IMIBUZO: I-ASAM entsha "inkcazo yokulutha" (Agasti 2011) iphelisa ingxoxo malunga nokuziphatha kweziyobisi, kubandakanya isini kunye neziyobisi ze-porn. Le nkcazo intsha yokulutha, ebandakanya iziyobisi, njengokutya, ukungcakaza kunye nokwabelana ngesondo, i-ASAM ngokungathandabuzekiyo ithi izilingo zokuziphatha zibandakanya ukutshintsha kwengqondo okufanayo kunye neendlela ze-neural njengoko kunjalo ngeziyobisi. Siyakholelwa ukuba umlutha we-intanethi we-Intanethi akufuneki ubephantsi kwesambulela sokuxhatshazwa ngokwesondo. Uninzi lwamadoda ababa likhoboka lemifanekiso engamanyala ngekhe abengaba ngamakhoboka ezesondo ukuba babephila ngaphambi kwexesha le-Intanethi. (Ndinezicatshulwa ezichaziweyo kwimikhwa ethile yokuziphatha.)
- UHLAZIYO (2013) - Isiko seSizwe seMpilo yengqondo (i-NIMH): I-DSM iphosakele kwaye iphelelwe yisikhathi.
- PHAMBISA (2016) -Iphepha eliqwalaselwe ngontanga ngu UDLM-5 ilungu leqela lomsebenzi wezocansi uRichard Krueger MD: Ukuxilongwa koxhatshazo okanye uxanduva lokuziphatha ngokwesondo kungenziwa ngokusebenzisa i-ICD-10 kunye ne-DSM-5 nxamnye nokuchaswa kwesi sifo kwi-American Psychiatric Association
- UHLAZIYO (2018) - Ukuxilongwa ngokusemthethweni? Incwadi yokusetyenziswa kwezifo zonyango ngokubanzi, Ulwahlulo lwaMazwe ngamazwe (ICD-11), iqulethe uvavanyo olutsha esifanelekile ukuxhatshazwa koononophelo okanye ukuxhatshazwa ngokwesondo: "Ukuxhatshazwa kwezesondo ngokunyanisekileyo. "(2018)
Qhagamshelana kwiwebhusayithi ye-ASAM
- Ii-FAQ ze-ASAM kwinkcazo: Inkcazo ye-ASAM yoTywala -Imibuzo ebuzwa rhoqo (ngo-2011)
- I-ASAM Inkcazo yokuLawulwa kweNgcaciso entsha: I-ASAM yokuLawulwa kweeNkcazo (2011)
- Inqaku elihle kakhulu kwintetho kunye nesitatimende somgaqo-nkqubo: Iingcali eziPhambili zaseMelika (i-ASAM) zisandula ukukhupha iNkcazo eNtsha yokuThoba iziyobisi (ngo-2011)
Amanqaku amabini ngeYBOP esuka kwi-2011:
- Ukucima iincwadi zakho zeencwadi: Amadokhumenti aphinde ahlaziye iziLawuli zoLuntu (2011). I-American Society of Addiction Medicine iyavuma ukungavumelani ne-DSM
- Ngaba Unamathele kwiSono? Buza i-ASAM (2011). Abasebenzisi beSonografi bachaza oko kuthanda ukuxhamla
Ukuphela komgca we-DSM:
Inkcazo yomgaqo-nkqubo kaRhulumente: Inkcazo yokuLungisa (i-Long Version)
Ukulutha sisifo esiyintloko, esingapheliyo somvuzo wobuchopho, ukukhuthaza, inkumbulo kunye nokujikeleza okuhambelana. Iziyobisi zichaphazela i-neurotransuction kunye nokunxibelelana ngaphakathi kwamanqanaba omvuzo wobuchopho, kubandakanya i-nucleus accumbens, i-cterex ye-cterxe yangaphambili, i-basal forebrain kunye ne-amygdala, ezinokuthi i-hierarchies eziguqulweyo kunye neendlela zokuziphatha ezichasayo, ezinokuthi okanye zinokuthi zingabandakanyi utywala kunye nokunye ukusebenzisa iziyobisi, ukugqithisa okunempilo , indlela yokuziphatha enxulumene nokuzikhathalela. [Kwaye] umlutha uchaphazela ne-neurotransuction kunye nokusebenzisana phakathi kwesekethe kunye ne-hippocampal circuits kunye nemilo yomvuzo wobuchopho, ukuze imemori yokuvezwa kwangaphambili komvuzo (ezifana nokutya, isondo, utywala kunye nezinye iziyobisi) kukhokelela ekuphenduleni kwezinto eziphilayo kunye nokuziphatha kwimiqathango yangaphandle, ngokubangela ukukhanga kunye / okanye ukubandakanyeka ekuziphatheni komlutha.
I-neurobiology yeziyobisi iquka ngaphezulu kwe-neurochemistry yomvuzo. (1) I-cortex engaphambili yengqondo kunye nokusekwa kwemicimbi emhlophe phakathi kwecortex yangaphambili kunye nemijikelezo yomvuzo, inkuthazo kunye nenkumbulo zibalulekile ekubonakalisweni kolawulo lwempembelelo eguqulweyo, isigwebo esitshintshiweyo. , kunye nokusukela okungafunekiyo kwemivuzo (ehlala ifunyanwa ngumntu ochaphazelekayo njengomnqweno wokuba "uqheleke") ubonwa kumlutha-ngaphandle kweziphumo ezibi ezifumanekayo zokuzibandakanya ekusebenziseni iziyobisi nakwezinye iindlela zokuziphatha.
Iindawo zokubambisa ezingaphambili zibalulekile ekuthinteleni ukunyanzeliswa nasekuncedeni abantu ukuba balibazise ngokufanelekileyo ukuzonwabisa. Xa abantu abanengxaki yokulutha babonisa iingxaki ekudluliseleni ukwaneliseka, kukho indawo ekuza kubakho kuyo kwezi ngxaki kwi-cortex yangaphambili. Frogal lobe morphology, uqhagamshelo kunye nokusebenza kusekule nkqubo yokuvuthwa ngexesha lokufikisa kunye nokuba mdala, kunye nokubonisa kwangoko ukusetyenziswa kweziyobisi yenye into ebalulekileyo kuphuhliso lweziyobisi. Uninzi lweengcali ze-neuroscientist zikholelwa ukuba ukukhula kwe-morphology sisiseko esenza ukuba ukubonakaliswa kobomi kwangethuba kubaluleke kangako.
Imiba ye-Genetic iphendula malunga nesiqingatha sobunzima ukuba umntu uya kuhlakulela umlutha. Imiba yokusingqongileyo ibandakanyeka ne-biology yomntu kwaye ithintela ubukhulu bezinto eziphathekayo. Izibonelelo ezithatha umntu (ngokufumana umzali okanye amava okuphila kamva) zingathintela ubukhulu obunjani bokuthi izidalwa zendalo zikhokelela ekuziphatheni nasekunye ukubonakaliswa kokulutha. INkcubeko nayo idlala indima kwindlela umlutha uqhutyelwa ngayo kubantu abanobungozi bezinto eziphilayo ekuphuhliseni umlutha.
Ezinye izinto ezinokubangela ukubonakala komlutha, ezikhokelela ekubonakalweni kwayo kwezinto ezibonakalayo ze-bio-psycho-socio-spirituals, zibandakanya:
a. Ubukho benkcitho yezinto eziphilayo ezingaphantsi komsebenzi wemibhobho yomvuzo, njengokuba izidakamizwa kunye nokuziphatha okuphakamisa umsebenzi wokuvuza zikhethwa kwaye zifunwa njengabaqinisekisi;
b. Ukubandakanya ngokuphindaphindiweyo ekusebenziseni iziyobisi okanye kwezinye iziphathamandla zokulutha, kubangele ukungabikho kwintsebenziswano kwesekethe ezikhuthazayo ezikhokelela ekulawuleni okungekho ukusetyenziswa kokusetyenziswa kweziyobisi okanye ukubandakanyeka ekuziphatheni komlutha;
c. Ukuphazamiseka kwengqondo kunye nokuphazamiseka, okuphazamisa imbono kunye nokunciphisa ukukwazi ukujongana neemvakalelo, okubangele ukukhohlisa;
d. Ukuphazanyiswa kweenkxaso zentlalo kunye neengxaki kwiintsebenziswano zontsebenziswano ezichaphazela ukuphuhliswa okanye impembelelo yokuqina;
e. Ukubonakalisa ukuxhatshazwa okanye uxinzelelo oludityanisela amandla okukhusela umntu;
f. Ukuphazamiseka ngentsingiselo, injongo kunye nezithethe ezikhokela iingcinga, ukucinga nokuziphatha;
g. Ukuphazamiseka ekuxhaseni komntu kunye nabanye, kunye nabanye abahamba phambili (ekuthiwa nguThixo ngabaninzi, Amandla aphakamileyo ngamaqela e-12-amaqela, okanye ukuqonda kwabanye); kwaye
h. Ubungqina beengxaki zokugula ngengqondo kubantu ababandakanya ukusetyenziswa kweziyobisi okanye ezinye iimpawu zokulahla.
Umlutha ubonakaliswe ngu-ABCDE (bona #2 ngezantsi):
a. Ukungakwazi ukwenza ngokufanayo uAbstain;
b. Ukuphazamiseka kolawulo lokuziphatha;
c. Ukuthanda; okanye ukwanda "kwindlala" kwiziyobisi okanye amava avuzayo;
d. Ukuqaphela ukubaluleka kweengxaki ezibalulekileyo ngokuziphatha kwabantu kunye nobudlelwane phakathi kwabo; kwaye
e. Impendulo engavumelekanga Yemvakalelo.
Amandla angaphandle angabangela ukukhanga nokusetyenziswa kwezidakamizwa, kunye nokwandisa imvama yokubandakanyeka kwezinye iziganeko zokulutha, kunye nesimo sokuxilonga, kunye ne-hippocampus ibalulekile ekukhunjweni kwamava amandulo okanye amava ahlaselekileyo, kunye i-amygdala ibalulekile ekubeni nefuthe lokugxila ekukhetheni iziphathamandla ezihambelana namava adlulileyo.
Nangona abanye bakholelwa ukuba umehluko phakathi kwabo banomlutha, kunye nabangenayo, ubungakanani okanye ubukhulu bokusetyenziswa kotywala / iziyobisi, ukubandakanyeka ekuziphatheni komlutha (njengokungcakaza okanye ukuchitha imali) (3), okanye ukuvezwa kwezinye iintlawulo zangaphandle (njengokutya okanye ngesondo), uhlobo lwesimo sokuxhatshazwa yindlela yokwenza umntu aphendule ngayo ukuchazwa, ukuxinezeleka kunye neengongoma zendalo. Inkalo ekhethekileyo yentsholongwane yendlela abantu abanomlutha abaphishekela ukusetyenziswa kweziyobisi okanye iimbuyekezo zangaphandle kukuba ukukhathazeka kunye / okanye ukulandela imiphumo (umzekelo, utywala kunye nezinye iziyobisi) ziyaqhubeka nangona ukuhlanganiswa kwemiphumo emibi. Ezi zibonakaliso ziyakwenzeka ngokunyanzeliswa okanye ngokukhawuleza, njengombonakalo wokulawulwa kakubi.
Umngcipheko oqhubekayo kunye / okanye ukuphindaphinda kokuphindaphinda, emva kwexesha lokuziyeka, yinto enye ebalulekileyo yokulutha. Oku kungabangela ukubonakalisa izinto ezivuzayo kunye nokuziphatha, ngokuchazwa kwimiba yokusingqongileyo yokusetyenziswa, kunye nokuvezwa kwezixinzelelo zengqondo ezibangelwa umsebenzi ophakamileyo kwizijikelezo zengqondo. (4)
Ngomlingo kukho ukuphazamiseka okuphawulekayo ekusebenzeni okulawulayo, okubonakalisa iingxaki ngokuqonda, ukufunda, ukunyanzelisa, ukunyanzelisa, kunye nokugweba. Abantu abanomlingo bavame ukubonakalisa ukulungelelanisa okuphantsi ukuguqula iziphathamandla zabo ezingafanelekanga naphezu kokukhathazeka okuboniswa ngabanye ababalulekileyo ebomini babo; kwaye ubonise ukungabikho kokuxabisa kokubaluleka kweengxaki kunye neengxaki. I-lobes eqhubekayo yokuphuhlisa i-lobes yabantwana abakwishumi elivisayo inokubambisa ezi zintlupheko ekusebenzeni okulawulayo kwaye zenze ukuba abatsha bazibandakanye "ukuziphatha okuphezulu," kuquka ukubandakanywa kotywala okanye ezinye iziyobisi. Ukuqhuba ngamandla okanye ukufuna ukusebenzisa izinto okanye ukubandakanyeka ekuziphatheni okuvuzayo okubonakalayo, okubonakala kwizigulane ezininzi ezinomlutha, kugxininisa imimiselo enyanzelekileyo okanye engavumelekanga kwesi sifo. Oku kukudibanisa "nokungenamandla" ngaphezu komlutha kunye "nokungazinyathelo" zobomi, njengoko kuchazwe kwiNyathelo 1 yeenkqubo ze-12 zeNkqubo.
Umlutha ungaphezu kweengxaki zokuziphatha. Izixhobo zobunzima ziquka iinkalo zomntu umntu aziphathe ngayo, iingcamango, iimvakalelo kunye nokusebenzisana nabanye, kubandakanye nokukwazi komntu ukuhambelana namalungu entsapho, kumalungu omphakathi, kwiimeko zabo zengqondo kunye nezinto ezithatha imihla ngemihla amava.
Ukubonakaliswa kokuziphatha kunye neengxaki zokulutha, ngokukodwa ngenxa yokulawulwa kakubi, kunokuquka:
a. Ukusetyenziswa okugqithisileyo kunye / okanye ukubandakanyeka ekuziphatheni okuluthayo, kwiimfono eziphezulu kunye / okanye ubuninzi kunomntu ohlosiweyo, ngokuqhelekileyo unxulumene nomnqweno oqhubekayo wokuzama ukulawula ukuziphatha;
b. Ixesha eligqithiseleyo lahleka ngokusetyenziswa kweziyobisi okanye ukubuyisela kwimiphumo yokusetyenziswa kweziyobisi kunye / okanye ukubandakanyeka ekuziphatheni izilonda, kunye nefuthe elibi kakhulu kwimisebenzi yentlalo kunye nokusebenza (umz. Ukuphuhliswa kweengxaki zobudlelwane phakathi kwabantu okanye ukunyanzeliswa kweembopheleleko ekhaya, kwisikolo okanye emsebenzini );
c. Ukusetyenziswa okuqhubekayo kunye / okanye ukuthatha inxaxheba ekuziphatheni komlutha, nangona kubakho ubunzima obuqhubekayo okanye obunokuphindaphindiweyo ngokomzimba okanye engokwengqondo obunokubangela okanye ukunyusa ngokusetyenziswa kweziyobisi kunye / okanye iimpawu zokuxhatshazwa;
d. Ukunciphisa i-repertoire yokuziphatha igxile kwimiphumo eyingxenye yomlutha; kwaye
e. Ukungabikho kwamandla kunye / okanye ukulungele ukuthatha isenzo esifanelekileyo, esilungelelanisayo nangona kuqaphela iingxaki.
Izinguqu ezinokwenkcenkcesha kwi-addiction zingabandakanya:
a. Ukukhathazeka ngokusetyenziswa kweziyobisi;
b. Ukuphonononga okutshintshileyo kwezibonelelo ezinxulumene kunye neziphumo ezinxulumene neziyobisi okanye iziphatho ezivuzayo; kwaye
c. Inkolelo engaqinisekiyo yokuba iingxaki ezenzeka ebomini bomntu zibangelwa ezinye izizathu kunokuba zibe ngumphumo wokuxilisa.
Utshintsho lwengqondo kumlutha lungabandakanya:
a. Ukuxhalabisa, ukunyuka kwengqondo kunye nentlungu;
b. Ukwenyuka kwengqondo kwiingcinezelo ezinxulumene nokuqashwa kweenkqubo zoxinzelelo lweengqondo, ezifana nokuba "izinto zibonakala zinzima kakhulu" ngenxa yoko; kwaye
c. Ubunzima ekuchazeni iimvakalelo, ukuhlula phakathi kwemizwa kunye nokuvakalelwa komzimba kokuvusa ingqondo, nokuchaza iimvakalelo kwabanye abantu (ngamanye amaxesha kuthiwa yi-alexithymia).
Iimpawu zengxaki yokuxilisa ziyinkimbinkimbi. Abanye abantu basebenzisa utywala okanye ezinye iziyobisi okanye baphinde baphishekele eminye imivuzo ngenxa yokuba bafuna "ukuqiniswa okuqinisekileyo" okanye ukudala isimo sengqondo esifanelekileyo ("ukunyamezela"). Abanye baphishekela ukusetyenziswa kweziyobisi okanye neminye imivuzo kuba baye bafumana uxolo kwiimeko eziphazamisayo ("i-dysphoria"), ebonisa ukuba "ukuqiniswa okungalunganga." Ngaphandle kwamathuba okuqala okufumana umvuzo kunye nokukhululeka, kukho isimo sengqondo esingasebenzi kakuhle kwiimeko ezininzi zokuxhatshazwa ehambelana nokuphikelela kokubandakanyeka nokuziphatha okuluthayo.
Umoya wokulutha umlingo awufani nendawo yokuxila. Xa umntu ufumana ukuxiliswa ngokucokisekileyo ngokusetyenziswa kotywala okanye ezinye iziyobisi, okanye xa umntu engenazo izifo ezinokubakho umlutha okanye ukutya, umntu unokufumana "phezulu", abe nomuvo "omoya" wesimo sengqondo ehambelana nokunyuka kwe-dopamine kunye ne-opioid peptide umsebenzi kumasekethe omvuzo. Emva kwesova, kukho umonakalo we-neurochemical, apho umsebenzi wokuvuza awuyi kubuyiselwa kwinqanaba elisezantsi, kodwa ngokuphindaphindiweyo wehla ngaphantsi kwamazinga okuqala. Oku kudla ngokungaqondakaliyo ngabanye kwaye akuhambelananga nxamnye nokukhubazeka okusebenzayo.
Ixesha elingaphezulu, amava aphindaphindwayo ngokusetyenziswa kweziyobisi okanye isimilo esixhaphakileyo asidibani nomsebenzi owandayo womjikelezo kwaye awonwabisi kwaphela. Xa umntu efumana ukurhoxa ekusetyenzisweni kweziyobisi okanye kwiindlela zokuziphatha ezinokuthelekiswa, kukho unxunguphalo, ukuphazamiseka, ukudakumba kunye namava emvakalelo, onxulumene nomvuzo ongaphantsi kunye nokufunyanwa kwengqondo neenkqubo zoxinzelelo lwehomoni, ezinxulunyaniswa nokurhoxa phantse kuzo zonke iiklasi zonyango iziyobisi. Ngelixa ukunyamezelana kukhula ukuya “phezulu,” ukunyamezelana akukukhuli ukuya “kuphantsi” okunxulunyaniswa nomjikelezo wokunxila kunye nokurhoxa.
Yiyo loo nto, kumlutha, abantu bephinda-phinda bezama ukwenza "phezulu" -kodwa eyona nto banamava kuyo kukuba nzulu kwaye kunzulu "phantsi." Ngelixa nabani na enokufuna "ukuphakama", abo banomlutha baziva "isidingo" sokusebenzisa iziyobisi okanye ukuzibandakanya nokuziphatha gwenxa ukuzama ukusombulula imeko yabo yeemvakalelo okanye iimpawu zomzimba zokurhoxa. Abantu abanomlutha basebenzise ngokunyanzelekileyo nangona isenokungabenzi bazive bonwabile, kwezinye iimeko ixesha elide emva kokufuna "umvuzo" ayisiyiyo kwaphela eyonwabisayo. (5) Nangona abantu bayo nayiphi na inkcubeko banokukhetha "ukuphakama" komnye okanye komnye. Umsebenzi, kubalulekile ukuba uqonde ukuba umlutha ayisiyiyo kuphela into oyikhethayo. Ukubeka nje, ukuba likhoboka akuyiyo imeko oyifunayo.
Njengoko umlutha uyisifo esingapheliyo, ixesha lokuphindaphinda, elingaziphazamisa ukuphazamiseka, luyinto eqhelekileyo yokulutha. Kwakhona kubalulekile ukuqaphela ukuba ukubuyela ekusebenziseni iziyobisi okanye ukuphishekela imithwalo yembuyekezo akunakwenzeka.
Ukungenelela kwezonyango kunokusebenza kakuhle ekutshintsheni inkqubo yokulutha. Vala ukubeka esweni iimpawu zokuziphatha komntu ngamnye kunye nokulawulwa kwemigqaliselo, ngamanye amaxesha kubandakanye nemiphumo yokuziphatha yokuphindaphinda ukuziphatha, kunokufaka isandla kwimiphumo emihle yeeklinikhi. Ukuzibandakanya kwimisebenzi yokukhuthazwa kwempilo ekhuthaza ukuxanduva lomntu kunye nokuphendula, ukuxhamla nabanye kunye nokukhula komntu siqu kubangela ukuba abuyele. Kubalulekile ukuqaphela ukuba umlutha ungabangela ukukhubazeka okanye ukufa kwangaphambili, ingakumbi xa kushiywe kungaphathwa kakubi okanye kungaphathwa kakubi.
Izindlela zobunjani apho iingqondo kunye nokuziphatha kwindlela yokuphendula ukusetyenziswa kweziyobisi kunye nokubandakanyeka ekuziphatheni izilingo zihluke kwiimigangatho ezilandelayo zokuxilisa kunezigaba zangaphambili, ezibonisa ukuqhubela phambili, okungekho kubonakala ngokugqithiseleyo. Njengoko kunjalo nakwezinye izifo ezingapheliyo, imeko kufuneka ilandelwe kwaye ilawulwe ngokuhamba kwesikhathi ukuba:
a. Ukunciphisa ubukhulu kunye nobukhulu bokuphindaphinda;
b. Ukugcinwa kwexesha lokuxolelwa; kwaye
c. Ukuphucula izinga lomntu lokusebenza ngexesha lokuxolelwa.
Kwezinye iimeko zomlutha, ukulawulwa kwamachiza kunokuphucula iziphumo zonyango. Kwiimeko ezininzi zokuxhatshazwa, ukuhlanganiswa kokuvuselelwa kwengqondo kunye nokunyamekela okuqhubekayo kunye neyeza-based medical treatment based provides the best results. Ukulawulwa kwezifo ezingapheliyo kubalulekile ekunciphiseni iipasiti zokuphindaphinda kunye nefuthe labo. Ukunyangwa komlingo kusindisa ubomi †
Abaqeqeshi bezobisi kunye nabantu abayifumanayo bayazi ithemba elitholakala ekubuyiseni. Ukubuyisela kufumaneka kubantu abangekho ekuqaleni ukuba bakwazi ukuqonda le nethemba, ngakumbi xa kugxininiswa kwimiphumo yempilo kwisifo soxilongo. Njengoko kwezinye iimeko zempilo, ukulawulwa ngokwabo, ngokuxhasana, kubaluleke kakhulu ekubuyiseleni kwi-addiction. Inkxaso yoontanga efana neyokufunyanwa kwizinto ezahlukeneyo "zokuncedisa" inenzuzo ekuphuculeni isimo sezempilo kunye neziphumo ezisebenzayo zokubuyiselwa. ‡
Ukubuyiselwa kwisilonda kuphunyezwe kakuhle ngokubambisana nokuphathwa, ukuxhaswa kunye kunye nokunyamekelwa kobugcisa obubonelelwe ngabaqeqeshi abaqeqeshiwe nabaqinisekisiweyo.
Amagama achazayo e-ASAM:
1. I-neurobiology yomvuzo iye yaqondwa kakuhle ngamashumi eminyaka, kanti i-neurobiology ye-addiction isacatshungulwa. Uninzi lweekliniki zifunde ngemiphumo yomvuzo kuquka iinkalo ezivela kwingingqi ye-ventral (VTA) yengqondo, ngokusebenzisa umthwalo we-median forebrain (MFB), kunye nokuphela kwe-nucleus accumbens (i-Nuc Acc), apho i-dopamine neurons evelele. I-actuology neuroscience iyaqaphela ukuba i-neurocircuitry yomvuzo iquka neesekethe ezizizityebi ezihamba phambili ezidibanisa i-nucleus accumbens kunye ne-basal forebrain. Umgcini wesiphaluka apho umvuzo ubhalisiwe, kwaye apho imiphumo eyona mivuzo efana nokutya, i-hydration, isondo, kunye nokukhulisana kusebenza ngamandla.
Utywala, iicicin, nezinye iziyobisi kunye neengxaki zokugembula zengcambu zenza imiphumo yazo yokuqala ngokuthatha umvuzo ofanayo ojikelezayo ovela kwingqondo ukwenza ukutya kunye nesondo, umzekelo, ukuqinisa ngakumbi. Eminye imiphumo, njengobunxila kunye novuyo lwengqondo oluvela kwimiphumo, kuvela ekusebenziseni isiphaluka somvuzo. Nangona ukuxhatshazwa kunye nokuhoxiswa kuqondwa kakuhle ngokufunda umgca wesiphaluka, ukuqonda umlutha kudinga ukuqonda inethiwekhi ebanzi yobunxibelelwano be-neural obubandakanya i-forebrain kunye nezakhiwo ze-midbrain. Ukukhethwa kwemivuzo ethile, ukuxhalabisa ngemiphumo ethile, impendulo ekubangela ukuba kube nemiphumo ethile, kunye nezizathu zokukhuthaza ukusetyenziswa kotywala kunye nezinye iziyobisi kunye / okanye ukufuna ezinye iimvuzo, ziquka indawo ezininzi zeengqondo ngaphandle komvuzo we-neurocircuitry ngokwawo.
2. Ezi zinto zintlanu azenzelwanga yi-ASAM ukuba zisetyenziswe njenge- "diagnostic criteria" ukumisela ukuba umlutha ukhona okanye awukho. Nangona ezi zinto ziphawulekayo kwiimeko ezininzi zokuxhatshazwa, kungakhathaliseki ukuba i-pharmacology yokusetyenziswa kwezinto ezibonakalayo kwi-addiction okanye umvuzo osuselwa emva kwentsholongwane, nganye into ayinakufaneka nakwiimeko zonke. Ukuxilongwa komlingo kudinga uvavanyo olubanzi lweengqondo, lwengqondo, lwentlalo kunye nolwasemoyeni ngumqeqeshi oqeqeshiwe kwaye oqinisekisiweyo.
3. Kolu xwebhu, igama elithi "isimilo sokuziphatha" libhekisa kwiindlela zokuziphatha eziqhelekileyo zinomvuzo kwaye ziluphawu kwiimeko ezininzi zokuba likhoboka. Ukubonakaliswa kwezi ndlela zokuziphatha, kanye njengoko kusenzeka ekuvezeni iziyobisi ezinomvuzo, kuququzelela inkqubo yokulutha kunokuba kubangele ukuba likhoboka leziyobisi. Imeko yobuchwephesha bobuchwephesha kunye ne-physiology kukungafani okusisiseko okuthe ngqo kungunobangela weziyobisi. Ke, kolu xwebhu, igama elithi "isimilo sokuziphatha" alibhekiseli kukungasebenzi okanye ukungaziphathi kakuhle ekuhlaleni, okunokubonakala kwiimeko ezininzi zokuba likhoboka. Ukuziphatha, njengokunganyaniseki, ukwaphula amaxabiso omnye okanye amaxabiso abanye, izenzo zolwaphulo-mthetho njl.njl. ezi zijongwa ngcono njengeengxaki ezibangelwa endaweni yokuba negalelo kumlutha.
4. I-anatomy (i-circuit circuit involved) kunye ne-physiology (i-neuro-transmitters) uphando.
- Ukubuyela umva kubangelwe kukuchaphazeleka kweziyobisi ezikhobokisayo / ezinomvuzo, kubandakanya notywala, kubandakanya i-nucleus accumbens kunye ne-VTA-MFB-Nuc Acc neural axis (ingqondo ye-mesolimbic dopaminergic "incentive salience circry" -bona umbhalo osemazantsi 2 ngasentla). Ukuphinda ubuye kubangele ukubuyela umva kwakhona kulungelelaniswe nemijikelezo ye-glutamatergic eqikelela kwi-nucleus accumbens evela kwi-cortex yangaphambili.
- Ukuphindaphinda okubangelwa ukutyhila kwiimpawu ezisemgangathweni ezisuka kwimimandla kubandakanya i-glutamate circuits, ezivela kwi-cortex yangaphambili, i-insula, i-hippocampus kunye ne-amygdala ecwangcisa ukuqhubela phambili kwesekethe.
- Ukuphindaphinda okubangelwa ukutyhila kumava okuxinzelelekileyo kubandakanya izijikelezo zengqondo ngaphaya kwe-hypothalamic-pituitary-adrenal axis eyaziwa ngokuba yingundoqo yenkqubo yokuxinwa kwe-endocrine. Kukho ezimbini zezi zihlandlo zokuvuselela iingqondo zengqondo - enye ivela kwi-nucleus ye-noradrenergic i-A2 kwingingqi yecala yengqondo yengqondo kunye neeprojekthi kwi-hypothalamus, i-nucleus accumbens, i-cortex yangaphambili kunye ne-nucleus yebhedi ye-stria terminalis, kwaye isebenzisa i-norepinephrine njenge-neurotransmitter; enye ivela kwi-nucleus ephakathi ye-amygdala, iiprojekthi kwi-nucleus yebhedi ye-stria terminalis kwaye isebenzisa i-corticotrophin-release release (CRF) njenge-neurotransmitter.
5. Umvuzo wokulandela ngokwenzululwazi (okhankanyiweyo kwiNgxelo emfutshane yale nkcazo ye-ASAM) ke unamacandelo amaninzi. Ayisiyombali yokuvezwa komvuzo (umzekelo, umthamo wechiza) okanye uburhabaxa okanye ubude bexesha lokuvezwa okukuko kwe-pathological. Ngokombulo, ukulandela umvuzo kuqhubekeka, nangona iingxaki zobomi ziqokelelana ngenxa yokuziphatha okuluthayo, nokuba ukubandakanyeka ekuziphatheni kuyayekiswa. Ngokunjalo, kumanqanaba angaphambili okulutha, okanye kwanangaphambi kokuba kubonakaliswe ukubonakaliswa kwangaphandle kotywala, ukusetyenziswa kweziyobisi okanye ukubandakanyeka kwiindlela zokuziphatha ezinobuthathaka kunokuba ngumzamo wokulandela ukukhululeka kwidysphoria; ngexa kumanqanaba okugqibela esi sifo, ukubandakanyeka kwiindlela zokuziphatha ezimbi kungaqhubeka nangona isimilo singasaboneleli.
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