BACKGROUND & AIMS: BACKGROUND:The international Life In Recovery (LiR) surveys have provided an important message to the public and policy makers about the reality of change from addiction to recovery, consistently demonstrating both that there are marked gains across a range of life domains and that the longer the person is in recovery the better their recovery strengths and achievements. However, to date, no attempt has been made to quantify the Life In Recovery scales and to assess what levels of change in removing barriers and building strengths is achieved at which point in the recovery journey. METHODS:The current study undertakes a preliminary analysis of strengths and barriers from the Life in Recovery measure, using data from a European survey on drug users in recovery (n = 480), and suggests that the instrument can be edited into a Strengths And Barriers Recovery Scale (SABRS). The new scale provides a single score for both current recovery strengths and barriers to recovery. RESULTS:The resulting data analysis shows that there are stepwise incremental changes in recovery strengths at different recovery stages, but these occur with only very limited reductions in barriers to recovery, with even those in stable recovery typically having at least two barriers to their quality of life and wellbeing. Greater strengths in active addiction are associated with greater strengths and resources in recovery. CONCLUSION:As well as demonstrating population changes in each of the domains assessed, the current study has shown the potential of the Life In Recovery Scale as a measure of recovery capital that can be used to support recovery interventions and pathways.

背景与目标：

BACKGROUND & AIMS: :Adenosine A2A receptors localized in the dorsal striatum are considered as a new target for the development of antiparkinsonian drugs. Co-administration of A2A receptor antagonists has shown a significant improvement of the effects of l-DOPA. The present review emphasizes the possible application of A2A receptor antagonists in pathological conditions other than parkinsonism, including drug addiction, sleep disorders and pain. In addition to the dorsal striatum, the ventral striatum (nucleus accumbens) contains a high density of A2A receptors, which presynaptically and postsynaptically regulate glutamatergic transmission in the cortical glutamatergic projections to the nucleus accumbens. It is currently believed that molecular adaptations of the cortico-accumbens glutamatergic synapses are involved in compulsive drug seeking and relapse. Here we review recent experimental evidence suggesting that A2A antagonists could become new therapeutic agents for drug addiction. Morphological and functional studies have identified lower levels of A2A receptors in brain areas other than the striatum, such as the ventrolateral preoptic area of the hypothalamus, where adenosine plays an important role in sleep regulation. Although initially believed to be mostly dependent on A1 receptors, here we review recent studies that demonstrate that the somnogenic effects of adenosine are largely mediated by hypothalamic A2A receptors. A2A)receptor antagonists could therefore be considered as a possible treatment for narcolepsy and other sleep-related disorders. Finally, nociception is another adenosine-regulated neural function previously thought to mostly involve A1 receptors. Although there is some conflicting literature on the effects of agonists and antagonists, which may partly be due to the lack of selectivity of available drugs, the studies in A2A receptor knockout mice suggest that A2A receptor antagonists might have some therapeutic potential in pain states, in particular where high intensity stimuli are prevalent.

背景与目标： : 位于背侧纹状体的腺苷A2A受体被认为是开发抗帕金森病药物的新靶标。A2A受体拮抗剂的共同给药显示了l-多巴的作用的显着改善。本综述强调了A2A受体拮抗剂在帕金森氏症以外的其他病理疾病 (包括药物成瘾，睡眠障碍和疼痛) 中的可能应用。除背侧纹状体外，腹侧纹状体 (伏隔核) 还包含高密度的A2A受体，其突触前和突触后调节皮质谷氨酸能投射到伏隔核的谷氨酸能传递。目前认为，皮质伏隔肌谷氨酸能突触的分子适应与强迫性药物寻找和复发有关。在这里，我们回顾了最近的实验证据，表明A2A拮抗剂可能成为药物成瘾的新治疗剂。形态学和功能研究已经确定了除纹状体以外的大脑区域中较低水平的A2A受体，例如下丘脑的腹外侧视前区，其中腺苷在睡眠调节中起着重要作用。尽管最初认为主要依赖于A1受体，但我们在这里回顾了最近的研究，这些研究表明，腺苷的促睡眠作用主要由下丘脑A2A受体介导。因此，A2A) 受体拮抗剂可以被认为是发作性睡病和其他睡眠相关疾病的可能治疗方法。最后，伤害感受是另一种腺苷调节的神经功能，以前被认为主要涉及A1受体。尽管关于激动剂和拮抗剂的作用存在一些相互矛盾的文献，这可能部分是由于缺乏可用药物的选择性，但对A2A受体敲除小鼠的研究表明，A2A受体拮抗剂在疼痛状态下可能具有一定的治疗潜力，特别是在高强度刺激普遍存在的地方。

BACKGROUND & AIMS: AIM:To assess the progress and impact of genetic studies in the addictions arena and to present this information in a form accessible to the general readership of Addiction. METHODS:Review of the evidence that genes are involved in addiction, approaches to their identification, current findings and the potential implications. RESULTS:Family, twin and adoption studies provide strong evidence that addiction runs in families and that this is determined in part by genetic factors. Two main molecular genetic approaches, namely linkage and association, have been adopted to identify the specific genes involved. Both methods are fraught with problems. Linkage is limited by issues of sensitivity, and association by false positives. Perhaps the strongest finding in psychiatric genetics to date is the impressive effect that a single genetic variant, in the aldehyde dehydrogenase 2 gene, has on drinking behaviour and reducing the risk of developing alcohol dependence. Other findings are currently less robust; however, the implications of elucidating the genetic underpinning of addiction will be profound. CONCLUSIONS:Addiction genetics is a developing science that has yet to prove its worth in the clinical setting.

背景与目标：

BACKGROUND & AIMS: :Health care in the USA faces a double challenge, the crisis of chronic pain and the crisis of opioid misuse and overdose. Patients have been prescribed opioids at high doses with unclear indications for long periods of time, putting them at high risk for morbidity and mortality. A significant proportion of these patients have comorbid psychiatric or substance use disorders complicating their pain conditions. The challenges to treating these patients adequately are discussed, along with potential solutions to these issues at the level of the individual provider, healthcare systems, and society.

背景与目标： : 美国的医疗保健面临双重挑战，慢性疼痛危机和阿片类药物滥用和过量的危机。长期服用高剂量阿片类药物，适应症不明确，使患者发病和死亡的风险很高。这些患者中有很大一部分患有合并症的精神或物质使用障碍，使他们的疼痛状况复杂化。讨论了充分治疗这些患者的挑战，以及在个人提供者，医疗保健系统和社会层面针对这些问题的潜在解决方案。

BACKGROUND & AIMS: :This article reviews: (1) the relative importance of spirituality and religion in Switzerland and the United States, (2) the rationale for faith-based addiction intervention programs and the drawbacks of measurement approaches, and (3) results from a pilot study exploring the meaning of spirituality and religiosity from the consumer's perspective. Twenty-three patients entering the Swiss Südhang clinic in-patient alcohol user treatment program during the first five months in 2012 participated upon their admission in a video-taped drawing task, designed to provide their personal visualized definitions of the terms "spirituality" and "religiosity." Nine dimensions emerged pointing to a high complexity of the concepts.

背景与目标： : 本文回顾了 :( 1) 瑞士和美国的精神和宗教的相对重要性，(2) 基于信仰的成瘾干预计划的基本原理以及测量方法的弊端，(3) 一项试点研究的结果，该研究从消费者的角度探讨了灵性和宗教信仰的意义。在最初的五个月中，有23名患者进入了瑞士s ü dhang诊所的住院酒精使用者治疗计划，2012年在入院时参加了录像带绘画任务，旨在提供他们对 “灵性” 和 “宗教信仰”。”出现了九个维度，这表明这些概念非常复杂。

BACKGROUND & AIMS: BACKGROUND:There is a dearth of research in the published literature on substance use and addiction in the Middle East and Islamic countries. This study was the first to explore whether the biopsychosocial-spiritual model of addiction was relevant to an addicted treatment population in Jordan, an Islamic country. METHODS:A qualitative study design using semi-structured, face-to-face interviews were conducted with a sample of 25 males in addiction treatment. The sample was drawn from a cohort of in-patients at a treatment centre in Amman, Jordan who had already participated in a quantitative survey. A purposive sample was selected to ensure the inclusion of a range of characteristics that might affect their experience of developing addiction and its consequences, i.e., age, marital status and educational level. Interviews were transcribed and thematic analysis conducted using verbatim quotes to illustrate themes. Themes were mapped onto the biopsychosocial-spiritual model of addiction. RESULTS:This study found addiction was associated with a range of health (physical and psychological), social and spiritual factors. Unpleasant physical withdrawal effects, psychological symptoms, such as anxiety and suicide attempts, were experienced. There was breakdown in marital and family relations, loss of employment, involvement in crime and neglect of religious practices, resulting in social isolation. CONCLUSION:This study found that, despite some differences in emphasis, the biopsychosocial, spiritual model of addiction fit wel,l particularly given the relative importance of religion in Islamic culture. Spirituality was not explored and further study of spirituality versus religious practice in this culture is recommended.

背景与目标：

BACKGROUND & AIMS: :Cancer is a multistep process whereby genetic events that result in the activation of proto-oncogenes or the inactivation of tumor suppressor genes usurp physiologic programs mandating relentless proliferation and growth. Experimental evidence surprisingly illustrates that the inactivation of even a single oncogene can be sufficient to induce sustained tumor regression. These observations suggest the hypothesis that tumors become irrevocably addicted to the oncogenes that initiated tumorigenesis. The proposed explanation for this phenomenon is that activated oncogenes result in a signaling state in which the sudden abatement of oncogene activity balances towards proliferative arrest and apoptosis. Indeed, substantial evidence supports this hypothesis. Here, we propose an alternative, although not necessarily mutually exclusive, explanation for how oncogenes initiate and sustain tumorigenesis. We suggest that oncogene activation initiates tumorigenesis precisely because it directly overrides physiologic programs inducing a state of cellular amnesia, not only inducing relentless cellular proliferation, but also bypassing checkpoint mechanisms that are essential for cellular mortality, self-renewal, and genomic integrity. Because no single oncogenic lesion is sufficient to overcome all of these physiologic barriers, oncogenes are restrained from inducing tumorigenesis. Correspondingly, in a tumor that has acquired the complete complement of oncogenic lesions required to overcome all of these safety mechanisms, the inactivation of a single oncogene can restore some of these pathways resulting in proliferative arrest, differentiation, cellular senescence, and/or apoptosis. Thus, oncogenes induce cancer because they induce a cellular state of enforced oncogenic amnesia in which, only upon oncogene inactivation, the tumor becomes aware of its transgression.

背景与目标： : 癌症是一个多步骤的过程，其中导致原癌基因激活或抑癌基因失活的遗传事件会破坏生理程序，从而迫使其持续增殖和生长。实验证据令人惊讶地表明，即使是单个癌基因的失活也足以诱导肿瘤持续消退。这些观察结果表明，肿瘤对引发肿瘤发生的癌基因不可撤销地上瘾的假设。对这种现象的拟议解释是，活化的癌基因导致信号传导状态，其中癌基因活性的突然减弱与增殖停滞和凋亡平衡。事实上，大量证据支持这一假设。在这里，我们提出了一种替代的，尽管不一定相互排斥的解释，以解释癌基因如何启动和维持肿瘤发生。我们建议癌基因激活启动肿瘤发生，正是因为它直接超越了诱导细胞失忆症状态的生理程序，不仅诱导细胞持续增殖，而且绕过了细胞死亡，自我更新和基因组完整性必不可少的检查点机制。由于没有单一的致癌病变足以克服所有这些生理障碍，因此抑制了癌基因诱导肿瘤发生。相应地，在获得克服所有这些安全机制所需的完整致癌病变的肿瘤中，单个癌基因的失活可以恢复其中一些途径，从而导致增殖停滞，分化，细胞衰老和/或细胞凋亡。因此，癌基因会诱发癌症，因为它们会诱导一种强制的致癌性遗忘的细胞状态，在这种状态下，只有在癌基因失活后，肿瘤才会意识到其侵袭。

BACKGROUND & AIMS: Background and aims:Individuals with addictive disorders are usually characterized by impaired executive control, persistent craving and excessive reward-seeking. However, it is unclear whether there is a deviation in the connection pattern among the neural systems implicated in these problem behaviors. Methods:One hundred thirty-six online gaming players were recruited in the current study (68 Internet gaming disorder (IGD) subjects and 68 recreational game users (RGUs) who served as controls matched on age, sex, years of education, and years of gaming). Dynamic interactions among the reward system (striatum), control system (prefrontal cortex), and the interoceptive awareness system (insula) were calculated and compared when subjects were facing gaming cues. Results:The results revealed that RGUs showed a significant positive correlation in the putamen-middle frontal gyrus (MFG)-insula neural pathway when facing gaming cues, which was missing in the IGD subjects. Additionally, dynamic causal modeling (DCM) analysis revealed that the MFG region was more inhibited by the putamen in the IGD subjects relative to the RGUs. Conclusions:These findings suggest that the inhibitory neuromodulation of the putamen to the prefrontal cortex in IGD individuals undermines the balance among the tripartite systems. Our findings provide novel neurobiological evidence for understanding the internal connection bias of the addicted individual's neural system and how the addictive disorder impairs executive control; consequently, the pathway from the striatum to the prefrontal cortex may serve as a potential biomarker to predict the risk of developing an addiction.

背景与目标：

BACKGROUND & AIMS: :The most challenging aspect of treating alcohol and drug addiction is the relapsing course of these disorders. Although substitution therapies for nicotine and opioid dependence have proven to be relatively effective, there is a need for new pharmacotherapies designed to decrease the frequency and severity of relapse. The aim of this paper is to provide an overview of the potential utility of N-methyl-D-aspartate (NMDA) receptor antagonists as treatments for substance abuse as shown in preclinical models and preliminary clinical trials. It is hypothesized that NMDA receptors mediate the common adaptive processes that are involved the development, maintenance, and expression of drug and alcohol addiction. Modulation of glutamatergic neurotransmission with NMDA receptor antagonists offers a novel treatment approach. It is proposed that NMDA antagonists may have multiple functions in treating addictions, including an attenuation of withdrawal effects, normalization of the affective changes following initiation of abstinence which arise from neurochemical changes resulting from chronic addiction, and an attenuation of conditioned responses arising from drug-related stimuli.

背景与目标： : 治疗酒精和药物成瘾最具挑战性的方面是这些疾病的复发过程。尽管尼古丁和阿片类药物依赖的替代疗法已被证明是相对有效的，但仍需要旨在降低复发频率和严重程度的新药物疗法。本文的目的是概述N-甲基-D-天冬氨酸 (NMDA) 受体拮抗剂作为药物滥用治疗的潜在用途，如临床前模型和初步临床试验所示。假设NMDA受体介导共同的适应过程，这些过程涉及药物和酒精成瘾的发展，维持和表达。用NMDA受体拮抗剂调节谷氨酸能神经传递提供了一种新的治疗方法。有人提出，NMDA拮抗剂在治疗成瘾方面可能具有多种功能，包括减弱戒断效应，戒断开始后情绪变化的正常化 (由慢性成瘾引起的神经化学变化引起) 以及药物引起的条件性反应的减弱相关刺激。

BACKGROUND & AIMS: :This study assessed the utility of adding the Addiction Severity Index (ASI) to demographic and clinical diagnostic information for the purpose of predicting subsequent substance use disorder service use, and use of other healthcare services by 260 veterans admitted for outpatient substance use disorder treatment. Data collected included demographics, clinical diagnoses, assessment data from the ASI, as well as measures of six-month health service utilization (e.g., substance use disorder services, other mental health services, outpatient medical visits, urgent care visits, inpatient psychiatric and medical). Multivariate analysis using Tobit regression models showed six out of seven ASI scales were significant predictors, and that combining ASI data with demographics and clinical data significantly improved prediction of health care services. It also was found that certain psychiatric and medical diagnoses were related to service use measures, and that a diagnosis of depression was related to overall healthcare utilization.

背景与目标： : 这项研究评估了将成瘾严重程度指数 (ASI) 添加到人口统计学和临床诊断信息中的效用，以预测随后的物质使用障碍服务的使用情况，以及260名接受门诊物质使用障碍治疗的退伍军人使用其他医疗服务的情况。收集的数据包括人口统计学，临床诊断，ASI的评估数据以及六个月卫生服务利用率的衡量标准 (例如，物质使用障碍服务，其他精神卫生服务，门诊就诊，紧急护理就诊，住院精神病和医疗)。使用Tobit回归模型进行的多变量分析显示，七个ASI量表中有六个是重要的预测指标，并且将ASI数据与人口统计学和临床数据相结合可以显着改善对医疗保健服务的预测。还发现某些精神病学和医学诊断与服务使用措施有关，而抑郁症的诊断与总体医疗保健利用有关。

BACKGROUND & AIMS: :Tobacco smoking is a leading preventable cause of death in the United States and produces a major health and economic burden. Although the majority of smokers want to quit, few are successful. These data highlight the need for additional research into the neurobiology of tobacco dependence. Addiction to nicotine, the main psychoactive component of tobacco, is influenced by multiple factors that include individual differences in genetic makeup. Twin studies have demonstrated that genetic factors can influence vulnerability to nicotine addiction, and subsequent research has identified genes that may alter sensitivity to nicotine. In humans, genome-wide and candidate gene association studies have demonstrated that genes encoding nicotinic acetylcholine receptor (nAChR) proteins are associated with multiple smoking phenotypes. Similarly, research in mice has provided evidence that naturally occurring variability in nAChR genes is associated with changes in nicotine sensitivity. Furthermore, the use of genetic knockout mice has allowed researchers to determine the nAChR genes that mediate the effects of nicotine, whereas research with knockin mice has demonstrated that changes to nAChR genes can dramatically alter nicotine sensitivity. This review will examine the genetic factors that alter susceptibility to nicotine addiction, with an emphasis on the genes that encode nAChR proteins.

背景与目标： : 在美国，吸烟是可预防的主要死亡原因，并造成重大的健康和经济负担。尽管大多数吸烟者都想戒烟，但很少有人成功。这些数据强调了对烟草依赖的神经生物学进行更多研究的必要性。烟草的主要精神成分尼古丁成瘾受多种因素影响，包括遗传构成的个体差异。双胞胎研究表明，遗传因素会影响尼古丁成瘾的脆弱性，随后的研究发现了可能改变尼古丁敏感性的基因。在人类中，全基因组和候选基因关联研究表明，编码烟碱乙酰胆碱受体 (nAChR) 蛋白的基因与多种吸烟表型相关。同样，对小鼠的研究提供了证据，表明nAChR基因的自然变化与尼古丁敏感性的变化有关。此外，基因敲除小鼠的使用使研究人员能够确定介导尼古丁作用的nAChR基因，而对敲除小鼠的研究表明，nAChR基因的改变可以显着改变尼古丁的敏感性。这篇综述将研究改变尼古丁成瘾易感性的遗传因素，重点是编码nAChR蛋白的基因。

BACKGROUND & AIMS: :The final common pathway of addiction (the dopamine hypothesis of reward) has recently been evolving, with the mesocorticolimbic dopaminergic system now seen as key to natural rewards and drug-seeking behaviour, though perhaps having less of a role in the maintenance of such behaviour. The perception of a common pathway has meant that treatments for one drug of addiction have 'crossed-over' and become possible treatments for other addictive drugs.

背景与目标： : 成瘾的最终共同途径 (奖赏的多巴胺假说) 最近一直在发展，中皮质边缘多巴胺能系统现在被视为自然奖赏和寻求药物行为的关键，尽管在维持这种行为方面的作用可能较小。对共同途径的感知意味着对一种成瘾药物的治疗已经 “交叉”，并成为其他成瘾药物的可能治疗。

BACKGROUND & AIMS: :The most critical unresolved issue associated with psychoanalysis is whether its core precepts belong in today's substance use armamentarium. Psychoanalytic theories have resisted the criterion of falsifiability, putting them at odds with the current paradigm for treating addiction. However, Freud's earliest pronouncement on the subject, "making the patient a collaborator in his own treatment" (i.e., therapeutic alliance) not only holds up to scientific scrutiny, but is a robust determinant in improving treatment outcomes. Psychoanalytic constructs today appear as conjectures, but recognition of the primacy of the collaborative therapeutic relationship is one example of how psychoanalytic observations have influenced current research.

背景与目标： : 与精神分析相关的最关键的未解决问题是其核心戒律是否属于当今的物质使用武器。精神分析理论抵制了可证伪性的标准，使其与当前治疗成瘾的范式背道而驰。然而，弗洛伊德关于这一主题的最早声明 “使患者成为自己治疗的合作者” (即治疗联盟) 不仅具有科学依据，而且是改善治疗结果的有力决定因素。今天，精神分析结构似乎是猜想，但是对合作治疗关系的首要地位的认识是精神分析观察如何影响当前研究的一个例子。

BACKGROUND & AIMS: :Nineteen heroin-dependent male volunteers were administered buprenorphine sublingually, in ascending daily doses of 2, 4, and 8 mg. They were maintained on 8 mg daily through study day 18. On study days 19 through 36, subjects in group 1 continued to receive burprenorphine daily; subjects in group 2 received buprenorphine or placebo on alternate days. On days 37 through 52, all subjects received placebo. Subjects receiving buprenorphine on alternate days reported significantly greater urge for an opioid, increased dysphoria scores, and pupillary dilation on placebo days. After abrupt termination of buprenorphine, no withdrawal signs were detected with the Himmelsbach scale. However, subjects reported mild-to-moderate opioid withdrawal symptoms, peaking at 3 to 5 and lasting for 8 to 10 days. Daily administration of buprenorphine provided greater control of subtle opioid withdrawal symptoms, but subjects could tolerate a between-dose interval of 48 hours.

背景与目标： : 19名海洛因依赖型男性志愿者以每天2、4和8 mg的剂量向舌下注射丁丙诺啡。在研究第18天，他们每天维持8 mg。在研究的第19至36天，第1组的受试者继续每天接受burprenorphine; 第2组的受试者每隔几天接受丁丙诺啡或安慰剂。在第37至52天，所有受试者均接受安慰剂。每隔几天接受丁丙诺啡的受试者报告说，在安慰剂日，阿片类药物的冲动明显增加，烦躁不安评分增加和瞳孔扩张。丁丙诺啡突然终止后，Himmelsbach量表未检测到戒断迹象。然而，受试者报告了轻度至中度阿片类药物戒断症状，在3至5点达到峰值，持续8至10天。每天服用丁丙诺啡可更好地控制微妙的阿片类药物戒断症状，但受试者可以耐受48小时的剂量间隔。

BACKGROUND & AIMS: OBJECTIVE:This study aimed to examine the differences in personality characteristics between adolescents with and without Internet addiction and substance use experience as defined by the Tridimensional Personality Questionnaire (TPQ), and to compare personality characteristics among groups of adolescents with both Internet addiction and substance use experience (comorbid group), those with only Internet addition (Internet addiction group), those with only substance use experience (substance experience group), and those without Internet addiction or substance use experience (control group). METHOD:In the cross-sectional investigation, we recruited 3662 students (2328 boys and 1334 girls) from high schools in southern Taiwan. Our investigation was conducted using the TPQ, the Chen Internet Addiction Scale, and Questionnaires for Experience in Substance Use. RESULTS:Adolescents with Internet addiction were more likely to have substance use experience. High novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) predicted a higher proportion of adolescents with Internet addiction. High NS, low HA, and low RD predicted a higher proportion of adolescents with substance use experience. Of the 4 groups, the Internet addiction group had the highest HA scores and the comorbid group had the lowest HA scores. CONCLUSION:Adolescents with high NS and low RD should be provided with effective strategies for preventing Internet addiction and substance use. In addition, the Internet addiction group and the comorbid group should be provided with different preventative strategies focused on HA.

背景与目标：