心理依赖（英语：Psychological dependence），亦称精神依赖，指的是在停药、停止某项活动时因情感产生的依赖导致的戒断症状（如烦躁、失乐、焦虑等）。[1][2][5]心理依赖有时候也被认为是成瘾症状的一部分。[6]然而，有些能够让人产生依赖性的药物并不会让人成瘾，反过来也是如此。[6]成瘾与心理依赖都可通过强化（一种操作制约）来缓和症状，但是这两种各自有不同的强化方式。[1][2] 成瘾是一种对奖励刺激的寻求，可通过正向强化的方式减轻症状。[1][2]心理依赖则通常需要反向强化的方式来解决，需要进行某些能够避免戒断症状的行为才能缓和。[1][2]
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Quick Facts
| “成瘾及生理、心理依赖”的相关术语词汇表[1][2][3][4] |
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- 成瘾：脑部失调的情形，特征是会强迫性的接触犒赏刺激，不去考虑其带来的负面结果。
- 成瘾行为：具有犒赏性及正向增强效应的行为
- 成瘾药物：具有犒赏性及正向增强效应的药物
- 依赖性：之前曾频繁接触刺激源（例如药物摄取），中断接触后出现戒断症状的情形
- 药物敏化或逆耐药性：在固定药物剂量的情形下重复给药，而相同剂量的药物效果增强的情形
- 药物戒断：在重复药物使用后停药，出现的症状
- 生理依赖：出现持续生理戒断症状（例如疲劳及震颤性谵妄）的依赖性
- 心理依赖：出现情绪或是精神戒断症状（例如烦躁及失乐）的依赖性
- 增强刺激：特定类型的刺激，接触后会增加再接触此刺激的可能性
- 犒赏刺激：特定类型的刺激，大脑会认为此刺激是正向的，会想再进行的
- 敏化作用：重复接受某一刺激后产生的刺激增强性反应
- 物质使用疾患 ：使用特定物质，而且造成临床上或是功能上的损伤或是困境的情形
- 药物耐受性：重复接受某一药物后产生的药物降低性反应
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Glossary. Icahn School of Medicine. [2021-04-29]. Malenka RC, Nestler EJ, Hyman SE. Chapter 15: Reinforcement and Addictive Disorders. Sydor A, Brown RY (编). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience 2nd. New York: McGraw-Hill Medical. 2009: 364–368. ISBN 9780071481274. The defining feature of addiction is compulsive, out-of-control drug use, despite negative consequences. ...
Addictive drugs are both rewarding and reinforcing. ... Familiar pharmacologic terms such as tolerance, dependence, and sensitization are useful in describing some of the time-dependent processes that underlie addiction. ...
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.
