I-Philos Trans R Soc Lond B Biol Sci. I-2019 Feb 18; 374 (1766): 20180129. doi: 10.1098 / rstb.2018.0129.
Leeman RF1,2, I-Rowland BHP1, UGebru NM1, Potenza MN2,3,4,5.
abstract
Ubudlelwano be-Impulsivity ekuziphatheni okuluthayo nasekuziphatheni ngokocansi kuphakamisa imibuzo maqondana nobukhulu bokungafisi kungenzeka kube yisici sengozi yokuba nokuziphatha okulandelayo kokulutha nokuziphatha kocansi kanye / noma imiphumela evela ngakunye kwalokhu. Lapha, sibuyekeze ngokuhlelekile ukusekelwa kwamandla okuphoqeleka njengento ebambekayo noma umphumela wokuziphatha okuluthayo noma kocansi. Sizikhawulele esifundweni sakamuva, esenziwa ngabantu ngokuhlolwa ngokuhamba kwesikhathi, kufaka okungenani isilinganiso esisodwa sokungafisi, isimilo nokuziphatha kocansi, sinikeze isibuyekezo kubandakanya nemibiko eshicilelwe engama-29 evela ezifundweni ezingama-28. Okutholakele kukhomba ekuzijwayezeni okujwayelekile, okuzibika ngokwakho njengesibikezelo sokuziphatha okuluthayo nokuya ocansini ebucayi obukhulu, obunezici zombili zokungacabangi nokuphoqeleka kulezi zenzo. Ukuphuza utshwala kuvame ukukhulisa isimilo esingacabangi, kufaka phakathi ukuthambekela ekwenzeni izenzo zocansi ezingacindezeli nezingaba yimpoqo. Ukucwaninga usebenzisa i-Sexual Delay Discounting Task kuveze okutholakele okuxhumanisa ukungazweli, ukulutha nokuziphatha kocansi futhi ngaleyo ndlela kuyithuluzi elibalulekile lokucwaninga okufanele lisetshenziswe kakhulu. Ukubuyekezwa kwamanje kuveze izikhala okumele kubhekwane nazo ocwaningweni oluqhubekayo oluhlola ngasikhathi sinye izici zokungacabangi, ukulutha nokuziphatha kocansi, ikakhulukazi ngoba izindlela zokuphazamiseka kokuziphatha ngokocansi zifakiwe kuhlelo lweshumi nanye lwe-International Classification of Diseases. Le ndatshana iyingxenye yendaba yengqikimba ethi 'Ukuthatha ubungozi nokuziphatha ngokuxhamazela: ukutholakala okuyisisekelo, imibono yethiyori kanye nemithelela yomtholampilo'.
IZIHLOKO: utshwala; i-cocaine; ukubambezeleka kwesaphulelo; ucwaningo lwelabhorethri yabantu; insangu; ukuphuthuma
I-PMID: 30966924
I-DOI:10.1098 / rstb.2018.0129
1. Isingeniso
(a) Isendlalelo ekuziphatheni okungafanele futhi ekuziphatheni okubi nasekuziphatheni ngokocansi
Ukuphoqelela, kuchazwa njengokuthambekela esenzweni esisheshayo noma esisheshayo ngokubheka okuncishisiwe ngemiphumela yesikhathi esizayo [1,2], inomthelela ekuphazamisweni kwengqondo okuningana kanye namaphethini wokuthatha izinqumo okuhlobene nengozi okuhlobene nezempilo. Ukuphazamiseka okuningi kwengqondo nokuthambekela okuhlobene kuhlangana ndawonye, ngokuziphatha okuthe xaxa kocansi kuyingozi futhi kube yizibonelo ezimbili [3]. Ukuziphatha okuluthayo [4] zichazwa njengokusetshenziswa kwezidakamizwa [5] nezinye izenzo ezingahle zakha umkhuba futhi zingahle zenzeke ngokungaphezu komthelela wazo omubi. Ukuziphatha kobuchopho okuyingozi kufaka phakathi umsebenzi wezocansi ongavikelekile, nabalingani abaningi noma abayitoho, kanye / noma ukusetshenziswa kwezidakamizwa okulandelayo [6].
Kunokuhluka okuningana phakathi kokuziphathisa, umlutha nokuziphatha kocansi. Emazingeni asezingeni eliphansi kuya kokuphakathi, ukushesha, umlutha nokuziphatha kocansi konke kuyinto evamile. Kumazinga aphansi, ukusondelana kungabhekwa njengokuzenzakalelayo okuvamile [7]. Utshwala, ikakhulukazi, bubhekwa njengento evumelekile nezimpikiswano ezisebenzayo mayelana nokuthi ukusetshenziswa okulinganiselayo kungahle kube nezinzuzo zezempilo [8]. Ngokufanayo, ukuziphatha kobulili okufaka engcupheni i-akhawunti yakho futhi kushoda ngamazinga athile okuphoqelekile kubalulekile ebudlelwaneni bezothando nokuzala [9]. Ubufakazi bukhombisa ukuthi ukufakwa ngaphandle kokufaka esivivaneni hhayi kuphela ekusungulweni (kufaka phakathi ukuqalwa kokuqala) kokuziphatha okuluthayo nokuya ocansini kepha futhi kusheshisa lezi zindlela zokuziphatha [10,11]. Lapho ukushesha kwenzeka, izindlela zokuziphatha eziluthayo nezingcolile zingaba yinkinga [12-14].
Ngokukhethekile, ukusetshenziswa kwezidakamizwa nokuziphatha kocansi okudlula amazinga ajwayelekile kuvame ukwenzeka yize kungaba nemiphumela emibi. Lokhu kubonakala encazelweni yezinkinga zokusebenzisa kabi izidakamizwa (ama-SUDs): ukusetshenziswa kwezidakamizwa okwenzeka njalo okuholela ekuwohlokeni kokusebenza okuhle futhi ngokomtholampilo kubandakanya nezinkinga zezempilo, ukukhubazeka kanye nokwehluleka ukufeza izibopho [15]. Ngokufanayo, ukuziphatha kocansi okuphoqayo kubonakaliswa ukucindezeleka okukhulu kanye / noma ukuphazamiseka emisebenzini yokusebenza kwengqondo [9,10]. Ngaphezu kwalokho, lapho impulsivity, umlutha nokuziphatha kocansi kuguqukela emazingeni anezinkinga ezengeziwe, izingqinamba zigcina ukulawula kuvame ukubonakala ngakunye [1-3,9-11]. Amabili eDSM-5 (I-Diagnostic kanye ne-Statistical Manual of Mental Disriers-5) Izinqubo ze-SUD (okusho ukusebenzisa into ngamanani amakhulu noma isikhathi eside kunalokho okuhlosiwe; ubunzima bokwehlisa noma ukumisa ukusetshenziswa [15]) zihlobene nokulawulwa okungalungile kokusetshenziswa kwezidakamizwa. Izindlela zokulawulwa okungalungile kokusebenzisa kabi utshwala zihlanganisa kakhulu nezindlela zokuphoqelela [16]. Ngaphezu kwalokho, ukuphoqelelwa kuyingxenye yezimo eziningana zengqondo ezihlobene kakhulu nokuziphatha okuyingozi kobulili, lapho ukulawulwa komuntu siqu kokuziphatha kuyinto ekukhathazayo (isb. Ubuntu bomngcele, ukuphazamiseka kwengqondo) [15].
Ukungazinikeli kwemiphumela emibi efanekisela ukusetshenziswa kwezidakamizwa okuyinkinga nokuziphatha kocansi nakho kuyingxenye yencazelo yokuphoqelela [1,2]. Kepha ukuziphatha okuphoqayo kuvame ukulinganiswa nenani lomvuzo nokuthinta okuhle [17], ukuqina kokuziphatha umlutha nokuziphatha kocansi kuvame ukwenzeka yize izimfanelo zabo ezinemivuzo ziphela ngokuqhubeka kwesikhathi. Lolu shintsho lufanekisa ukusuka ekuziphatheni okubonakaliswa ngokuphoqelela ekuziphatheni okuphoqayo noma okwenziwe ngendlela ejwayelekile [9,18,19]. Ukuziphatha okuphoqayo kuchazwe njengezenzo ezingafanelekile ezimweni eziqhubeka naphezu kokuntuleka kobudlelwano obucacile emgomweni wonke, ovame ukuholela emiphumeleni emibi [20]. Ngenxa yaleli zinga lokungazinaki izinhloso kanye nemiphumela, imiphumela izoqhubeka ikhula ngokuzibandakanya okukhulu ekuziphatheni okulutha kanye / noma nokuziphatha kocansi.
Ngaphezu kwendima yokungafakwa kokuziphatha ngokweqile nokulutha, ukuziphatha okuluthayo kungakhuphula nomfutho [3,10] futhi uholele ekuziphatheni kobulili, okubandakanya nokuziphatha okuyingozi [11]. Ubudlelwano phakathi kokusetshenziswa kwezidakamizwa nokuziphatha okuyingozi kobulili kungabhebhetheka ngokubambezeleka kokutholakala kwekhondomu [11]. Impendulo engaphezulu kokulibala nayo ibuye isici sokuphoxeka [21].
(b) Ukugudluzwa njengokwakhiwa okuyinkimbinkimbi
Uphenyo oluhilela ukufakwa emgudwini kufanele luqonde uhlobo lwayo oluyinkimbinkimbi, olunezici eziningi. Umehluko phakathi kokuxoshwa njengombuso wesikhashana, othonywe ukusetshenziswa kwezidakamizwa nokunye okulusizi, futhi njengenkambiso noma isici esivamile esiboniswe ngokuhamba kwesikhathi nangaphezulu kwezimo zesekelwa ngamandla [10]. Ngokuphawuleka, bobabili jikelele / kanye nokuthambekela kanye nesimo sokuphoqelelwa kwesimo singathonya izimilo zokuziphatha okuluthayo nezobulili [10,11]. Yize izici ezicacisiwe zokufaka ngokungxamile ziyehluka kuzo zonke izifundo, zivame ukungahambelani ngokuqinile [10,21]. Ukwahlukaniswa okujwayelekile kwezici zokuphoqelela, okuxhaswa ukusekelwa kokuhlaziywa kwesizathu okuzayo [21], iphakathi kokuphendula, ukukhetha nokuxoshwa okujwayelekile okufakazelwa ubufakazi bokuthi lezi zimbili zangaphambili zivela ngokuyinhloko emisebenzini yokuqonda kanti ezokugcina zisuka emibikweni yokuzazisa.
Ukuphoqelela ukuphendula kuchazwe njengokubuyiselwa kokusebenza okusheshayo okungahambisani nezimfuno zamanje zemvelo [22] kanye nobunzima ekuvingeni izimpendulo [1]. Ukuphoqelela ukuzikhethela kuchazwa ngokujwayelekile njengokuzimisela okunciphile noma amandla okubekezelela ukubambezeleka kuvame ukubandakanya izaphulelo zokubambezeleka: izintandokazi ezincanyana, maduze ezinkudlwana, nemivuzo yamuva21]. Ukusetshenziswa kwezidakamizwa naphezu kwemiphumela emibi nakho kuhlobene nalokhu kuthambekela kokuthola imivuzo yesikhathi esijana ekhombisa ukungafakwa [21]. Ukwakhiwa okuhlobene kungukuncipha kwezephulelo, okubandakanya okuncamelayo kokukhulu, okungaqiniseki ngokuncane, nemivuzo ethile ethe xaxa [23]. Ngenkathi ukusabela kusabela [22] kanye nezephulelo ezinokwenzeka [23,24] zizwela imiphumela emibi yento, ukubambezeleka okubambezelayo, okungenani ukuthola imali ne-mali yangempela, kubonakala kungumahluko ozinzile, ohlukile10]. Ngokuphambene nokusebenza komsebenzi, imibiko yokuzenzela ejwayelekile ithwebula imibono yabantu ngokuthambekela kwabo [10]. Isikali se-UPPS Impulsive Behaeve, isilinganiso esivelele sokuphoqelela, sibonisa ukufuna umuzwa, ukungahleleki, ukuntula ukubekezelela, kanye nezimo eziphuthumayo nezingezinhle (ie impulsivity stemming from the state positive and good affiliity husika) [25,26]. Ngaphandle kwe-UPPS, ithiythi nobufakazi kukhombisa ukuthi ukufuna umuzwa kuhlobene kepha kuhlukaniswe [21].
(c) Ukubuyekezwa okuhlelekile okukhona njengamanje
Ukudidiyelwa okuyinkimbinkimbi nokulandelana kwemibuzo ephathelene nobudlelwano phakathi kokuphoqelelwa, umlutha nokuziphatha kocansi kugunyaza ukuthi kubuyekezwe izifundo ezibandakanya izinyathelo zazo zontathu izakhi ngokuhamba kwesikhathi (ngokuzayo / okude noma ngokuhlolwa, elebhu). Ukubuyekezwa okunjalo kunganikeza ukuqonda kwezinga lapho ukuphoqelelwa kusebenza njengento eqondisayo noma umphumela wokuziphatha okuluthayo noma wobulili ngokukhomba izinto ezithile ezingaphansi kobudlelwano, izici zomtholampilo kanye nezimo ezenzeka ndawonye. Lezi zihloko, ezinemithi yokwelashwa kanye nemiphumela yezempilo yomphakathi, zigxile ekubuyekezweni okuhleliwe okukhona kwezincwadi zakamuva. Ngokubaluleka kokubaluleka kokushintsha kusuka kokujwayelekile kuya ekuziphatheni okuyinkinga nasekuguqukeni okuhlobene kuya ekuguqukeni kokuphoqelela, kuyadingeka ukuhlukanisa phakathi kwezifundo ezilinganisa ukuziphatha ngezinga eliphansi nelikhulu. Ngokuqokomisa lo mehluko, sizobhekisisa ubudlelwano phakathi kokungazibandakanyi nokuzibandakanya ngokuvamile nangengxaki.
(d) Ukufakwa ngaphansi kwemvelo kanye nofuzo
Njengoba kunikezwe ukubaluleka kwezinkinga zokuphoxeka ekubuyekezweni kwamanje, ucwaningo olubandakanya i-neuroimaging kanye / noma izakhi zofuzo kunomthelela ongafani nalutho. Ukuphoqelelwa kufaka ukuphazamiseka kwezinhlobo eziningi zezinqubo ze-neural kufaka phakathi ukuhlanganiswa kwezinqubo zemoto nokuqonda, ukuqonda nokunaka [10]. Ngokwemvelo, ukuphoqelelwa kungahle kubonakaliswe ukulawulwa kokungalawuleki kwe-cortical stryatal circry kanye / noma umsebenzi omningi kumjikelezo womvuzo we-fronto-striatal [3]. Kokubili ukuphoqelelwa kanye nama-SUDs kungahle kufake phakathi ama-dopaminergic neurons anwebeka kusuka endaweni yangaphakathi ye-infralal tegmental aze afike kuma-nucleus accumbens (NAc) [3,27]. Ukuziphatha okuluthayo nemivuzo yemvelo efana nomsebenzi wezocansi kubonakala kukhiqiza umsebenzi wesekethe ofanayo ezifundeni kufaka i-amygdala, hippocampus ne-frontal cortex [27].
Izici zofuzo / zomndeni zihambisana nokuxakwa ezifundweni zabantu nezilwane [3]. Izihlobo zabantu zabantu abane-SUDs zinamazinga aphezulu wokuxoshwa kunabantu abangahlangene nabo, abalawula abahlanganyeli [28]. Ezifundweni ezinkulu, isikweletu sofuzo esibonakalisa ama-SUDs, impulsivity kanye nezakhi ezihlobene (yokuziphatha / i-antisocial botho disorder) zibonakala zigqagqene [29].
I-2. Izindlela
Sibuyekeze izincwadi zakamuva, zabantu eziphathelene nobudlelwano phakathi kokuxoshwa kanye nokuziphatha umlutha nokuziphatha kocansi ngokuhamba kwesikhathi. Sikhawulele ekucwaningeni kubandakanya okungenani isilinganiso esisodwa saleso nalezi zinto ezintathu. Sizikhawulela ngqo ezifundweni kufaka phakathi isilinganiso sokuphoqeleka okufanele njengoba sekuxoxiwe esethulweni. Izifundo ezilinganise kuphela izehlakalo ezihlobene njengokuthi ukuphazamiseka kokulawula umthelela, ukuthatha ingozi, noma ukufuna umuzwa zazingafakwanga (bona [21]). Ucwaningo olubika ngesimo se-HIV ngaphandle kwesilinganiso esilandelanayo sezinto zocansi aluzange lubhekwe. Njengoba kunikezwe inani eliphakeme lokubuyekezwa mayelana nalezi zinto, kufaka phakathi ukubuyekezwa okuningi kweqembu lethu (isib.30]), sizikhawulela ezincwadini ezishicilelwe kusuka ku-2013 phambili. Ngokugxila kwethu ngqo kulokhu kubuyekezwa, sibheke futhi nezifundo ezihlola lobu budlelwano ngokuhamba kwesikhathi, kufaka phakathi okufushane (okusho ukuhlolwa kwelabhorethri) noma isikhathi eside (okusho ukuthi abazoba ngababekhona noma abacwaningi isikhathi eside). Ngakho-ke, izifundo ezingekho ngaphansi kwesisekelo zazingafakwa.
Saseshe izincwadi sisebenzisa imininingwane ye-PubMed ne-PsycInfo ekubuyekezweni kontanga, kwezilimi zesiNgisi. Yomibili imininingo egciniwe yaseshelwe la magama abalulekile: 'impulsiv *', 'go no go', 'go stop', 'slow decreaseing', 'barratt', 'upps', 'alcohol', 'drug', 'addict *', 'I-HIV', i-'cansi 'kanye' nocansi oluyingozi. ' Siphenya amagama ngamaqembu amathathu; Ngakho-ke, igama elilodwa elingukhiye elimele ngayinye yalezi zinto ezintathu lifakiwe kusesho ngalunye futhi zonke izimvume ziphelile. Ngaphandle kwezimpinda, ukusesha kukhiqize amaphepha e-420 ukuthi abukezwe ngo-Ephreli 2018.
Ababhali ababili bahlole imiphumela yokuqala yalezi zindlela ezilandelayo zokufakwa: (1) ukulinganisa ukungafisi; (2) ukulinganisa kokuziphatha okuluthayo; (3) ukulinganiswa kokuziphatha ngokocansi; (4) ukwakheka kokutadisha (okokuhlola, kokubheka / kokuhlola ubude besikhathi eside noma isivivinyo somtholampilo); kanye (5) nokufakwa kwabahlanganyeli abangabantu. Okokuqala, izihloko kanye nezifushaniso zephepha ngalinye zibuyekeziwe ukuqeda izifundo ngokusobala ukuthi azihlangabezani nenqubo eyodwa noma ngaphezulu. Umbhalo ogcwele wephepha ngalinye elisele ubuyekezwe ngokuthembeka okuqinile phakathi kwalesi sinyathelo (Cohen's kappa = 0.83). Ukungaboni ngaso linye kwaxazululwa ngengxoxo. Ukubuyekezwa kombhalo ogcwele kuholele emaphepheni angama-29 akhishwe ezifundweni zabazali ezingama-28 (umdwebo 1).
Ababhali abathathu babuyekeze imininingwane emaphepheni asele. Imininingwane elandelayo ikhishwe: (1) usayizi wesampula; (2) amaphesenti abesifazane abahlanganyeli; (3) inqubo yokufaka / yokususa ukhiye; (4) idizayini yokufunda; (5) amaqembu nemibandela yokufunda; (6) okutholakele okuphathelene nokungaziphathi nokuziphatha okuluthayo; (7) okutholakele okuphathelene nokunxenxa nokuziphatha kocansi; (8) okutholakele okuhlobene nokuziphatha umlutha nokuya ocansini; kanye (9) okutholakele phakathi kwazo zontathu izici.
Izinyathelo ezenziwa kulokhu kubuyekezwa okuhleliwe zazisuselwa kwinqubo ye-PRISMA [31]; kodwa-ke, izinyathelo ezihlobene nesizukulwane sokulinganisa kwesilinganiso somphumela azange ziphothulwe. Izinhlobo eziningi ezibanzi nezindlela eziqondile ezifakiwe ocwaningweni olukhethwe kulokhu kubukezelwa lunqabile ukuhlelwa kwe-meta noma okunye ukucatshangelwa kokulinganisa kosayizi womphumela. Ubungozi bezinyathelo ezibandayo abuzange futhi buthathwe ngokunikezwa kokuntuleka kwezivivinyo ezilawulwa ngokungahleliwe ezifakwe ekubuyekezweni futhi ngenxa yokuthi izinhlobo zokuhlola ezifakiwe ekubuyekezweni zazingavumeli ukuphenya ngokuphelele ukuphenya.
I-3. Imiphumela
Ngenxa yokucatshangelwa kwesikhala, sichaze incazelo yombhalo emibhalweni yesandla efanele kakhulu, efingqiwe kuyo ithebula 1; kodwa-ke, imiphumela ephelele yokubuyekezwa isezintweni zokungezelelwa zikagesi, itafula S1. Imiphumela ihlelwe ngokusho ukuthi yiziphi izici ezibandakanyekile (ukuphoqelelwa kanye nokuziphatha okuluthayo; ukufakwa kokuziphatha okubi nokuziphatha kocansi; ukuziphatha okuluthayo nokuziphatha kocansi; noma ubudlelwano phakathi kwabo bobathathu). Kula maqembu, imiphumela ihlukaniswe ngokwezinga lobukhulu bokuziphatha okubikiwe. Sisebenzisa igama elithi 'ukuqagela' ukubhekisisa imininingwane ye-longitudinal ephakamisa into eyodwa eholela kwesinye. Imiphumela yezakhi zofuzo ne-neuroimaging, ehlukile, ibikwe esigabeni sabo.
Ithebula 1.
Isifinyezo esifushane semibhalo yesandla emqoka efakiwe ekubuyekezweni. Bonke ubudlelwane obuhle ngaphandle kokuthi buvezwe ngenye indlela. Acronyms: AD, ukuncika kotshwala; I-AWT, isebenza ngaphandle kokucabanga; I-CSB, ukuziphatha kocansi okuphoqayo; I-IDG, ukungakwazi ukubambezela ukuzanelisa; I-LHPP, i-phospholysine phosphohistidine inorganic pyrophosphate phosphatase; NA, ayikho imiphumela ebalulekile ebikiwe; I-NR, ayibikwa; I-OD, ukuncika kwe-opioid; Ama-STI, izifo ezithathelwana ngocansi; I-SDDT, umsebenzi wokunciphisa ukubambezeleka ngokobulili; I-SPDT, umsebenzi wokunciphisa izilinganiso zocansi.
(a) Ukuziphatha okuxakile kanye nokulutha
(i) Ukuqina kanye nokusetshenziswa kwezidakamizwa
Usebenzisa idatha evela kuFiladelphia Trajectory Study, shintsha ngokuhamba kwesikhathi ekubikeni ngokwakho kokuthi 'ukwenza ngaphandle kokucabanga' okuhlobene kakhulu nokwandisa imvamisa yokusebenzisa utshwala ngesikhathi esifanayo [40]. Ocwaningweni olufanayo, ubunzima bokubambezela ukuzanelisa emsebenzini wokuphungula imali bebengahlobene kakhulu nesilinganiso esifanayo sokuphuza, kepha babenobudlelwano bezinga lokuphuza kakhulu (okungukuthi imvamisa yokuphuza iziphuzo ezinhlanu noma ngaphezulu zabesilisa, abane noma ngaphezulu kwabesifazane abangenaso isiqu sesikhathi). Ocwaningweni olulindelwe lwenyanga ye-18 lubhalisa amadoda amadala asebekhulile alala nabesilisa, ukuphuthuma okuhle nokubi kanye nokufuna umuzwa kubikezela ukuphuza kakhulu (okusho imvamisa yokuphuza okuhlanu noma ngaphezulu ngesikhathi se-2 h) nokufuna umuzwa okubikezelwe ukusetshenziswa kwensangu [45]. Ocwaningweni olungenzeka, ukubhaliswa kwabafundi besilisa basekolishi, ukuvivinya okujwayelekile, kanye nokuzibika okuxutshiwe ngonyaka wabo wokuqala wekolishi kwabikezela imvamisa yokuphuza kakhulu i-1 ngonyaka olandelayo [41].
Ukuphathwa kotshwala ocwaningweni lokuhlolwa kwelabhoratri akuzange kuqondane kakhulu nokusho ukuthi ukuphoqelelwa (ubukhulu bokuthi umuntu uzizwe sengathi uyaphoqeka, unesibindi, njll. Okwamanje) ezizibika yena uqobo ngesikhathi sezimo zocansi ezithinta abesilisa abadala abancane, abesilisa nabathandanayo, nabangenazinkinga zokuphuza utshwala [35].
Phakathi kwabantu abaphuza ngezikhathi ezithile, ukuphathwa kotshwala welebhu kuhlotshaniswa nokuncipha okungatheni okwenqabayo kwemivuzo yezezimali kunokwe-placebo (okusho ukuthi uzwela ubungozi obuncane). Kodwa-ke, ocwaningweni olufanayo, utshwala abuzange bube nomthelela omkhulu ekunciphiseni kokubambezeleka kwemali yangempela noma ye-hypothetical [24].
(ii) Ukuqina kanye nokuphazamiseka kokusetshenziswa / kokusebenzisa inkinga
Ocwaningweni lokuhlola olungabandakanyi ukuphathwa kwezidakamizwa ngokuqhathanisa imibandela yokuhlangana kwabangeneleli yokuthembela kotshwala e-DSM-IV nezifundo zokulawula okunempilo, umehluko phakathi kweqembu neqembu mayelana nokuncishiswa kwemali.38].
Ukuphathwa kwe-cocaine kwelebhu phakathi kwalabo abanenkinga yokusebenzisa i-cocaine kuholele ekutholakaleni okufanayo kokuncishiswa kwemali kanye nokuncishiswa kwe-cocaine njengotshwala phakathi kwabantu abaphuza ngezikhathi ezithile ocwaningweni lwelabhoratri olubhalwe ngaphezulu. Ngaphezu kwalokho, umphumela wotshwala ekunciphiseni okungenzeka awuphindwanga nge-cocaine [39].
(iii) Isifingqo
Ukutholwa kusekela isiphetho sokuthi ukufakwa okujwayelekile okubanzi, okuzenzakalelayo okubikwa kuhlotshaniswa nemvamisa enkulu yokuphuza utshwala nokuphuza ngokweqile ngokuqondile. Kodwa-ke, ubufakazi obuxhasa ubudlelwano bokusetshenziswa kotshwala kanye nokuphazamiseka kokusetshenziswa kokuncishiswa kokubambezeleka okukhulu kuhlanganiswa. Ukuphuzwa kotshwala kodwa hhayi ukuphathwa kwe-cocaine kunomthelela ekunciphisweni kwemali, kodwa hhayi ukubambezeleka ukwehliswa kwemali.
(b) Ukuqina kanye nokuziphatha kobulili
(i) Ukuqina kanye nokwenza ucansi
Phakathi kwabafundi abangaphansi konyaka wokuqala wesifazane ocwaningweni olungenzeka lokwenza imibiko yanyanga zonke, ukufakwa okujwayelekile kubikezelwe ngokuthola ubulili bomlomo (ngokutholwa okufanayo kokufuna umuzwa). Ukufuna-inqondo futhi kuhlobene nemvamisa yokuya ocansini -36]. Ku-Philadelphia Trajectory Study, inkumbulo yokusebenza ngokuqina ibikezela amathuba aphansi wokuhlangana kobulili (ikakhulukazi ukuhlangana okungavikelekile) ekulandeleni, okuqondiswe ngamazinga aphansi 'okusebenza ngaphandle kokucabanga' kanye nokuthambekela okukhulu kokubambezela ukuzanelisa, izici ezimbili zokuphoqelela [40]. Ocwaningweni olufanayo, ukuvumela okwengeziwe 'kokusebenza ngaphandle kokucabanga' kuhlangene nokuzibandakanya okwandayo kokuvikelwa okungavikelekile. Kubekhona futhi okutholakele okuyize okutholakele. Phakathi kwabafundi besifazane abasebenza kwezocansi, abangaxhamazeli abaningi, abazibika bona ngokwabo noma abafuna umuzwa ohlobene nokusetshenziswa kwekhondomu ocwaningweni olubandakanya imibiko yokuzinyanga nenyanga ngonyaka we-1 [48].
Izivivinyo eziningi zokuhlola eziphathelene nokufaka kokuthambekela ocansini zisebenzisa i-Tecle Discounting Task (SDDT) yocansi.51]. Kulomsebenzi, ababambiqhaza babuzwa ukuthi yibaphi abantu ezithombeni abangabacabangela ubulili obucatshangelwayo, okungajwayelekile, ngokususelwa ekubukekeni komzimba kuphela, inqobo nje uma imvelo ibilungile futhi bebuthanda ubuntu balowo muntu. Ababambiqhaza bayalwa ukuba bacabange ukuthi abashadile futhi bayatholakala bengenamathuba okukhulelwa. Kulabo abakhethiwe, ababambiqhaza baphinde bayalelwa ukuthi bakhethe abantu abane (1) kanye nabancane (2) abafuna ukuya nabo ocansini bese bekhetha abantu ababona ukuthi baningi (3) kanye nabancane (4) okungenzeka babe nezifo ezithathelwana ngocansi. (Izifo ezithathelana ngokocansi). Ababambiqhaza babe sebebuzwa uchungechunge lwemibuzo eyisishiyagalombili yokulinganisa okulinganayo komlingani ngamunye. Umbuzo wokuqala unebanga kusuka ku-0 elibonisa ucansi olusheshayo ngaphandle ikhondomu ku-100 ekhombisa ubulili ngokushesha nge ikhondomu. Imibuzo elandelayo igcina isitatimende se-0 futhi iguqule isitatimende se-100 ukwengeza ukubambezeleka okwandayo kwezocansi nekhondomu. Emiphumeleni ehilela lo msebenzi, sibheke izimpendulo zale mibuzo njengokuphathelene nokuziphatha kocansi kanye nokuziphoqelela. Kwisampula yokwelashwa yabesifazane abane-opioid-use disorder, ukubikwa okuzenzakalelayo, nokubikwa okuzenzakalelayo [52] kuhlobene kakhulu nokuntuleka kokulinda ubulili obuvikelwe yikhondomu (okusho ukuncishiswa okubambezeleka kwezocansi). Kodwa-ke, ocwaningweni olufanayo, kwabikwa imiphumela emibi phakathi kokuncishiswa kokubambezeleka kwezocansi kanye nesaphulelo sokulibaziseka kwemali [37]. Umphumela ofanayo wokuncishiswa kokubambezeleka kwezezimali kubikwe kubantu abanenkinga yokusebenzisa i-cocaine [53]. Ngokuqhathanisa nokutholwa kokuzibizela kokuzenzisa okwedlule okwabikwa ngaphambilini [52], ukungatholakali okubalulekile kubikwe phakathi kokuzibizela okujwayelekile nokubekelwa phansi kokuncishiswa kwezocansi kubantu abadala abancane [33].
(ii) Ukuqina kanye nobudlova bocansi
Phakathi kwabafundi abangaphansi kokwenza iziqu, okubikwa ukuthi kuzona, kanye nokuzibika okuxutshiwe ngonyaka wokuqala wekolishi kwabikezela ukuthi kunobudlova ngokobulili (okusho ukuthi ukuthintana ngocansi okungafuneki, ukuphoqa, ukuzama ukuqeda ukudlwengulwa) okuhlolwe ngombiko we-35 wento yangonyaka wesithathu wekolishi [41]. Ukugudluzwa okubanzi, okuzenzakalelayo okubikwa futhi kuhlobene nokuzibizela phansi kobudlova nokuhlukumezeka ngokocansi phakathi kwabesilisa abadala abesilisa phakathi kwabesilisa abancane abesilisa ababikiwe esifundweni sezinyanga ezintathu [34]. Ngokunjalo, ngesikhathi sokufunda isikhathi eside kuyo yonke iminyaka ye-4 yasekolishi, iziqeshana zabafundi abangaphansi kwabafundi ababika ukusetshenziswa kwangaphambi kwezindlela ezahlukahlukene zokudlwengula bonke babika amaphuzu aphezulu kunabangewona abenzi bokubi esenzweni esivumelanayo esuselwa kwimibiko yokuzicabangela kufaka phakathi ukuzenzisa okujwayelekile. Ngaphezu kwalokho, lezo ezivumela ukudlwengulwa okuphoqayo zithole amaphuzu aphezulu kule nto yokuhlukumeza kunezinye izinhlobo zabenzi bokubi [50].
Ngokwesimo sesifundo sokuhlola, sokulawulwa kophuzo lwelabhoratri, ubudlelwano phakathi komlando ozivezile wobudlova bezocansi nezinhloso zokumelana nokusetshenziswa kwekhondomu kwaqondiswa ukuzenzisa kombuso [35].
(iii) Isifingqo
Ocwaningweni olubonayo / oluzayo, okujwayelekile, okuzibika njengokuzibikezela kwabikezela ukuya ocansini kufaka phakathi ngaphandle kwekhondomu, yize bekutholakale into eyodwa nje. Kubuye kube nobufakazi bokuxhumeka phakathi kokujwayelekile, ukuzibika ngaphandle kokuncishiswa kanye nokuncishiswa okukhulu kokubambezeleka kwezocansi (okusho ukuthi kuzimisele kakhulu ukulinda ikhondomu ukuze kwenziwe ucansi) ocwaningweni lokuhlola yize bekutholakale nokuyinto engekho. Ukuncishiswa kokubambezeleka kwemali kwakungahlobene kakhulu nesephulelo sokubambezeleka kwezocansi. Ukutholwa / okucatshangelwa nokuhlolwayo kuxhumanise ukufakwa okuvamile kulaka lwezocansi.
(c) Ukuziphatha okuluthayo nokuphathelene nezocansi
(i) Ukusetshenziswa kwezidakamizwa nokuya ocansini
Phakathi kwabafundi besifazane bonyaka wokuqala ocwaningweni olufaka imibiko yanyanga zonke, imvamisa yokuphuza kakhulu nensangu basebenzisa izibalo ezibikezela ukuthi zenziwa futhi zithola ubulili bomlomo nobungasese [36]. Ocwaningweni wokuhlola okomzuzwana bemvelo ababhalisa abangaphansi kweziqu zobulili, amazinga aphansi wotshwala abikezela ukuthi ucansi oluphephile oluphephile (ikakhulukazi kubantu besifazane), kepha njengoba ukukhathazeka kokudakwa kukhuphuka, amathuba okuya ocansini okungavikelekile anda kakhulu [46]. Phakathi kwabafundi abasebenza okokuqala ocansini unyaka wokuqala, ukusetshenziswa kotshwala (noma yikuphi futhi okusindayo) kungenzeka kube nomthelela ocansini nabalingani abangajwayelekile. Lokhu bekungenjalo ngensangu, ebihambisana nokuncipha kokuncipha kocansi oluphephile ebudlelwaneni obusunguliwe [48].
Ocwaningweni lwelabhorethri olufaka ukuphathwa kotshwala kubhalisa abantu abadla utshwala ngaphandle kokuphazamiseka ekusebenziseni utshwala, ababambiqhaza bakhethe izithombe eziningi ezibonisa abalingani bezocansi abanohlonze emsebenzini wesifiso sokuya ocansini kulandela ukuqhathanisa ne-placebo. Utshwala futhi buhlotshaniswa nokukhuphuka kwezici ezizibikayo ezingezinhle / eziphikisayo zokuvuselela / inkanuko yezocansi [24]. Kokunye ucwaningo lwelebhu obhalisa abantu abadla utshwala ngaphandle kokuphazamiseka kokusebenzisa utshwala, ukudakwa bekuhlobene ngqo nezinhloso zokunqanda ukusetshenziswa kwekhondomu [35]. Ocwaningweni oluhlukile lwelabhorethri phakathi kwabasebenza ngocansi, ngokuyinhloko abesilisa abangashadanga (abaphuza kakhulu), ukudakwa bekuhlotshaniswa ngenhloso yokuzibandakanya ocansini olungavikelekile [49].
(ii) Ukusetshenziswa kwezidakamizwa kanye nolaka
Phakathi kweziqu zesilisa zonyaka wokuqala, ukuphuza okuncane okuhlobene nokuhlukumezeka okuncane kocansi [41]. Kokunye ucwaningo, abahlaseli bokuhlaselwa abangavumelekile futhi abaphoqayo kungenzeka kakhulu kunalabo ababandakanyeka ekuphoqeleleni ngomlomo ukubika ukusetshenziswa kotshwala ngaphambi kwesikhathi [50]. Kutholakale ukutholwa kukaNull phakathi kokusetshenziswa kotshwala ngokweqile kanye nokuhlukunyezwa ngokocansi [43] nokukhohlakala [34] phakathi kwabantu abadala abasha kwezinye izifundo.
(iii) Isifingqo
Ezifundweni zokubuka, noma yikuphi ukuphuza nokuphuza kakhulu, futhi ngezinga elincane, ukusetshenziswa kwensangu kwakuhlobene nezinhlobo ezahlukahlukene zokuya ocansini kufaka phakathi i-riskier sex. Ucwaningo lwelabhoratri yokuhlola inikeze ubufakazi obuqinile bokuthi ukuphathwa kotshwala kuhlotshaniswa nezinhloso zokwenza ucansi olungavikelekile. Ngokuphawulekile, lolu cwaningo lufake okutholakele okuxhumanisa utshwala nokuthambekela ekuzibandakanya ocansini naphezu kokukhula okufanayo kwezici zokuzithiba ezingezinhle / eziphikisayo. Ucwaningo lokuhlola luphinde lwaveza nobufakazi obuxhumanisa notshwala nezindlela zokwenza ucansi ngocansi, kepha kube nokutholakele okungekho.
(d) Ukuziphoqelela, umlutha nokuziphatha kocansi
(i) Ukudlanga, ukusetshenziswa kwezidakamizwa kanye nokwenza ucansi
Ubudlelwane obungenhla phakathi koshintsho ekusebenzeni ngaphandle kokucabanga nokuya ocansini, ikakhulukazi ngaphandle kokusebenzisa ikhondomu kuPhiladelphia Trajectory Study kwaqondiswa ingxenye yoshintsho ekusetshenzisweni kotshwala [40]. Mayelana nokulinganisela, phakathi kwabesilisa asebekhulile abathandana nabesilisa nabesilisa abathandanayo, ubudlelwano phakathi kokucwaswa kwangaphakathi kanye nokuphuza ngokweqile kanye nokuziphatha ngocansi okungavikelekile kunamandla phakathi kwalabo ababika ukuphuthuma okungekuhle noma okuhle [45]. Okutholwe ngenhla kwidayari yansuku zonke okuxhuma ukwandisa ukudakwa kotshwala nobudlelwano obungavikelekile kuqhutshwa ngabafundi abangaphansi kothisha abanamazinga aphansi wokulawula okusebenzayo [46]. Kodwa-ke, phakathi kwabafundi abasebenza ngocansi besifazane, ukuhlolwa okungabalulekanga okwenziwe ngabodwa, ukufakwa okujwayelekile kanye nokufuna umuzwa kwabikwa ngobudlelwano obuningi phakathi kokusetshenziswa kotshwala nokusebenzisa amakhondomu [48].
Ezifundweni zokuhlola ezingabandakanyi ukuphathwa kwezidakamizwa, inani lezinto ezizisebenzayo ezihlobene kakhulu nokuncishiswa kokubambezeleka kwezocansi kwi-SDDT phakathi kwabantu abadala abasha [33]. Ngaphezu kwalokho, abantu abasebenzisa i-cocaine yokuzilibazisa babonisa ukwehla kwezinga lokungena kokuya ocansini kwi-SDDT kunabahlanganyeli abalawulayo, okutholakele okubonisa ukuthi ukusetshenziswa kwe-cocaine kokuzijabulisa kwakuxhunyaniswe nokuthambekela kokugwema ukusetshenziswa kwekhondomu [42]. Ukusetshenziswa kwe-cocaine yokuzijabulisa kwakuchazwa njengokusetshenziswa okungejwayelekile, amanani amancane ezimweni zenhlalo ngaphandle kokulimazeka kokusebenza nokungasebenzi komtholampilo.
Phakathi kwabaphuza ngezikhathi ezithile, ukuphathwa kotshwala elabhorethri kwakuhambisana nokuncishiswa kokubambezeleka kwezocansi. Lolu cwaningo olufanayo lwahlola uhlobo lokunciphisa isaphulelo somsebenzi lapho amathuba e-STI ahlukahlukene. Ukulandela utshwala, ngokuqhathaniswa ne-placebo, ababambiqhaza kungenzeka ukuthi bamukele isilinganiso sobungozi be-STI. Ukutholwa okufanayo kubikwe ocwaningweni olwenziwe ngaphambili lwe-cocaine lokulibaziseka kwezocansi kanye nokungahle kwenzeke kwezinto [39]. Ngokuphambene, ocwaningweni olwandulelayo lwabantu abasebenza ngocansi, ngokuyinhloko abangaphansi kobulili obuhlukile [49], abukho ubudlelwano obalulekile phakathi kwesaphulelo semali [54] nazo zonke ezinye izinto ezifundwayo ezilandela ukusetshenziswa kotshwala.
(ii) Ukugudluzwa, ukusetshenziswa kwezidakamizwa okuyinkinga nokuzibandakanya ocansini
Abahlanganyeli abanenkinga yokusebenzisa kabi utshwala [38], ukugula kokusebenzisa i-opioid [37] kanye nokuphazamiseka kokusebenzisa i-cocaine [42] bonise isaphulelo esikhulu sokubambezeleka kwezocansi kwi-SDDT kunalabo ababambe iqhaza.
(iii) Ukugudluzwa, ukusetshenziswa kwezinkinga kwezidakamizwa kanye nolaka lwezocansi
Phakathi kwabafundi abasebenza ngaphansi kweziqu zabesifazane, okubikwa ukuthi bayazibopha, futhi babika ukuthi kungenzeka ukuthi baphinde bahlukunyezwe ngokocansi, ngisho nangemva kokubalwa kwezinkinga ezihlobene notshwala nokusetshenziswa kwensangu [43].
(iv) Isifingqo
Ucwaningo lokubheka / oluzokwenzeka lusekele ubudlelwano phakathi kokunye ukuphuza, ukuphuza kakhulu nokuphuza ukudakwa; ukukhuthazeka okujwayelekile, okuzibikayo; kanye nezocansi ezingavikelekile. Kodwa-ke, imiqondo efanele kanye nokutholakele maqondana nokulamula noma ukumodareyitha kuyehluka ezifundweni zonke, kunciphisa izinga lapho iziphetho ezithile zingatholwa khona. Ucwaningo lokuhlola luveze ukutholwa okungaguquki kokusebenzisa izinto eziningi nama-SUD kuhlotshaniswa nesaphulelo esikhulu sokubambezeleka kwezocansi nokuthi ukuphathwa kotshwala nakho kuhlotshaniswa nokwenyuka kwezephulelo kwezocansi. Ubudlelwano ekuphungweni kwezezimali bekungenamandla. Ukutholwa okulinganiselwe kwabafundi abangaphansi kweziqu zabesifazane kuxhumanise ukufakwa okujwayelekile ekuhlukunyezweni ngokobulili ngaphezulu nangaphandle kwendima yensangu nokusetshenziswa kwezinkinga kotshwala.
I-4. Izifundo zofuzo neze-neuroimaging
Imininingwane yezinqubo zamamolekyuli ukusetshenziswa kotshwala okungenza ukuthi kube nengxenye ekuziphatheni kobulili okuyingozi ayisiyonto. Ukubuyekezwa kwethu kuveze izifundo ezimbili ezifanele ezinemiphumela yokuxoshwa. Ukuhlaziywa kofuzo kufakiwe ocwaningweni olude lapho abahlanganyeli bahlolwe ekuqaleni konyaka wabo wokuqala njengabafundi [undergraduates]32]. Basebenzise 'i-phenotyping' ukucacisa into efaka ngaphandle ukusetshenziswa kufaka phakathi ukusetshenziswa kabi kwezidakamizwa, ukubikwa kwabantu ngokweqile kanye nokuziphatha okuyingozi kwezocansi i-3281 single nucleotide polymorphisms (SNPs) ezinhlotsheni ze-104 ezihlobene nokuncika kotshwala ocwaningweni lwangaphambilini. Baye babika ukuthuthuka okukhulu kokuzibandakanya phakathi kwala ma-SNPs kanye nesici sokukhipha, kepha hhayi ekusetshenzisweni kabi kwezidakamizwa, ukuziphoqelela noma ukuzibandakanya kwezocansi okuyingozi ngokwahlukana. Lokhu kuphakamisa ukuthi ubudlelwane phakathi kokuncika kotshwala nezinye izindlela zokuphuma ngaphandle, okubandakanya ukusetshenziswa kabi kwezinye izinto, ukubekezelela kanye nokuziphatha okuyingozi kwezocansi, kutholakala okungenani ngokwengxenye yezici ezijwayelekile zofuzo, yize izici zofuzo kungenzeka zingabi nesibopho sobudlelwano phakathi kwezinhlobo ezithile ukukhipha izici. Kokunye ucwaningo, ukuhlaziya kokuncika kofuzo okubangelwa i-genome-by-alcohol-kuholele ekuhlonipheni i-LHPP rs34997829 [44], esihlotshaniswe nezinye izimo zengqondo [55]. Kube nokuhlangana okubalulekile okuthi ubudlelwano obuphakathi kwe-LHPP rs34997829 ne-STI kwaxazululwa ngokuxilongwa kokuncika kotshwala, ngaleyo ndlela kuqinisekiswa ukuhambisana kwale SNP ekuziphatheni kobulili nasekusebenziseni kabi utshwala. Abaphenyi babe sebesenza isifundo esilandelanayo se-neuroimaging kwesinye isampula futhi bathola i-C allele ye-LHPP rs34997829 ehlobene namaphethini womsebenzi we-neural ezifundeni ezihambisana nokuqhutshwa yizandla (bheka okokusebenza kokungezelelwa kwe-elekthronikhi, itafula S1). Kokunye ucwaningo lwe-fMRI, izilinganiso zesifiso sobulili esizenzakalelayo zazihlotshaniswa kahle nomsebenzi ku-dorsal anterior cingulate cortex (dACC) phakathi kwabesilisa abathandanayo nabangaphandle ngaphandle kokuziphatha okucindezelayo kocansi. Ukuvezwa kwamavidiyo abeka obala ezocansi kuhlotshaniswa nokwenza kusebenze kakhulu kwe-dACC, i-ventral striatum kanye ne-amygdala emadodeni aqhathaniswa ngaphandle kokuziphatha okucindezelayo kocansi, nokuxhumeka okusebenzayo ngaphakathi kwalezi zifunda ezihambisana nesifiso sobulili / ukufisa ngezinga elikhulu emadodeni anekuphoqelela izimilo zocansi [47]. Ucwaningo lwakamuva olungafakwanga ekubuyekezweni kwethu luthole umsebenzi omkhulu wokuphamba wezinzwa ezithombeni ezilindelekile zezithombe ezinamadoda emadodeni anezinkinga zokusebenzisa izithombe zocansi uma kuqhathaniswa nalezo ezingenazo [56]. Ukusetshenziswa kobuchopho okuyinkinga kube nokuxhunyaniswa ngokufakwa okujwayelekile ocwaningweni lwangaphambilini [57]. Isibonakaliso sokucabanga kwe-oxygen-oxygen-wate-imaging (BOLD) ngaphakathi kwalesi sifunda sasixhunyaniswe nesikhathi sokuphendula ezintweni zokuziphatha okubi nokuziphatha kocansi [56]. I-dACC, i-ventral striatum kanye ne-amygdala kuhlotshaniswe nokuhlangana kwezidakamizwa kanye nezici zokuphoqelela ocwaningweni olwedlule kanye [30,58]. Ngokufingqa, okutholwe okulinganiselwe kofuzo nokubonakalayo kuveza ukufana maqondana nezici zofuzo nomsebenzi ongasebenzi ezifundeni ezisemqoka zobuchopho ezisekela ubudlelwane phakathi kokuziphatha okungafanele, umlutha nokuziphatha kocansi.
I-5. Ingxoxo
Ngokucatshangwayo iphethini ebaluleke kakhulu yokutholakele ekubuyekezweni kwethu yinani lokuqagela elihlukahlukene lezinyathelo zokuzibika zokufakwa okujwayelekile. Ngokusekelwe kunani labo, lezi zinyathelo kufanele zifakwe kulo lonke ucwaningo olubandakanya isimilo noma izimilo zocansi. Ukufakelwa okujwayelekile, okuzibikwa kuye uqobo bekuqagela eminye imiphumela yokuzibika yokulutha kanye nezocansi ezifundweni zokubheka / ezinokwenzeka kanye nezinhloso zokuya ocansini olunobungozi, olungamukeleki36,37,40,45]. Ngokuphawulekile, ezifundweni zokubuka, ukufakwa okujwayelekile kubikezela bobabili ubutha bocansi kwabesilisa abancane kanye nokuhlukumezeka ngokocansi kwabesifazane [34,41,43,50]. Le ndlela isikisela ukuthi ukucindezela okujwayelekile kubikezela kokubili isenzo sokuya ocansini okuphoqayo, okungenzeka ukuthi kuqhutshwa ngokwengxenye ngumvuzo olindelekile noma ongokoqobo, kanye namaphethini ezenzo zobulili ezingaphoqeleka ngokwemvelo (okusho ukuthi zenzeka yize kunemiphumela emibi futhi incipha ukuthi ibe nomvuzo). Iminyaka encane yababambiqhaza kulezi zifundo iyaphawuleka; Ngakho-ke, ubudlelwano phakathi kokuphoqelelwa okuvamile kanye nokuhlukumeza ngokocansi / ukuphoqa okucindezelayo kungenzeka kungathathi iminyaka eminingi ukuthuthukisa. Yize kudingeka ucwaningo olwengeziwe ukubhalisa abesilisa nabesilisa, okutholakele kokuqala kusikisela ukuthi le miphumela iphathelene nabesilisa nabesifazane abadala.
Okutholakele manje kusekela ukubonwa kwangaphambilini kokukhishwa okubumbili phakathi kokuphoqelelwa kanye nokusetshenziswa kwezidakamizwa [38,40,41,45]. Ukulawulwa kotshwala elabhorethri kuhlangene nokuncishiswa kwemali okungenzeka [24] nokubambezeleka okukhulu kwezocansi kanye nezephulelo ezinokwenzeka [24,39], okubandakanya zombili ukungaziphathi nokuthambekela ekufakweni okuyingozi (okungavikelekile) ekuziphatheni kobulili.
Ezifundweni zokubuka, ukuphuza kakhulu kubikezela umsebenzi wobulili oyingozi [36,46,48]. Yize kufakwe ezifundweni ezimbalwa, ukusetshenziswa kwensangu nakho kuhlotshaniswa nokuya ocansini, kutholakala okulinganiselwe okuxhumanisa ukusetshenziswa kwensangu ukuze iziphathe kabi ezocansi [36,48]. Ocwaningweni lwelabhoratri, utshwala bungahlangene nokuthambekela kokuzibandakanya ocansini kuphela kepha futhi nokwengezwe kokuzithiba okungekuhle / okuphikisayo kokuzitika ngocansi [24]. Lokhu kuthola kukhulisa ukuthi kungenzeka ukuthi ukusetshenziswa kotshwala, noma kube phakathi kwalabo abangenazinkinga zokusebenzisa utshwala, kungahle kuvuse inkambiso yokwenza ucansi okungathiwa kuyimpoqo. Lokhu kungenzeka kubhekwane nakho ocwaningweni oluzayo. Ukuphuza kakhulu kuhlotshaniswa nolaka lwezocansi [50], noma lokhu okutholakele bekungahambisani njengokuzibika, ukugxila okujwayelekile. Lobu budlelwano buveza ukuthi ukuvikela noma ukwelapha ukuxhashazwa ngokobulili, ukuqondisa ukuthambekela okuphoqelela ngokusebenzisa i-pharmacotherapy, ukungenelela kokuziphatha noma zombili kungaba zinzuzo.
Kukhona okutholakele okusekela ubudlelwano phakathi kokuziphathisa kanye nokuziphatha umlutha nokuya ocansini okuvela kwizifundo ezinqunyelwe ezibandakanya izindlela zazo zonke lezi zakhi ezintathu. Kodwa-ke, ngaphezu kwalezi zifundo ezikhawulelwe ngenombolo, zifaka izindlela ezahlukahlukene kanye nemidwebo ehlukene ngokwemibono yobudlelwano phakathi kwabakhiqizi (isib. Eziphathelene nokuhlolisisa noma ukulamula). Izifundo ezingeziwe ngokuzayo kufanele zifake izinyathelo zazo zonke lezi zinhlaka ezintathu. Ngaphezu kwalokho, i-SDDT iyithuluzi elibalulekile lokucwaninga lokuhlola umehluko okhona ngamunye (isib. Labo abanokuphazamiseka ngaphandle kokusebenzisa kabi utshwala) nokubheka imiphumela yokulawulwa kwezidakamizwa elabhorethri ekuthambekeni ekuthatheni izinqumo ngokocansi okukhona futhi okuyingozi.
Izingqinamba eziphathelene nokuya ocansini kanye nomsebenzi wezocansi nabalingani bobulili obuhlukile obufanayo kufanelekile; kepha, munye kuphela ucwaningo olufakiwe oludingida le nkinga. Lolu cwaningo lubhalise kuphela abesilisa abalala nabesilisa. Ucwaningo luphakamise udaba olubalulekile maqondana nobudlelwano obuphakathi kwabantu abathandana nobungqingili kanye nemiphumela yokuya ocansini eyingozi, nokubika ukuthi lobu budlelwano buqina phakathi kwabantu ababika ukushukunyiswa okuthe xaxa. Kungenxa yokuthi abantu abaphoqayo bangathola ukuqiniswa okungekuhle okuqinile kokucwaswa. Lezi zinkinga kufanele zibhekelwe phambili futhi, lapho kufaneleka khona, izifundo eziningi kufanele zibhalise bobabili abantu abazibandakanya ocansini nabalingani abathandanayo nabobulili obuhlukile ukuvumela ukuqhathanisa phakathi kwalawa maqembu.
I-genetics nedatha ye-neuroimaging ilinganiselwe, kepha izifundo ezifakiwe ziphakamisa ama-SNPs ahlobene ngasikhathi sinye ekuziphatheni okungekuhle kanye nokuziphatha okulutha nokuya ocansini [32,44]. Ngokufanayo, idatha etholakalayo ye-neuroimaging etholakalayo ifaka izifunda zobuchopho ezihambelana nazo zontathu izici, zembulwa endaweni yokuphumula nangesikhathi sokuqedelwa kwemisebenzi efanele ukungahambi kahle nomsebenzi wobulili [44,47]. Ngokuphawulekile, uVoon nozakwabo babike ukuthi ukuxhumana okusebenzayo phakathi kwe-dACC, i-ventral striatum kanye ne-amygdala, okubuye kufanekise ukwenzeka kabusha kwezidakamizwa nokuxoshwa, okuhlobene kakhulu nesifiso sobulili kunokuthanda abesilisa abanokuziphatha okucindezelayo kocansi [47,59]. Lokhu kuphakamisa ukuthi into yokucindezelwa ihambelana nokuzibandakanya phakathi kokuziphathisa, umlutha nokuziphatha kocansi. Ucwaningo lofuzo kanye neurourovolution kuyizindlela okufanele zisetshenziswe ekuqhubekiseleni phambili ulwazi lwe-etiologies eyabiwe neyodwa nemithelela yokwelashwa.
Ukubuyekezwa okukhona bekunemikhawulo kufaka phakathi ukuntuleka okuphelele kokutholwayo okuxhumanisa ukusetshenziswa kwezidakamizwa / ukuphazamiseka kokusetshenziswa kocansi / ulaka kanye nokuntuleka kokubika ngokutholakele kulungisa ngqo ubudlelwano phakathi kwezakhi zethu ezintathu zenzalo. Imisebenzi yokuthwebula ukusabela kokuphendula ibingasetshenziswa. Ucwaningo kulokhu kubuyekezwa futhi belunqabele ukungazibandakanyi izimpawu zokuphazamiseka kobuntu kanye / noma ukuxilonga ekubandakanyekeni ekuhlanganyeleni nasekuhlaziyweni kwezibalo. Ukuziphatha nokuthambekela kwezocansi kucatshangelwe kuphela njengezinyathelo zokukhishwa. Ngenkathi lokhu kubalulekile, ucwaningo luvame ukunganaki ukuziphatha kobulili, ukuvuka, izinhloso kanye nezinye izinto ezihlobene njengokukhishwa kokusetshenziswa kwezidakamizwa noma isimilo esixakile. Ukubuyekezwa futhi akubanga nezifundo zokuphamba, futhi lokhu kufanele kuhlolwe lapho kusenziwa uphenyo ngokuzayo.
6. Isiphetho
Okutholakele kusukela kusibuyekezo esikhona kuphikisana kakhulu nenani lokuqagela lokuzibika, lokufakwa okujwayelekile. Ngokuphawulekile, lokhu okutholakele kufake phakathi ubudlelwano kulaka lwezocansi kanye nokuhlukunyezwa kabusha, imiphumela engathathwa njengefanelekile ekucindezelweni. Imibiko yokuzenzisa yokuphoqelelwa okujwayelekile kufanele ifakwe kulo lonke ucwaningo lwesikhathi esizayo olubandakanya isimilo sokuziphatha okulutha noma ngokocansi. Ukulawulwa kotshwala kwakuhambisana nokuncishiswa okungenzeka kwemali kanye nokuncipha kwezaphulelo zezenzo zobulili kanye nokukhula kokuthambekela kokuya ocansini kufaka phakathi izinto zokuphoqelelwa. Okutholakele kulokhu kubukeza kusekela inani le-SDDT ngaphandle kokulawulwa kwezidakamizwa elabhoratri.
Ukubuyekezwa okukhona manje kukhombe izikhala eziningi zokucwaninga, kufaka phakathi isidingo sezifundo ezengeziwe: ukubika ngobudlelwano phakathi kwezici zokuziphoqelela kanye nokuziphatha umlutha nokuya ocansini; ukuqasha abesifazane kanye nabesilisa (kanye nabantu abadlulisanayo) kanye nokuhlola umehluko ngamunye nokusebenzisana okubandakanya ubulili; ukuphenya umehluko ongaba khona ophathelene nokuthanda ucansi / okuncamelayo kokuya ocansini nabalingani bobabili kanye / noma nabalingani obuhlukile; cwaninga izinhlobo zezinto ezithandwayo zokwenza ucansi; kusetshenziswa imisebenzi yokuphendula okungafanele; kanye nokufaka ukuhlolwa kofuzo kanye neuroimaging. Ucwaningo lwesikhathi esizayo olubhekana nazo zonke lezi zinto ezintathu ngasikhathi sinye kufanele lufake izinto ngaphandle kotshwala (kufaka phakathi ugwayi) kanye nezinkinga zokugembula nezokudlala. Mayelana nokugcina, ukuphazamiseka kwemidlalo, kanye nokuziphatha okuphathelene nocansi okuphoqayo, kufakiwe ohlelweni lweshumi nanye lweInternational Classified of Diseases [60], futhi ezokuziphatha nezithombe zocansi zokuziphatha kungenzeka zixhunyaniswe ngezindlela ezinengqondo [59]. Ngakho-ke, ubudlelwano obungahle bube nobunzima obuhilela ukusetshenziswa kwezidakamizwa kanye nokuphoqelela ngalezi zimo buginga uphenyo olwengeziwe.
Ngenkathi imiphumela yokulawulwa kwezidakamizwa (ikakhulukazi utshwala) ekubandakanyekeni kombuso kanye nokwanda kwezenzo zocansi kuphenywe kaningi, ngokungafani nalutho bekukhona ucwaningo olukhombisa ukufakwa kwesimo kanye nokusetshenziswa kwezidakamizwa okubangelwa ukuvuswa kwesifiso sobulili, ukuvuka komoya, njll. Kunesandulelo sokuhlola umthelela wokudonswa yizinto ezingezona izidakamizwa ekugxambukeni kombuso nokusetshenziswa kwezidakamizwa (isib. ukucindezelwa [61]). Imisebenzi yezocansi njengesisusa sokungabanjiswa ngamandla kokusetshenziswa kwezidakamizwa okwandisiwe kufanele kubhekwane nayo kwizifundo ezizayo.
Ngokuvala, ukucindezelwa (ikakhulukazi, okubikwa ngokujwayelekile, nokuzikhulumela) kuvame ukubikezela ukuzibandakanya ekuziphatheni okungekuhle nokuya ocansini ngamanani ahlukahlukene obukhulu, okunezici zokuzibizela kanye nokuphoqelelwa kulezi zenzo. Ukuphuza utshwala kuvame ukukhulisa isimilo esingaphoqeleli, kufaka phakathi ukuthambekela ezenzweni zobulili ezingaphoqeleli nezimpoqo. Isibuyekezo esikhona sikhombe inqwaba yezikhala zokucwaninga ezizobhekelwa ezifundweni ezizayo.
Ukutholakala kwedatha
Izinsizakusebenza ezingeziwe ezilayishwe njengezinto zokungezelela zikagesi.
Iminikelo yabalobi
I-RFL, BHPR ne-NMG bafake isandla ekubuyekezweni kwezincwadi. I-RFL yabhala okusalungiswa kokuqala kombhalo wosizo ngosizo oluvela ku-BHPR naku-NMG; I-MNP ibukeze umbhalo wesandla futhi yabheka ukubuyekezwa kwe-RFL Bonke ababhali banikeze imvume yokugcina ukuthi ishicilelwe.
Izithakazelo zokuncintisana
Simemezela ukuthi asinazintshisekelo zokuncintisana. UDkt Potenza udalula okulandelayo. UDkt Potenza uthintane nabakwaShire, INSYS, Healthmend Health, Opiant / Lightlake Therapeutics kanye neJazz Pharmaceuticals; uthole ukwesekwa kocwaningo (ku-Yale) kusuka kuMoregan Sun Casino nakwisikhungo Sikazwelonke Sokubheja Ngokudlala Imidlalo; ubambe iqhaza ocwaningweni, ekubhaleni ngeposi noma ngokuxhumana ngocingo okuhlobene nokuluthwa izidakamizwa, ukuphazamiseka kokulawulwa kokuthinteka noma ezinye izihloko zezempilo; uthinte futhi / noma weluleka ukugembula nezinhlaka zezomthetho mayelana nezinkinga eziphathelene nokulawulwa kokulawula / umlutha; uhlinzekele ukunakekelwa kwemitholampilo ohlelweni lwezinsizakalo zokugembula eziyinkinga; wenze ukubuyekezwa kwesibonelelo kuma-ejensi okuxhasa ngemali ucwaningo; uhlele amaphephabhuku kanye nezigaba zamaphephabhuku; unikeze izinkulumo zezifundo emjikelezweni omuhle, imicimbi ye-CME nakwezinye izindawo zokwelapha noma zesayensi; futhi ukhiqize izincwadi noma izahluko zencwadi zabashicileli bemibhalo yezempilo yengqondo.
Izimali
Lokhu kubuyekezwa kwasekelwa ngemali evela kwi-State of Florida, ukwesekwa okuvela esikhungweni sikazwelonke sokuqhubekisela phambili ukuguqulela isayensi yezemfundo kuzwelonke ngaphansi kwezikhungo zemfundo ephakeme i-University of Florida Clinical and Translational Science Awards TL1TR001428 kanye ne-UL1TR001427 ku-NMG kanye ne-NIH izibonelelo ze-R21 AA023368 ne-UH2 AA026214 ne-UH01 AA035508. I-RFLMNP yayisekelwa yi-National Center for Responsible Gaming (Isikhungo Sokunika Imigwaqo Esezingeni Elihle), uMnyango Wokuxhumana Wemisebenzi Yezengqondo Nezingqondo, I-Connecticut Council on Inkinga Yokugembula kanye ne-NIH (R50 DA09241, P01 DA026437, R01 DA039136, R01 DA040699 DA21, R040138 DA03 kanye R045289 DAXNUMX).
Imibhalo yaphansi
Umnikelo owodwa we-14 odabeni lwengqikithi 'Ukuthatha ingozi nokuziphatha okuphoqayo: ukutholwa okuyisisekelo, ukubuka kwethiyori kanye nemithelela emtholampilo'.
Izinto zokwengeza ze-elekthronikhi zitholakala online at https://doi.org/10.6084/m9.figshare.c.4309340.
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