TIM HIEU CO CHE G A Y NGHIEN TD GOC DO TAM LY HOC THAN KINH
PGS.TS. Vo Thi Minh Chi Vien Nghien cdu Suphgm.
I
TOM TAT
Theo dinh nghia cua Td chuc Y ti Thi gidi (WHO), nghien Id cdn benh mdn tinh cita ndo. Cdc nhd nghien cim vi sinh ly thdn Irinh cho thdy nghien lien quan den suxudi hien ciia cdm xiic duang tinh - euphoric do Idc ddng ciia cdc chdt gdy nghien vdo cdc dinh khu xdc dinh tren ndo.
TCr khoa: Nghien: Chit gdy nghien: Tdm ly hgc thin kinh; Ca chi gdy nghien tir cdch tiep can tdm ly hgc thdn kinh.
Ngdy nhdn bdi: 31312017; Ngdy duyel ddng bdi: 25/3/2017.
ABSTRACT
As defined by World Health Organization (WHO), addiction is a chronic disease of the brain. Researchers in neurological physiology have indicated that addiction is related to the presence of positive emotions called euphory due to the impacts of substances on certain zonations on Ihe brain.
Keywords: Addiction: Addictive agents, Euphory emotions: Neurological psychology:
Addictive mechanism based on the neurological psychology approach.
Nghien la khai niem ma trong Tam ly hgc chua cd ndi ham rd rang nhung cho den nay, dinh nghTa dugc nil ra tu ket qua ciia cupc hdi thao ban trdn eua Vien Y te Qudc gia Hoa Ky da dugc chap nhan, theo dd, nghien la '"mdt benh ciia ndo cd dien bien tuang tic nhu cdc benh mdn tinh khdc, duac bieu Men thdng qua cdc rdi loan phirc tgp hdnh vi do su tuang tdc ciia cdc yeu td di truyen, sinh hgc, tdm ly xd hdi vd dnh hudng ciia mdi trudng'' [1].
0 Viet Nam. ngudi nghien ma tiiy da xuit hien d 100% eac tinh, thanh phd, gan 90%o quan, huyen va khoang 70%i xa, phuong. thi Irin; vdi mgi thanh phan trong xa hdi til hgc sinh, sinh vien, can bp cdng chirc, vien chirc din ngudi lao ddng. Trong dd, dai da sd ngudi nghien d dp ludi lao ddng [1].
TAP CHi TAM LV HOC, So 4 (217), 4 - 2017
Diiu tri nghien ma tuy la mdt qua trinh lau dii, bao gdm tdng thd cac can thiep ho teg ve y tl [5], tam 1^, xa hpi [1] nhim lam thay doi nhan thiic, hanh vi, tiln tdi giam tac hji cua nghidn va giam tinh trang sii dung ma tiiy trai phep [6]. Do ban chit nghidn la mpt loai benh man tinh ndn nguy ca tai nghien la rat cao, thdi gian diiu trj lau dai va qua trinh dieu tri phiic tap, ddi hdi tinh toan dien, ddng bp.
Trong thyc te, da cd nhttng ngudi cai nghien thanh cdng dugc nhiiu nam nhu nhttng ngudi d Cau lac bd Kit ndi thanh cdng - Hai Phdng va dac biet, tim guang ciia Le Trung Tuan (Chu tich Hdi ddng Sang lap Trung tam Nghien ciru va Hd trg tam \^ cho ngudi nghien ma tiiy - PSD) - ngudi da doan tuyet duge vdi ma toy va trd thanh doanh nhan thanh dat. Da ed nhimg ly giai ve ca chd nghidn, tai nghien cung nhu nhieu phuong phap cai nghien da duge ap dung, my nhien ty Id tai nghien van eao. Thuc te nay da dat ra van dd can tidp tuc nghidn cim vd cac eg chd nghidn tu nhieu each tiep can khae nhau, tu dd tim ra cac phuong phap dieu tri, gdp phan cai nghien, giam thieu viec tai nghidn.
1. Cac khai niem ctf ban - Ciidl gdy nghien:
Theo djnh nghia ciia Td chttc Y tl Thi gidi (WHO), chit gay nghien la mpt chit hda hpc gay sttng sd, hdn me hoac vd cam vdd dau ddn. Thuat ngu nay thudng dl cap din trong y te la thudc phien - opioid hay gpi la thudc giam dau CO chat gay me.
Lich su nghidn ciiu ve chat gay nghien cho thiy, Hippocrates la ngudi diu tien six dung thuat ngtt "vapKoinKo?" - tiing Hy Lap ed nghia la hda da, vdi cac md ta vl sir gay mat cam giac hay lidt. Thuat ngtt nay cung dugc bac si ndi tieng cua thdi cd dai, Claudius Galen stt dung. Khi de cap den eac chat nay, Galen da ndi
"vapKomKd;" cd chung "goc tir" vdi mdt gidng cay doc va hat gidng cay thudc phien.
Trong tieng Anh, tu "narcotic" dugc diing de chi thudc phien, tranh nham lan vdi "drug" vdi nghTa chinh xae nhat la "thudc me, thudc ngii".
Ngay nay, chat gay nghien ed the dugc phan loai Iheo nhieu each, song phd bien la nhdm thudc hgp phap va bat hgp phap.
- Ddi vdi nhdm hgp phap (dugc cho phep), bao gdm cac loai thudc:
thudc la, rugu va mdt sd thudc sir dung trong y le. Viee sd huu va sir dung nhung chiit nay khdng phai chiu hinh phat, cd the inua ehiing trong cac cira hang hoac nha thudc.
Trong sd nhdm thudc bit hgp phap (bi cim), pho biin nhit la hashish, cocaine va heroin.
TAP CHi TAM LV HOC, Sd4 (217). 4-2017 45
Tuy nhien, tinh "hgp phap" hay "bSt hgp phip" khdng dua ra mdt khai niem ro rang ve sy nguy hidm cua chat gSy nghidn [3],
Cac chat gay nghidn bat hgp phap hay hgp phap ddu dugc dSc trung bdi:
Tac ddng len he thdng thin kinh tnmg uomg, ma tryc tiep la bd nao con ngudi, din den mat cam giac va nhttng dinh hinh lien quan ddn khdng gian va thdi gian, tac ddng den cac trai nghidm cam xiic, cung nhu nhan thiic "cai tdi" ca nhan.
- Lam nang them cac benh nhu AIDS. Vao cudi thi ky XX, trong sd bdnh nhan AIDS, cd ban 80%) la ngudi nghien. Ngoai ra, sy tang trudng nghien ed quan he tryc tiep va sy lan truyen nhanh ehdng ciia eac loai bdnh viem gan, kd ca B va C. Cac bdnh nay dien ra d ngudi nghidn hau nhu khdng thi chira dugc [3].
Theo hang thdng tan qudc td AMI ve ehdng nghidn ma tiiy va Hiep hdi kinh doanh thudc, trong nam 2005, da cd hgn 90.000 tdi pham lidn quan din ma liiy, trong sd dd ngudi nghien chiem 60%.
- Su phu thudc vdo chdt gdy nghien:
Day la khai niem phan anh ehinh xae "mdi quan he qua lai" giua ngudi nghien va chat gay nghien. Chi Irong mpt thdi gian ngan sti dung chat gay nghidn, d ca nhan da xuat hien thdi quen sir dung chat gay nghien, ed nghTa la, su le thudc (theo dung nghTa den) vao viec sir dung chat gay nghien, cung nhu viec phai tim kiem ngudn lai chinh de ngudi nghien ed the sd httu duge lupng chat gay nghien can thiet.
Su phu thupc la hien lugng mang tinh chat ca ve thi chit iin tinh than (tam ly), dugc the hien bdi cac trieu chung kinh dien cua vide cai (kieng nhin), khi ma ngudi nghien phai trai nghiem Irang thai rat nang ne vdi cac con dau Ihuc the hay chuc nang mpl each tram trgng.
Cac nghien ciru ve nghien cho thay, dii chat gay nghidn la loai nao thi cung lac dpng len nao theo eo che chung. Do vay, viec lim hilu, xac djnh cae vimg dinh khu chirc nang tren nao gay nghien la cd co sd khoa hpc.
2. Co che benh sinh eiia nghien
Trude het, cac nha nghien cim, ca ve ly luan iin thyc nghiem tren ddng vat cd nao, deu khang dinh, nghien dii bat cir tac ddng eiia dang chit gay nghien nao thi chac chan ciing deu lien quan den ITnh vyc cam xiic trong boat ddng sdng ciia chii the. Chinh xac hon la su xuit hien va hinh thanh nghien Irong nhttng budc dau lien ludn dugc ket ndi vdi cac tae ddng ciia chit gay nghien vao cac trung tam cam xiic ducmg tinh cua nao. Tiip Iheo, nhung biin ddi cam xuc do tac ddng CLia cac chat gay nghien dan den hinh Ihanh cai gpi la "phan xa eiia
46 TAPCHITAM L? HOC, So 4 (217), 4 - 2017
muc dich", nghia la, phai tim kidm them ciing c6 cam xuc duang tinh the hien qua hanh vi ciJa nguoi nghien.
He thdng da chirc nang benh Iy sau m6i ciing c6 mai cang trd ndn vung chic han, din din su bdn vung them cua trang thai benh Iy. Nhir vay, khi b^n Iu$n vd ca chd bdnh sinh ciia nghidn, cho du mang tinh xac suit, cung khong thd khong dd cap den van dd c^m xiic.
Cac nghidn cihi vd cam xiic tu goc do sinh ly thSn kinh da duoc cac tac gia P.I. Pavlov, P.K. Anokhin [7] dd cap den tu lau. CJ day se chi ban ddn nhung npi dung ve cam xiic duang tinh, lidn quan ddn co chd gay nghidn; tren ca so do tim hidu dinh khu ciia co che nay tren nao nguoi.
Khi CO tac d6ng ciia chat gay nghien, cam xuc duong tinh nay sinh.
Truac het, cam xiic duang tinh da de cap den dugfc goi la euphoria - sang khoai bdnh Iy (tieng Hy Lap la enphoria) - la trang thai khi nguoi benh co khi sac bdnh hoan vui ve tang nhung khong c6 nguyen nhan thuc td.
Nhihig buoc dau tien trong sir hieu biet vd giai phau va sinh ly hpc than kinh cua cam xuc da duac thirc hidn bai nha khoa hgc Thuy ST Y.W. Hess, vao nam 1928. Khi lam vide voi mpt con meo tinh tao, Hess sii dung vi dien cue gay kich thich dien vao cau true than kinh khac nhau, mgt phan trong do la viing duai doi thi (xem so do hinh 1) tren nao, da gay ra o con vat hanh vi tan bao voi tat ca cac dau hieu ben ngoai cua con thinh no, tiic gian (voi tu each la phan ung tu ve), trong khi trong thuc td, con vat khong phai dap ting voi mgt tac ddng nao gay khiing bd, sp hai. Cac thi nghiem ciia Hess da dugc hoan chinh bdi thi nghiem ciia W. Cannon - mdt nha sinh ly ndi tieng khac trong cac nghien cuu hanh vi ciia dgng vat (ciing trdn mpt con meo) sau khi giai phau cat bo phan nam d phia duoi vung dudi ddi thi. Khi bi kich thich, d con vat da xuat hidn phan iing gian du khong c6 nguydn nhan thuc te. Trong trudng hpp do, neu nhat cat dugc thirc hidn thap hon viing dudi doi thi (nghTa la chia cat vung gian nao va nao giira), phan iing ciia "con thinh no gia" se bien mat hoan toan.
Cac thi nghiem da cho phep Hess va Cannon dua ra mpt sd ket luan thii vi:
+ Viing dudi ddi thi la mdt trong nhiing trung tam than kinh tham gia vao dieu khien cac hanh vi cam xiic duang tinh ciia con vat.
+ Chuc nang viing dudi ddi thi kiem soat cam xiic dugc dieu khien bdi nao trude (vd tran ban cau dai nao).
+ Cac phiin iing cam xiic cd the xay ra chi trong trudng hop cac ket ndi than kinh giira viing dudi ddi thi va cku triic khac cua nao dupe bao tdn. Trong hau het cac nghien ciru sau ciia cac nha sinh ly hgc th§n kinh vd chuc nang nao bp cho thay, viing dudi doi thi. ve nguyen tfic, khong phai la trung tam duy nh§t
TAP CHI TAM LV HOC, Sd4 (217), 4 - 2017 47
diiu Mnh cac hanh vi cam xiic ciSa con vit. Phan ling eiia "con thinh nO gii"
cd the tai dien khi kich thich v4o mdt s6 phan cOa nSo giiJa, thjm chi ngay ca trong trudng hgp nao gitta dugc phlu thuSt t4ch rdi khdi tit cA cic thanh phan nim cao hon trong he thdng thin kinh Irung uomg. Tuy nhidn, cac thi nghiem tiip theo Cling da khing dinh, c4c trung tSm cim xdc c i a nao gitta d t o bao sy phdi hgp gitta cac ciu thanh v|ta dOng ciia phin iing c t o xiic nhung ban th4n nd khdng cd tac dpng diiu hinh ISn c4c trung tam cao hon ndn vide tu nd lan tda c t o xuc la khdng thi [7].
3. Binh khu chAc ning g&y nghifn trdn nio
Nhin chung, vide diiu hinh phin xa cua trang thai c t o xiic ddng hanh cimg trang thai nghidn diin ra nhu sau:
Hinh i . Dinh kliu cac chirc n i n g gfty cam xuc tren nao ngirai
Chii thich hinh ve: [8]' /. Vimg ddi thi;
2. Ndo giira;
3. The ludi;
4. Viing duai ddi thi;
5. Tuyin yen;
6. Cdu Varoliev;
7. Hdnh ndo.
^ Ptian chii ttiich bang tieng Vigt do tdc gia bAi b i o thirc hi^n.
48 TAP CHi TAM L f HOC, Sd 4 (217), 4 - 2017
Cac he co quan phan tich co khoang each (ngiii, nghe, nhin) theo dudng dan truydn cua minh dem ddn vd ban cku dai nao thdng tin vd su thay ddi lien tuc ciia mdi trudng bdn ngoai. Ngo^i ra, di vao cac dinh khu trdn^ cdn cd cac thdng tin tu xiic giac va xung tir cac bo phan nhan cam ben trong nam d cac co quan ndi tang. Vide phan tich cac thdng tin thu duoc se kdt thiic bang sir hmh thanh cac md hinh hudng t§m vd ket qua du kidn ciia hoat ddng. Cac dudng lidn he phong phii trdn vd n^o, vung dudi ddi thi va sir tham gia ciia eae xung ddng than kinh din den hinh thanh mgt trang thai cam xiie nhat dinh. Thdng qua mdi lien he giiia viing dudi ddi thi vdi ndp cuon d thuy tran, vd nao se hinh thanh viec nhan bidt cam xiic duong tinh hay am tinh va sau do, nhd ed cac kdt ndi ly tam cua nep cuon, cac cau thanh van ddng va than kinh thuc v$t ciia hanh vi cam xiic dupe hinh thanh.
Nhu vay, hanh vi cam xiic ciia mdt co the thdng nhii duoc xac dinh bdi sir tac ddng qua lai phiic tap ciia h4u hdt cac bd phan trdn nao, tao ndn mot he thdng nhat dinh dupe ggi la "vong Pape" (theo ten gpi ciia nha benh ly thSn kinh ngudi Nam My) hay cdn dupe gpi la "he thdng limbic". Cau triic trung tam dac trung dd "phan phdi cam xiic" la bd phan dudi ddi thi tren nao. Bang cae phuang phap dan truyen than kinh eiia minh, bd phan dudi ddi thi lien kdt vdi eac nhan phia trude ciia ddi thi, rdi qua do di den viing dae biet ciia vd nao - nep cudn vanh dai, nai ma theo J. Pape, la viing phdng ehieu eiia vd nao [4], dam trach viec tri giae va hieu cam xiic.
Tdm lai, dinh khu chirc nang trdn nao khi co tac dgng eiia cae chat gay nghien la dinh khu cd he thdng. He thdng nay eon dupe Vien sT N.P. Andkhina gpi la he thdng ciing co [7]. Ngoai dieu hanh cam xuc, he thdng cdn Hen quan den viec dieu khien khi sac, ddng ca, truang luc tam sinh ly. hanh vi va kha nang thich ling cua con ngudi noi chung vd) mdi trudng xung quanh. Dac biet hon, vong Pape cdn dupe biet den vdi chirc nang dieu khien tri nhd ciia con ngudi dang hoi chiing Cooxacov (nhd qua khii, quen hien tai) [4]. Cd the van dung he thdng chiic nang nay ciing vdi cae phuong phap tdng the tac dgng tranh tai nghien.
4. Ket luan
Nhu vay, vice tim hieu co che gay nghien tir gdc do Tam Iy hpe than kinh tren co sd tim ra mdi lien he giua djnh khu cac vCing chiic nang tren nao va cam xuc duang tinh do tac dgng ciia cac chat gay nghien, dugc gpi la sang khoai benh iy, la eo co sd khoa hoc.
Tii mdi quan he ciia he thong dinh khu cac chiic nang nay vdi viec dieu khien tri niid d ngudi binh ihuOTg, cd thd dd xuk phuong an gop phkn tranh tai nghien bang each tu van va tap hu^n dd tao ra cho ngudi nghien ludn cd lien tudng vdi nhirng hinh anh lanh manh, tdt dep trong tri nhd vdi hanh vi da trai
TAP CHI TAM LV HOC, Sd4 (217), 4 - 2017 49
nghiem trong qua khii. Tren co sd nay, gdp phan hinh thanh ddng co, ren y chi, xay dvmg kha nang "chdng lai" su dam me cua cac con them thudc.
Tai lif u tham khao
1. Bp Lao dong, Thuong binh va Xa hdi, Be dn ddi mdi cdng tdc cai nghien ma tiiy a VielNam din nam 2020, 2013.
2. Bao cao ting kit: Nghien deu nguyen nhdn Idi sir dung tdi nghidn a ngudi cai nghien ma luy Trung Idm Nghien ciru vd Hd Ira Idm ly cho nguai nghidn ma tuy (PSD), 2014.
3. Bid Thi Xuan Mai, Gido Irinh Chit gdy nghien vd xd hdi, Dai hpc Lao dpng - Xa hoi, NXB Lao dpng - Xa hpi, 2013.
4. A.R. Luria, Ca sd Idm ly hgc thin kinh, Vo Thi Minh Chi, Pham Minh Hac, Trin Trong Thuy (dich), H., NXB Giao dye, 2002.
5. Nguyen Dien Hdng, Nghien ciru cdt can ddi ma lily (nhdm opiat) bdng phucmg phdp dien chdm, Luan an tien sT Y hpc, Dai hpc Y Ha Npi, 2003.
6. Nghiem Xuan Minh, Nghien cdu dac diem phgm nhdn dang chdp hdnh dn hinh su ve ma tuy phuc vu cdng tdc phdng ngira tdi phgm cua luc luong cdnh sdt nhdn ddn, Luan an tien sT Luat hpc, Hpc vien Canh sat nhan dSn, 2013.
7. Sudakov K.V., Kuzichev LA., Nhikolaev A.B., Su phdt trien ciia thuat ngd hoc va sa do he thdng chdc ndng Irong n-udng phdi khoa hoc P.K Anokhin, Matxcova, 2010.
8. httpyAvww.google.coni.vn/seaidi?q=google&riFlClAOHY_viVN708VN708&ocf=g&aqs=
chrome.3.69i6012j69i65j.
TAP CHI' TAM L? HOC. Sd 4 (2171, 4 - 2017
