Le craving comme symptôme central de la toxicomanie : de ses fondements neurobiologiques à sa pertinence clinique

Abstract

Le craving, ce désir intense de consommer, est un symptôme central de la toxicomanie. Jusqu’au début des années 2000, peu d’outils existaient afin d’étudier le phénomène de manière plus concrète pour mieux le définir, le comprendre et approfondir les fondements neurobiologiques qui le sous-tendent. Avec les avancées technologiques des dernières années (IRM fonctionnelle, PET Scan), puis l’arrivée du DSM-V et son inclusion comme critère diagnostique des troubles liés à l’utilisation de substances, le craving est devenu un symptôme central en toxicomanie. Sa définition a évolué et est de plus en plus précise à plusieurs égards. Nous avons une meilleure compréhension des voies neurobiologiques impliquées dans le phénomène ainsi qu’une meilleure compréhension des facteurs capables de le déclencher. Finalement, plusieurs travaux ont évoqué le rôle du craving dans la rechute lors de l’abstinence, et quelques traitements pharmacologiques se sont démontrés efficaces afin d’atténuer ce symptôme et éviter la rechute. Le craving s’avère ainsi une cible de choix afin de trouver de nouvelles avenues thérapeutiques pour briser le cycle de la dépendance.Objective: Observed by physicians and often reported by patients, craving is a core symptom of addiction, although not well defined nor understood completely. In the last several years, functional imaging as well as the measurement of different biological substrates of addiction have greatly evolved, allowing for a better understanding of the underlying neurobiological pathways of craving. Furthermore, with the development of the DSM-V and its inclusion as a diagnostic criterion for substance use disorders, craving has gained a whole new level of interest. Hence, the general objective of this article is to examine findings of studies that have led to a better understanding of craving and its implications. First, we address the definition of craving and its epidemiology in individuals with substance use disorders. We then summarize the results of the research conducted on the neurobiological substrates of craving. Finally, we present the role of craving in the cycle of addiction and its potential as a therapeutic target for pharmacological and non-pharmacological interventions.Methods: Narrative review of the literature.Results: The definition of craving has greatly evolved throughout the years, and it is commonly described as an abnormal desire or need to take a drug. While its conscious aspect is well known, whereas it is expressed subjectively, it is growingly also defined as an unconscious phenomenon illustrated by a physiologic activation that is not perfectly correlated with subjective measures. Available data on craving have also demonstrated the presence of this symptom in all three phases of the addiction cycle, including early and prolonged abstinence, long after the acute physical withdrawal syndrome. Three factors have been identified as potent craving inducers: the drug itself, drug related cues and stress. PET scan studies and fMRI studies confirmed the implication ...

Reliability and construct validity testing of a questionnaire to assess nomophobia (QANP)

“…Neurobiological research on addiction has revealed the existence of a common mechanism between substance addiction and behavioural addictions (Leeman & Potenza, 2013;Weinstein & Lejoyeux, 2015). Regarding similarities between MP overuse/nomophobia and substance addiction, the results of different studies (Cheung & Wong, 2011;Gao et al, 2018;Jenaro et al, 2007;Morissette et al, 2014;Ozturk et al, 2013;Reed et al, 2015;Thomée et al, 2011) indicate a variety of adverse effects for health, such as depression, social anxiety, insomnia, and hyperactivity. Further studies about these problems are necessary and specific tools to assess these constructs.…”

Anxiety associated with substance abuse

“…Патогенетическое родство алкоголизма и расстройств, ассоциированных с тревогой, определяется, в частности, тем, что общей основой тревоги и потребности индивида в алкоголе служит нарушение нейротрансмиссии норадреналина, серотонина и ГАМК [2,3]. В то же время психотропные и наркогенные эффекты 2 алкоголя и других ПАВ обусловлены влиянием на нейротрансмиссию ГАМК, дофамина, серотонина и других нейротрансмиттеров, что способствует в числе прочих причин возникновению сопутствующих психических нарушений, включая тревогу, у пациентов наркологической клиники.…”

“…Префронтальная кора, миндалина, прилежащее ядро, а также бледный шар, вентральная область покрышки и ряд других отделов мозга образуют церебральную систему награды (англ. : reward system), измененное функционирование которой лежит в основе злоупотребления ПАВ и нехимических зависимостей 2. Под наркогенными эффектами, или аддиктивным потенциалом вещества (abuse potential), понимают его способность вызывать пристрастие и зависимость 3.…”

Tobacco craving and withdrawal symptoms in psychiatric patients during a motivational enhancement intervention based on a 26-hour smoking abstinence period

“…According to many smokers, craving is the major reason for failing or not attempting to stop. This concept has been described as 'an abnormal desire or need to take a drug' 2 , including conscious and unconscious aspects. Although a large consensus supports the importance of craving, this construct remains complex to define and explain [3][4][5] .…”