作为家长，亲人，朋友，我们身边人是否有成瘾倾向，怎样才能确定某人已经快一脚踏入成瘾的深渊了，该如何来预防避免和治疗快要成瘾的人？ 相信这篇文章对您多少有点用处。此文是作者Lantie Elisabeth Jorandby M.D.于2022-03-08发表于《Psychology Today》上的，此处是转载，翻译文。感谢作者，感激《Psychology Today》。
Calling out this phase of addiction makes total sense. And it will save lives. 提出“前驱成瘾”非常重要，它可能救命。
Posted August 3, 2022 | Reviewed by Gary Drevitch
作者
Lantie Elisabeth Jorandby M.D.
About简介
Lantie Jorandby, M.D., is a board-certified psychiatrist with a specialty certification in Addiction Psychiatry and Addiction Medicine. She completed her general psychiatry training at the University of Florida and her Addiction Psychiatry training at Yale School of Medicine. She has served as medical director of the dual diagnosis unit at McLean Hospital and as faculty with Harvard Medical School. Lantie Jorandby, M.D，董事会认证的精神病学家，在佛罗里达大学获得成瘾精神病学培训专业认证，并在耶鲁大学医学院接受成瘾精神病学培训。她曾担任麦克莱恩医院双重诊断部门的医学主任，并在哈佛医学院任教。
She is currently Chief Medical Officer of Lakeview Health, a residential facility in Jacksonville, Florida, that specializes in treating addictive and psychiatric disorders. 她目前是佛罗里达州杰克逊维尔Lakeview Health医院住院部的主治大夫，专门治疗成瘾和精神疾病。
KEY POINTS 关键点
Some addiction-treatment leaders propose the use of the term “pre-addiction” to describe mild-to-moderate substance use disorder. 一些成瘾治疗权威建议使用“前驱成瘾”一词来描述轻度至中度物质使用障碍。
The pre-addiction designation could enable interventions at an earlier stage, when it is easier and less expensive to treat people. 确定了“前驱上瘾”可以使干预治疗在更容易且成本更低的早期阶段进行。
Research is needed to identify the behaviors and risk factors that would raise concern for future problems with addiction. 研究需要确定引起成瘾的行为和风险因素，以便对成瘾会引发的问题产生重视。
THE BASICS 基础知识
·THE BASICS 什么是成瘾？
I’ve written here before that our understanding of addiction and addiction treatment has come a long way in the last two decades. As an addiction psychiatrist and chief medical officer at a large treatment center based in Jacksonville, Florida, it’s been incredibly gratifying to see how those changes have benefitted our patients. 我之前在这里提起过，在过去的二十年里，我们一直在探索成瘾和成瘾治疗。作为佛罗里达州杰克逊维尔一家大型治疗中心的成瘾精神病学家和主治医生，我非常欣慰地看到这些变化让我们的患者如何受益。
For example, we know so much more about the brain chemistry of addiction now, which has profoundly changed how we treat patients. Also, the therapies and medications we use are more effective and evidence-based. We’re also much more aware of, and are better able to treat, the mental conditions that often accompany addiction—from depression and trauma to eating disorders and ADHD. 例如，我们现在对成瘾的脑部化学了解得更多，这深刻地改变了我们治疗患者的方式。此外，我们的疗法和药物更有效，也更基于证据。我们对伴随成瘾的精神状况——从抑郁和创伤到饮食失调和多动症更加了解并且能够更好地治疗。
Out of this much-improved landscape comes another potentially game-changing development I’m very excited about: a group of experts has recently coined the term “pre-addiction” as a new way of understanding and treating an earlier stage of addiction. As you’ll see, this has far-reaching implications. 伴随着这种提高，另外一个令我激动的可能具有颠覆性的改变正在形成：一群专家最近创造了“前驱成瘾”一词，让我们能理解和治疗早期成瘾。正如您将看到的，这具有深远的影响。
The basics of pre-addiction 前驱成瘾的基础知识
Nora Volkow, director of the National Institute on Drug Abuse, and two other prominent thinkers in the addiction treatment field recently proposed the term “pre-addiction” to describe mild-to-moderate substance use disorder (SUD). 国家药物滥用研究所所长Nora Volkow 和其他两位成瘾治疗领域的杰出思想家最近提出了“前驱成瘾”一词来描述轻度至中度物质使用障碍 (SUD)。
The term consciously mimics “prediabetes,” a now-accepted term to describe people with higher-than-normal blood sugar levels and who are at high risk of developing diabetes. The “prediabetes” designation has allowed resources and interventions to be targeted to this earlier stage of the condition, when it is easier and less expensive to treat. 该术语有意识地模仿“前驱糖尿病”，这是一个现已被接受的术语，用于描述血糖水平高于正常水平和患糖尿病的高风险人群。 “前驱糖尿病”的出现让针对糖尿病的早期干预措施成为可能，而此时的治疗更容易且成本更低。
That’s exactly the goal that Volkow & Co. have in mind with pre-addiction. Here’s how she explains it in a recent commentary in JAMA Psychiatry: “The term ‘pre-addiction’ gives a readily understandable name to a vulnerable period of time in which preventive care could help avert serious consequences of drug use and severe substance use disorders.” 这正是Volkow & Co.提出“前驱成瘾”这个词的目的所在。她最近在《JAMA 精神病学》的一篇评论中是这样解释的：“‘前驱成瘾’这个词给了易感时期的一个容易理解的名字，在这个时期，预防性措施可以避免吸毒和物质滥用的严重后果。
Volkow compares this to other conditions: “It is now standard to monitor risk factors like cholesterol, blood pressure, and BMI during routine checkups, so that steps can be taken to avert heart attacks or stroke through some combination of lifestyle changes and medications.” Volkow 将此与其他情况进行了比较：“现在，对胆固醇、血压和BMI 等因素进行常规检查已成为控制风险的标准，此种方法也可以结合生活方式的改变和药物使用一起来避免心脏病发作或中风。”
The point being, we can do the same thing with addiction. Why do people with alcohol and drug addiction need to “hit rock bottom,” as the saying goes, before their condition is recognized and treated? 关键是，我们可以采取同样的方式对待成瘾。为什么酗酒和吸毒的人需要到情况最糟糕的时候，才能被承认和治疗？
If this designation takes hold, it will hopefully force the healthcare establishment (including insurers) to recognize and target resources for the pre-addiction stage. Also, people with pre-addiction will be better able to recognize it, and seek treatment for it. 如果“前驱成瘾”一词得到承认和认可，它将有望迫使医疗保健机构（包括保险公司）认识它并为此提供相应的资源帮助。此外，前驱成瘾的人将能被更好地识别和治疗。
Again, the idea is that the condition will be caught early, when it’s easier to get a handle on and before serious interventions like detox or inpatient treatment become necessary .同样，我们的想法是，在需要采取像排毒或住院治疗等严重干预措施之前，“前驱成瘾”一词使成瘾更容易被发现和控制。
A key point to keep in mind: By the time a person hits full-blown addiction from drugs or alcohol, their brain chemistry and structure have been reconfigured. Those changes can be reversed over time, but that takes months of sobriety. Meanwhile, the altered brain chemistry makes it more difficult to stay on track with recovery. 需要记住的关键点：当一个人因毒品或酒精而完全上瘾时，他们的脑部化学和结构已经重新配置。这些变化可以随着时间的推移而逆转，但这需要几个月的清醒时间。与此同时，大脑化学物质的改变使得恢复正常变得更加困难。
The beauty of intervening at the pre-addiction stage is that in most cases, those addiction-associated brain changes won’t have happened yet. Consequently, the path back to a healthy mental state is less arduous. 在前驱成瘾阶段进行干预的好处在于，在大多数情况下，那些与成瘾相关的脑部变化还不会发生。因此，恢复健康的精神状态并不那么艰难。
To recap, here’s why targeting treatment at the pre-addiction stage makes so much sense: 回顾一下，这就是为什么在前驱成瘾阶段进行靶向治疗如此重要：
You have a better chance of arresting the progression of the disease.更好的阻止疾病的继续发展的机会
You are better able to make your own lifestyle changes and other important course corrections to head off addiction. 能更好地改变自己的生活方式或调整重要的行为方式，以阻止成瘾
Your available treatments and therapies are less expensive and easier to obtain. 治疗更便宜，疗法更容易。
Your prognosis for long-term recovery is significantly better. 识别和治疗前驱成瘾更有助于长期康复
Identifying and treating pre-addiction 界定和治疗前驱成瘾
To treat pre-addiction, you first have to identify it. This means screening and intervention during routine checkups in the primary-care setting, among other places. That sounds obvious enough, but we’re not there yet in terms of what those screens look like. The goal of intervention is clear, though: As Volkow puts it in her JAMA Psychiatry commentary, we want “to alert people to problematic patterns of drug or alcohol use that do not (yet) meet the threshold of addiction.”
要治疗前驱成瘾，您首先必须识别它。这意味着需要在初级保健机构等地方的常规检查中进行筛查和干预。这听起来好像足够了，但做筛查时我们不在现场，我们不了解筛查的现实情况怎样。不过，干预的目标很明确：正如Volkow 在她的 JAMA 精神病学评论中所说，我们希望“提醒人们注意尚未达到成瘾程度的不良药物或酒精使用行为。”
Further, we need to “define and detect substance use that is clinically significant and amenable for early intervention. Existing DSM criteria for mild to moderate substance use disorder are a starting point, as are existing screening tools used in primary care that ask about frequency of substance use. But research is needed to better characterize the kinds of substance use and the kinds of individual risk factors that would raise concern for future addiction and other health problems.” 此外，我们需要“确定和检测具有临床意义且适合早期干预的物质使用。现有的轻度至中度物质使用障碍的DSM 标准是一个最基本的方面，初级保健中使用的询问物质使用频率的现有筛查工具也是方法之一。但是我们需要更好地研究物质使用的种类以及可能引起成瘾和其他健康问题的风险因素。”
As for self-treating pre-addiction, the beauty is that this can be done at all, unlike when people have full-blown addiction. Following are the sorts of adjustments that someone diagnosed with pre-addiction would be able to make if they’re worried about their problem drinking or drug use: 不像已经完全成瘾，前驱成瘾的美妙之处在于这完全可以自我治疗。以下是被诊断为前驱成瘾的人可以预防成瘾做出的调整：
Don’t drink or use drugs alone at all. 一定不要单独饮酒或吸毒。
Eat food and take in water when you drink. 喝酒时记得同时吃东西和喝水
Know that in the “upsized” world of bar and restaurant portions, the alcohol content of beer, wine, or mixed drinks can be higher than the average, so be careful and conscious of that. 要知道在越来越多的酒吧和餐厅中，啤酒、葡萄酒或混合饮料的酒精含量可能高于平均水平，请提醒自己小心这一点。
Assess all areas of your life—your job, relationships, finances,the amount you exercise, and so on—to see if drugs or alcohol are having a negative affect on any. 评估酒精或药物对你生活中工作、人际关系、财务状况、运动量等方面是否构成了不良影响。
Make a conscious effort to replace unhealthy habits like drinking or drug taking with healthy habits. These include daily exercise (maybe at the end of the workday, when you would normally have a drink), fun hobbies, or regular self-care such as meditation, reading, yoga, or a weekly massage. 有意识地用健康的习惯代替像饮酒或吸毒等不健康的习惯。这些包括日常锻炼（也可能是在下班后，您通常会喝一杯）、有趣的爱好或定期的自我保健，例如冥想、阅读、瑜伽或每周一次的按摩。
We still have a long way to go in our understanding of addiction and addiction treatment. This country’s recent, tragic increase in drug overdoses shows we’re not there yet. But we are making progress on several fronts. This new thinking about pre-addiction is a significant example of that. It could lead to a new way of diagnosing, treating, and paying for addiction and addiction care. 在成瘾和成瘾治疗的方面，我们还有很长的路要走。国内最近急剧增加的吸毒成瘾事实表明我们做的还很不够。但我们正在一些方面取得进展。“前驱成瘾”的提出就是一个重要的例子。它可能会带来一种有关成瘾的诊断、治疗，支付和护理的新方法。
References 参考
McLellan, Koob & Volkow. (2022). Pre-Addiction: A Missing Concept for Treating Substance Use Disorders. JAMA Psychiatry. 麦克莱伦、库布和沃尔科。（2022 年）。前驱成瘾：治疗物质使用障碍的缺失概念。JAMA精神病学。
作者
Lantie Elisabeth Jorandby M.D.
About简介
Lantie Jorandby, M.D., is a board-certified psychiatrist with a specialty certification in Addiction Psychiatry and Addiction Medicine. She completed her general psychiatry training at the University of Florida and her Addiction Psychiatry training at Yale School of Medicine. She has served as medical director of the dual diagnosis unit at McLean Hospital and as faculty with Harvard Medical School. Lantie Jorandby, M.D，董事会认证的精神病学家，在佛罗里达大学获得成瘾精神病学培训专业认证，并在耶鲁大学医学院接受成瘾精神病学培训。她曾担任麦克莱恩医院双重诊断部门的医学主任，并在哈佛医学院任教。
