药物成瘾记忆的神经生物机制及临床干预方法

药物成瘾者戒断后的持久复吸是治疗药物成瘾的难点.成瘾者出现持续复吸的重要原因是由于成瘾记忆的长期存在.成瘾物质的长期反复使用导致前额叶-边缘多巴胺系统结构和功能的适应性改变,这种改变是成瘾记忆形成的神经基础.本文从学习记忆的角度来理解成瘾形成,介绍了成瘾记忆的初始形成阶段、习惯化阶段和成瘾行为维持阶段及其相应的神经基础.回顾了近年来成瘾记忆的临床干预方法,包括消退干预方法、增强消退干预的多情境干预方法,以及直接干预消除成瘾记忆的记忆再巩固干预方法,并总结了虚拟现实、神经调控技术在成瘾记忆干预中的应用.对记忆再巩固干预方法与虚拟现实、神经调控技术相结合干预成瘾记忆进行展望,为药物成瘾的临床干预和治疗提供了新方法、新思路.

Neurobiological Mechanism of Drug-associated Memories and Its Clinic Intervention

Relapse behavior after long-term abstinence is the key problem of addiction treatment. A major factor to induce relapse is the persistence of maladaptive drug-associated memories. Persistent changes in structure and function of prefrontal cortex-mesolimbic dopamine system caused by chronic drug abusing, lead to the formation of pathological drug-associated memories. This article reviews addiction with a focus on how it can be conceptualised as a disorder of maladaptive memory, considering the neural basis of drug-associated memories during the initial phase, the habituation phase and the maintenance phase of addictive behavior. The present review summarizes the clinical intervention methods of drug-associated memories in recent years including extinction training, extinction in multiple contexts to facilitate extinction and reconsolidation intervention to disrupt drug-associated memories directly, and the application of virtual reality technology and neuromodulation methods in addiction intervention. The intervention methods combined memory reconsolidation with virtual reality technology or neuromodulation methods are prospected to target drug-associated memories, providing new methods and new ideas to treat addiction in future clinical researches.