg / kg; Caster le Kuhn 2009). Libakeng tse ngata tsa boko, leha ho le joalo, fos induction e tšoana pakeng tsa lilemo tse peli (bakeng sa bokoali amygdala, locus coeruleus, lateral septum, colliculus ea phahameng (Cao et al. 2007a; Shram le al. 2007a) le bakeng sa k'hok'heine (the nucleus of the stria terminalis)Cao et al. 2007b), cortex, le cerebellum (Kosofsky le al. 1995)). Sehlahisoa se tsitsitseng sa protheine ea mofuta oa fos, delta Fos B, se boetse se laoloa ka mokhoa o amanang le lithethefatsi le tikoloho. Kamora kalafo ka bokoali, sehlopha se le seng ha se tlalehe hore na lilemo ha se sebetse joang (Soderstrom et al. 2007). Kamora k'hok'heine or amphetamine, bacha ba bua ka mokhoa oa Fos B o natefisang B ka har'a li-nucleus accumbens le caudate putamen (Ehrlich et al. 2002). Ka kakaretso, lithuto tsa hajoale ha li lumellane mabapi le hore na liphetoho tsa limolek'hule tse nahanoang hore ke tsa bohlokoa bakeng sa phetoho ea ho nka lithethefatsi e tlisoang ke tekano ho batjha.

Litlamorao tsa nako e telele tsa boits'oaro ba ho sebelisa lithethefatsi khafetsa li kanna tsa kopanngoa le ts'ebetso e ntlafalitsoeng ea synaptic e tlisoang ke mekhahlelo ea sebopeho le ea biochemical. Li-arcane tsa dendritic tse bokellaneng ba li-nucleus li bokellanang le li-cortex tsa pele li fetoloa kamora nako e telele k'hok'heine 'me amphetamine tlhahiso (Robinson le Kolb 2004), empa liphetoho tsena ha li e-so bapisoe ho bacha le ho batho ba baholo. Kamora ho pepesehela bokoali, bolelele ba dendritic bo ameha ka tsela e fapaneng litabeng tsa bongoana le ho likhoto tsa batho ba baholo mokokotlong oa prelimbic (Bergstrom le ba bang. 2008)McDonald et al. 2007). Bohlokoa bo sebetsang ba liphapang tsena bo ntse bo hlakisoa.

Likarabo tsa electrophysiological li ka fetoloa ke lithethefatsi tsa tlhekefetso. Mohlala, liphuputso tse entsoeng ka litoeba tsa batho ba baholo li bonts'itse ts'ebetso ea ho itaola kapa ea ho pheta-pheta ea k'hok'heine e fokotsa matla a glutamatergic synaptic ho li-nucleus accumbens (Thomas et al. 2001; Schramm-Sapyta et al. 2005) hape e fokotsa khatello ea maikutlo ea nako e telele mokokotlong oa bethe ea stria terminalis (Grueter et al. 2006). Liphetoho tsena li tšoana hantle le maemo a polelo a α-amino-3-hydroxyl-5-methyl-4-iso-xazole-propionate le N-methyl-D-aspartic acid receptorsLu et al. 1997, 1999; Lu le Wolf 1999). Likhoto tsa lilemong tsa bocha hangata li na le monyetla oa ho ba polasetiki ho li-nucleus accumbens (Schramm le al. 2002) le libakeng tse ling tse ngata tsa boko (Kirkwood le al. 1995; Izumi le Zorumski 1995; Crair le Malenka 1995; Liao le Malinow 1996; Partridge et al. 2000) ka lebaka la ts'usumetso ea motlakase, ka hona, e ka ba le ts'oaetso ea litlamorao tsa koae. Karabelo ea electrophysiological ea potoloho ena ho lithethefatsi tsa tlhekefetso e hlahisa mokhoa o ka ntlafatsang ts'ebetso ea bongoana ho SUD empa ha e so ka e bapisoa ka kotlolloho ho liphoofolo tsa batho ba baholo. Mekhoa e meng e mengata e ka lulang e sa sebetsoa ho bacha lilemong tsa batho ba baholo ka nako ena, joalo ka polelo ea glutamate receptor (Lu et al. 1999; Lu le Wolf 1999) le chromatin ea nchafatso (Kumar et al. 2005). Haeba lithuto tsa boits'oaro li senola ka mokhoa o hlakileng hore ho kena bohlankaneng ho bakoa ke ho qobella ho batla lithethefatsi, mekhoa ena e lokela ho hlahlojoa.

Lithuto tsa nako e tlang li lokela ho tsepamisa ho hokahanya lithuto tsa limolek'hule le tsa 'mele le litekanyetso tsa boitšoaro bo nepahetseng ho sebetsana le liphetoho tseo limolek'hule li amehang haholo ho itšetleha ka lithethefatsi le ho botsa hore na phapang e teng pakeng tsa bacha le batho ba baholo e ka baka liphapang mekhoeng ea boitšoaro e amanang le SUD.

Summary

Thutong ena, re shebile potso ea hore na bacha ba kotsing ea ho lemalla lithethefatsi ho feta batho ba baholo ka ho akaretsa liphetho ho tsoa lithutong tsa liphoofolo. Lithuto tsena li fana ka maikutlo a liqeto tse 'ne:

1. Tekanyo e tlatselletsang ea litla-morao tse tlisoang ke lithethefatsi tsa tlhekefetso e eketsoa moputsong oa bongoaneng, joalo ka ha ho bonts'itsoe ho khetha, ho beha motho le ho tlohela lithuto tsa ho khesoa. Sena se ka eketsa tšebeliso ea lithethefatsi tsa tlhekefetso ke bacha.
2. Bacha ha ba na taba khafetsa litlamorao tsa ho tlohela. Sena se ka khothaletsa tšebeliso ea lithethefatsi methating ea pele le ho sireletsa khahlanong le nts'etsopele ea ho batla lithethefatsi ka mora ts'ebeliso ea nako e telele.
3. Bacha ha ba na kutloelo-bohloko haholo ho khothaletsa litlamorao tsa lithethefatsi tsa tlhekefetso joalo ka ha ho bonts'itsoe lithutong tsa boithati le boitšisinyo.
4. Bacha ba ntse ba fetoha ka sebopeho sa methapo ea methapo le tšebetso libakeng tsa boko tse amanang le moputso le tloaelo, e leng se ka bakang ts'ebeliso ea ts'ebeliso ea lithethefatsi, leha lithuto li bonts'a ho hloka toka hona joale.

Boithuto bona bo fana ka maikutlo a hore bacha ba na le “teka-tekano” e fapaneng ea meputso e khahlisang le e khahlang ea lithethefatsi tsa tlhekefetso. Tekano ena e ka emela ts'oaetso e ka bang teng bakeng sa liteko tse eketsehileng. Leha ho le joalo, ho na le ntlha e le 'ngoe e bohlokoa e haellang ho bokhoni ba rona ba ho lekola kotsi ea ho ba kotsing ea ho kena bohlankaneng ba bocha ho SUD. Ho na le lintlha tse fokolang mabapi le tsoelo-pele ea ho batla lithethefatsi ka mokhoa o qobelloang, letšoao la ts'ebeliso ea lithethefatsi. Ho bohlokoa ho hlahloba ka botlalo mefuta ea liphoofolo ea tsoelo-pele ea ts'ebeliso ea lithethefatsi ho sebetsana le hore na bacha ba ba le tšebeliso e qobelloang khafetsa kapa ka potlako ho feta batho ba baholo le hore na bacha ba na le khatello e matla kapa ea ho fokotsa bokhoba ba lithethefatsi kapa che. Taba ea bobeli, lithuto tse ling tsa litlamorao tsa ho pepesetsoa ha mocha lilemong mabapi le ts'ebetso ea kelello, li amanang haholo le taolo e kholo, li loketse. Taba ea boraro, lithuto tsa liphetoho tse fetotsoeng molek'huleng ka lebaka la lithethefatsi tsa tlhekefetso ho bacha le ho batho ba baholo ha lia phethahala ebile ha li lumellane. Ha mefuta ea liphoofolo e ntseng e tsoela pele ho kenella bokhobeng e ka utloisisoa le ho ntlafatsoa, ​​liphetoho tse hlahisitsoeng ke phetoho ena li ka hlahlojoa ka botebo bo fetang bo boholo le tšebeliso ea litlamorao tsa litlamorao tsena.

Qetellong, tataiso ea bohlokoa bakeng sa lipatlisiso tsa nako e tlang ke phapano lipakeng tsa phapang e amanang le lilemo le motho ka mong. Lithuto tsa batho (Dawes et al. 2000) le lithuto tse ling tsa liphoofolo (Barr le al. 2004; Perry et al. 2007) fana ka maikutlo a hore liphatsa tsa lefutso, tikoloho le psychopathology li kenya letsoho ho nkeng lithethefatsi le ho holiseng temallo. Kutloisiso e ntlafalitsoeng ea kamano ena e tla thusa haholo liteko tsa thibelo le kalafo: ha re ka tseba hore na ke mang ea ka lemalloang le ho feta, le hobane hobaneng, re ka thibela le ho phekola mathata a lithethefatsi ho batho bao ka katleho, ho sa tsotelehe hore na ba qala ts'ebeliso ea lithethefatsi neng.

Boitsebiso ba bafani

MONGOLI OA TSOANG: Nicole L. Schramm-Sapyta, Univesithi ea Duke, Durham, NC, USA.

P. David Walker, Univesithi ea Duke, Durham, NC, USA.

Joseph M. Caster, Univesithi ea Duke, Durham, NC, USA.

Edward D. Levin, Univesithi ea Duke, Durham, NC, USA.

Cynthia M. Kuhn, Univesithi ea Duke, Durham, NC, USA.

References