Modelle der Substanzabhängigkeit
Neurobiologische und neuropsychologische Modelle der Substanzabhängigkeit
Abstract
Neurobiologische Modelle der Substanzabhängigkeit postulieren, dass Abhängigkeit aus einem Zusammenspiel zwischen positiver und negativer Verstärkung entsteht. Die positive Verstärkung wird über die dopaminerge Transmission im Striatum vermittelt, während die negative Verstärkung die neurobiologischen Stresssysteme involviert. Abhängigkeit geht mit lang anhaltenden Änderungen der zerebralen Motivationssysteme einher. Neuropsychologische Forschungsarbeiten weisen auf ein beeinträchtigtes Entscheidungsverhalten hin, welches mit einer Dysfunktion im ventromedialen präfrontalen Kortex zusammenhängen könnte. Sie betonen die Rolle der Insula, welche die neuronale Grundlage für die fehlende Einsicht ins problematische Suchtverhalten als auch für die Vermittlung des bewussten Drangs, die Substanz zu konsumieren, sein könnte. Neurobiologische und neuropsychologische Sichtweisen werden in einem Modell integriert, das impulsive subkortikale und dopamin-bezogene Prozesse mit einer Beeinträchtigung der kortikalen Hemmung und kognitiven Defiziten verbindet.
Neurobiological models of substance dependence hypothesize that addiction results from interplay between positive and negative reinforcement. Positive reinforcing effects of drugs are mediated through dopamine transmission in the striatum, while negative reinforcement involves the central stress systems. Substance dependence leads to persistent changes in the brain motivational systems. Neuropsychological research showed impairment in decision-making that could be related to a dysfunction in the ventromedial prefrontal cortex. A further critical region is the insula that could be involved in the impaired insight in addictive behaviour and in the mediation of the conscious urge to take the drug. Neurobiological and neuropsychological perspectives are integrated here in a model combining impulsive subcortical and dopamine-related processes with dysfunction of cortical inhibition and cognitive deficits.
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