演讲题目：What causes addiction, and why is it so hard to treat?

演讲简介：

截至2021年，估计有超过3600万人患有物质使用障碍。这种状况涵盖了一系列模式化的药物使用行为，会给人的生活带来问题，其中物质成瘾处于更为严重的一端。为什么有些人更容易对成瘾物质上瘾？为什么成瘾如此难以治疗？



中英文字幕

As of 2021, more than 36 million people worldwide were estimated to be experiencing substance abuse disorder.

截至2021年，全球约有超过3600万人有药物滥用障碍。

This condition spans a spectrum of patterned drug use that causes issues in a person's life.

这种情况包括了一系列药物使用模式，会给人的生活带来问题，

At the more severe end of the spectrum is substance addiction.

其中更严重的是物质成瘾。

To understand why some people are more susceptible to addiction and why it can be so difficult to treat, let's take a look at how addictive drugs affect the body.

为了理解为什么有些人更容易成瘾，以及为什么成瘾如此难以治疗，让我们来看看成瘾性药物是如何影响人体的。

When someone repeatedly uses an addictive substance, their brain may adjust to account for its regular presence.

当人反复使用成瘾物质时，他们的大脑可能会自我调整以适应这种物质的经常存在，

This is called tolerance; it diminishes the drug's effect and means more is required to produce the same experience.

这被称为耐受性。它使得药物的作用降低，而且意味着需要更大的量才能产生相同的体验。

Alcohol, for instance, increases the transmission of chemical messengers like endorphin and GABA, which promote sensations of pleasure and calmness.

例如，酒精会增加一些化学信使的传递，如内啡肽和GABA（一种神经递质），它们促进愉悦感和平静感的产生。

When someone uses alcohol frequently, their brain will adapt to its presence.

当人经常饮酒时，大脑会适应酒精的存在，

So when they don't use it, their brain receives fewer signals from those pleasure- and calm-inducing neurotransmitters, which impacts their energy and mood.

因此当不饮酒时，大脑接收到的那些愉悦和镇静神经递质信号就会减少，这会影响他们的精力和情绪。

In addition to the unique effects each addictive substance has, all of them alter the release of dopamine in a brain region called the nucleus accumbens.

除了每种成瘾物质自身独特的作用外，所有这些物质都会改变大脑中一个名为“伏隔核”区域多巴胺的释放。

This area is part of the brain's reward pathway, which is sensitive to experiences that give us pleasure and drives us to repeatedly seek them out.

这个区域是大脑奖赏通路的一部分，它对带给我们愉悦的体验非常敏感，并促使我们反复寻找这些体验。

The reward pathway is essential to our well- being— but addictive substances also exploit it.

奖赏通路对我们的健康至关重要，但成瘾物质也会利用它。

When someone is repeatedly using a substance and their body has adapted to its presence, they may develop dependence where the drug is necessary for them to function comfortably.

当有人反复使用某种物质并且其身体已适应该物质的存在时，他们可能会产生依赖性，此时那种物质成了他们舒适地日常生活的必要条件。

Meanwhile, repeated use can decrease the influence of the brain's cortex, which is responsible for driving deliberate decision-making and limiting impulsive behaviors.

同时，反复使用会降低大脑皮层的影响，大脑皮层负责执行深思熟虑的决策以及限制冲动行为；

And it can increase the influence of the brain's subcortex, which is crucial in habit-learning and impulsivity.

并且还能增加大脑下皮层的影响，下皮层对习惯养成和冲动控制至关重要。

Together, these changes can make someone feel a lack of control over how they're using a substance.

这些变化加在一起让人感觉无法控制自己使用一个成瘾物质的方式，

This can mean suffering in other facets of their life and taking risks to continue using it.

这可能意味着他们在生活的其它方面遭受折磨，并冒险继续使用它。

If the substance leaves their system, their body's equilibrium is disrupted, so they may experience cravings that motivate thoughts and behaviors of seeking and using the drug.

如果该物质离开他们的机体，其身体平衡会被打破，因此他们可能会产生渴望，激发他们寻求和使用药物的想法和行为。

And if they continue without the substance, they may experience withdrawal.

而且，如果他们继续停用该物质，他们可能会有戒断症状。

Opioids, for example, relieve pain and induce sedation.

例如，类阿片可以缓解疼痛并诱发镇静作用，

Withdrawal from them causes heightened pain, anxiety, and insomnia.

戒断它们会加剧疼痛、焦虑和失眠。

The faster a drug reaches the brain and stimulates the reward pathway, the more addictive it is.

药物进入大脑并刺激奖赏通路速度越快，它就越容易成瘾。

For example, heroin and morphine have similar effects, but heroin's chemical structure enhances its ability to penetrate the blood-brain barrier and bind to specific receptors.

例如，海洛因和吗啡具有相似的作用，但海洛因的化学结构增强了其穿透脑血屏障及与特定受体结合的能力，

This makes it faster acting and more addictive than morphine.

这使它比吗啡起作用更快、更易成瘾。

Meanwhile, compared to nicotine patches and gum, regular and electronic cigarettes are more addictive because smoking and vaping deliver nicotine to the brain fastest.

同时，与尼古丁贴片和尼古丁软糖相比，普通香烟和电子烟更容易成瘾，因为吸香烟和电子烟将尼古丁输送到大脑的速度最快。

Depending on their chemical structure and mode of delivery, drugs vary in how addictive they are— but people also vary in how susceptible they are to substance use disorder.

根据其化学结构和输送方式，药物的成瘾程度各不相同，但人们对物质使用障碍的敏感程度也不尽相同。

Scientists think this is due to a mix of life experiences and genetically inherited traits, though neither predetermines addiction.

科学家们认为，这是由于生活经历和基因上的遗传特征，尽管这两者都不能预先决定成瘾。

Trauma and mental health conditions appear to make people more susceptible.

创伤和心理健康状况似乎令人更易染瘾，

And, overall, using addictive substances before 18 is considered a strong risk factor.

而且总体而言，18岁之前使用成瘾性物质被认为是强风险因素，

This is in part because the reward pathways of younger brains are especially sensitive.

部分原因是年轻大脑的奖赏通路尤为敏感。

Many of the genetic factors at play remain unknown, but some genes do seem to track with certain substance use disorders.

许多起作用的遗传因素仍然未知，但有些基因似乎确实与某些物质使用障碍有关。

For example, specific genes increase the risk for nicotine addiction by making certain receptors more sensitive to nicotine and withdrawal from it more difficult.

例如，特定基因会增加尼古丁成瘾风险，因为它们使得某些受体对尼古丁更加敏感，也让人对尼古丁的戒断更困难。

At the same time, some genes actually make people more resistant to substance use disorders, such as genes that slow the breakdown of alcohol, leading to unpleasant side effects that make people less interested in drinking.

同时，某些基因其实使人们对物质使用障碍的抵抗力更强。例如减缓酒精分解的基因，它们产生令人不快的副作用，使人们对饮酒的兴趣降低。

In fact, one drug that treats alcohol use disorder operates with this very mechanism.

实际上，一种用于治疗酒精使用障碍的药物正是通过这种机制起作用的。

Detoxing from a substance the body has become dependent on can be extremely difficult.

排出一个机体已经依赖的物质可能非常困难，

And in some cases, abruptly quitting can also be physically risky, so it isn't always advised.

而且在某些情况下，突然的戒断可能带来健康上的风险，因此并不总是建议这样做。

Beyond detoxing, quitting is often a long-term process.

除了排毒外，戒断通常是一个长期过程。

It's aided by treatment plans that prioritize addressing underlying conditions; developing new associations with experiences previously linked with drug use; and creating safe, supportive environments.

治疗计划优先考虑解决潜在的问题，以前与吸毒有关的经历要建立新的联系，并创造安全的支持性环境。

Ultimately, both addiction and recovery are the results of a brain with an incredible ability to adapt from experience.

归根结底，成瘾和康复都是大脑从经验中获得惊人适应能力的结果。

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