Dipendenza psicologica

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Glossario della Dipendenza e Tossicodipendenza^[1]^[2]^[3]^[4]

dipendenza: uno stato medico caratterizzato da ricerca compulsiva di stimoli gratificanti, nonostante le conseguenze negative
comportamento di dipendenza: un comportamento che è al tempo stesso gratificante e di rinforzo
farmaco dipendenza: un farmaco che è al tempo stesso gratificante e di rinforzo
la dipendenza: uno stato di adattamento associato a una sindrome di astinenza al momento della cessazione dell'esposizione ripetuta a uno stimolo (ad esempio, l'assunzione di farmaci)
tolleranza inversa o sensibilizzazione al farmaco: l'effetto crescente di un farmaco derivante dalla somministrazione ripetuta ad una data dose
sospensione del farmaco: sintomi che si verificano al momento della cessazione del consumo ripetuto di sostanze
dipendenza fisica: dipendenza che comprende i sintomi persistenti di astinenza fisica-somatico (ad esempio, la fatica e il delirium tremens)
dipendenza psicologica: dipendenza che comprende i sintomi di astinenza emotivo-motivazionali (ad esempio, disforia e anedonia)
stimoli rinforzo: stimoli che aumentano la probabilità di comportamenti ripetuti associati loro
stimoli gratificanti: stimoli che il cervello interpreta come intrinsecamente positivo o come qualcosa a cui avvicinarsi
sensibilizzazione: una risposta aumentata a uno stimolo derivante dalla ripetuta esposizione ad esso
disturbo da uso di sostanze: una condizione in cui l'uso di sostanze porta a una compromissione funzionale significativa o disagio
tolleranza: la diminuzione dell'effetto di un farmaco dovuto alla somministrazione ripetuta ad una data dose

La dipendenza psicologica è una forma di dipendenza che comprende i sintomi di astinenza emotivo-motivazionali (ad esempio, uno stato di disagio o di insoddisfazione, una ridotta capacità di provare piacere, o ansia) al momento della cessazione del consumo di droga o impegnandosi in certi comportamenti.^[2]^[1]^[5] Le dipendenze fisica e psichica sono talvolta classificate come sfaccettatura o componenti della dipendenza, come nel DSM-IV-TR.^[6]Tuttavia, alcuni farmaci che producono sindromi da dipendenza non producono dipendenza, e viceversa, negli esseri umani^[6] La dipendenza e la dipendenza psicologica sono entrambe mediate dal rinforzo, una forma di condizionamento operante, ma sono associati a diverse forme di rinforzo.^[2]^[1] La dipendenza è una costrizione per gli stimoli gratificanti che viene mediata attraverso il rinforzo positivo.^[2]^[1] La dipendenza psicologica, che è mediata attraverso il rinforzo negativo, produce un desiderio di utilizzare un farmaco o seguire un comportamento per evitare la sindrome di astinenza sgradevole che deriva dalla cessazione di esposizione ad esso.^[2]^[1]

La dipendenza psicologica si sviluppa attraverso l'esposizione costante e frequente ad uno stimolo.^[7] Comportamenti che possono produrre i sintomi di astinenza psicologica osservabili (vale a dire, causare dipendenza psicologica) includono l'esercizio fisico, lo shopping, il sesso e l'autoerotismo con la pornografia, e mangiare cibo ad alto contenuto di grassi o di zuccheri.^[5]^[8] La terapia comportamentale è in genere utilizzata per aiutare le persone a superare la dipendenza psicologica da droghe o comportamenti adattativi che producono dipendenza psicologica.^[9]

Note

^ ^a ^b ^c ^d ^e Nestler EJ, Cellular basis of memory for addiction, in Dialogues Clin. Neurosci., vol. 15, n. 4, December 2013, pp. 431–443, PMC 3898681, PMID 24459410.
«Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.⁴¹. ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.».
^ ^a ^b ^c ^d ^e Malenka RC, Nestler EJ, Hyman SE, Chapter 15: Reinforcement and Addictive Disorders, in Molecular Neuropharmacology: A Foundation for Clinical Neuroscience, 2nd, New York, McGraw-Hill Medical, 2009, pp. 364–375, ISBN 978-0-07-148127-4.
^ Glossary of Terms, su Mount Sinai School of Medicine, Department of Neuroscience. URL consultato il 9 febbraio 2015.
^ Volkow ND, Koob GF, McLellan AT, Neurobiologic Advances from the Brain Disease Model of Addiction, in N. Engl. J. Med., vol. 374, n. 4, January 2016, pp. 363–371, DOI:10.1056/NEJMra1511480, PMID 26816013.
^ ^a ^b Olsen CM, Natural rewards, neuroplasticity, and non-drug addictions, in Neuropharmacology, vol. 61, n. 7, December 2011, pp. 1109–1122, DOI:10.1016/j.neuropharm.2011.03.010, PMC 3139704, PMID 21459101.
^ ^a ^b Malenka RC, Nestler EJ, Hyman SE, Chapter 15: Reinforcement and Addictive Disorders, in Molecular Neuropharmacology: A Foundation for Clinical Neuroscience, 2nd, New York, McGraw-Hill Medical, 2009, pp. 364–368, ISBN 978-0-07-148127-4.
«The defining feature of addiction is compulsive, out-of-control drug use, despite negative consequences. ...
Dependence is defined as an adaptive state that develops in response to repeated drug administration, and is unmasked during withdrawal, which occurs when drug taking stops. Dependence from long-term drug use may have both a somatic component, manifested by physical symptoms, and an emotional–motivation component, manifested by dysphoria. While physical dependence and withdrawal occur with some drugs of abuse (opiates, ethanol), these phenomena are not useful in the diagnosis of addiction because they do not occur with other drugs of abuse (cocaine, amphetamine) and can occur with many drugs that are not abused (propranolol, clonidine).

The official diagnosis of drug addiction by the Diagnostic and Statistic Manual of Mental Disorders (2000), which makes distinctions between drug use, abuse, and substance dependence, is flawed. First, diagnosis of drug use versus abuse can be arbitrary and reflect cultural norms, not medical phenomena. Second, the term substance dependence implies that dependence is the primary pharmacologic phenomenon underlying addiction, which is likely not true, as tolerance, sensitization, and learning and memory also play central roles. It is ironic and unfortunate that the Manual avoids use of the term addiction, which provides the best description of the clinical syndrome.».
^ Hanson, Glen, Peter J. Venturelli, and Annette E. Fleckenstein. Drugs and Society. Sudbury, MA: Jones and Bartlett, 2009. Print.
^ Psychological Dependence, su treatment-now.com. URL consultato il 2 dicembre 2010 (archiviato dall'url originale il 17 luglio 2011).
^ "Wasting the Best and the Brightest: Substance Abuse at America’s Colleges and Universities", march 2007, also published on, The national center on addiction and substance abuse at Columbia University. URL consultato il 9 novembre 2016.

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[Cellular_basis-1] Nestler EJ, Cellular basis of memory for addiction, in Dialogues Clin. Neurosci., vol. 15, n. 4, December 2013, pp. 431–443, PMC 3898681, PMID 24459410.
«Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.⁴¹. ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.».

[Addiction_glossary-2] Malenka RC, Nestler EJ, Hyman SE, Chapter 15: Reinforcement and Addictive Disorders, in Molecular Neuropharmacology: A Foundation for Clinical Neuroscience, 2nd, New York, McGraw-Hill Medical, 2009, pp. 364–375, ISBN 978-0-07-148127-4.

[Nestler_Labs_Glossary-3] Glossary of Terms, su Mount Sinai School of Medicine, Department of Neuroscience. URL consultato il 9 febbraio 2015.

[Brain_disease-4] Volkow ND, Koob GF, McLellan AT, Neurobiologic Advances from the Brain Disease Model of Addiction, in N. Engl. J. Med., vol. 374, n. 4, January 2016, pp. 363–371, DOI:10.1056/NEJMra1511480, PMID 26816013.

[Natural_and_drug_addictions-5] Olsen CM, Natural rewards, neuroplasticity, and non-drug addictions, in Neuropharmacology, vol. 61, n. 7, December 2011, pp. 1109–1122, DOI:10.1016/j.neuropharm.2011.03.010, PMC 3139704, PMID 21459101.

[NHM_terms-DSM_flaw-6] Malenka RC, Nestler EJ, Hyman SE, Chapter 15: Reinforcement and Addictive Disorders, in Molecular Neuropharmacology: A Foundation for Clinical Neuroscience, 2nd, New York, McGraw-Hill Medical, 2009, pp. 364–368, ISBN 978-0-07-148127-4.
«The defining feature of addiction is compulsive, out-of-control drug use, despite negative consequences. ...
Dependence is defined as an adaptive state that develops in response to repeated drug administration, and is unmasked during withdrawal, which occurs when drug taking stops. Dependence from long-term drug use may have both a somatic component, manifested by physical symptoms, and an emotional–motivation component, manifested by dysphoria. While physical dependence and withdrawal occur with some drugs of abuse (opiates, ethanol), these phenomena are not useful in the diagnosis of addiction because they do not occur with other drugs of abuse (cocaine, amphetamine) and can occur with many drugs that are not abused (propranolol, clonidine).

The official diagnosis of drug addiction by the Diagnostic and Statistic Manual of Mental Disorders (2000), which makes distinctions between drug use, abuse, and substance dependence, is flawed. First, diagnosis of drug use versus abuse can be arbitrary and reflect cultural norms, not medical phenomena. Second, the term substance dependence implies that dependence is the primary pharmacologic phenomenon underlying addiction, which is likely not true, as tolerance, sensitization, and learning and memory also play central roles. It is ironic and unfortunate that the Manual avoids use of the term addiction, which provides the best description of the clinical syndrome.».

[7] Hanson, Glen, Peter J. Venturelli, and Annette E. Fleckenstein. Drugs and Society. Sudbury, MA: Jones and Bartlett, 2009. Print.

[8] Psychological Dependence, su treatment-now.com. URL consultato il 2 dicembre 2010 (archiviato dall'url originale il 17 luglio 2011).

[9] "Wasting the Best and the Brightest: Substance Abuse at America’s Colleges and Universities", march 2007, also published on, The national center on addiction and substance abuse at Columbia University. URL consultato il 9 novembre 2016.

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Dipendenza psicologica

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