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| Caption =
| Field = [[Адикциона психијатрија]]<br />[[Адикциона медицина]]
| ICD10 = {{ICD10|F10-F19}} subdivisionодсек .2
}}
{{рут}}
Зависност је [[Болести централног нервног система|мождани поремећај]] карактерисан компулсивно ангажовањем у [[reward system|награђивање]] стимулуса, упркос штетних последица.{{refn|<ref name="Cellular basis" /><ref name="Nestler Labs Glossary" /><ref name="Brain disease" /><ref name="pmid18790142">{{cite journal |vauthors=Angres DH, Bettinardi-Angres K | title = The disease of addiction: origins, treatment, and recovery | journal = Dis Mon | volume = 54 | issue = 10 | pages = 696–721 |date=October 2008| pmid = 18790142 | doi = 10.1016/j.disamonth.2008.07.002 | url = }}</ref><ref name="NHM addiction-reward-reinforcement" /><ref name="Reward system and psychostimulants" />}} Упркос учешћа бројних психосоциолошких фактора, биолошки процес – онај који је индукован репетитивним излагањем на адиктивни стимулус – је сржна [[патологија]] која подстиче развој и одржавање зависности.<ref name="Cellular basis" /><ref>{{cite web | author = American Society for Addiction Medicine | title = Definition of Addiction | journal = | volume = | issue = | pages = | year = 2012 | url = http://www.asam.org/for-the-public/definition-of-addiction}}</ref> Два својства која карактеришу све адиктивне стимулусе су они [[Поткрепљење|поткрепљујући]] (-{i.e.}-, они повећавају вероватноћу да ће особа тражити поновљено излагање њима) и [[intrinsic reward|интринзично награђујући]] (-{i.e.}-, они се перципирају као инхерентно позитивни, пожељни и угодни).<ref name="Cellular basis" /><ref name="Nestler Labs Glossary" /><ref name="Reward system and psychostimulants" />
Зависност је поремећај можданог система награђивања који настаје путем [[Транскрипција (генетика)|транскрипционих]] и [[Епигенетика|епигенетичких]] механизама и јавља се током времена улед хронично високих нивоа излагања адиктивном стимулусу (нпр., морфину[[морфин]]у, кокаину[[кокаин]]у, [[Хиперсексуалност|сексуалном односу]], [[коцкањe|коцкању]], итд.).<ref name="Cellular basis" /><ref name="What the ΔFosB?" /><ref name="Natural and drug addictions">{{cite journal | author = Olsen CM | title = Natural rewards, neuroplasticity, and non-drug addictions | journal = Neuropharmacology | volume = 61 | issue = 7 | pages = 1109–1122 |date=December 2011 | pmid = 21459101 | pmc = 3139704 | doi = 10.1016/j.neuropharm.2011.03.010 }}<br />[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139704/table/T1/ Table 1: Summary of plasticity observed following exposure to drug or natural reinforcers]"</ref> -{[[FOSB|ΔFosB]]}-, a geneген [[transcriptionтранскрипциони factorфактор|транскрипционог фактора]], isје aкритична criticalкомпонента componentи andчест commonфактор factorу inразвоју theвиртуално developmentсвих ofформии virtuallyбихавиоралне allадикције formsи of behavioral and drug addictionsнаркоманије.<ref name="What the ΔFosB?" /><ref name="Natural and drug addictions" /><ref name="G9a reverses ΔFosB plasticity" /><ref name="Nestler" /> TwoТоком decadesдве ofдеценије researchистраживања intoулоге -{ΔFosB's}- roleу inзависности addictionје haveпоказано demonstratedда that addictionзависност arisesнастаје, andи theда associatedсе compulsiveповезано behaviorкомпулсивно intensifiesпонашање orинтензивира attenuatesили умањује, alongзаједно with theса [[overexpression|прекомерним изражавањем]] of -{ΔFosB}- inгена theу [[Receptor sličan D1 receptoru|-{D1}--typeтипу]] [[medium spiny neuron|-{MSN}-]]s of theнеурона [[nucleus accumbens|нуклеус акумбенса]].<ref name="Cellular basis" /><ref name="What the ΔFosB?" /><ref name="Natural and drug addictions" /><ref name="G9a reverses ΔFosB plasticity" /> DueЗбог toузрочног theодноса causal relationship betweenизмеђу -{ΔFosB}- expressionизражавања andи addictionsадикција, itто isсе usedкористи као [[preclinical research|preclinicallyпреклинички]] as an addiction [[biomarkerБиомаркер (medicineмедицина)|biomarkerбиомаркер]] адикције.<ref name="Cellular basis" /><ref name="What the ΔFosB?">{{cite journal | author = Ruffle JK | title = Molecular neurobiology of addiction: what's all the (Δ)FosB about? | journal = Am. J. Drug Alcohol Abuse | volume = 40 | issue = 6 | pages = 428–437 | date = November 2014 | pmid = 25083822 | doi = 10.3109/00952990.2014.933840 }}</ref><ref name="G9a reverses ΔFosB plasticity">{{cite journal | vauthors = Biliński P, Wojtyła A, Kapka-Skrzypczak L, Chwedorowicz R, Cyranka M, Studziński T | title = Epigenetic regulation in drug addiction | journal = Ann. Agric. Environ. Med. | volume = 19 | issue = 3 | pages = 491–496 | year = 2012 | pmid = 23020045 | doi = }}</ref> -{ΔFosB}- expressionизражавање inу theseтим neuronsнеуронима directlyдиректно andи positivelyпозитивно regulatesрегулише drugсамодозирање [[self-administration]]дроге andи [[#Sensitization|rewardсензибилизација sensitizationнаграђивања]] throughпутем [[positiveПоткрепљење|позитивног reinforcementпојачавања]], whileуз decreasingумањивање sensitivityсензитивности toна [[wikt:aversion|aversion]]аверзију.{{#tag:ref|AСмањење decreaseосећајне in aversion sensitivityаверзије, in simplerнајјеноставније termsгледано, meansзначи thatда anје individual'sпонашање behaviorособе isмање lessвероватно likely toда beбуде influencedпод byутицајем undesirableнежељених outcomesисхода.|group="note"|name="ΔFosB behaviors"}}<ref name="Cellular basis" /><ref name="What the ΔFosB?" />
AsДве describedгрупе byистраживача twoсу groupsобјасниле ofкако researchers,адикција addictionпроизводи exacts„запањујуће anвисоке "astoundinglyфинансијске highи financialљудске andтрошкове” humanкод toll"особа onи individualsдруштва andкао societyцелине asпутем aдиректних wholeнепожељних throughдејстава the direct adverse effects of drugsдрога, associatedвезаних healthcareздравствених costsтрошкова, long-termдугорочних complicationsкомпликација (e.g., [[lungрак cancerплућа]] withуслед smokingпушења tobaccoдувана, [[liverцироза cirrhosisјетре]] withуслед drinkingконзумирања [[alcohol (drug)|alcoholалкохола]], orили [[meth mouth|мет уста]] fromуслед intravenousинтравенозног methamphetamineуноса [[метамфетамин]]а), theфункционални functionalпоследица consequences of alteredизмењене [[neural plasticity|неуропластичности]] in the brainмозга, andи theкосеквентни consequent loss ofгубитак productivityпродуктивности.<ref name="Societal toll">{{cite book |vauthors=Malenka RC, Nestler EJ, Hyman SE |veditors=Sydor A, Brown RY | title = Molecular Neuropharmacology: A Foundation for Clinical Neuroscience | year = 2009 | publisher = McGraw-Hill Medical | location = New York | isbn = 9780071481274 | page = 4 | edition = 2nd | chapter = Chapter 1: Basic Principles of Neuropharmacology }}</ref><ref name="Epidem">{{cite journal |vauthors = KR Merikangas KR, McClair VL | title = Epidemiology of Substance Use Disorders | date = June 2012 | journal = Hum. Genet. | pages = 779–789 | issue = 6 | volume = 131 | pmc = 4408274 | doi = 10.1007/s00439-012-1168-0 | pmid = 22543841 }}</ref><ref name="ABAM" /> ClassicКласичне hallmarksознаке ofзависности addictionобухватају includeумањену impairedконтролу controlнад overсупстанцама substancesили or behaviorпонашањем, preoccupationпреокупацију withсупстанцом substanceили orпонашањем behavior, andи continuedконтинуирану useупотребу despiteупркос consequencesпоследица.<ref name="pmid1501306">{{cite journal |vauthors=Morse RM, Flavin DK | title = The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism | journal = JAMA | volume = 268 | issue = 8 | pages = 1012–4 |date=August 1992| pmid = 1501306 | doi = 10.1001/jama.1992.03490080086030 }}</ref> HabitsНавике andи patternsобрасци associatedвезани withза addictionзависност areобично typicallyсе characterizedкарактеришу byнепосредним immediate gratificationзадовољавањем (short-termкраткорочна rewardнаграда), coupledзаједно withса delayedодложеним deleteriousштетним effectsефектима (long-termдугорочним costsтрошковима).<ref name="pmid3278676">{{cite journal |vauthors=Marlatt GA, Baer JS, Donovan DM, Kivlahan DR | title = Addictive behaviors: etiology and treatment | journal = Annu Rev Psychol | volume = 39 | issue = | pages = 223–52 | year = 1988 | pmid = 3278676 | doi = 10.1146/annurev.ps.39.020188.001255 }}</ref>
ExamplesПримери ofнаркоманије drug andи behavioralбихевиоралних addictionsадикција includeсу: [[alcoholismалкохолизам]], [[amphetamineАмфетамин|амфетаминска addictionадикција]], [[cocaineкокаинска addictionадикција]], [[nicotineникотин|никотинска addictionадикција]], [[opiateопиоид|opiјatна addictionадикција]], [[foodадикција addictionна храну]], [[gamblingПатолошко коцкање|коцкарска addictionадикција]], andи [[sexualсексуална addictionадикција]]. TheЈедина onlyбихевиорална behavioralадикција addictionпрепозната recognized by theу -{[[DSM-5]]}- isје gamblingкоцкарска addictionадикција. The termТермин ''addictionадикција'' is misused frequently to refer to other compulsive behaviors or disorders, particularly ''[[substance dependence|dependence]]'', in news media.<ref name="Addiction-dependence distinction">{{cite web|author=American Psychiatric Association |title=Substance-Related and Addictive Disorders |url=http://www.dsm5.org/documents/substance%20use%20disorder%20fact%20sheet.pdf |publisher=American Psychiatric Publishing |accessdate=10 July 2015 |pages=1–2 |date=2013 |quote=Additionally, the diagnosis of dependence caused much confusion. Most people link dependence with "addiction" when in fact dependence can be a normal body response to a substance. |deadurl=yes |archiveurl=https://web.archive.org/web/20150815050402/http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf |archivedate=15 August 2015 |df= }}</ref> An important distinction between drug addiction and dependence is that drug dependence is a disorder in which cessation of drug use results in an unpleasant state of [[drug withdrawal|withdrawal]], which can lead to further drug use. Addiction is the compulsive use of a substance or performance of a behavior that is independent of withdrawal.
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== Неуропсихологија ==
== Неуропсхологија ==
[[Cognitive control]] and [[stimulus control]], which is associated with [[operant conditioning|operant]] and [[classical conditioning]], represent opposite processes (i.e., internal vs external or environmental, respectively) that compete over the control of an individual's elicited behaviors.<ref name="Cognitive - stimulus">{{cite journal | vauthors = Washburn DA | title = The Stroop effect at 80: The competition between stimulus control and cognitive control | journal = J Exp Anal Behav | volume = 105 | issue = 1 | pages = 3–13 | year = 2016 | pmid = 26781048 | doi = 10.1002/jeab.194 }}</ref> Cognitive control, and particularly [[inhibitory control|inhibitory control over behavior]], is impaired in both addiction and [[attention deficit hyperactivity disorder]].<ref name="Executive functions">{{cite journal | author = Diamond A | title = Executive functions | journal = Annu Rev Psychol | volume = 64 | issue = | pages = 135–168 | year = 2013 | pmid = 23020641 | pmc = 4084861 | doi = 10.1146/annurev-psych-113011-143750 }}</ref><ref name="NHM-Cognitive Control">{{cite book |vauthors=Malenka RC, Nestler EJ, Hyman SE |veditors=Sydor A, Brown RY | title = Molecular Neuropharmacology: A Foundation for Clinical Neuroscience | year = 2009 | publisher = McGraw-Hill Medical | location = New York | isbn = 9780071481274 | pages = 313–321 | edition = 2nd | chapter = Chapter 13: Higher Cognitive Function and Behavioral Control }}</ref> Stimulus-driven behavioral responses (i.e., stimulus control) that are associated with a particular [[rewarding stimulus]] tend to dominate one's behavior in an addiction.<ref name="NHM-Cognitive Control" />
Reviews of preclinical studies indicate that long-term frequent and excessive consumption of high fat or sugar foods can produce an addiction ([[food addiction]]).<ref name="Natural and drug addictions" /><ref name="Nestler" />
Gambling is a natural reward which is associated with compulsive behavior and for which clinical diagnostic manuals, namely the [[DSM-5]], have identified diagnostic criteria for an "addiction".<ref name="Natural and drug addictions" /> There is evidence from functional neuroimaging that gambling activates the reward system and the [[mesolimbic pathway]] in particular.<ref name="Natural and drug addictions" /><ref name="Behavioral addictions" /> Similarly, shopping and playing videogames are associated with compulsive behaviors in humans and have also been shown to activate the mesolimbic pathway and other parts of the reward system.<ref name="Natural and drug addictions" /> Based upon this evidence, [[gambling addiction]], [[video game addiction]] and [[shopping addiction]] are classified accordingly.<ref name="Natural and drug addictions" /><ref name="Behavioral addictions" />
== Фактори ризика ==
<ref name="Cellular basis">{{cite journal | author = Nestler EJ | title = Cellular basis of memory for addiction | journal = Dialogues Clin. Neurosci. | volume = 15 | issue = 4 | pages = 431–443 |date=December 2013 | pmid = 24459410 | pmc = 3898681 | doi = }}</ref>
<ref name="Cellular basis">{{cite journal | author = Nestler EJ | title = Cellular basis of memory for addiction | journal = Dialogues Clin. Neurosci. | volume = 15 | issue = 4 | pages = 431–443 |date=December 2013 | pmid = 24459410 | pmc = 3898681 | doi = }}</ref>
<ref name="Cellular basis" />
<ref name="Nestler Labs Glossary">{{cite web|title=Glossary of Terms|url=http://neuroscience.mssm.edu/nestler/glossary.html|website=Mount Sinai School of Medicine|publisher=Department of Neuroscience|accessdate=9 February 2015}}</ref>
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