IZIMPENDULO: Incazelo entsha ye-ASAM "yokulutha umlutha" (Agasti 2011) iqeda impikiswano mayelana nokulutha kokuziphatha, kubandakanya ucansi nokulutha kocansi. Le ncazelo entsha yokulutha, ehlanganisa ukulutha kokuziphatha, njengokudla, ukugembula kanye nezocansi, i-ASAM ngokungangabazeki ithi izilingo zokuziphatha zibandakanya ukuguqulwa kobuchopho okufanayo nezindlela ze-neural njengezidakwa zezidakamizwa. Sikholelwa ukuthi umlutha wezocansi we-Intanethi akufanele ube ngaphansi kwesambulela sokulutha ngokocansi. Iningi lamadoda ababa umlutha wezithombe zobulili ezingcolile abengeke abe yizilonda zocansi ukube abephila esikhathini sangaphambi kwe-Intanethi. (Nginezinkomba ezibhalwe ngomqondo ezithile zokulutha okuthile kokuziphatha.)
- QAPHELA (2013) - I-National Institute of Health Mental (NIMH): I-DSM iphutha futhi iphelelwe yisikhathi.
- QAPHELA (2016) - Iphepha elibukezwe ngontanga ngu I-DSM-5 ilungu leqembu lesisebenzi socansi uRichard Krueger MD: Ukuxilongwa kwe-hypersexual noma ukuziphatha kocansi okuphoqeleka kungenziwa ngokusebenzisa i-ICD-10 ne-DSM-5 naphezu kokulahla lokhu okuxilongwa yi-American Psychiatric Association
- QAPHELA (2018) - Ukuxilongwa okusemthethweni? Umbhalo wezokwelapha wezokwelapha osetshenziswa kakhulu emhlabeni, I-International Classification of Diseases (ICD-11), iqukethe ukuxilongwa okusha kufanelekile ukubheja kwezicansi noma ukulutha ngokobulili: "Ukucindezeleka Ngokuziphatha Ngokwemvelo. "(I-2018)
Xhumanisa kuwebhusayithi ye-ASAM
- Imibuzo evame ukubuzwa ye-ASAM encazelweni: Incazelo ye-ASAM Yokulutha Umlutha - Imibuzo Ebuzwa Njalo (2011)
- I-ASAM Press Release ngencazelo entsha: I-ASAM Press Release (i-2011)
- Isihloko esihle kakhulu sencazelo nesitatimende senqubomgomo: Ochwepheshe Abakhulu BaseMelika (ASAM) Usanda Kukhipha Incazelo Entsha Yokushaywa Komlutha (2011)
Izihloko ezimbili ze-YBOP kusuka ku-2011:
- Toss Amabhuku Wakho Okubhaliwe: Amadokhumenti Aphinde Ahlukanise Izidakamizwa Zokuziphatha Ngocansi (2011). I-American Society of Addiction Medicine ivuma ukungavumelani ne-DSM
- Ingabe Ukhunjulwe Ezingcolile? Buza i-ASAM (2011). Abasebenzisi be-Porn bachaza lokho okuthandana ukuyobamba khona
Ukuphela komugqa we-DSM:
Isitatimende Senqubomgomo Yomphakathi: Incazelo Yokwehla (Isikhathi Eside)
Umlutha isifo esiyisisekelo, esingamahlalakhona somvuzo wobuchopho, isisusa, inkumbulo nokujikeleza okuhlobene. Umlutha uthinta i-neurotransication kanye nokusebenzisana ngaphakathi kwengqondo yomvuzo, kufaka phakathi i-nucleus accumbens, i-cortex cterex yangaphandle, i-basal forebrain kanye ne-amygdala, okuthi ukuguqulwa kwama-hierarchies kuguqulwe futhi kube yimikhuba yokuziphatha, engahle noma ingahlanganisi utshwala nokunye ukusetshenziswa kwezidakamizwa, kuqhubeke kube nempilo enhle , ukuziphatha okuhlobene nokuzikhathalela. [Futhi] umlutha futhi uthinta i-neurotransication kanye nokuxhumana phakathi kokujikeleza kwe-cortical ne-hippocampal kanye nezakhiwo zomvuzo wobuchopho, ukuze inkumbulo yokudalulwa kwangaphambilini yemivuzo (njengokudla, ubulili, utshwala nezinye izidakamizwa) kuholela ekuphenduleni kwezinto eziphilayo nezokuziphatha ezibhekiswe ngaphandle, okubangela ukuthanda kanye / noma ukubandakanya ekuziphatheni okuluthayo.
I-neurobiology yokulutha ihlanganisa ngaphezu kwe-neurochemistry yomvuzo. (1) I-cortex engaphambili yobuchopho nokuxhumeka okuyizinto ezimhlophe phakathi kwe-cortex engaphambili namasekethe omvuzo, ukugqugquzela kanye nenkumbulo kubalulekile ekubonakalisweni kokulawulwa kwethonya eliguquliwe, ukwahlulela okushintshiwe , nokuphishekela ukungasebenzi kahle kwemivuzo (okuvamise ukubonwa ngumuntu othintekile njengesifiso sokuba "ovamile") ebonwa ekuluthekeni – naphezu kwemiphumela emibi ekhulayo etholwa ukubandakanyeka ekusetshenzisweni kwezidakamizwa nakwezinye izindlela zokuziphatha eziluthayo.
Ama-lobes angaphambili abalulekile ekuvimbeleni ukushukumiseka nasekusizeni abantu ukubambezeleka okufanele kokugculiseka. Lapho abantu abanomlutha bebonisa izinkinga ekudluliseleni ukwaneliseka, kuba khona indawo yezinzwa yalezi zinkinga ku-cortex yangaphambili. I-Frontal lobe morphology, ukuxhumeka kanye nokusebenza kwayo kusesimweni sokuvuthwa kokukhula kobuntwana kanye nokuba mdala, kanye nokuchayeka ekuqaleni ukusetshenziswa kwezidakamizwa kungenye into ebaluleke kakhulu ekuthuthukiseni umlutha. Izazi eziningi ze-neuroscientist zikholelwa ukuthi i-morphology yentuthuko iyisisekelo esenza ukuboniswa kwezinto zakuqala kube yinto ebalulekile.
Izakhi zofuzo zenza cishe ingxenye yesipiliyoni sokuthi umuntu uzokuhlakulela ukulutha. Izimo zemvelo zihlangana nobuntu bomuntu futhi zithinte izinga lapho izakhi zofuzo zithonya khona. Izinzuzo umuntu azizuza (ngokusebenzisa ukubeletha noma okuhlangenwe nakho kwesikhathi esizayo) zingathinta izinga lapho izakhi zofuzo ziholela ekuziphatheni nakwezinye izibonakaliso zokulutha. Amasiko nawo athatha indima ekutheni umlutha usebenza kanjani kubantu abanokukhubazeka kwemvelo ekuthuthukiseni umlutha.
Ezinye izici ezingabangela ukubonakala komlutha, okuholela ekubonisweni kwayo kwe-bio-psycho-socio-spirituals, kufaka:
a. Ukuba khona kwezinto eziphilayo ezingezansi ekusebenzeni kwezijikelezi zemivuzo, njengokuthi izidakamizwa kanye nokuziphatha okukhulisa umsebenzi wokuvuza zikhethwa futhi zifunwa njengabaqinisekisi;
b. Ukuzibandakanya okuphindaphindiwe ekusebenziseni izidakamizwa noma ezinye izimo zokulutha, okubangela ukungahambi kahle kwezikhungo ezigqugquzelayo okuholela ekulawuleni okungekho emthethweni ekusetshenzisweni okunye kwezidakamizwa noma ukubandakanyeka ekuziphatheni okuluthayo;
c. Ukuphazamiseka kwengqondo nokuphazamiseka, okuphazamisa imibono nokunciphisa ikhono lokubhekana nemizwa, okuholela ekukhohliseni okuphawulekayo;
d. Ukuphazanyiswa kwezinsizakalo ezempilo ezenhlalakahle nezinkinga ebuhlotsheni bomphakathi obuthinta ukuthuthukiswa noma umthelela wokuphelelwa amandla;
e. Ukuvezwa kokuhlukunyezwa noma ukucindezeleka okuphazamisa amakhono okubhekana nomuntu;
f. Ukuphazamisa ngenhloso, inhloso kanye nemigomo ehola izimo zengqondo, ukucabanga nokuziphatha;
g. Ukuphazamiseka ekuxhumaneni komuntu nomuntu siqu, nabanye kanye nalabo abadlula phambili (okubhekwa ngokuthi nguNkulunkulu ngabaningi, Amandla aphakeme kakhulu ngamaqembu we-12-amaqembu, noma ukuqonda okuphakeme kwabanye); futhi
h. Ukutholakala kokukhathazeka kwengqondo kubantu abasebenzisa izidakamizwa noma ezinye izimo zokulutha.
Isiyaluyalu sibonakala nge-ABCDE (bona #2 ngezansi):
a. Ukuhluleka ukuhlala njalo u-Abstain;
b. Ukukhubazeka ekulawuleni ukuziphatha;
c. Ukuthanda; noma ukwandisa "indlala" yezidakamizwa noma okuhlangenwe nakho okuvuzayo;
d. Ukunciphisa ukuqashelwa kwezinkinga ezibalulekile ngokuziphatha komuntu kanye nobuhlobo bomuntu siqu; futhi
e. Impendulo engavumelekile Yomzwelo.
Amandla angamazwi angaphandle okubangela ukukhanga nokusetshenziswa kwezidakamizwa, kanye nokwandisa imvamisa yokubandakanyeka kwezinye izimo zokulutha, okungumkhuba wokulutha umlutha, kanti i-hippocampus ibalulekile ekukhunjweni okuhlangenwe nakho kwangaphambilini noma okubuhlungu, futhi i-amygdala ibalulekile ekukhuthazeni ukugqugquzela ekukhetheni ukuziphatha okuhambisana nalokhu okuhlangenwe nakho okudlule.
Nakuba abanye bakholelwa ukuthi umehluko phakathi kwalabo abanomlutha, nalabo abangenayo, ubuningi noma imvamisa yokusetshenziswa kotshwala / izidakamizwa, ukuhlanganyela ekuziphatheni okuluthayo (njengokugembula noma ukuchitha) (3), noma ukuchayeka kwezinye izikweletu zangaphandle (njengokudla noma ubulili), isici esiyinkinga yokulutha umlutha yindlela yokuziphatha lapho umuntu ephendula khona, ukucindezeleka kanye nezindawo ezithinta indawo. Isici esibaluleke kakhulu sokuthi abantu abanomlutha baphishekela ukusetshenziselwa ukusetshenziswa kwezidakamizwa noma umvuzo wangaphandle ukuthi ukukhathazeka kanye nokuzikhandla kanye / noma ukuphishekela imivuzo (isib. Utshwala nezinye izidakamizwa) ziqhubeka naphezu kokuthola imiphumela emibi. Lezi zibonakaliso zingase zenzeke ngokucindezela noma ngokuphazamiseka, njengombonakaliso wokulawulwa ukukhubazeka.
Ingozi eqhubekayo kanye / noma ukuphindaphindiwe kokuphindaphindiwe, emva kwezinkathi zokuziqeda, kuyisici esiyisisekelo sokulutha. Lokhu kungabangela ukuvezwa kwempahla emihle kanye nokuziphatha, ngokuchazwa kwimizila engokwemvelo yokusebenzisa, nangokuveza ukucindezeleka ngokomzwelo okubangela umsebenzi ophakeme emiphakathini yokucindezeleka ebuchosheni. (4)
Ukulutha umuthi kukhona ukukhubazeka okuphawulekayo ekusebenzeni okuphezulu, okubonisa izinkinga zokubona, ukufunda, ukulawula ukucindezela, ukuphoqeleka, nokwahlulela. Abantu abanomlutha ngokuvamile babonisa ukulungela okuphansi ukushintsha ukuziphatha kwabo okungasebenzi kahle naphezu kokukhathazeka okuvezwe ngabanye abavelele empilweni yabo; futhi babonise ukungabi nakubonakala kokubonga ngobukhulu bezinkinga zokuqoqa kanye nezinkinga. Ama-lobes asetshenziselwa ukukhula kwezingane ezisencane angase ahlanganise lezi zinsalela ekusebenzeni okuphezulu futhi ahlele izingane ukuba zihlanganyele "engozini enkulu," kuhlanganise nokubandakanya utshwala noma ukusebenzisa ezinye izidakamizwa. Ukushayela okujulile noma ukufisa ukusebenzisa izinto noma ukuziphatha ngendlela ebonakalayo evuzayo, ebonakala iziguli eziningi ezinomlutha, kugcizelela isici sokuphoqelela noma esiphezulu lesi sifo. Lokhu kuxhunyanwa "nokungenamandla" ngokweqile futhi "ukunganaki" kokuphila, njengoba kuchazwe ku-Step 1 yezinhlelo ze-12 Izinyathelo.
Isiyaluyalu singaphezu kwesifo sokuziphatha. Izici zokulutha umlutha zihlanganisa izici zokuziphatha komuntu, izingxoxo, imizwelo, nokusebenzisana nabanye, kubandakanya ikhono lomuntu lokuxhumana namalungu omndeni wakhe, kumalungu omphakathi wabo, esimweni sabo sengqondo, nasezintweni ezidlula zonke izinsuku zabo isipiliyoni.
Ukubonakaliswa kokuziphatha kanye nezinkinga zokulutha, ngokuyinhloko ngenxa yokulawulwa ukukhubazeka, kungafaka:
a. Ukusetshenziselwa ngokweqile kanye / noma ukubandakanyeka ekuziphatheni okuluthayo, emazingeni aphezulu kanye / noma ubuningi kunomuntu ohlosiwe, okuvame ukuhlotshaniswa nesifiso esiqhubekayo sokuzama imizamo yokulawula ukuziphatha;
b. Isikhathi esiningi kakhulu esilahlekile ekusebenziseni izidakamizwa noma ekubuyiseleni emiphumeleni yokusetshenziswa kwezidakamizwa kanye / noma ukubandakanyeka ekuziphatheni okuluthayo, kanye nomthelela omubi kakhulu ekusebenzeni komphakathi kanye nokusebenza (isib. Ukuthuthukiswa kwezinkinga zobudlelwano bomuntu siqu noma ukunganakwa kwemithwalo yemfanelo ekhaya, esikoleni noma emsebenzini );
c. Ukusetshenziswa okuqhubekayo kanye / noma ukubandakanyeka ekuziphatheni okuluthayo, naphezu kokuba khona kwezinkinga eziqhubekayo ezingokomzimba noma ezingokwengqondo ezingapheli noma eziphindaphindiwe okungenzeka kubangelwe noma kuqhutshwe ngokusetshenziswa kwezidakamizwa kanye / noma ukuziphatha okuhambisana nomlutha;
d. Ukunciphisa umlando wokuziphatha ngokugxila emihlalweni eyingxenye yokulutha; futhi
e. Ukuntuleka okubonakalayo kwekhono kanye / noma ukulungele ukuthatha isinyathelo esifanayo, sokuvuselela naphezu kokuqaphela izinkinga.
Izinguquko ezinengqondo ekugqilazweni zingabandakanya:
a. Ukukhathazeka ngokusetshenziswa kwezidakamizwa;
b. Ukuhlolwa okulingene kwezinzuzo nezihlobo ezihlobene nezidakamizwa noma ukuziphatha okuzuzayo; futhi
c. Inkolelo engalungile ukuthi izinkinga ezenzeka ekuphileni komuntu zibangelwa ezinye izimbangela kunokuba kube umphumela wokulutha.
Izinguquko ezingokomzwelo zokulutha komzimba zingabandakanya:
a. Ukukhathazeka okwandisa, ukucindezeleka nokucindezeleka ngokomzwelo;
b. Ukuzwela okukhulu ekucindezelweni okuhlobene nokuqashwa kwezinhlelo zokucindezeleka kobuchopho, njengokuthi "izinto zibonakala zicindezela" ngenxa yalokho; futhi
c. Kunzima ekuboneni imizwa, ukuhlukanisa phakathi kwemizwa nokuzwa komzimba kokuvusa ngokomzwelo, nokuchaza imizwa kwabanye abantu (ngezinye izikhathi kuthiwa i-alexithymia).
Izimo zomzwelo zokulutha umlutha ziyinkimbinkimbi kakhulu. Abanye abantu basebenzisa utshwala noma ezinye izidakamizwa noma baphishekele eminye imivuzo ngoba bafuna "ukuqiniswa okuqondile" noma ukudala isimo esihle ngokomzwelo ("euphoria"). Abanye baphishekela ukusetshenziswa kwempahla noma eminye imivuzo ngoba baye bathola ukukhululeka emazweni angathandeki ngokomzwelo ("i-dysphoria"), okusho ukuthi "ukuqiniswa okungalungile." Ngaphandle kokuhlangenwe nakho kokuqala komvuzo nokukhululeka, kunesimo sengqondo esingasebenzi kahle esikhona kakhulu ezimweni zokulutha okuhambisana nokuphikelela kokuzibandakanya nezimo zokulutha.
Isimo somlutha asifani nesimo sokudakwa. Uma noma ubani ebhekene nokudakwa ngokweqile ngokusebenzisa uphuzo noma ezinye izidakamizwa, noma uma umuntu engenzi ngokungapheli emithonjeni yokulutha njengokwenza ukugembula noma yokudla, umuntu angase abe "phezulu", abe nomuzwa wokuthi "isimo esihle" somzwelo sihambisana nokukhula kwe-dopamine nomsebenzi we-pepide opioid kumasekithi wokuvuza. Ngemuva kokuhlangenwe nakho okunjalo, kune-rebound ye-neurochemical, lapho umsebenzi wokuvuza awugcini ukubuyela emuva, kodwa ngokuvamile uvame ngaphansi kwamazinga okuqala. Lokhu kuvame ukungaqondakali muntu futhi akuhlobene neze nokukhubazeka okusebenzayo.
Ngokuhamba kwesikhathi, okuhlangenwe nakho okuphindaphindwayo nokusetshenziswa kwezidakamizwa noma izimilo zokuhlobisa akuhlotshaniswa nomsebenzi okhula njalo wesekethe lomvuzo futhi awuzivuzi ngokuzuzayo. Lapho umuntu esethola ukuhoxa ekusetshenzisweni kwezidakamizwa noma ekuziphatheni okuqhathanisayo, kuba nokukhathazeka, ukuguguleka, isiphuzo kanye nesipiliyoni sobuhlakani, okuhlobene nomvuzo ongaphezulu kanye nokuqashwa kwezinhlelo zokuxineka kwengqondo kanye ne-hormonal, okuhambisana nokukhishwa kuzo zonke izigaba zamakhemikhali ze izidakamizwa eziluthayo. Ngenkathi ukubekezelela kukhula kube “phezulu,” ukubekezelela akuthuthukeli “kuphansi” komoya okuhambisana nomjikelezo wokudakwa nokuhoxa.
Ngakho-ke, ekuluthekeni, abantu bazama kaningi ukudala "okuphezulu" - kepha lokho abakuthola kakhulu kujulile futhi kujulile. Ngenkathi noma ngubani anga "funa" ukuthola "phezulu", labo abanomlutha banomuzwa wokuthi "kunesidingo" sokusebenzisa into eluthayo noma ukuzibandakanya ekuziphatheni okuluthayo ukuzama ukuxazulula isimo sabo somzwelo esibuhlungu noma izimpawu zabo zomzimba zokuhoxa. Abantu abanomlutha basebenzisa ngokweqile yize kungeke kwabenza bazizwe kahle, kokunye kwesinye isikhathi sekudlule isikhathi eside ngemuva kokuphishekela “imivuzo.” (5) Yize abantu abavela kunoma yiluphi usiko bengakhetha "ukukhuphuka" kusuka komunye noma komunye umsebenzi, kubalulekile ukuqonda ukuthi umlutha awuyena umsebenzi wokuzikhethela kuphela. Kalula nje, ukulutheka akusona isimo osifunayo.
Njengoba umlutha kuyinto isifo esingapheli, izikhathi zokuphindaphinda, okungase kuphazamise izikhala zokukhululwa, kuyisici esivamile sokulutha. Kubalulekile ukuqaphela ukuthi ukubuyela ekusetshenzisweni kwezidakamizwa noma ekuphishekeleni ukuphindaphindiwe kwemiphumela kuyinakugwema.
Ukungenelela kwemitholampilo kungasiza kakhulu ekushintsheni inkinga yokulutha. Vala ukuqapha ukuziphatha kweziphathimandla zomuntu ngamunye kanye nesimo se-contingency, ngezinye izikhathi kuhlanganise nemiphumela yokuziphatha yokuphindaphinda ukuziphatha, kungabangela imiphumela emihle yomtholampilo. Ukuzibandakanya emisebenzini yokukhuthazwa kwempilo ekhuthaza ukuzibophezela komuntu siqu nokuziphendulela, uxhumano nabanye, nokukhula komuntu siqu kunomthelela ekubuyiseleni. Kubalulekile ukuqaphela ukuthi ukulimala kungabangela ukukhubazeka noma ukufa kwangaphambi kwesikhathi, ikakhulukazi uma kushiywa kungalashwa noma kungelashwa ngendlela engafanele.
Izindlela zokuziphatha lapho ubuchopho nokuziphatha kuthatha ukutholakala kwezidakamizwa nokuzibandakanya ekuziphatheni okuluthayo kuhlukile ngezigaba kamuva zokulutha kunokuba kuzinyathelo zangaphambili, okubonisa ukuqhubeka, okungase kungabonakali nakakhulu. Njengoba kunjalo nezinye izifo ezingelapheki, lesi simo kumele sihlolwe futhi sigcinwe ngokuhamba kwesikhathi ku:
a. Nciphisa ukuvama nokuqina kokubuyela kabusha;
b. Izinkathi zokulondoloza ukukhululwa; futhi
c. Yenza ngcono izinga lomuntu lokusebenza phakathi nezinkathi zokukhululwa.
Kwezinye izimo zokulutha umuthi, ukuphathwa kwemithi kungathuthukisa imiphumela yokwelapha. Ezimweni eziningi zokulutha umlutha, ukuhlanganiswa kokuvuselelwa kwengqondo kanye nokunakekelwa okuqhubekayo nokwelashwa kwemithi ehambisana nobufakazi kunikeza imiphumela emihle kakhulu. Ukuphathwa kwezifo ezingapheli kubalulekile ekunciphiseni iziqephu zokuphindaphindiwe kanye nomthelela wazo. Ukwelashwa kwezidakamizwa kusindisa izimpilo †
Izidakamizwa abaqeqeshiwe nabantu ekubuyiseleni bazi ithemba elitholakala ekubuyiseni. Ukubuyiselwa kuyatholakala ngisho nakubantu abangase bangakwazi ukuqonda leli themba okokuqala, ikakhulukazi uma kugxila ekuxhumaniseni imiphumela yezempilo esifweni sokulutha. Njengazinye izimo zempilo, ukuzitholela ukuphathwa, ngokusekelwa ngokubambisana, kubaluleke kakhulu ekubuyiseleni ekudakwa. Ukusekelwa kontanga okunjengokuthi kutholakala emisebenzini ehlukahlukene "yokuzisiza" kunenzuzo ekwandiseni isimo sezempilo nemiphumela esebenzayo ekubuyiseleni. ‡
Ukubuyiswa kokulahla kuyaphumelela kakhulu ngokusebenzisa inhlanganisela yokuzilawula, ukusekela, nokunakekelwa kochwepheshe okuhlinzekwa ochwepheshe abaqeqeshwe nabaqeqeshiwe.
Imibhalo yaphansi ye-ASAM:
I-1. I-neurobiology yomvuzo iye yaqondwa kahle emashumini eminyaka, kanti i-neurobiology yokulutha izidakamizwa isacubungulwa. Iningi labahlengikazi baye bafunda ngezindlela zokuvuza ezibandakanya izilinganiso ezivela endaweni ye-ventral tegmental (VTA) yobuchopho, ngokusebenzisa i-median forebrain sack (MFB), nokuqeda i-nucleus accumbens (i-Nuc Acc), lapho i-dopamine neurons evelele khona. I-neuroscience yamanje iyaqaphela ukuthi i-neurocircuitry yomvuzo iphinde ihlanganise nezifunda ezicebile eziqondisayo ezixhuma i-nucleus accumbens kanye ne-basal forebrain. Kungumjikelezi wokuvuza lapho kubhaliswe khona umvuzo, futhi lapho imivuzo eyisisekelo kunazo zonke njengokudla, i-hydration, ubulili, nokukhulisa kudala ithonya elinamandla nokuphila.
Utshwala, i-nicotine, nezinye izidakamizwa futhi ukugembula okuphambene nokuziphatha kubhekana nemiphumela yabo yokuqala ngokwenza umjikelezo ofanayo ojikelezayo ovela ebuchosheni ukwenza ukudla kanye nobulili, isibonelo, ukuqinisa ngokujulile. Eminye imiphumela, njengokudakwa nokuzizwa ngokomzwelo kusuka emivuzo, kutholakala ekusebenziseni umjikelezo wesifundazwe. Nakuba ukuxila nokuhoxiswa kahle ngokuqondisisa umjikelezo wesifundazwe, ukuqonda umlutha kudinga ukuqonda inethiwekhi ebanzi yezixhumanisi ze-neural ezibandakanya i-forebrain kanye nezinhlaka zamaphakathi. Ukukhethwa kwemivuzo ethile, ukukhathazeka ngemiphumela ethile, impendulo ezibangelwa ukuphishekela imivuzo ethile, kanye nokushayela okugqugquzelayo ukusebenzisa utshwala nezinye izidakamizwa kanye / noma ukufuna ezinye izikweletu, kubandakanya izindawo eziningi zobuchopho ngaphandle komvuzo we-neurocircuitry uqobo.
2. Lezi zici ezinhlanu azihloselwe i-ASAM ukuze zisetshenziswe njenge “ndlela yokuxilonga” ukuthola ukuthi umlutha ukhona noma cha. Nakuba lezi zici ezibonakalayo zikhona kakhulu ezimweni eziningi zokulutha umuthi, kungakhathaliseki ukuthi imithi yokusetshenziswa kwemithi eboniswe ekulutha umlutha noma umvuzo ophishekelelwa ngokomzimba, isici ngasinye singase singabi nakakhulu ngokufanayo kuzo zonke izimo. Ukuxilongwa kokulutha umlutha kudinga ukuhlolwa okuphelele kwezinto eziphilayo, ezengqondo, ezenhlalakahle nezingokomoya ngumqeqeshi oqeqeshwe futhi oqinisekisiwe.
3. Kulo mbhalo, igama elithi "ukuziphatha okuluthayo" lisho izindlela zokuziphatha ezivame ukuvuza futhi eziyisici ezimweni eziningi zokulutha. Ukuvezwa kwalezi ziphathamandla, njengoba kwenzeka nje ngokuchayeka ezidakamizweni ezinomvuzo, kusiza inqubo yokulutha kunokuba kubangele ukuluthwa. Isimo se-anatomy yobuchopho kanye ne-physiology yiyona eguquguqukayo eyisisekelo ebangela ngokuqondile ukulutha. Ngakho-ke, kulo mbhalo, igama elithi "izindlela zokulutha" alibhekiseli ekuziphatheni okungavumelekile noma emphakathini, okungabonakala ezimweni eziningi zokulutha. Ukuziphatha, njengokungathembeki, ukwephula izindinganiso zakho noma izindinganiso zabanye, izenzo zobugebengu njll, kungaba yingxenye yokulutha; lezi zibhekwa kangcono njengezinkinga ezibangelwa kunokufaka isandla ekubeni umlutha.
I-4. I-anatomy (i-brain circuitry ehilelekile) kanye ne-physiology (i-neuro-transmitters ehilelekile) kulezi zindlela ezintathu zokuphindaphinda (ukuphindaphinda izidakamizwa noma ukubuyisela umvuzo) kanye nokuphindaphindiwe kwengcindezi) kuye kwachazwa nge-neuroscience ucwaningo.
- Ukubuyela emuva kudalwe ukuvezwa kwezidakamizwa eziluthayo / ezinomvuzo, kufaka phakathi utshwala, kufaka phakathi i-nucleus accumbens kanye ne-VTA-MFB-Nuc Acc neural axis (i-mesolimbic dopaminergic "incentive salience circry" -bheka umbhalo waphansi 2 ngenhla). Ukubuyela emuva okubangelwe ngumvuzo futhi kuyalamulwa ngamasekethe e-glutamatergic akhombisa ama-nucleus accumbens avela ku-cortex engaphambili.
- Ukuphindaphindiwe okubangelwa ukuvezwa kweziqu ezifakwe emvelweni kubandakanya izigubhu ze-glutamate, ezivela e-cortex yangaphambili, i-insula, i-hippocampus kanye ne-amygdala ekhombisa ukuhamba kwe-stimulus.
- Ukuphindaphindiwe okubangelwa ukuvezwa kokuhlangenwe nakho okucindezelayo kuhlanganisa izifunda ezicindezelayo zobuchopho ezingaphezu kwe-hypothalamic-pituitary-adrenal axis eyaziwa ngokuthi iyinhloko yesistimu yokucindezeleka ye-endocrine. Kunezinhlobo ezimbili zalezi zimbangela zokuvuselela ubuchopho ezivela ebuchosheni - okuvela ku-noradrenergic nucleus i-A2 endaweni engezansi yebuchopho kanye nemiklamo e-hypothalamus, i-nucleus accumbens, i-cortex yangaphambili, ne-nucleus yebhede ye-stalis terminalis, futhi isebenzisa i-norepinephrine njenge-neurotransmitter yayo; enye ivela enyakatho yenkaba ye-amygdala, amaphrojekthi kuya ku-nucleus yombhede we-stria terminalis futhi isebenzisa i-corticotrophin-release factor (CRF) njenge-neurotransmitter yayo.
5. Umvuzo wokuphishekela impilo (okukhulunywe ngayo kuFushane Version yale ncazelo ye-ASAM) unezakhi eziningi. Akusikho inani lokuchayeka emvuzweni (isib. Umthamo wesidakamizwa) noma imvamisa noma ubude besikhathi sokuvezwa okuyisifo. Ngokumlutha, ukuphishekela imivuzo kuyaqhubeka, naphezu kwezinkinga zempilo eziqongelela ngenxa yokuziphatha okuluthayo, noma ngabe ukuzibandakanya ekuziphatheni kuyayeka ukujabulisa. Ngokufanayo, ezigabeni zangaphambili zokulutha, noma ngaphambi kokuba kubonakale ukubonakaliswa komlutha, ukusetshenziswa kwezidakamizwa noma ukuzibandakanya ekuziphatheni okuluthayo kungaba umzamo wokufuna ukukhululeka kusuka dysphoria; ngenkathi ngezigaba zakamuva zesifo, ukuzibandakanya ekuziphatheni okuluthayo kungaphikelela yize indlela yokuziphatha ingasinikezi impumuzo.
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