Relaciones psicosociales adversas y trastorno por uso de sustancias: una revisión narrativa
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Resumen
Introducción: el abuso de sustancias es reconocido como un trastorno cerebral que afecta principalmente dos sistemas: el sistema de motivación-recompensa y el sistema de defensa. El primero es responsable de modular comportamientos dirigidos a obtener reforzadores placenteros, como interacciones sociales y comida. El uso frecuente de drogas disminuye la respuesta de este sistema, lo que lleva a la tolerancia de sus efectos hedónicos. Por otro lado, el sistema de defensa, orientado a salvaguardar la integridad física del individuo, responde ante estímulos amenazantes por medio de sensaciones de miedo o ansiedad, y muestra una naturaleza antifrágil.
Objetivo: describir la interacción entre estos sistemas, que se ve alterada por el uso frecuente de drogas, y que conduce a una disminución de la respuesta del sistema de motivación-recompensa y un aumento de la respuesta del sistema de defensa, así como el efecto de las interacciones sociales adversas en estos sistemas.
Método: se realizaron búsquedas y revisiones críticas de artículos científicos recientes publicados en PubMed y se incluyeron tanto investigaciones en humanos como en animales.
Discusión y conclusiones: las interacciones sociales adversas, como la negligencia parental y el abuso infantil, promueven una carga alostática y fortalecen la naturaleza antifrágil del sistema de defensa, que favorece y mantiene el consumo de drogas. En modelos animales, se ha observado que la privación de cuidados maternos en los primeros días de vida conduce a comportamientos maladaptativos en la edad adulta y un aumento en el consumo de alcohol. De manera similar, los animales subordinados consumen más drogas que sus contrapartes dominantes. Estos hallazgos sugieren una relación compleja entre experiencias adversas tempranas, el desarrollo de los sistemas de recompensa y defensa, y la vulnerabilidad a la adicción.
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