Tìm hiểu cơ chế gây nghiện từ góc độ tâm lý học thần kinh

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
the brain. Researchers in neurological physiology have indicated that addiction is rel
to the presence of positive emotions called euphory due to the impacts of substances o
certain zonations on Ihe brain.

Keywords: Addiction: Addictive agents, Euphory emotions: Neurological psycho
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

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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 cia 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 ning 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 bio 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