韩建中擒招视频:上瘾不是一种病

上瘾不是一种病

by Alva Noë

作者：Alva Noë

大约1870年前后：人类大脑和神经的解剖图

摄影：Hulton Archive/Getty 图片社

Addiction has been moralized, medicalized, politicized, and criminalized. And, of course, many of us are addicts, have been addicts or have been close to addicts. Addiction runs very hot as a theme.

上瘾已经被道德化，医疗化，政治化和犯罪化。当然，我们中有许多人是瘾君子，对某事物成瘾或者接近成瘾。上瘾是一个备受关注的话题。

Part of what makes addiction so compelling is that it forms a kind of conceptual/political crossroads for thinking about human nature. After all, to make sense of addiction we need to make sense of what it is to be an agent who acts, with values, in the face of consequences, under pressure, with compulsion, out of need and desire. One needs a whole philosophy to understand addiction.

     使上瘾受到如此关注的一个原因是它涉及到关于人类本性的概念性或者政治性的思考。不过为了搞清楚上瘾的含义，我们首先要明白具有价值观念，在压力，强迫，需求和欲望的作用下，一个人是如何产生上瘾行为。为了了解上瘾，我们需要进行全面的解读。

Today I want to respond to readers who were outraged by my willingness even to question whether addiction is a disease of the brain.

    今天，对于那些被我的意愿激怒的读者，我要回答他们上瘾到底是不是一种疾病。

Let us first ask: what makes something — a substance or an activity — addictive? Is there a property shared by all the things to which we can get addicted?

  让我们先问一下：是什么--一种事物或者行为--导致了上瘾？它们之间是否存在着共同点？

Unlikely. Addictive substances such as alcohol, heroin and nicotine are chemically distinct. Moreover, activities such as gambling, eating, sex — activities that are widely believed to be addictive — have no ingredients.

   我想未必如此。从化学角度而言，酒精，海洛因，尼古丁等是可以导致上瘾的物质。此外，像是赌博，暴饮暴食，性爱，这些让人上瘾的行为并未含有类似的化学成分。

And yet it is remarkable — as Gene Heyman notes in his excellent book on addiction — that there are only 20 or so distinct activities and substances that produce addiction. There must be something in virtue of which these things, and these things alone, give rise to the distinctive pattern of use and abuse in the face of the medical, personal and legal perils that we know can stem from addiction.

   值得注意的是----在Gene Heyman关于上瘾的一部优秀作品中提到的---只有20余种不同的行为和物质能导致上瘾。它们必须含有一些可以在医学，个人和法律风险面前激发使用和滥用而导致上瘾的成分。

What do gambling, sex, heroin and cocaine — and the other things that can addict us — have in common?

  赌博，性爱，海洛因和可卡因以及其他能导致我们上瘾的事物，到底有什么共同点？

One strategy is to look not to the substances and activities themselves, but to the effects that they produce in addicts. And here neuroscience has delivered important insights.

  一个方法是观察它们致使上瘾时所导致的影响，而并不先研究它们的成分。在此，神经科学起到了关键作用。

If you feed an electrical wire through a rat's skull and onto to a short dopamine release circuit that connects the VTA (ventral tegmental area) and the nucleus accumbens, and if you attach that wire to a lever-press, the rat will self-stimulate — press the lever to produce the increase in dopamine — and it will do so basically foreover, forgoing food, sex, water and exercise. Addiction, it would seem, is produced by direct action on the brain!

   如果在老鼠头骨上穿过一根电线，连接VTA神经元（腹侧背盖区）和伏隔核并激发一个短暂的多巴胺释放电路，如果在电线上接通一定电压，老鼠会产生自我刺激---增加电压以产生多巴胺---它会基本上放弃食物，性，水以及活动。上瘾，由此可得，是由脑部直接产生!

(See here for a useful Wikipedia review of this literature.)

And indeed, there is now a substantial body of evidence supporting the claim that all drugs or activities of abuse (as we can call them), have precisely this kind of effect on this dopamine neurochemical circuit.

    事实上，目前有一个确凿的证据支持这项结论，所有药物或行为的滥用（如我们所述），都是这种多巴胺神经电路的产物。

When the American Society of Addiction Medicine recently declared addiction to be a brain disease their conclusion was based on findings like this. Addiction is an effect brought about in a neurochemical circuit in the brain. If true, this is important, for it means that if you want to treat addiction, you need to find ways to act on this neural substrate.

  美国成瘾药物协会最近公布的上瘾是一种疾病这一结论也是基于类似的发现。上瘾缘自大脑的神经电路。如果这是事实，那就表明如果你想要治疗上瘾，重要的是找到应对这种神经基质的方法。

All the rest — the actual gambling or drug taking, the highs and lows, the stealing, lying and covering up, the indifference to work and incompetence in the workplace, the self-loathing and anxiety about getting high, or getting discovered, or about trying to stop, and the loss of friends and family, the life stories and personal and social pressures — all these are merely symptoms of the underlying neurological disease.

  那么其余的---现实中的赌博，服用药物，高潮和低谷，偷盗，欺骗，隐瞒，工作的差异，在工作环境中的无法胜任，达到高潮时的自我厌恶和焦虑，或者被揭露，尝试着停止，以及朋友和家庭的丧失，生活故事和个人以及社会的压力---所有这些几乎都只是神经性疾病的症状。

But not so fast. Consider:

  但并非如此。试想：

All addictive drugs and activities elevate the dopamine release system. Such activation, we may say, is a necessary condition of addiction. But it is very doubtful that it is sufficient. Neuroscientists refer to the system in question as the "reward-reinforcement pathway" precisely because all rewarding activities, including nonaddictive ones like reading the comics on sunday morning or fixing the leaky pipe in the basement, modulate its activity. Elevated activity in the reward-reinforcement pathway is a normal concomitant of healthy, nonaddictive, engaged life.

  所有成瘾药物和行为都刺激着多巴胺释放系统。我们说这种行为是上瘾的基本条件。但是并不能确认这就是决定因素。神经学家把这个系统称之为“奖惩路径”，因为所有的奖励行为，包括并没有上瘾的人喜欢在周日的清晨阅读幽默笑话，或者在地下室修补漏水的管道，都调节着它的活动。奖惩路径中的活性提高是一种健康，非上瘾，充实的生活的正常伴随物。

Neuroscientists like to say that addictive drugs and activities, but not the nonaddictive ones, "highjack" the reward-reinforcement pathway, they don't merely activate it. This is the real upshot of the rat example. The rat preferred lever-pressing to everything; it dis-valued everything in comparison with lever-pressing. And not because of the intrinsic value of lever-pressing, but because of the link artificially established between the lever-pressing and the dopamine release.

   神经科学家倾向于认为成瘾药物和行为，而不是那些非上瘾事物，“劫持”了奖惩路径，他们几乎没有激活它。这正是老鼠实例的结果。老鼠更喜欢对一切事物施压；与施压相比，它舍弃了其他事物。并不是因为施压的本身价值，而是因为它可以建立施压与多巴胺释放之间的联系。

If this is right, then we haven't discovered, in the reward reinforcement system, a neurochemical signature of addiction. We haven't discovered the place where addiction happens in the brain. After all, the so-called highjacking of the reward system is not itself a neurochemical process; it is a process whereby neurochemical events get entrained within in a larger pattern of action and decision making.

  如果这是正确的结论，那么我们还没有揭露在奖惩系统中，神经科学家关于上瘾的解释。我们还未发现上瘾在大脑中发生的部位。毕竟，所谓的对奖惩系统的劫持并不是一个神经过程；它是一个更广泛的行为和决策模型，神经事件只是被牵扯其中。

Is addiction a disease of the brain? That's a bit like saying that eating is a phenomenon of the stomach. The stomach is an important part of the story. But don't forget the mouth, the intestines, the blood, and don't forget the hunger, and also the whole socially-sustained practice of producing, shopping for and cooking food.

  上瘾到底是不是一种疾病？这就像是在说吃是胃的一个现象。胃是整个故事的主角。但是不要忘记嘴，肠道，血液，还有饥饿，以及整个食品生产，销售的社会性环节以及食物的烹煮。

And so with addiction. The neural events in VTA clearly belong to the underlying mechanisms of addiction. They are necessary, but not sufficient; they are only part of the story.

  所以再说回上瘾，VTA上产生的神经反应明确属于产生上瘾的化学基质。它们是必备的，但不是全部。它们只是这个故事的一部分。

Remember: normally there is a dynamic quality to our actions and preferences, just as there is with those of rats. We enjoy exercising, but we soon get tired or bored. But rest, too, soon loses its appeal. We eat, and then we are sated. And then we are ready for the tread mill again. And so on. Things have gradually changing and complementary values. In addiction, this dynamic goes rigid. The addicts goal assumes a fixed value, and the value of everything shrinks to zero, and with terrible costs.

  请记住：对于我们的行为和偏好，通常是一个动态的数量变化，就像是那些老鼠。我们享受锻炼，但不久会感到疲惫和乏味。但是休息，不多时同样也会失去它的吸引力。我们进食，酒足饭饱。然后继续吃，反复下去。事物会具有渐变的互补的价值。在上瘾现象中精确呈现着这种动态。上瘾者享受着一个特定的价值，其他事物的价值降为零，并带来惨重的损失。

Our strategy was to look for systematic effects that all and only the addictive drugs and activities have on addicts. And we've found what we were looking for. The effects are behavioral and experiential. The things that addict us all produce a very distinctive breakdown in the organization of our preferences, actions and choices.

  我们的策略是寻找一种只有成瘾药物和行为能导致的系统效应。我们已经找到了它。这些效应是行为和体验方面的。使我们上瘾的事物都可以在我们的偏好，行为和选择的组织上产生一种特有的破坏。

Is addiction a disease of the brain? This strikes me as a dubious falsification of what is, really, a phenomenon that can only be understood in terms of the life, choices, needs and understanding of the whole person.

 上瘾是一种病？这对我而言更像是一个可疑的推断。因为在我看来，上瘾更是关乎一个人的生活，选择，需求和认知的现象。