非药物干预治疗物质使用障碍

Non-pharmaceutical Intervention for The Treatment of Substance Use Disorders

物质使用障碍(substance use disorder,SUD)是一个全球性的卫生和社会问题。针对大多数成瘾性物质,目前还没有有效的治疗药物,普遍还是采用心理治疗和行为矫治。近年来,针刺、深部脑刺激(DBS)、重复经颅磁刺激(rTMS)、经颅直流电刺激(tDCS)和运动等非药物干预手段在治疗神经系统疾病的有效性逐渐得到重视。越来越多的研究也开始关注非药物干预手段在治疗SUD中的应用。本综述在文献检索(如PubMed、Google Scholar等)的基础上总结了针刺、DBS、rTMS、tDCS和运动等非药物干预手段对阿片类药物、精神活性物质、尼古丁、酒精等不同成瘾性物质的心理渴求、戒断时间、使用剂量和成瘾伴随的情绪、认知功能障碍等的影响。研究表明,针刺、DBS、rTMS、tDCS和运动等非药物干预手段可以有效降低成瘾性物质引起的心理渴求、降低物质摄入量、增加戒断时间,同时改善长期使用成瘾性物质引起的认知障碍、焦虑和抑郁样行为等。如果非药物干预手段结合药物、心理等治疗方式,效果更佳。尽管非药物干预方法在现阶段主要作为辅助性治疗手段,未来的研究应注重明确非药物干预手段的神经生物学机制,并完善非药物干预的技术方法。

Substance use disorder(SUD)is a global problem that is crucial to public health and security.Since the effective pharmaceutical agent is still largely lacking,behavioral therapy,psychotherapy,or rehabilitation has been the major approach for the treatment of SUD.In the recent years,there has been growing interest in the effectiveness of non-pharmaceutical intervention for the treatment of neurological and psychological disorders,including acupuncture,deep brain stimulation(DBS),repetitive transcranial magnetic stimulation(rTMS),transcranial direct current stimulation(tDCS)and exercise.From both preclinical and clinical studies,the present review is focused on the studies which investigated the therapeutical potential of acupuncture,DBS,rTMS,tDCS and exercise on the withdrawal duration,craving,drug intake and comorbidity of other behavioral disorders of SUD.The review included the studies involving different substances,including opioids,psychoactive substances,nicotine,alcohol,etc.The results showed that non-pharmacological intervention enabled to significantly reduce craving,drug consumption,prolong abstinence duration and improve cognitive impairment,anxiety and depression induced by substance exposure.Additionally,pharmaceutical treatment is a main therapeutic method,but effective pharmaceutical agents are still largely lacking.Non-pharmaceutical intervention has somewhat effect and mainly used as complementary approach,lacking research on the neurobiological mechanisms.Simultaneous use of pharmaceutical treatment and non-pharmaceutical intervention have better treatment outcomes with the reduced dosage of therapeutic drugs.Although non-pharmaceutical intervention is currently used as a complementary approach,future research is required to specifically examine the neurobiological mechanism underlying the effect of non-pharmaceutical intervention on SUD and improve the technical methods of nonpharmaceutical intervention.