Name: 探索成癮的脆弱性：天性和後天的影響？| Anna Lembke (Exploring addiction vulnerability: what roles do nature and nurture play? | Anna Lembke)
Uploaded: 2024-12-11T08:23:15.000Z
Duration: 17 min 55 s

情態副詞

A big part of what I wanted to chat about was actually this idea of why different individuals become addicted to very different stimuli, even if the final common pathway is comparable, right?

我想談的很大一部分內容其實是這樣一個想法：為什麼不同的人會對截然不同的刺激上癮，即使最終的共同途徑是相似的，對嗎？

程度副詞

So even if you could put all of us into whatever it is we use, fMRI, or whatever type of scan that we might use to pick up on the areas of the brain that undergo excitation, why is it that for one individual, alcohol becomes the thing, whereas for another person, it becomes an opioid?

是以，即使你可以把我們所有人都放入我們使用的任何東西中，如核磁共振成像，或我們可能使用的任何類型的掃描，以捕捉大腦中發生興奮的區域，為什麼對一個人來說，酒精就成了東西，而對另一個人來說，它就成了阿片類藥物？

And by the way, are there clusters where for certain people chemicals really are the problem, whether it be opioids, alcohol, cocaine, and yet for others, it's more behaviors?

順便問一句，是否存在這樣的群集：對某些人來說，無論是阿片類藥物、酒精還是可卡因，化學物質才是真正的問題所在，而對其他人來說，更多的是行為問題？

And I'll share with you just as an example of why this is a question that is on my mind so often.

下面我就舉例說明，為什麼我經常會想到這個問題。

So I've shared this story publicly before, but when I was actually in medical school, I suffered a really, really debilitating back injury.

我以前曾公開分享過這個故事，但實際上，當我還在醫學院就讀時，我的背部受了一次非常非常嚴重的傷。

And to make a very long story short, through some errors in the part of the medical system, I ended up on a really, really high, at the time, very high doses of oxycodone and oxycontin, and predictably went through the escalation of those doses until at one point I was up to 300 milligrams a day of oxycontin, so I'm sure you can put that in the context of the patients that you see, and I'm sure you've seen patients higher, but that's a pretty staggering dose.

長話短說，由於醫療系統的一些失誤，我最終服用了非常非常高劑量的羥考酮和奧施康定，而且可以預見的是，這些劑量會不斷升級，直到有一次我一天服用了 300 毫克的奧施康定，所以我相信你可以把它放在你所看到的病人的背景下，我相信你見過更高劑量的病人，但這是一個相當驚人的劑量。

It's a dose that if you or I split it right now, we would be dead, so just for context to people.

這是一種劑量，如果你或我現在把它劈開，我們都會死，所以只是為了給人們提供背景資訊。

So after several, oh, I don't know, probably six months of being on such a, again, enough oxy to kill a horse, I just decided I wanted off.

所以經過幾個月，哦，我也不知道，大概六個月的時間，我又一次服用了足以殺死一匹馬的催眠藥，我就決定要戒掉了。

And it was a very strange wake-up moment where I realized I wasn't even taking it because I was in pain anymore, I was taking it because I wanted to escape how depressed I was that I was debilitated.

那是一個非常奇怪的醒悟時刻，我意識到我服用它甚至不是因為我感到痛苦了，我服用它是因為我想逃避我的衰弱所帶來的抑鬱。

於是，我就決定戒掉，徹底戒掉。

And I, at the time, was dating an anesthesiology resident, and she was like, you are effing crazy, you're going to die, we need to put you on nortriptyline and 10 other drugs to taper you off.

當時，我正和一位麻醉科住院醫生約會，她就說，你真是瘋了，你會死的，我們需要給你服用去甲替林和其他十種藥物來減輕你的病情。

And I said, no, I'm doing this cold turkey, which I did, and I proceeded to spend the next two weeks in hell.

我說，不，我要冷處理，我照做了，接下來的兩週我都在地獄中度過。

But this is the point of the story, it's nothing that I said so far.

但這才是故事的重點，而不是我目前所說的。

The point of the story is I'm no more inclined to struggle with an opioid than any other person for reasons I don't understand.

故事的重點是，我並不比其他人更傾向於與阿片類藥物作鬥爭，原因我也不明白。

In other words, after that experience, I was quite afraid of opioids and I assumed I was addicted.

換句話說，在那次經歷之後，我非常害怕阿片類藥物，我以為自己上癮了。

But maybe 10 years later, when I had a really bad tooth condition and nothing was touching the pain, I finally succumbed and took Percocet.

但也許是 10 年後，當我的牙齒出現嚴重問題，沒有任何東西能緩解疼痛時，我終於屈服了，服用了 Percocet。

And then after two days, when the tooth was addressed, I stopped taking the Percocet and there was no issue.

兩天後，當牙齒得到治療後，我停止服用 Percocet，就沒有問題了。

And I came to conclude, I concluded from that experience that this was not a willpower thing that allowed me to quit.

我得出結論，我從那次經歷中得出結論，這不是我的意志力讓我戒菸的。

There's something physiologically about me that was not becoming addicted to that substance.

從生理上講，我並沒有對這種物質上癮。

And that's why I was able to stop cold turkey.

這也是我能戒掉 "火雞療法 "的原因。

In other words, I wasn't morally superior to the opioid addict, I was lucky.

換句話說，我在道德上並不比阿片類藥物成癮者高尚，我只是幸運而已。

Because there are clearly areas like work where I'm not so lucky and where the addiction is indeed real and where the struggle is daily.

因為在工作等領域，我顯然沒有那麼幸運，毒癮確實存在，每天都在掙扎。

Why don't we just start with your interpretation of your experience, which is, yes, I got physiologically dependent on opioids in medical school, but ultimately I'm not a person who's going to be addicted to opioids.

我們為什麼不從你對自己經歷的解釋開始呢，那就是，是的，我在醫學院時對阿片類藥物產生了生理依賴，但最終我不是一個會對阿片類藥物上癮的人。

Well, I thought I was, but it didn't appear to be the case based on subsequent use patterns, yes, yes.

我本以為是這樣，但根據後來的使用模式，似乎又不是這樣，是的，是的。

Right, you ultimately decided, you ultimately decided, oh, I'm actually, this is not an inevitable problem for me, but I recognize that, especially given what you went through, that it could be an inevitable problem for somebody else, right?

是的，你最終決定，你最終決定，哦，其實我，這對我來說不是一個不可避免的問題，但我認識到，尤其是考慮到你所經歷的，這對其他人來說可能是一個不可避免的問題，對嗎？

Okay, so let's start with risk factors for addiction.

好了，讓我們從成癮的風險因素開始。

So risk factors for addiction can broadly be placed into three separate buckets, which I call nature, nurture, and neighborhood.

是以，成癮的風險因素大致可分為三類，我稱之為天性、教養和鄰里關係。

The inherited or inborn risk for addiction based on family and twin studies is about 50 to 60%.

根據家族和雙胞胎研究，遺傳或先天的成癮風險約為 50%至 60%。

So this is, for example, based on studies showing that if you have a biological parent or grandparent addicted to alcohol, you are at increased risk of getting addicted to alcohol than the general population, even if raised outside of that alcohol-using home, right?

例如，有研究表明，如果你的親生父母或祖父母酗酒，那麼你酗酒的風險就會比普通人高，即使你是在不酗酒的家庭中長大的，對嗎？

So these are really nicely carefully done studies.

是以，這些研究做得非常仔細。

So high heritability is determined by twin concordance, basically.

是以，高遺傳率基本上是由雙胞胎的一致性決定的。

Looking back in family trees, looking at kids who were adopted into non-alcohol-using homes who developed alcohol use disorder at higher rates because they had a biological parent or grandparent.

回顧家譜，看看那些被領養到不酗酒家庭的孩子，他們酗酒的比例更高，因為他們有親生父母或祖父母。

And for a long time, you know, people have talked about the quote-unquote addictive personality.

長期以來，人們一直在談論 "上癮型人格"。

無論做什麼，我都要做到極致。

You know, that's a kind of colloquial use, but it gets to the heart of this idea that yes, people come into the world with different vulnerability to this tendency to take to the extreme the pursuit of certain types of highly reinforcing substance behaviors once discovered in the environment, okay?

你知道，這只是一種口語化的用法，但它抓住了這一觀點的核心：是的，人來到這個世界上，一旦在環境中被發現，就會有不同程度的脆弱性，從而將追求某種類型的高度強化物質行為的傾向發揮到極致，好嗎？

It's also probably true that we each have different, what are called drugs of choice.

我們每個人都有不同的所謂藥物選擇，這可能也是事實。

So even with people who are, you know, polysubstance users, which by the way, is more common than not today, people use a lot of different substances and behaviors.

是以，即使是使用多種物質的人，順便說一句，如今也比不使用多種物質的人更常見，人們會使用很多不同的物質和行為。

They'll still tell you, but you know, my preference is opioids, or the thing I really wanna do is smoke a cigarette, or alcohol is my go-to.

他們還是會告訴你，但你知道，我的偏好是阿片類藥物，或者我最想做的事情是抽菸，或者喝酒是我的首選。

And interestingly, there's very little science on the concept of drug of choice, because I looked pretty hard for that, and I couldn't find very much.

有趣的是，關於 "首選藥物 "這一概念的科學研究非常少，因為我找了很久，也沒找到多少。

But it is a really important one, because what it means is that here we have the phenomenon of access intersecting with drug of choice to increase the risk for certain individuals.

但這確實是一個非常重要的問題，因為它意味著，在這裡，我們有機會獲得藥物的現象與選擇藥物的現象交織在一起，從而增加了某些人的風險。

One of the, so we've got the, let me back up.

其中一個，所以我們已經得到了，讓我倒回去。

So we've got the nature, right, in the inherited risk.

是以，我們已經掌握了遺傳風險的本質。

By the way, that probably goes along with co-occurring mental health disorders.

順便說一句，這可能與同時存在的精神疾病有關。

People with mental health disorders are at increased risk of developing addictive disorders, and addiction is probably a complex polygenic phenomenon.

精神疾病患者罹患成癮性疾病的風險會增加，而成癮可能是一種複雜的多基因現象。

Then we have risk factors based on nurture.

然後，我們還有基於養育的風險因素。

So this is the way that we are raised, early childhood development, parents that model maladaptive, addictive behaviors, or that explicitly or implicitly condone substance use or other addictive behaviors.

是以，這就是我們的成長方式，幼兒期的發展，父母以適應不良的成癮行為為榜樣，或者明示或暗示縱容使用藥物或其他成癮行為。

Those kids are more likely to develop addiction in adulthood, especially if there's trauma, if there's negative attachment.

這些孩子成年後更有可能染上毒癮，尤其是在有創傷、有負面依戀的情況下。

Whereas kids who are raised in a home where patients are modeling healthy, adaptive coping strategies, where they have a good attachment to their kids, where there's not sexual, physical, or emotional abuse, those kids are protected, right, or relatively protected.

而那些在病人以健康、適應性強的應對策略為榜樣，與孩子有良好依戀關係，沒有性虐待、身體虐待或情感虐待的家庭中長大的孩子，這些孩子是受到保護的，對吧，或者說是相對受到保護的。

You can have the perfect childhood and still end up addicted.

你可以擁有完美的童年，但最終還是會上癮。

And then we have what I call neighborhood risk factors, and these get to the key of access.

然後，我們還有我所說的鄰里風險因素，這些都是獲取信息的關鍵。

So one of the biggest risk factors for addiction is simple access to that drug.

是以，上癮的最大風險因素之一就是能簡單地獲得這種藥物。

If you live in a neighborhood where drugs are sold in the street corner, you're more likely to try them and more likely to get addicted.

如果你生活的社區街角都有毒品出售，你就更有可能嘗試毒品，也更有可能染上毒癮。

If you go and get medical care at a place where people liberally prescribe opioids, benzodiazepines, stimulants, your brain will be exposed to those drugs, will change in response to those drugs, and you are at increased risk of getting addicted to those drugs.

如果你去一個人們隨意開阿片類藥物、苯二氮卓類藥物和興奮劑的地方接受治療，你的大腦就會接觸到這些藥物，就會對這些藥物產生反應，你對這些藥物上癮的風險就會增加。

Now, in your case, the risk of access was ultimately what got you initially hooked, but probably other innate protective factors that you have allowed you to not end up with a serious addiction, probably in terms of genetic protective elements, maybe having to do with the way that you were raised.

在你的案例中，獲取毒品的風險最終讓你上癮，但可能是其他先天保護因素讓你最終沒有嚴重成癮，可能是遺傳保護因素，也可能與你的成長方式有關。

I don't know you, so it's hard for me to judge.

But essentially, that's kind of how we think about it.

但本質上，我們就是這麼想的。

But what's interesting, and I guess this is the part that's most curious to me, is I am, I mean, if I'm being brutally honest and take an honest stock of my life, there are clearly things where I behave in very addictive ways today.

但有趣的是，我想這是最讓我好奇的部分，我是說，如果我對自己的生活進行一次殘酷的誠實評估，很明顯，我今天的行為方式非常容易上癮。

So, and let's just acknowledge that the neighborhood for those things is high, right?

所以，讓我們承認，這些東西的鄰里關係很好，對嗎？

Like, I mean, online shopping, like my wife describes me as an e-shopaholic, and she can tell my stress level by the number of Amazon packages that come to the door.

比如，我的意思是，網上購物，就像我妻子形容我是個電子購物狂一樣，她可以從送上門的亞馬遜包裹數量看出我的壓力程度。

So when I'm under low stress, will go a week without a package.

所以，當我壓力小的時候，會一個星期不寄包裹。

When I'm under high stress, three packages a day.

I'm buying stupid, irrelevant trinkets, but it's this dumb little escape I have where, oh my God, I need a key chain.

我買的都是些愚蠢的無關緊要的小玩意兒，但就是因為這種愚蠢的小逃避，天哪，我需要一個鑰匙鏈。

I wonder what kind of key chains they have on Amazon.

我想知道亞馬遜上有什麼樣的鑰匙鏈。

Oh, look, I gotta, you know, so it's, and I fully acknowledge that there are real, that that is a true addiction.

哦，聽著，我得，你知道，所以，我完全承認，有真正的，那是一個真正的癮。

Now I'm fortunate in that the consequences of that addiction are minimal, but I'd like to believe I'm at least wise to the fact that there's just a general good luck that is permitting Amazon to be my pusher as opposed to someone selling illicit drugs.

現在我很幸運，毒癮造成的後果微乎其微，但我願意相信，我至少明智地認識到，亞馬遜是我的推手，而不是販賣毒品的人，這只是一種普遍的好運氣。

我想知道為什麼，這就是問題所在。

I wonder why, because this to me speaks to, like, we're all addicts potentially.  Why are some people unlucky in that the addiction is, it turns out to either kill them or destroy the quality of their life and their relationships?

我想知道為什麼，因為對我來說，這說明我們都有可能上癮。  為什麼有些人運氣不好，上了癮，結果不是要了他們的命，就是毀了他們的生活品質和人際關係？

Right, so let me answer that in a couple of different ways.

好吧，讓我用幾種不同的方式來回答這個問題。

First of all, thank you for sharing the online shopping addiction.

首先，感謝您分享網購上癮的經歷。

As you know, in my book, Dopamine Nation, I talk about how I got addicted to romance novels.

如你所知，在我的書《多巴胺國度》中，我談到了我是如何沉迷於言情小說的。

Now, granted, it was a minor addiction and I was able to, once I recognized it, you know, change those behaviors without having to get professional help, which, again, brings us back to this concept of drug of choice and how it intersects with access.

當然，這只是輕微的毒癮，一旦我意識到這一點，我就能夠改變這些行為，而無需尋求專業幫助。

Because what's so challenging about the world today is that not only do we have more access to more potent forms of traditional drugs, including alcohol, but all the other drugs that have been around for millennia, but we also have brand new drugs that didn't exist before.

因為當今世界極具挑戰性的一點是，我們不僅有更多機會接觸到藥效更強的傳統毒品，包括酒精，以及已經存在了幾千年的所有其他毒品，而且我們還有以前不存在的全新毒品。

All of the online digital media, online shopping, pornography, the drugification of the romance novel, et cetera, et cetera.

所有的在線數字媒體、在線購物、色情製品、愛情小說的毒品化，等等等等。

You described this, Anna, sorry to interrupt, in a way that I loved so much.

安娜，抱歉打斷一下，你的描述讓我愛不釋手。

我們是生活在熱帶雨林中的仙人掌。

I mean, it's just such a beautiful way to describe the bizarre existence of the human in this condition relative to 10,000 years ago and for millennia.

我的意思是，用這種美妙的方式來描述人類在這種情況下的奇異存在，相對於一萬年前和幾千年來都是如此。

Yes, and I'd love to take credit for that metaphor, but I can't.

是的，我很想為這個比喻邀功，但我不能。

That's Dr. Finnecane from Johns Hopkins, but it's a fantastic metaphor.

那是約翰霍普金斯大學的芬尼肯博士，但這是一個絕妙的比喻。

We weren't evolved for the world that we live in now.

我們並不是為現在的世界而進化的。

So again, just to go back to my own example, I thought that I hadn't inherited this so-called addiction gene because alcohol was never reinforcing for me.

所以，還是回到我自己的例子，我以為我沒有遺傳到所謂的成癮基因，因為酒精對我來說從來沒有強化作用。

These are the legal and easily accessible drugs that people who do find those drugs reinforcing are going to be vulnerable to because they're legal and accessible.

這些都是合法且容易獲得的毒品，那些覺得這些毒品能增強體質的人很容易接觸到這些毒品，因為它們是合法且容易獲得的。

Why do nicotine and alcohol kill more people every year than any other drug?

為什麼尼古丁和酒精每年造成的死亡人數比其他任何藥物都多？

Because they're legal and they're accessible.

因為它們是合法的，也是可以獲取的。

So I think that's a really important first thing to say.

是以，我認為這是第一件非常重要的事情。

Now that we have drugs like online shopping and romance novels, people like you and me who maybe thought, well, I didn't inherit this addiction gene.

現在，我們有了網購和言情小說等毒品，像你我這樣的人也許會想，好吧，我沒有遺傳這種成癮基因。

字幕列表影片播放

探索成癮的脆弱性：天性和後天的影響？| Anna Lembke (Exploring addiction vulnerability: what roles do nature and nurture play? | Anna Lembke)

perspective

vulnerable

ultimately

struggle