1387 lines
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El ciclo de la adicción al alcohol
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<span>El ciclo de la adicción al alcohol</span>
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</h1>
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<!--pub-lead -->
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<div class="content-river">
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<div><p>La adicción al alcohol es un trastorno crónico recurrente asociado con el consumo compulsivo de alcohol, la pérdida del control sobre la ingesta y la aparición de un estado emocional negativo cuando el alcohol ya no está disponible. El trastorno por consumo de alcohol (AUD, por su sigla en inglés) es una afección caracterizada por la capacidad deteriorada para detener o controlar el consumo de alcohol a pesar de las consecuencias sociales, ocupacionales o de salud adversas. Es un trastorno del espectro y puede ser leve, moderado o grave y abarca las afecciones a las que algunas personas se refieren como abuso de alcohol, dependencia del alcohol o el término coloquial, alcoholismo. La adicción al alcohol se refiere al extremo moderado a severo del espectro AUD.</p>
|
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<h2>¿Cómo se desarrolla la adicción en el cerebro?</h2>
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<article class="align-right media-image">
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<div>
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<div class="visually-hidden">Image</div>
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<div> <img src="/sites/default/files/styles/large/public/Three_Stages_Alcohol_Disorder_Cycle_Brain_Graphic_SPANISH.jpg?itok=QlPbRydV" width="700" height="667" alt="Un cerebro muestra la corteza prefrontal que controla la preocupación/anticipación, los ganglios basales controlan el consumo excesivo y peligroso/intoxicación y la amígdala extendida controla el afecto negativo/abstinencia." loading="lazy">
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<p>El alcohol, al igual que otras drogas, tiene un poderoso efecto en el cerebro, produciendo sentimientos placenteros y atenuando los sentimientos negativos. Estos sentimientos pueden motivar a algunas personas a beber alcohol una y otra vez, a pesar de los posibles riesgos para su salud y bienestar. Por ejemplo, las investigaciones demuestran que, con el tiempo, beber para lidiar con el estrés, si bien puede proporcionar un alivio temporal de la incomodidad emocional, tiende a intensificar los estados emocionales negativos entre los episodios de consumo de alcohol. Estos cambios pueden motivar a seguir bebiendo y hacer que un individuo se quede atrapado en un ciclo poco saludable de consumo de alcohol.<sup>1,2</sup></p>
|
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|
||
<p>A medida que las personas continúan bebiendo alcohol con el tiempo, pueden ocurrir cambios progresivos en la estructura y función de sus cerebros. Estos cambios pueden comprometer la función cerebral e impulsar la transición del consumo controlado y ocasional al consumo indebido crónico, que puede ser difícil de controlar. Los cambios pueden durar mucho después de que una persona deja de consumir alcohol y pueden contribuir a la recaída en el consumo de alcohol.</p>
|
||
|
||
<h2>Etapas del ciclo de adicción</h2>
|
||
|
||
<p>La adicción se puede enmarcar como un ciclo repetitivo, con tres etapas. Cada etapa se relaciona y se alimenta de las demás. Estas etapas involucran principalmente tres dominios: prominencia de incentivos, estados emocionales negativos y función ejecutiva. Los dominios se reflejan en tres regiones clave del cerebro: los ganglios basales, la amígdala extendida y la corteza prefrontal, respectivamente. Una persona puede pasar por este ciclo de tres etapas en el transcurso de semanas o meses, o progresar a través de él varias veces en un día.<sup>3,4,5</sup> Tenga en cuenta también que una persona puede entrar en el ciclo de adicción en cualquiera de las siguientes etapas.</p>
|
||
|
||
<p>1. Etapa del consumo excesivo de alcohol (<em>binge drinking</em>)/intoxicación: recompensa, prominencia de incentivos y hábitos patológicos</p>
|
||
|
||
<ul>
|
||
<li>Durante esta etapa, una persona experimenta los efectos gratificantes del alcohol, como la euforia, la reducción de la ansiedad y la relajación de las interacciones sociales.</li>
|
||
<li>La activación repetida del sistema de recompensa de los ganglios basales refuerza el comportamiento de consumo de alcohol, aumentando la probabilidad de consumo repetido. Los ganglios basales juegan un papel importante en la motivación, así como en la formación de hábitos y otros comportamientos rutinarios.</li>
|
||
<li>Esta activación repetida de los ganglios basales también desencadena cambios en la forma en que una persona responde a los estímulos asociados con el consumo de alcohol, como personas específicas, lugares o señales asociadas con el alcohol, como ciertas cristalerías o imágenes o descripciones de la bebida. Con el tiempo, estos estímulos pueden desencadenar poderosos impulsos de beber alcohol.</li>
|
||
<li>El consumo repetido de alcohol también resulta en cambios en los ganglios basales que conducen a la formación de hábitos, lo que a la larga contribuye al uso compulsivo.</li>
|
||
</ul>
|
||
|
||
<p>2. Etapa de afecto negativo/abstinencia: déficits de recompensa y exceso de estrés</p>
|
||
|
||
<ul>
|
||
<li>Cuando una persona que es adicta al alcohol deja de beber, experimenta síntomas de abstinencia, o síntomas que son opuestos a los efectos positivos del alcohol que se experimentan al beberlo. Estos síntomas pueden ser físicos (trastornos del sueño, dolor, sentimientos de enfermedad) y emocionales (disforia, irritabilidad, ansiedad y dolor emocional).</li>
|
||
<li>Se cree que los sentimientos negativos asociados con la abstinencia de alcohol provienen de dos fuentes. En primer lugar, una activación disminuida en los sistemas de recompensa, o un déficit de recompensa, de los ganglios basales hace que sea difícil para las personas experimentar los placeres de la vida cotidiana. En segundo lugar, una mayor activación de los sistemas de estrés del cerebro, o un exceso de estrés, en la amígdala extendida contribuye a la ansiedad, la irritabilidad y la inquietud.</li>
|
||
<li>En esta etapa, la persona ya no bebe alcohol por los efectos placenteros ("embriagado"), sino más bien para escapar sentirse "bajo" a lo que ha contribuido el consumo crónico del alcohol.</li>
|
||
</ul>
|
||
|
||
<p>3. Etapa de preocupación/anticipación: deseo, impulsividad y función ejecutiva</p>
|
||
|
||
<ul>
|
||
<li>Esta es la etapa en la que un individuo busca alcohol nuevamente después de un período de abstinencia. Una persona se preocupa por el alcohol y cómo obtener más de él, y espera con ansias la próxima vez que lo consumirá.</li>
|
||
<li>La corteza prefrontal, un área del cerebro responsable de la función ejecutiva, incluida la capacidad de organizar pensamientos y actividades, priorizar tareas, administrar el tiempo y tomar decisiones, se ve comprometida en las personas que experimentan adicción al alcohol. Como resultado, esta área del cerebro juega un papel clave en esta etapa.</li>
|
||
</ul>
|
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|
||
<div class="pub-highlighted">
|
||
<h2><strong>Hiperkatifeia</strong></h2>
|
||
|
||
<p>Hiperkatifeia es una palabra que se puede utilizar para describir el estado emocional negativo asociado con la abstinencia de drogas. Se plantea la hipótesis de que este estado emocional negativo hiperactivo impulsa el consumo de alcohol para encontrar alivio de este estado emocional, y puede ser causado por cambios profundos en los sistemas de recompensa cerebral y estrés.</p>
|
||
</div>
|
||
|
||
<h2>¿Por qué deberíamos preocuparnos por el AUD y la adicción al alcohol?</h2>
|
||
|
||
<p>El consumo de alcohol se relaciona con muchas <a href="https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body">consecuencias sociales y de salud</a> (disponible en inglés) incluida la interferencia con las relaciones personales, enfermedades cardíacas y hepáticas, cánceres, colisiones de vehículos motorizados y otros accidentes, sobredosis de alcohol, violencia, homicidio y suicidio. Si una persona tiene AUD, particularmente si es de moderada a grave e implica adicción al alcohol, es más probable que consuma alcohol regularmente en niveles asociados con estos efectos sobre la salud.</p>
|
||
|
||
<p>Los jóvenes están especialmente en riesgo de AUD. El consumo de alcohol durante la adolescencia (desde preadolescentes hasta mediados de los 20 años) puede afectar el desarrollo del cerebro, por lo que es más probable que se les diagnostique AUD más adelante en la vida. Sin embargo, la mayoría<br>
|
||
de las personas con AUD, sin importar su edad o la gravedad de sus problemas con el alcohol, pueden beneficiarse del <a href="https://alcoholtreatment.niaaa.nih.gov/">tratamiento con terapias de salud conductual, medicamentos o ambos</a> (disponible<br>
|
||
en inglés).</p>
|
||
|
||
<p>Para obtener más información sobre cómo el alcohol afecta el cerebro, visite <a href="https://www.niaaa.nih.gov/publications/recursos-del-niaaa-sobre-el-alcohol-y-el-cerebro">El alcohol y el cerebro</a>, y para obtener más información sobre los tratamientos disponibles basados en la evidencia para el AUD, visite el <a href="https://alcoholtreatment.niaaa.nih.gov/"><em>Navegador de tratamientos de alcohol de NIAAA</em></a> (disponible en inglés).</p>
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<hr>
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<p><sup>1 </sup>Armeli, ; Sullivan, T.P.; and Tennen, H. (2015). Drinking to cope motivation as a prospective predictor of negative affect. <em>Journal of Studies on Alcohol and Drugs </em>76(4):578–584, 2015. PMID: 26098033</p>
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||
<p><sup>2 </sup>Wardell, J.D.; Kempe, T., Rapinda, K.K.; et al. Drinking to cope during COVID-19 pandemic: The role of external and internal factors in coping motive pathways to alcohol use, solitary drinking, and alcohol <em>Alcoholism, Clinical and Experimental Research </em>44(10):2073–2083, 2020. PMID: 32870516</p>
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<p><sup>3 </sup>S. Department of Health and Human Services. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. <a href="https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf">https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf.</a> Visitado el 8 de diciembre de 2021.</p>
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<p><sup>4</sup> Koob, G.F.; and Volkow, N.D. Neurobiology of addiction: A neurocircuitry analysis. <em>Lancet Psychiatry </em>3(8):760–773, 2016. PMID: 27475769</p>
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<p><sup>5 </sup>Koob, G.F., Powell, P., and White, A. Addiction as a coping response: Hyperkatifeia, deaths of despair, and COVID-19.<em> The American Journal of Psychiatry </em>177(11):1031–1037, 2020. PMID: 33135468</p>
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