(L) Iingcali eziPhambili zaseMelika (ASAM) Usandula ukukhupha inkcazo eNtsha yokuTshabalalisa iziyobisi (ngo-2011)

IINKCUKACHA: Eli lelona nqaku libalaseleyo eligubungela u-Agasti, 2011 wokukhutshwa kwe-American Society of Addiction Medicine kwinkcazo entsha yokulutha. Oku kubhaliwe, Umbono omtsha oMnxila wokuLungisa umlutha ugxininisa iSimo seSayensi ivela kwiwebhusayithi ethi "The Fix." Amacandelo abhalwe apha ngezantsi ahambelana neengcinga ezixoxwe apha kwi-YBOP.

Amanqaku amabini esabhala:

Umlutha yizo zifo zengqondo. Kodwa iya kugqitywa njani? NguJennifer Matesa kunye noJed Bickman 08 / 16 / 11

Iingcali eziphezulu zaseMelika zisandula ukukhupha inkcazo entsha yokutshaya. Ibeka indawo ekuphikisaneni ngayo kwimicimbi emikhulu-ukuphazamiseka kwengqondo ngokuchasene nokuziphatha okungalunganga, ukungabinakho ukuzonwabisa, ukuba likhoboka lesini, ukubonelela ngento ethile kubo bonke abantu-ngakumbi indawo yokungena kwengqondo enamandla-ukuphikisana nayo.

Ukuba ucinga ukuba umlutha konke malunga nokusela, iziyobisi, isondo, ukugembula, ukutya kunye nezinye izinto ezingenakuphikiswa, cinga kwakhona. Kwaye ukuba ukholelwa ukuba umntu unokhetho okanye ukuba angayithobeli indlela yokuziphatha umlutha, yifinyelele. I-American Society of Addiction Medicine (ASAM) yavuthela ikhwelo kule ngcamango enzulu ngokukhutshwa kwayo ngokusemthethweni kwincwadi echaza umlutha njengengxaki engapheliyo yeengxaki zegazi ezibandakanya imisebenzi eninzi yengqondo, ngokugqithiseleyo ukungalingani okuphazamisayo kwi-circuitary circuit reward. Loo mpahla oyintloko kwiva lonwabo ngokunyanisekileyo unyanzelisa umlutha wokugxotha iikhemikhali eziphezulu eziveliswa yizinto ezinjengeziyobisi kunye notywala kunye nokuziphatha okugqithisileyo njengokuziphatha ngokwesondo, ukutya nokugembula.

Inkcazo, umphumo weminyaka emine kwinkqubo equka ngaphezu kweengcali ezikhokelayo ze-80 kwi-addiction kunye neurology, igxininisa ukuba likhoboka lesigulo esisisiseko-ngamanye amagama, alibangelwa yimicimbi yezempilo yengqondo enje ngemo yeemvakalelo okanye ukuphazamiseka kubuntu, ukubeka umbono oqhelekileyo wokuba isimilo esiluthando luhlobo "lokuzinyanga ngokwakho", masithi, intlungu yokudakumba okanye uxinzelelo.

Enyanisweni, entsha ye-neurologically igxile kwi-definition debunks, epheleleyo okanye inxalenye, ininzi yeembono eziqhelekileyo malunga nomlutha. Ukuxhatshazwa komzimba, isitatimende esichazelayo, isifo "sesigxina-psycho-socio-spirituality" esichazwe ngu- (a) nokwenza izigqibo ezonakalisiweyo (okuchaphazela ukufunda, ukuqonda kunye nesigwebo) kunye (b) nobungozi obuqhubekayo kunye / okanye ukuphindaphinda kwakhona; iimpembelelo ezingabonakaliyo kukuba (a) izilutha azikwazi ukulawula iziphatho zabo eziluthayo kunye (b) nokuziyeka ngokupheleleyo, ngenxa yezilingo ezithile, injongo engenakwenzeka yokunyanga.

Ukuziphatha okungalunganga ngokwazo zonke iimpawu zokulutha, hayi isifo uqobo. "Imeko yokulutha ayifani nemeko yokunxila," i-ASAM ithatha iintlungu ukubonisa. Kude kubungqina bokusilela kwentando okanye isimilo, isimilo sisilingo somlutha sokusombulula "imeko yeemvakalelo ezingasebenzi kakuhle" ethi ikhule ngokuhambelana nesi sifo. Ngamanye amagama, ukhetho olwaziyo ludlala indima encinci okanye alunanxaxheba kwaphela kwimeko yesiyobisi; ngenxa yoko, umntu akanakukhetha ukuba angabi likhoboka. Olona hlobo lukhobokisayo olunokukwenza kukukhetha ukungasebenzisi iziyobisi okanye ukubandakanyeka kwindlela yokuziphatha eyomeleza yonke into yokuzilimaza yokujikeleza umvuzo.

Nangona kunjalo i-ASAM ayifuni ihlumelo xa ifika kwimiphumo emibi yokulutha, ivakalisa ukugula "okubangela ukukhubazeka okanye ukufa kwangaphambili, ingakumbi xa kushiywe kungaphathwa kakubi okanye kungaphathwa kakubi."

Intsha entsha ichaza ngokungathandabuzeki ukuba zonke izilingo-nokuba utywala, i-heroin okanye isondo, zithi-zifana ngokufanayo. UDkt. Raju Haleja, owayengumongameli weCanada Society for Addiction Medicine kunye nosihlalo wekomiti ye-ASAM eyenza inqaku elitsha, watshela i-Fix, "Sibheke umlutha njengesifo esinye, ngokuchasene nalabo abababona behlukileyo izifo.

Iziyobisi likhoboka. Ayinamsebenzi into yokuba ingqondo yakho ibheka ngaphi, ukuba itshintshile, usengozini yokuba kuko konke ukutshaya. ” Ukuba uluntu luye lwagxininisa ukuxilongwa ngesondo okanye ukugembula okanye ukuxhatshazwa kokutya njengoko yonke into efanelekileyo ngokusemthethweni njengotywala okanye i-heroin okanye i-crystal meth inokubangela ukuphikisana ngaphezu kokungafihli kodwa ukulingana okude.

Intsha entsha ichaza nje nge-American Psychiatric Association (APA) eyenza ipapashwe kakhulu, iminyaka elishumi-in-yokwenza ukuhlaziywa kwenkcazelo yalo yobuntshwankathelo kwiNcwadana yokuHlola kunye neSatisatisti yeengxaki zeengqondo-iBhayibhile yezobuchopho bengqondo. I-DSM ye-DSM iya kuba nefuthe elikhulu kwimigaqo-nkqubo yempilo ekhokela unyango lokulutha, ikakhulu ngenxa yokuba iinkampani ze-inshorensi zigunyazwe ngumthetho ukusebenzisa i-DSM iindidi zokuxilonga kunye neendlela zokumisela ukugqiba ukuba zeziphi unyango abazihlawulelayo.

UDkt. Haleja utshele i-Fix ukuba inkcazo ye-ASAM yavela ngaphandle kokungavumelani nekomiti ye-DSM; nangona i-DSM iya kuchaza umlutha njengesifo, iimpawu zayo (kwaye ngoko impawu zokuxilonga) ziya kubonwa njengezona ziphathekayo. Kwakhona, i-DSM iya kuchaza uhlobo oluthile lomlutha njengesifo esahlukileyo, endaweni yesigqibo esisodwa kunye esihlangeneyo sesifo esiziphakamisayo njenge-ASAM. Ngonyango, kubaluleke kakhulu ukuba abantu bangajongi kwinto enye yesi sifo, kodwa sisifo siphela, utshilo uHaleja. Kude kukusilela kwentando okanye isimilo, isimilo sokuziphatha okukhobokisayo lilinge lomlutha lokusombulula “imeko yeemvakalelo ezingasebenzi kakuhle” ethi ikhule ngokuhambelana nesi sifo. Ngamanye amagama, ukhetho olwaziyo ludlala indima encinci okanye alunanxaxheba kwaphela kwimeko yesiyobisi; ngenxa yoko, umntu akanakukhetha ukuba angabi likhoboka.

Nangona izilingo zingenakukhetha ukuba zingabi zilutha, zinokukhetha ukufumana unyango. Ukubuyiswa kwezinto, i-ASAM ithi, ayifumanga kakuhle nje ngokulawulwa ngokwabo kunye namacandelo okuxhasa abafana ne-12-step-step, kodwa kunye noqeqesho oluqeqeshiwe loqeqesho.

Ezinye iingcali zonyango zibona i-definition entsha ecacileyo njengento yokuqinisekisa ukuba yintoni, ekubeni ukupapashwa kwezilwanyana ezixhamlayo ku-1939, kwaziwa ngokuba "yingcamango yesifo" somlutha. "Abantu abaninzi kubemi bebona ukuxilonga njengengxaki yokuziphatha-'Ngenjani ukuba bayeke nje? '" Utshilo uDkt. Neil Capretto, umlawuli wezonyango weZiko loKhuseleko lokuSungulwa kweSango ePittsburgh kunye nelungu le-ASAM elisebenzayo. "Kuba abantu abanamava abasebenzayo kwimithi yobunzima iminyaka, siyazi ukuba isifo sengqondo."

Ngaba le ngxelo ityhala amanyathelo ali-12, eyona ndawo iphambili kumaziko onyango, iinkqubo kunye neeklinikhi, ukuya kuphelelwe lixesha? Emva kwayo yonke loo nto, xa ingxaki kusithiwa yingxaki “yezonyango”, oko akuthethi ukuba isisombululo kufuneka sibe sesezonyango — njengakugqirha nakwiziyobisi? “Zombini ezi ndlela ziyasebenza,” utshilo uGqirha Marc Galanter, unjingalwazi kwizifundo zengqondo kwiYunivesithi yaseNew York, umlawuli oyintloko weCandelo loTywala kunye nokuSetyenziswa gwenxa kweziyobisi kunye nomlawuli weNkqubo yoQeqesho yoBambiswano kwi-Addiction Psychiatry. Inyaniso yokuba ukuba likhoboka lesifo akuthethi kuthi ichaphazeleka lula kwiziyobisi. ”UCapretto uthi:“ Le nkcazo intsha ayithi iindlela zengqondo okanye zokomoya azibalulekanga. Inkxalabo yam kukuba abanye abantu abangabuqondiyo ubungakanani bokubakho kweziyobisi baya kuyibona kuphela njengesifo seeseli zobuchopho. Asizinyangi iikhompyuter-ngabantu bonke, njengoko inkcazo isitsho, isidalwa 'se-bio-psycho-socio-spiritual', kwaye ngubani oya kuthi asadinga uncedo kwezo ndawo. ”

I-statement ye-ASAM yehla-ngokubanzi-ngakwesinye icala lemibuzo yenkukhu kunye neqanda eliye lafudumala abantu abanomdla wokuxhatshazwa, oogqirha kunye nokubuyisela izilwanyana ezifanayo: eza kuqala, ingxaki yegazi okanye ukuziphatha okunyanzelisayo kunye nokusetyenziswa kweziyobisi? Inkcazo ithi ukungabikho komsebenzi kwintsebenziswano ye-neuroloji umvuzo-uxhulumano phakathi kweendawo zobuchopho, ngakumbi abo baqhuba imemori, iimpendulo zengqondo kunye nenjabulo-beza kuqala, kwaye baqhube umlutha kwixesha eliza kutshabalalisa ukuze bahlawule umlinganiselo wokungafani kwemali ngokusebenzisa umlutha wokuziphatha. Kodwa kamva, lo mbhalo uqaphele ukuba ezi ziphatha ngokwazo zingonakalisa umjikelezo wesiphaluka kwaye zikhokelela ekulawuleni ukuphazamiseka nokunyaniseka.

Le nkcazo iyavumelana, kwiingxelo zayo jikelele, kunye nesiseko esiphezulu ekutsaleni inzululwazi yenzululwazi yokuba inkqubo yovuyo yemvelo eyenzelwe ukuxhasa ulondolozo lomntu iyanqanyulwa okanye iphakanyiswe yintlawulo yeekhemikhali ezinikezelwa yimveliso yeziyobisi okanye ukuziphatha kakubi. UDkt Mark Publicker uthi, "Ukutya ukutya, ukukhulisa abantwana, ukulalana, ukulalana, ukugcina ubudlelwane obusondeleyo," kusho uDkt. Mark Publicker, umlawuli wezobugqirha kwiCentral Recovery Centre ePortland-Maine, I-Kaiser Permanente I-Mid-Atlantic Region.

Xa sisebenzisa utywala okanye iziyobisi, utshilo uPublicker, umvuzo weekhemikhali- "ophezulu" -unamandla amaninzi kunomvuzo wesekethe yendalo, kwaye inkqubo yeemithambo-luvo iyaziqhelanisa nezikhukula ze-neurotransmitters. “Kodwa ngenxa yokuba asikhange siguquke njengohlobo lwe-OxyContin okanye i-crack cocaine, indlela etshintshatshintshayo. Iya kuba yinto engavakaliyo ukonwaba, ”uqhuba watsho. Ukusetyenziswa kwento ke kwenzeka ngendleko yento enokukhuthaza ukusinda. Ukuba ucinga malunga naloo mbono, uqala ukuphendula ngokugula kunye nokufa ngaphambi kwexesha. ” Umlutha osebenzayo unomngcipheko ophezulu kakhulu wokufa kwangaphambili ngokugula okanye ukuzibulala.

Isiteyitimenti siphakamisa ii-alamu eziphindaphindiweyo malunga nengozi ebangelwe luphuhliso lolutsha kunye nabantu abadala abakwimikhwa yokusetyenziswa kwezinto kuba ubuchopho babo busekwinkqubo yokuvuthwa, kwaye ikhemikhali "yokuxhwila" inkqubo yomvuzo inokubangela ngaphambili nangaphezulu Ukuziphatha gwenxa kweziyobisi. Ngoxa uqiniseke ngokusesikweni kwindlela yokukhubazeka, isichazo asikho ncitshulwa izaziso zezinto eziphilayo (oko kuchaza malunga nesiqingatha sezizathu kwifa lakho leDNA). Uyakuyinyamekela ukuthetha ukuba izinto ezisingqongileyo zichaphazela nokuba ingaba i-genetics izakufikelela njani kwisikali. Le nkcazo ithi "ukuxhaswa kwezinto" ezifunyenwe ngokuvelisa abantwana kunye namava okuphila angakuvimbela ukubonakaliswa kwezilwanyana. "I-Genetics isenzo, kungekhona isigqibo," kusho uCapretto.

Izinto zengqondo nezendalo, ezinje ngokuchaphazeleka kukonzakala okanye uxinzelelo olugqithisileyo, izimvo ezigqwethekileyo malunga nentsingiselo yobomi, ukuzithemba, kunye nokudodobala konxibelelwano nabanye kunye "nomntu ogqithileyo (ekubhekiswa kuye njengoThixo ngabaninzi, Amandla aPhakamileyo ngo-12. amaqela ezinyathelo, okanye ukuqonda okuphezulu kwabanye) ”nazo ziyavunywa njengezinefuthe.

Ukongezelela, i-ASAM iqhubeka ithi ukuqonda inkqubo yokufumana umvuzo kuyingxenye yokuqonda umlutha we-neurobiology. Oososayensi bazama ukuqonda indlela abanye abagxekayo abaxakeke ngayo ngezilwanyana ezithile okanye iziphathamandla kunye nezinye izilonda kwabanye; indlela ezinye izilingo ezibangelwa ngayo ezinye izenzakalo ezingachaphazeli abanye; kunye nendlela iiminqweno ezinokuqhubeka ngayo kwiminyaka emininzi emva kokuphulukana ngokupheleleyo.

Le nkcazo izama ukubeka iingcamango zokuxilonga, zonke ezo ziziphatha: ukungakwazi ukuyeka; ukulawulwa kokuphazamiseka; nqwenela; kuncitshiswa kweengxaki zomntu; nezimpendulo zengxaki.

Ingaba ingxaki ukuba inkcazelo ayinakukwazi ukukhomba uphawu lokuxilongwa lokugula? "Mhlawumbi ndingabonakalisa into ecacileyo, apha," i-Publicker ithi, ukububula, "kodwa akudingeki ukuba wenze ubuchopho bombono ukuze uqaphele utywala obunxilisayo."

Ngapha koko iyagxininisa ukuba "ubuninzi kunye nokuphindaphinda" kweempawu ezikhobokisayo -njengokuba zingaphi iindlela osela ngazo ngosuku okanye zingaphi iiyure ozichitha ngokuphulula amaphambili-azikho njengophawu nje "kwendlela esemagqabini" Umlutha uphendula koxinzelelo kunye neendlela ngokuqhubeka nokulandela imeko yeziphumo ezibi ezikhulayo.

Inkcazelo entsha ye-ASAM yavela ngaphandle kokungavumelani nekomiti ye-DSM, eya kuchaza uhlobo oluthile lomlutha njengesifo esahlukileyo. "Ngokwonyango, kubaluleke kakhulu ukuba abantu bangagxininisa kwimiba ethile yesi sifo, kodwa isifo sisonke," kusho uHaleja.

I-Publicker, ilungu elisebenzayo le-ASAM ye-30 iminyaka kunye nomxhasi weyeza unyango oluxhaswa ngumlutha, inqaku lokuba ukubuyiswa komlingo kuxhomekeke kwonyango lweengqondo, ezentlalo kunye nolwalamano-kugqirha nje kuphela. "Kubizwa ngokuba unyango olusincediswa ngamachiza, kungekhona unyango oluncediswa ngamachiza," ushilo. "Amachiza yedwa ayiphumeleli. Ndiyibonile le ngethuba elide kakhulu. Kodwa kunokwenza ukuba umehluko kubantu abanobunzima bokuphinda aphindeke. "

Ubonisa ukufana nokudandatheka: "Ukuba ucela abantu abaninzi ukuba yiyiphi intlungu yokudakumba, baya kuyiphendula ingxaki yesifo se-serotonin kwaye isisombululo kukubeka umntu kwi-SSRI [i-anti-depressant medicine]. Kodwa leyo yindlela elula kwaye engafanelekanga yokulawula ukudandatheka. Amachiza anokunceda, kodwa kufuneka adityaniswe nentetho. Siphila ngexesha langoku apho intetho ingabuyiselwa khona. "Kuhlala kubonakala ukuba i-ASAM entsha yokwenza umlutha njengobulwelwe ngokugcwele-bhiliyo iya kukunceda abaxhamli bafumane ukubuyisela unyango. Ngokwe-insurers, ukucacisa ukuba isigulo "sineengcambu zezinto eziphilayo" -ukucwangcisa ukuba akusiyo iphoso lesigulane esinokugula-sinokudiliza iibhawlo.

UCapretto uyavuma: "Izinto ezinjengale nkcazo zinceda ukuzisa umlutha ngakumbi kwezinye izifo, ukwenzela ukuba ikamva liza kuthintela izithintelo ezimbalwa zabantu abafuna ukufumana uncedo."

Enye yeenjongo ze-ASAM ezingachazwanga ngokucacileyo yayikukulwa nehlazo eluntwini elinenkani ngokuchasene nokulutha okufunyanwa ngamakhoboka amaninzi. "Akukho mbuzo bazimisele ukunciphisa ukubekwa amabala," utshilo uPaplicker. “Akukho mntu ukhetha ukuba likhoboka lazo. Inkxalabo endinayo kukubeka ityala kwisigulana. Kuthatha ixesha elide kakhulu ukuba ingqondo iqheleke. Ngelixa ulinde ukuba kwenzeke, uziva ungalunganga, ukucinga kwakho kuphazamisekile, kwaye siseto sokubuyela umva. Izigulana kunokwenzeka ukuba zibekw 'ityala lokuphinda ubuye, kwaye iintsapho zibabona bengakhuthazekanga kwaye bebuthathaka. Kodwa ke seso sifo sokuba likhoboka. ”

UJennifer Matesa ubhala malunga nokulutha kunye nokubuyiselwa kwimibuzo kwiblogi yakhe, uGuinevere Gets Sober. Nguye umbhali weencwadi ezimbini ezingabonakaliyo malunga nemicimbi yezempilo, kubandakanywa i-journal win-winning of his pregnancy, I-Navel-Gazing: Iintsuku kunye neNtsuku zoMama ekwenzeni.

UJed Bickman unikele ingxelo eyongezelelweyo ngeli nqaku. Ubhalele iSizwe, iHuffington Post, kunye neCounterpunch.com kwaye uzakupapasha isiqwenga sakhe sokuqala Ukulungiswa kwiveki ezayo kwinkcazo entsha yokulutha kuhlaziyo lwe-APA ye-DSM kunye nefuthe lezopolitiko kunye nomgaqo-nkqubo wabantu.