Tlhaloso mabapi le "ho lemalla ho ja" khahlanong le "ho lemalla lijo" ka maikutlo a ho sebelisa lijo tse lemalloang (2016)

Takatso ea lijo. 2016 Oct 27. pii: S0195-6663 (16) 30647-X. Doi: 10.1016 / j.appet.2016.10.033.

EM Schulte1, Potenza MN2, Gearhardt AN3.

inahaneloang

Keketso ea ho lemalla lijo e etsa hore batho ba tlokotsing ba fumane karabelo e ts'oanang le ea ho ja lijo tse itseng, tse kang tse nang le mafura a mangata le lik'habohaedreite tse hloekisitsoeng. Haufinyane tjena ho ile ha etsoa tlhahiso ea mofuta o mong oa bokhoba ba lijo tse fanang ka maikutlo a hore ketso ea ho ja e kanna ea ba tšekamelo ea boits'oaro e ka tsosang karabelo e kang ena ho batho ba kotsing. Tlhahiso e 'ngoe e kholo bakeng sa sebopeho sa tšebeliso ea litheko tsa ho ja ke hore tlhahlobo ea ts'oaetso ea lijo e thehiloe matšoao a boits'oaro, jwaloka ho ja lijo tse ngata haholo ho feta tse boletsoeng le ho ja lijo tse itseng ntle le litlamorao tse mpe. Ho boetse ho boleloa hore ho haella ha lipatlisiso mabapi le hore na lijo le litšobotsi life tsa lijo (mohlala, tsoekere) li ka ba le tšenyo e ntle ke bopaki ba hore tšebeliso ea lijo ha e tsamaisane le lekhoba la tlhekefetso ebile le tšoana haholo le bokhoba ba boits'oaro. Pampiri ea hajoale e fana ka maikutlo a fanang ka maikutlo a hore tšebeliso ea bokhoba ba lithethefatsi, e nepahetse haholo ho feta tšebeliso ea bokhoba ba ho lemalla joala kapa joala ho latela tšebeliso ea tšebeliso ea lijo. Ho hlakisa ntlha ena, buka ena e ngotsoeng e tla bua ka likarolo tsa boits'oaro bathong bohle ba ts'ebeliso ea lithethefatsi, bopaki ba pele ho fana ka maikutlo a hore lijo tsohle ha li tsamaisane ka ho tšoana le ho ja tse joalo ka tlhekefetso le phapang e kholo lipakeng tsa tšibollo ea tšebeliso ea litheko tsa bojaki le eona feela tlhekefetso ea boitšoaro e teng ho Diagnostic and Statistical Manual of Mental Dis shida (DSM-5), bothata ba papali ea chelete. Ntle le moo, pampiri ena e tla nahana ka litlamorao tsa ho sebelisa lengolo la ts'ebeliso ea lithethefatsi ho ja le ho ja le ho fana ka litlhahiso mabapi le mekhoa ea ho etsa lipatlisiso nakong e tlang ho lekola hore na tšebeliso ea litheko tsa lijo ke 'nete ebile e na le ts'ebeliso e ntle ea bongaka.

LINKOTSO:

Mathata a ho lematsa; Boitšoaro ba ho ja; Tlatsetso ea lijo

PMID: 27984189

DOI: 10.1016 / j.appet.2016.10.033

1. Selelekela

Leqepheng la morao tjena, Hebebrand et al. (2014) etsa tlhahiso ea hore bokhoba ba lijo bo ka aroloa ka nepo e le bokhoba ba boitšoaro, kapa ho lemalla ho ja, eseng ho lemalla lithethefatsi. Le ha ho lemalla ho ja le ho lemalla ho ja ho bonahala ho amana, mabitso a bonts'a likhopolo tse fapaneng, ka maikutlo a fapaneng mekhoeng e ka tlisang boitšoaro bo ts'oanang le joala. Ho latela Google Scholar, sengoloa sa Hebebrand et al.'s (2014) se qotsitsoe makhetlo a 75 ho fihlela joale mme se thusitse ho hlahisa ngangisano ea hore na ho ja ho ts'oanang le lithethefatsi ho ka bontša ts'oaetso ea boitšoaro kapa ea lithethefatsi (Albayrak & Hebebrand, 2015 ; De Jong, Vanderschuren & Adan, 2016; Pressman, Clemens, & Rodriguez, 2015), e totobatsang tlhoko ea tlhahlobo ea mohopolo o lemalloang oa ho ja. Pampiri ea hajoale e tla fana ka litlhaloso tse fanang ka maikutlo a hore ts'ebeliso ea lithethefatsi, bokhoba ba lijo bo aha ka nepo ho feta tekano ho ts'ebeliso ea lijo tse ts'oanang le bokhoba ho feta boitšoaro, bokhoba ba ho lemalla ho ja. Leha ho le joalo, Hebebrand et al.'s (2014) pono ea bokhoba ba tahi e hlahisa lintlha tsa bohlokoa tse lokelang ho hlahlojoa le lipatlisiso tsa nako e tlang. Sengoloa sena se tla tšohla bopaki ba menyetla ea ho lemalla lijo tse itseng, se hlahlobe karolo ea boits'oaro mathateng ohle a lemalloang, se lekole boteng ba ho ja e le bokhoba ba boitšoaro, 'me se hlahise litaelo tsa bokamoso ba lipatlisiso.

Poleloana ea bokhoba ba lijo e bonts'a moralo oa bokhoba ba lithethefatsi, moo lijo li kenyang karolo ea bohlokoa ho hlohlelleng likarabo tse ts'oanang le tsa boitšoaro ho batho ba nang le ts'oaetso (Ahmed, Avena, Berridge, Gearhardt, & Guillem, 2013, maq. 2833e2857; Davis & Carter , 2009; Davis et al., 2011; Gearhardt, Corbin, & Brownell, 2009; Gearhardt, Davis, Kuschner, & Brownell, 2011; Khauta, Frost-Pineda, & Jacobs, 2003; Schulte, Avena, & Gearhardt, 2015) . Ka lehlakoreng le leng, pono ea bokhoba ba ho ja e fana ka maikutlo a hore ketso ea boits'oaro ea ho ja e ka lemalla batho ba bang, mme litšoaneleho tsa lijo (mohlala, tsoekere e ekelitsoeng) ha li bake ka kotloloho ho ja ho ts'oanang le ho lemalla.
phenotype (Hebebrand et al., 2014). Le ha maikutlo ana ka bobeli a lumela hore mokhoa oa ho ja o joalo ka tšebeliso o ka khona, phapang ea bohlokoa e teng mabapi le karolo ea lijo. Kahoo, ho bohlokoa ho hlahloba bopaki bo seng bo ntse bo le teng ho etsa lipatlisiso tsa hore na lijo tse itseng kapa litšobotsi tsa lijo li ka kenya letsoho kholisong le phepelong ea likarabo tse ts'oanang le tlhekefetso, joalo ka lithethefatsi tsa tlhekefetso.

Leha poleloana "bokhoba ba lijo" e sa khetholle hore na ke lijo life tse ka amanang le ho ja tse ts'oanang le lithethefatsi, moaho o fana ka maikutlo a hore lijo tse ling tse nang le mafura a eketsehileng le / kapa lik'habohaedreite tse ntlafalitsoeng joalo ka phofo e tšoeu kapa tsoekere (mohlala, pizza, chokolete, li-chips) Khetholla ka mokhoa o ikhethileng sistimi ea moputso ka tsela e ts'oanang le lithethefatsi tsa tlhekefetso, e ka bakang boitšoaro bo thata ba ho ja ho batho ba nang le ts'oaetso (Gearhardt et al., 2009; Gearhardt, Davis, et al., 2011; Schulte et al., 2015). Ho ts'ehetsa mohopolo ona, mefuta ea liphoofolo e senotse ho tšoana ho hoholo ka boits'oaro le boits'oaro lipakeng tsa ts'ebeliso ea lijo tse mafura a mangata, lijo tse nang le tsoekere e ngata le mathata a moetlo a lemalloang. Mohlala, ho itjella lijong tsena (mohlala, cheesecake) ho lebisa liphetohong tsamaisong ea moputso e teng ho mathata a mang a lemalloang, joalo ka tlolo ea molao ea li-receptor tsa dopamine (Johnson & Kenny, 2010; Robinson et al., 2015). Likhoto tse nang le tšekamelo ea ho itlopa joala li boetse li bonts'a lits'oants'o tsa boits'oaro ba ho lemalla lijo tse nang le mafura a mangata le / kapa lik'habohaedreite tse ntlafalitsoeng (mohlala, tsoekere), joalo ka ho itlopa joala, ts'ebeliso ho sa natsoe litlamorao tse mpe, le crosssensitization (Avena & Hoebel, 2003; Avena, Rada, & Hoebel, 2008; Johnson & Kenny, 2010; Oswald, Murdaugh, King, & Boggiano, 2011; Robinson et al., 2015). Mohlala, likhoto tse tloaetseng ho itlopa joala li susumetsoa ka mokhoa o ikhethileng ho batla lijo tse nang le mafura a mangata, tse nang le tsoekere e ngata le ha ho na le litlamorao tse mpe joalo ka ts'abo ea maoto, 'me u se ke oa bonts'a boits'oaro bona mabapi le chow e nang le phepo e nepahetseng (Oswald et al., 2011). Liphuputso tsa liphoofolo li boetse li hlokometse hore likhoto li bonts'a matšoao a ho hula (mohlala, ho qoqa ha meno, ho tšoenyeha) ha tsoekere e tlosoa lijong tsa bona kamora nako ea ho itlopa joala le ho itima lijo (Avena, Bocarsly, Rada, Kim, & Hoebel, 2008), eo ke boemo ba boits'oaro bo ka eketsang menyetla ea ho ja ka mokhoa o qobelloang (Berridge, 1996; Corwin, 2006).

Le ha lijo tse nang le mafura a mangata, tse nang le tsoekere e ngata li bonahala li ameha haholo lijong tse ts'oanang le ho lemalla, lipatlisiso tse ling li bonts'itse maemo a ka bakang ho ja ho feteletseng ka chow e nang le phepo e nepahetseng. Mohlala, leha likhoto li ke ke tsa itlopa joala haeba li hlahisoa li le 'ngoe, li tla ja chow ka mor'a ho amohela tatso ea lijo tse nang le mafura a mangata haholo (Hagan, Chandler, Wauford, Rybak, & Oswald, 2003), e totobatsang se ka etsahalang Tlhokahalo ea ho pepesehela mafura a mangata, lijo tse nang le tsoekere e ngata ho khothaletsa tšebeliso e mpe ea lijo. Ntle le moo, likhoto li tlola chow libakeng tse nang le likhakanyo tse kopantsoeng le kamohelo e fetileng ea lijo tse nang le mafura a mangata le tsoekere e ngata (Boggiano, Dorsey, Thomas, & Murdaugh, 2009). Sena se fana ka maikutlo a hore lijo tse nang le mafura a mangata, tse nang le tsoekere e ngata li ka baka boits'oaro bo thata ba ho ja (mohlala, ho ja ho tlōla) ka tsela e ts'oanang le litlhahiso tsa lithethefatsi tse bakang ho khutlela morao (Boggiano et al., 2009). Le ha liphuputso tse 'maloa li bone likhoto li ja chow haholo, boitšoaro bona bo bonahala bo etsahala ha feela bo qalisoa pele ka ho amohela lijo tse mafura a mangata, tse nang le tsoekere e ngata kapa ho pepesetsoa li-cue tseo pele li neng li kopantsoe le lijo tsa highfat, tsoekere e phahameng. Kahoo, liphuputso tsena li fana ka maikutlo a karolo ea bohlokoa bakeng sa lijo tse nang le mafura a mangata le tsoekere e ngata ho susumelletsang boitšoaro bo qobelloang ba ho ja.

Mosebetsi o fetileng oa ho hlahloba batho o fana ka ts'ehetso bakeng sa moralo oa tšebeliso ea lithethefatsi, o bonts'a hore ha se lijo tsohle tse hlahang li amahanngoa le mekhoa e lemalloang ea boits'oaro. Boithuto bo fumane hore lijo tse nang le mafura a eketsehileng le lik'habohaedreite tse ntlafalitsoeng (mohlala, pizza, chokolete, kuku, li-cookie) li ne li ka sebelisoa ka mokhoa o lemalloang, o nang le mathata (mohlala, leha ho bile le litlamorao tse mpe, ka bongata ho feta kamoo ho neng ho reriloe) lijo (mohlala, linate, litholoana, nama e se nang mafura) (Curtis & Davis, 2014; Schulte et al., 2015). Ntle le moo, phuputso ea haufinyane e fumane hore lijo tse nang le mafura a mangata, tse nang le tsoekere e ngata li ne li jeoa khafetsa har'a batho ba fihletseng litekanyetso ho Yale Food Addiction Scale (YFAS, Gearhardt et al., 2009) bakeng sa bokhoba ba lijo, ho bapisoa le ba entseng joalo. eseng (Pursey, Collins, Stanwell, & Burrows, 2015).

Ho feta moo, lijo tse nang le mafura a mangata le tse nang le tsoekere e ngata li bonahala li baka likarabo tsa boits'oaro tse lumellanang le boits'oaro ba ho ja le mathata a amanang le ho ja. Lijo tse nang le mafura a mangata, tse nang le tsoekere e ngata li sebelisoa khafetsa nakong ea ho itlopa joala (Rosen, Leitenberg, Fisher, & Khazam, 1986; Vanderlinden, Dalle Grave, Vandereycken, & Noorduin, 2001; Yanovski et al., 1992) mme e ka lebisa hampe. ho ja ho laoloang (Hona joale, Kenardy, & Agras; Vanderlinden et al., 2001; Metsi, Hill, & Waller, 2001). Lijo tse nang le mafura a mangata le lik'habohaedreite tse ntlafalitsoeng, tse amanang le litholoana le meroho, li na le monyetla oa ho lakatsa haholo (Gilhooly et al., 2007; Ifland et al., 2009; Weingarten & Elston, 1991; White & Grilo, 2005; Yanovski, 2003) mme e jeoa haholo ho arabela tšusumetso e mpe (Epel, Lapidus, McEwen, & Brownell, 2001; Oliver & Wardle, 1999; Oliver, Wardle, & Gibson, 2000; Zellner et al., 2006).

Leha ho le joalo, ho bonahala eka ho na le maemo a ikhethileng a ka lebisang ho jang ho ja lijo tse nang le mafura a mangata, lijo tse nang le tsoekere e ngata le lijo tse se nang mafura le lik'habohaedreite tse ntlafalitsoeng, joalo ka khaello ea lijo e matla (Keys, Bro? Zek, Henschel, Mickelsen, & Taylor (1950). Ntle le moo, lithuto tsa mathata a mofuta oa ho itlopa joala (ke hore, bulimia nervosa le bothata ba ho itlopa joala) li fumane hore batho bana ba tla ja le mefuta e fapaneng ea lijo ha ba fuoa monyetla oa ho ja lijo tsa bo-buffet mme ba laeloa ho itlopa joala (Goldfein, Walsh, LaChaussee , Kissileff, & Devlin, 1993; Guss, Kissileff, Devlin, Zimmerli, & Walsh, 2002; Hadigan, Kissileff, & Walsh, 1989; Walsh, Kissileff, Cassidy, & Dantzic, 1989; Yanovski et al., 1992). Ka hona, libakeng tse fetelletseng (mohlala, khaello ea lijo) le tlasa maemo a itseng a laboratori (mohlala, ho itlopa joala), batho ka bomong ba ka ja lijo tse fapaneng tsa phepo ka tšebeliso e kang ea binge. Leha ho le joalo, lipatlisisong tsena, batho ka bomong ba bonts'a lits'oants'o tse ngata tsa ho ja lijo tse nang le mafura a mangata, lijo tse nang le tsoekere e ngata, tse amanang le lijo tse ling (Hadigan et al., 1989; Yanovski et al., 1992), mme ba tlaleha hore boitšoaro ba bona ba ho itlopa joala li ka matlafatsoa haeba ba ne ba ka fumana lijo tse khethehileng tse nang le mafura a mangata, tse nang le tsoekere e ngata (mohlala, pizza, ice cream) (Yanovski et al., 1992). Ntle le moo, lithuto tsena ha lia ka tsa hlahloba boits'oaro ba bankakarolo ha ba fuoa phihlello ho lijo tse se nang mafura le lik'habohaedreite tse ntlafalitsoeng. Kahoo, bopaki bo seng bo le teng bo fana ka maikutlo a hore likarabo tsa boits'oaro (mohlala, taolo e fokotsehileng) e amanang le mathata a lemalloang li amahanngoa haholo le lijo tse nang le mafura a mangata le tsoekere e ngata bathong, leha lipatlisiso tse ling li tlameha ho utloisisa phapano ea tšebeliso ea lijo tlasa maemo a mabe haholo (mohlala, ho hloka khalori, ho laeloa ho itlopa).

Ntle le boits'oaro bo ts'oanang le lithethefatsi tsa tlhekefetso, lithuto tsa batho tsa neuroimaging li bonts'a hore lijo tse nang le mafura a mangata, tse nang le tsoekere e ngata li kenya tšebetsong lipotoloho tse amanang le moputso ebile li ka fetola sistimi ea moputso, e ts'oanang le lithethefatsi tse lemalloang (Smith & Robbins, 2013; Tryon et al. , 2015; Volkow & Wise, 2005; Volkow, Wang, Fowler, & Telang, 2008; Volkow, Wang, Fowler, Tomasi, & Baler, 2012; Wang, Volkow, Thanos, & Fowler, 2004). Ho feta moo, batho ka bomong ba tlaleha likarolo tsa bokhoba ba lijo joalo ka ha li sebelisoa ke YFAS li bonts'a mekhoa e sa sebetseng ea ts'ebeliso ea methapo e amanang le moputso ha ba lebelletse le ho ja moputso o phahameng oa lijo tse nang le tsoekere e phahameng o bonoang hape ho batho ba nang le mathata a ts'ebeliso ea lithethefatsi, a amanang le meputso e ikhethileng ea lithethefatsi (Gearhardt, Yokum, et al., 2011).

Ka kopanelo, bopaki bo teng bo tšehetsa mohopolo oa hore ha se lijo tsohle tse amanang ka mokhoa o tšoanang le litloaelo tsa boits'oaro ba ho ja
kapa mekgwa e sebetsanang le mathata a ho lemalla (mohlala, ho se sebetse ka moputso). Lijo tse nang le mafura a mangata, tse nang le tsoekere e ngata ha li bonahale li na le mathata a amanang le ho ja feela, empa hape li ka baka likarabo tsa boits'oaro (mohlala, taolo e mpe) ka mokhoa o ts'oanang le lithethefatsi tsa tlhekefetso. Kahoo, datha ea hajoale e ts'ehetsa mokhoa oa ho lemalla lijo o bonts'ang karolo ea bohlokoa bakeng sa lijo tse itseng, 'me sena se fapana le maikutlo a hore ketso ea ho ja, ntle le mofuta oa lijo tse jeoang, ke tsona lintho tse hlokahalang bakeng sa ho etsa hore motho a lemale. . Ka tsela e itseng, sena se kanna sa tšoana le ho hlalosa motho ea nang le bothata ba tšebeliso ea heroin eo ho thoeng o na le bothata ba ho “thunya” kapa ba ente e le bothata ba tšebeliso ea opioid.

Ka kakaretso, bopaki ba pele bo ts'ehetsa moralo oa tšebeliso ea lithethefatsi, moo lijo tse itseng kapa litšobotsi tsa lijo (mohlala, mafura a mangata, tsoekere e phahameng) li ka tsamaisang ka kotloloho le ho boloka mekhoa ea ts'ebeliso ea ts'ebeliso ea lithethefatsi (Avena, Rada, et al., 2008; Gearhardt, Davis, et al., 2011; Johnson & Kenny, 2010; Robinson et al., 2015; Schulte et al., 2015). Kahoo, Hebebrand et al.'s (2014) ho hana tšebeliso ea bokhoba ba lijo e hahelletsoeng bokhobeng ba boitšoaro, moralo oa bokhoba ba ho ja ha o latele ka mokhoa o utloahalang ho tsoa boitsebisong bo seng bo le teng. Ho feta moo, tseko ea bangoli ea hore bokhoba ba lijo ha bo fumanehe kapa ha bo eo (Hebebrand et al., 2014) ha e lumellane le tlhaiso-leseling ea morao-rao e bontšang hore ho ata ha bokhoba ba lijo mekhoeng ea sechaba, joalo ka ha ho lekantsoe ke YFAS, ke 5e10% ka karolelano ( Meule & Gearhardt, 2014), e ts'oanang le sekhahla sa ho ata ha mathata a ts'ebeliso ea lithethefatsi (Grant et al., 2004) Leha ho le joalo, e ipapisitse le maikutlo a mahlonoko a Hebebrand et al.'s (2014) mabapi le likheo libukeng tsa bokhoba ba lijo, re lumela hore mohato o latelang o loketseng ka ho fetesisa ke lenaneo le hlophisehileng la lipatlisiso ho lekola hore na ke litšobotsi life tsa lijo tse ka bonts'ang bokhoni bo phahameng ba ho lemalla le hore na lijo tsena li ka ba le bothata bo bokae.

3. Karolo ea boits'oaro mathateng a lematsang

Hebebrand et al. (2014) e bolela maemong a mangata a amanang le ho ja ho tlisoang ke ho ja-joala (mohlala, lipotso ho
YFAS) e its'etleha holima litšobotsi tsa boitsoaro (mohlala, taolo e mpe ea tšebeliso ea lijo), e fana ka maikutlo a ho lemalla ts'ebetso ea ketso ea ho ja ho e-na le tšebeliso e joalo ea joala litloaelong tse itseng. Bakeng sa ho lekola hore na ho ja-joala joalo ka ha ho ja joala kapa ho amana le litekanyetso, ho bohlokoa ho hlahloba hore na boits'oaro bo itseng bo kenya letsoho joang khaellong ea tšebeliso ea lithethefatsi le phapano lipakeng tsa bokhoba ba lithethefatsi le boits'oaro.

Mathata a ts'ebeliso ea lithethefatsi ke litholoana tsa tšebelisano lipakeng tsa tšekamelo ea motho ea ho lemalla joala le ntho e nang le bokhoni bo phahameng ba ho lemalla, ho bolelang hore ntho eo e matlafatsa haholo ebile e na le bokhoni ba ho fetola sistimi ea moputso le ho ntšetsa pele ts'ebeliso e tlamang (Everitt & Robbins, 2005; Koob & Le Moal, 2005; Volkow & Morales, 2015). Ha ntho eo e kenya letsoho kholisong ea karabelo e ts'oanang le ea lithethefatsi, mathata a ts'ebeliso ea lithethefatsi a fumanoa ka ho lekola lits'oants'o tse leshome le metso e 'meli tsa boits'oaro, joalo ka taolo e mpe ea ts'ebeliso le ts'ebeliso e tsoelang pele leha ho bile le litlamorao tse mpe (American Psychiatric Association, 2013, maq. LITLHAHISO TSA 481e590

Matšoao ana a amanang le boits'oaro a teng hohle litsietsing tsa tšebeliso ea lithethefatsi, leha ho na le litlamorao tse fapaneng tsa ntho ena ho motho ka mong. Mohlala, tšebeliso ea lino tse tahang li amahanngoa le maemo a phahameng a tahi a amanang le tšebeliso ea bokoali, le ha batho ka tsela e tšoanang ba bona litšobotsi tsa bokhoba (mohlala, bokhoni bo fokolang kapa boikemisetso ba ho fokotsa kapa ho tlohela ho sa tsotellehe takatso ea ho etsa joalo) ho arabela lintho tsena ka bobeli . Hajoale, litekanyetso tsa mathata a ts'ebeliso ea lithethefatsi li itšetlehile ka ho hlahloba litšobotsi tsa boits'oaro, kaha ha ho na mokhoa oa ho hlahloba litekanyetso kapa tlhatlhobo ea biomarker. Ka mokhoa o ts'oanang, YFAS e sebetsa joaloka ho ja kapa ho sebelisa lijo ka ho hlahloba matšoao a leshome le motso o mong a mathata a ts'ebeliso ea lithethefatsi ha ntho eo e nkoa e le "lijo tse itseng", e nang le mafura a mangata le / kapa lik'habohaedreite tse hloekisitsoeng.

Ntle le ho lekola mathata a ts'ebeliso ea lithethefatsi ka mekhoa ea boits'oaro, mekhoa e meng ea boits'oaro ea ts'ebeliso e ka mpefatsa monyetla oa ho lemalla ntho eo. Ho itlopa joala, phihlello ea nakoana, le ts'ebeliso ea karabelo ho litlamorao tse mpe ke likarolo tsa boits'oaro tse ntlafatsang monyetla oa ho lemalla ntho kapa ts'ebetso (Berridge, 1996; Hwa et al., 2011; Koob & Kreek, 2007; Robinson & Berridge, 2001; Sinha , 2001; Volkow & Morales, 2015). Mohlala, ho itlopa joala ke boits'oaro bo phahamisang bokhoba ba ethanol (joala) ka ho eketsa lethal dose la ntho 'meleng (Herz, 1997; Klatsky, Armstrong, & Kipp, 1990). Leha ho le joalo, ntho eo e bapala karolo ea bohlokoa, hobane boits'oaro ba ho itlopa joala bo le bong bo ke ke ba matlafatsa ho lekana ho bonts'a monyetla oa ho lemalla joala joaloka metsi. Kahoo, litšobotsi tsa ntho e lemalloang (mohlala, joala) li sebelisana le mekhoa ea boits'oaro ea boitlamo (mohlala, ho itlopa joala) ho fella ka mokhoa oa ts'ebeliso e mpe kapa e tlamang. Haholo-holo, boitšoaro (mohlala, ho itlopa joala) feela ha boa lekana ho tsosa karabelo e ts'oanang le bokhoba ntle le boteng ba ntho e nang le monyetla oa ho e lemalla. Ka mokhoa o ts'oanang, moralo o lemalitsoeng ke lithethefatsi, o ka hlahisa hore ho ja ho ts'oanang le lithethefatsi ke tšebelisano ea lijo tse ling tse nang le menyetla ea ho lemalla (mohlala, mafura a mangata, lijo tse nang le tsoekere e ngata), mekhoa ea boits'oaro (mohlala, ho ja Ho sebetsana ka katleho le tšusumetso e mpe, ho kenella nakoana), le lisosa tsa motho ka mong tsa ho lemala (mohlala, ho se ts'oenyehe) (Setšoantšo sa 1).

Ka kakaretso, mathata ohle a ts'ebeliso ea lithethefatsi a hlahlojoa ho sebelisoa mekhoa e itšetlehileng ka boits'oaro le mekhoa ea boits'oaro ea ho sebelisana le lintho ho ka eketsa bokhoni ba bona ba ho lemalla batho. Ka mokhoa o ts'oanang, bokhoba ba lijo bo boetse bo hlahlojoa ka ho fetola mekhoa e ts'oanang ea boits'oaro, mme maemo a boits'oaro a nahanoa hore a bohlokoa ka tsela e ts'oanang bakeng sa ho phahamisa monyetla oa hore lijo tse nang le mafura a mangata le tsoekere e phahameng li tla jeoa ka qobello. Kahoo, e le ho hlakisa hore na ho ja ho ts'oanang le ho lemalla lithethefatsi ho tsamaellana le tahi ea lijo tse itseng kapa ketso ea ho ja, ho bohlokoa ho lekola likarolo tse ikhethang tsa litlamorao tsa boits'oaro (mohlala, bothata ba papali ea chelete) tse sa arolelanoeng le lithethefatsi- mathata a ts'ebeliso. Bokhoba ba boitšoaro bo na le boits'oaro bo putsang haholo, bo matlafatsang, hape bo khona ho fetola sistimi ea moputso ka tsela e ts'oanang le lithethefatsi tsa tlhekefetso ho tsamaisa ka kotloloho ho kenella ka mokhoa o qobelloang boitšoarong (Blaszczynski & Nower, 2002; Potenza, 2008). Ho fihlela joale, bothata ba papali ea chelete ke eona feela temallo ea boits'oaro temaneng ea mantlha ea DSM-5 (American Psychiatric Association, 2013). E amana le lithethefatsi tsa tlhekefetso, ts'ebetso ea papali ea chelete e na le litšobotsi tse ka eketsang menyetla ea ho kenella ka mokhoa o qobelloang le ho fetola sistimi ea moputso ka tsela e ka lebisang likarabong tse ts'oanang le lithethefatsi ho batho ba bang. Ho becha ho ka phahamisa matla a matlafatsang a chelete ka ho hlahisa meputso ea nako le nako, maikutlo a potlakileng le liteko tse potlakileng tsa ho hapa le ho hlola, le maemo a hlohlelletsang leruo (Griffiths, 1999; Welte, Barnes, Wieczorek, Tidwell, & Parker, 2004). Ha chelete e ntse e putsa, e kanna ea ba le menyetla e fokolang ea ho lemalla kantle ho papali ea chelete. Joalo ka mathata a ts'ebeliso ea lithethefatsi, mofuta o lemalloang oa papali ea chelete o ka kenyelletsa mekhoa ea bohlokoa ea boits'oaro joaloka ho kenella (Alessi & Petry, 2003; Black & Moyer, 2014; Lesieur & Custer, 1984; Williams, Grisham, Erskine, & Cassedy, 2012 ).

Ho ea pele, tekolo ea bothata ba papali ea chelete ea ho becha e sebelisa matšoao a tšoanang a boitsoaro (mohlala, taolo e mpe) joalo ka mathata a ts'ebeliso ea lithethefatsi (American Psychiatric Association, 2013). Ha mekhoa ea tlhahlobo ea mantlha ea motsoako e le ngoe e ile ea fetoloa ho ikarabella bakeng sa phapang ea tlhaiso ea matšoao ho mathata a ts'ebeliso ea lithethefatsi (mohlala, ho se nkoe ha hallucinogens, ho hatisa semelo sa kelello sa ho tlohela
bakeng sa kannete), ho nahanoa ka leseli ho bile le karolo ho nts'etsopele ea mekhoa ea bothata ba papali ea chelete (Denis, Fatseas, & Auriacombe, 2012; Hasin et al., 2013; Lesieur & Rosenthal, 1991; Petry, Blanco, Stinchfield, & Volberg , 2013). Mohlala, ho fapana le ho hloka ho ja ntho e ngata ho feta nako ho fihlela sephetho se lakatsehang, mamello bothateng ba papali ea chelete e lekoa ka ho hloka papali ea chelete e ngata ho fihlela sepheo se lakatsehang (American Psychiatric Association, 2013). Ntle le moo, litekanyetso tse 'maloa tse thehiloeng linthong tse sebelisoang ha li sebelisoe ho lekola bothata ba papali ea chelete (mohlala, sebelisa maemong a kotsi' meleng), leha mekhoa e kenyelelitsoe ho ts'oara litšobotsi tse ikhethileng tsa bongaka ba bothata ba papali ea chelete (mohlala, ho lelekisa tahlehelo, ho itšetleha ka ba bang ho fana ka chelete ho baleha boemo ba lichelete bo amanang le papali ea chelete) (American Psychiatric Association, 2013). Kahoo, leha mekhoa ea boits'oaro ea ho fumana ts'oaetso ea ts'ebeliso ea lithethefatsi le bothata ba papali ea chelete li etselitsoe ho ipapisa le matšoao, mekhoa ea motheo (mohlala, taolo e mpe, mamello, liteko tse sa atleheng khafetsa tsa ho fokotsa kapa ho tlohela, le ho kena-kenana le likarolo tse kholo tsa bophelo bo sebetsang. ) li arolelanoa ka mathata a bakoang ke lithethefatsi le boits'oaro.

Qetellong, litloaelo tsa boitšoaro li fapana le mathata a ts'ebeliso ea lithethefatsi hobane ha ho na ntho e kenngoang. Ho fapana le bothata ba papali ea chelete, bokhoba ba boitšoaro bo seng bo le teng ho DSM-5, ho ja ho kenyelletsa ho kenoa ha lijo, athe ho becha ha ho ame tšebeliso ea lithethefatsi. Bakeng sa ho nahana ho ja lithethefatsi tsa 'nete tsa boitšoaro joalo ka papali ea chelete, mofuta oa lijo tse kenngoeng ha oa lokela ho ba le tšusumetso nts'etsopele ea ts'ebetso ea ho lemalla, e sa tšehetsoeng ke bopaki bo teng bo supang hore lijo tse mafura le tse nang le tsoekere e phahameng li bonahala li tse amanang haufi-ufi le boits'oaro bo tšoanang le ba ho ja (Avena, Bocarsly, et al., 2008; Avena, Rada, et al., 2008; Boggiano et al., 2007; Johnson & Kenny, 2010; Schulte et al., 2015) . Ho ts'ehetsa bopaki bona ba pele, lipatlisiso tsa nako e tlang li lokela ho etsa lipatlisiso hore na lijo tsena li khona ho fetola li-neural circry tse amanang le moputso ka tsela e otlang ka kotloloho ts'ebeliso e tlamang, joalo ka lithethefatsi tsa tlhekefetso.

Phapang e 'ngoe ea bohlokoa lipakeng tsa bokhoba ba boitšoaro bo joalo ka papali ea papali ea chelete le ho ja e ts'oanang le ho lemalla joala ke hore ketso ea ho ja, leha e le monate, ha e sebelise matla a sistimi kapa ho fetisa mesebetsi ea taolo ea phethahatso joalo ka nakong ea papali ea chelete. Ntle le moo, e 'ngoe ea litlhaloso tse lefisitsoeng khahlano le ts'ebeliso ea bokhoba ba lijo ke hore batho bohle ba hloka ho ja lijo hore ba phele, ka hona lijo li ke ke tsa lemalla (Corwin & Grigson, 2009). Leha ho le joalo, boitšoaro, bokhoba ba ho lemalla ho ja bo hlahisa hore batho ba ka hlaseloang habonolo ba kanna ba lemalla boitšoaro bo tšehetsang bophelo (ho ja), bo bakoang ke ts'ebeliso ea lijo life kapa life. Joalokaha ho boletsoe kaholimo, ho bonahala eka ke lijo tse itseng feela (mohlala, lijo tse nang le mafura a mangata, lijo tse nang le tsoekere e ngata) tseo hangata li seng "maemong a tlhaho" (ke hore, tse sebetsoang haholo) li kanna tsa ameha mokhoeng ona o lemalloang. karabelo (Gearhardt, Davis, et al., 2011; Ifland et al., 2009, 2015; Schulte et al., 2015). Ka hona, bopaki bo seng bo le teng bo fana ka maikutlo a hore ho ja ho ts'oanang le ho lemalla lithethefatsi ho ka bapisoa le ntho e thehiloeng linthong tse amanang le ho lemalla lijo, ho fapana le motho ea itšoereng hampe, ea lemaletseng ho ja, haholoholo ka lebaka la ho kenoa ha "ntho" e putsang.

4. Litlamorao tsa ho sebelisa tšebeliso ea lithethefatsi tsa joala le litloaelo tsa bokhoba ba ho ja

Hebebrand et al. (2014) e fana ka maikutlo a hore moralo oa bokhoba ba lijo bo thehiloeng ho lithethefatsi o fa batho lebaka la boits'oaro bo thata mme e bonts'a ts'ebetso e sa reroang e hlahelang motho. Bangoli ba pheha khang ea hore ho ja joala ke lentsoe le loketseng haholo hobane e hatisa karolo ea boits'oaro (Hebebrand et al., 2014). Leha ho le joalo, kalafo ea mathata a ts'ebeliso ea lithethefatsi le litloaelo tsa boitšoaro e itšetleha ka maano a boits'oaro, ka boitlamo bo boholo (mohlala, ho ba teng kopanong, ho phethela mosebetsi oa sekolo o etsetsoang hae, boitlamo ba bareki) bo amanang le liphetho tse ntle tsa kalafo (Dowling & Cosic, 2011; Simpson, 2004; Simpson , Joe, Rowan-Szal, & Greener, 1995; Wolfe, Kay-Lambkin, Bowman, & Childs, 2013). Leha ho le joalo, Hebebrand et al.'s (2014) ba bolela hore motho ke moamoheli ea sa tsotelleng oa ts'oaetso e ka nkuoang e le pale e nyarosang ea bokhoba bo sa bontšeng boemo ba hajoale ba lipatlisiso kapa maikutlo a sejoale-joale a batho ba nang le lithethefatsi (Corrigan , Kuwabara, & O'Shaughnessy, 2009; Hing, Russell, Gainsbury, & Nuske, 2015; Schomerus et al., 2011). Ho feta moo, Horch le Hodgins (2008) ha ba bone phapang lipakeng tsa sekhobo se amanang le bothata ba papali ea chelete bo amanang le ts'ebeliso ea joala. Kahoo, tlhahiso ea hore bothata ba ts'ebeliso ea lithethefatsi e ka ba bo sa tsotelleng le bo nyenyefatsang ho feta bokhoba ba boitšoaro ha bo tšehetsoe ke likhopolo le bopaki bo matla bo amanang le thupelo le kalafo ea lithethefatsi tsohle (Alavi et al., 2012; Feldman & Crandall, 2007 ; Horch le Hodgins, 2008).

Habohlokoa, liphuputso tse 'maloa tsa morao-rao li bonts'a hore ho pepesehela moralo oa ts'ebeliso ea lithethefatsi e nang le lithethefatsi ha ho nke lehlakore kapa ho na le litlamorao ho fokotsa sekhobo ebile ha ho na phello ho ja lijo (Hardman et al., 2015; Latner, Puhl, Murakami, & O'Brien, 2014; Lee, Holo, Lucke, Forlini, & Carter, 2014). Ka lehlakoreng le leng, boits'oaro ba boits'oaro, moralo oa bokhoba ba ho ja bo hlokomoloha monehelo oa litšoaneleho tsa lijo ntlafatsong le tlhokomelong ea karabelo e ts'oanang le lithethefatsi, e thibelang menyetla ea ho kenella. Kahoo, ntle le lits'ebetso tsa kalafo ea kelello, haeba lijo tse nang le mafura a mangata le tsoekere e ngata li bontša monyetla oa ho lemalla batho ba bang, mohato o le mong oa bohlokoa o latelang o tsoang ponong ea bophelo bo botle ba sechaba o ka kenyelletsa ho theha mekhoa e metle ka ho fetisisa indastering ea lijo, joalo ka ho fokotsa ho bapatsa ha tsena. Lijo ho bana (Harris, Pomeranz, Lobstein, & Brownell, 2009).

5. Summary

Le ha pampiri ea Hebebrand et al.'s (2014) e fana ka tlhahlobo e tebileng ea tahi ea lijo, mofuta o mong o khothalelitsoeng oa ho hlalosa ho ja e le tšebeliso ea boitšoaro o bonahala o le mathata ka mabaka a 'maloa. Bakeng sa ho hlakola ho ja e le tšibollo ea boitšoaro, lithuto tse matlafatsang li tla hloka ho bonts'a hore lijo tsohle li na le matla a lekanang a ho kenella ts'ebetsong ea bokhoba. Leha ho le joalo, bopaki ba pele lithutong tsa liphoofolo le tsa batho bo bontša karolo ea mantlha ea lijo tse nang le mafura a mangata, tsoekere e holimo kholisong ea mathata a amanang le phepo le ho bontša hore lijo tse itseng (mohlala, phepo e nepahetseng) li kanna tsa hloleha ho baka boitšoaro bo bobe ho bona ea hau.

Ntle le moo, pono e khothalletsoang ea tšebeliso ea litheko tsa ho ja e fosahetse e totobatsa boteng ba matšoao a boits'oaro ka ho ja-joala joalo ka bopaki ba hore ho ja ke temallo ea boitšoaro. Leha ho le joalo, mathata ohle a ho lemalla, ho kenyelletsa mathata a tšebeliso ea lithethefatsi le bokhoba ba boitšoaro, bo amana le mekhoa ea tlhahlobo ea boits'oaro (mohlala, ho shebella tšebeliso le ha ho na le litlamorao tse mpe), ho kenella ho its'ebetsong (mohlala, ho phethela mosebetsi oa lapeng), le likarolo tsa boits'oaro ba ho kenya letsoho (mohlala, tšebeliso ea nako le nako). Phapang ea mantlha lipakeng tsa mathata a tšebeliso ea lithethefatsi le bokhoba ba boitšoaro ke hore ha ho na ntho e kenang tlatsong e lemalloang ke boitšoaro (mohlala, papali ea chelete). E sebelisoa bakeng sa ho ja joala joalo ka ts'ebeliso, tšebeliso ea bokhoba ba tahi, e tla ba hantle feela haeba lipatlisiso li bonts'a hore mofuta oa lijo tse kentsoeng o ne o se na kamano le kholo ea tloaelo ea ho ja joalo ka mokhoa oa ho ja. Jwalo ka ha lijo tse itseng (mohlala, lijo tse nang le mafura a mangata, tse nang le tsoekere e ngata) li bonahala li amana haholo le ho ja joalo ka tšenyo, ho iphapanya karolo ea lijo tsena ho latela tšekamelo ea ho ja joala ho ka fokotsa menyetla ea ho kena lipakeng le mererong ea maano a sechaba.

Ka kakaretso, boemo ba hajoale ba lingoliloeng bo fana ka maikutlo a hore maikutlo a bakoang ke ho lemalla lijo, ho fapana le ho ja e le boitšoaro bo hlephileng, a bonts'a tšebelisano ka nepo pakeng tsa tšekamelo ea motho ea ho lemalla, mekhoa ea boits'oaro e phahamisang monyetla oa ho lemalla, le karolo e ka bang teng ea mafura a mangata, lijo tse nang le tsoekere e ngata ho hlahisa le ho ntšetsa pele mofuta oa phenotype o lemalloang. Mehato e latelang lethathamong lena la lipatlisiso e lokela ho ikemisetsa ho ntlafatsa poleloana e akaretsang "bokhoba ba lijo" ho bonts'a ka ho hlaka hore na ke lijo life kapa metsoako efe e ka bang le monyetla oa ho lemalla.