毒品使用障碍者渴求的体验特征及影响因素
文献类型：学位论文
| 作者 | 李丹阳 |
| 答辩日期 | 2023-12 |
| 文献子类 | 硕士 |
| 授予单位 | 中国科学院大学 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 李勇辉 |
| 关键词 | 毒品使用障碍 渴求 成瘾程度 亚型分析 |
| 学位名称 | 理学硕士 |
| 学位专业 | 应用心理 |
| 其他题名 | Multiple Experience Characteristics and Influencing Factors of Craving in Peoble with Drug Use Disorders |
| 中文摘要 | Drug Use Disorders (DUD) is a chronic and relapsing brain disease. Craving is a significant factor in the continued drug use and relapse of addicts. Craving refers to the subj ective experience of wanting to use drugs, which includes cognitive, emotional, and internal sensations. It is influenced by factors such as the severity of addiction, type of substance, and internal and external states like negative emotions and stress. Previous research has explored the triggers, motivations, and physiological characteristics of craving from the perspectives of classical conditioning, cognitive processing, decision-making, and neurobiology. However, there has been limited systematic exploration of the experience of craving. The cognitive-emotional theory proposes that craving is an emotionally charged cognitive process involving the imagination of substance use, intrusive thoughts, and a sense of urgency to use the substance. The Craving Experience Questionnaire (CEQ), developed based on this theory, has preliminarily explored the psychological characteristics of craving in tobacco and alcohol dependence. As drugs are highly addictive substances that cause more severe and persistent damage to the central nervous system and the brain compared to tobacco and alcohol, previous studies and clinical reports have also shown that drug addicts experience more intense and persistent physical sensations related to drug use. Therefore, the main purpose of this study is to explore the characteristics of craving experience in drug addicts and further investigate the influence of individual traits such as emotion regulation ability and impulsivity on craving experience. Additionally, the stu即examines the predictive role of emotional and stress states on craving. This article includes two studies. Study 1 explores the psychological experiential characteristics and internal and external triggers of drug addicts, consisting of two experiments. The aim of Experiment 1 is to preliminarily explore the dimensions and triggers of craving experience in drug addicts. Based on the results of Experiment 1 and the CEQ, which is grounded in the cognitive-emotional theory, Experiment 2 constructs an interview questionnaire suitable for capturing the craving experience characteristics of drug addicts. After conducting interviews using this questionnaire, latent profile analysis is employed to describe the heterogeneity of craving experience in the population and its relationship with the severity of addiction. Study 2 assesses craving experience using the questionnaire and examines its relationship with gender, substance type, impulsivity, and emotion regulation ability. Ecological momentary assessment is used to evaluate the predictive role of emotions, stress, and common craving triggers identified in Experiment 1 on craving during the drug deprivation period (in a compulsory isolation environment) and the drug availability period (in daily life). Experiment 1 recruited 174 individuals with drug addiction in compulsory isolation for in-depth interviews. The results showed that: (1) Craving triggers originate from internal and external sources. Internal triggers include emotions, sleep, stress, and other factors, while external triggers include drug-related environments, drug-related cues, interpersonal relationships, and others. (2) The experience of craving includes four aspects: urgency to seek drugs, drug-related imagery, intrusive thoughts, and negative physiological experiences. The dimension of negative physiological experiences was not previously included in the CES. Additionally, individuals with drug addiction have rich multi-sensory imagery, including visual, olfactory, gustatory, auditory, and tactile imaginations. The physiological experience is a prominent craving experiential characteristic in individuals with drug addiction. Based on these results, the craving psychological experiential characteristics interview questionnaire for individuals with drug addiction was developed by adding the dimension of physiological experiences (previously missing) and questions related to multi一sensory imagery, as well as optimizing other dimensions. The craving experience includes two dimensions: intensity and frequency, with each dimension consisting of four sub-dimensions: urgency, imagery, intrusiveness, and absence (negative physiological experiences). Experiment 2 used the developed questionnaire to interview 262 individuals with addiction about their craving experiences. To ensure that the questionnaire adequately reflects the aforementioned dimensions, exploratory structural equation modeling was conducted, and the questionnaire demonstrated good structural validity. The chi-square values for the intensity and frequency questionnaires were 178.503 and 173.235, respectively, with SRMR values of 0.024 and 0.020, CFI values of 0.970 and 0.972, TLI values of 0.941 and 0.945, and RMSEA values of 0.085 and 0.083.Reliability analysis showed that the Cronbach's a values for the intensity and frequency sub-questionnaires were 0.94 and 0.95, respectively, indicating good reliability. Based on the good validity and reliability of the questionnaire, latent profile analysis was used to classify the craving multidimensional characteristics of individuals in drug rehabilitation into five subgroups: moderate craving group, imagery craving group, urgency craving group, absence craving group, and low craving group. Comparative analysis was conducted on the gender, substance type, addiction severity, duration of drug use, impulsivity, emotion regulation efficacy, anxiety, and depression levels of these five groups. Significant differences were found in the age (p<0.05) duration of drug use（p＜0.05), number of detoxifications （p<0.01), addiction severity （p<0.001), and impulsivity （p=0.057), while no significant differences were found in the other measures. Study 2 employed ecological momentary assessment to explore the influence of sleep, emotions, and stress on craving. The study included 47 participants in drug deprivation (compulsory isolation) and collected data on sleep, emotions, stress, and craving over a period of 14 days. Using generalized estimating equations, a regression model was established with the intensity of craving as the dependent variable and the other measures as independent variables. The results showed that negative emotions had a significant predictive effect on craving (}=0.480, p<0.001), while no significant effects were found for sleep, stress, and other characteristics. Additionally, to enhance ecological validity, a mobile intelligent platform was developed to collect real-time and dynamic psychological data in daily life. The platform integrated psychological assessment, physiological monitoring, and psychological intervention, supporting personalized tasks, data storage, and export functions. It facilitated subjective assessment of craving and emotions, as well as objective measurement of stress and sleep. The platform aimed to capture internal and external craving triggers in the daily lives of individuals in drug rehabilitation. However, due to the limitations of high vigilance among individuals in drug rehabilitation, dispersed living locations, and concerns about potential punishment for truthful reporting, data was collected from only 7 participants. The findings revealed that craving in daily life was accompanied by unstable sleep patterns and smoking behavior. In summary, the results of this study indicate that the psychological experience of craving in individuals with drug addiction can be categorized into dimensions of urgency, imagery, intrusiveness, and absence. The craving experience can be classified into five subtypes: moderate craving, imagery craving, urgency craving, absence craving, and low craving. The differences in craving experience types may be influenced by factors such as impulsivity and duration of drug use. Furthermore, negative emotions in daily life are an important predictor of craving. This research provides a possibility for assessing various types of craving experiences and can serve as a basis for further development of a drug craving experience scale. Additionally, the development of a mobile intelligent platform lays the foundation for subsequent craving monitoring, assessment, and self-management. Exploring the internal psychological processes and external triggers of craving is crucial for providing effective targets for personalized interventions and reducing the risk of relapse. Future research can expand the monitoring of physiological indicators and conduct multidimensional comprehensive assessments of the psychological, physiological, and behavioral characteristics of craving. Moreover, increasing the sample size and establishing predictive models for craving based on the craving psychological characteristics of different populations can be pursued. |
| 英文摘要 | 障碍(Drug Use Disorders)是一种慢性高复发性脑疾病。渴求是成瘾者持续用药和戒断后复吸的重要原因。渴求是想要使用药物的主观体验，这种主观体验包含认知、情绪、内感受等多个维度。它会受到成瘾程度、物质类型等多种特质因素的影响，以及个体内外部状态因素如负性情绪、压力的诱发。前人研究从条件反射、认知加工、决策、神经生物学等角度探讨了渴求的诱因、动机、生理特征等，但是少有研究系统地探索渴求体验。认知一情绪理论提出渴求的体验是一种充满情绪的认知心理加工过程，涉及到对物质使用的想象、侵入的想法、使用物质的急迫感。基于此理论发展的《渴求体验问卷》初步探索了烟酒物质依赖者的渴求心理特征。毒品作为高成瘾性物质，与烟酒相比对中枢神经和大脑造成更加严重和持久的损伤。以往研究和临床报告也显示毒品成瘾者对毒品的躯体感受更为强烈且持久。 因此本研究的主要目的是探索毒品成瘾者渴求体验的特征，以及进一步探索情绪调节能力、冲动等个人特质对渴求体验的影响，另外还探讨了情绪、压力等状态因素对渴求的预测作用。本文包含两个研究，研究一探索了毒品成瘾者心理体验特征和内外部诱因，共两个实验。实验一目的是初步探索毒品成瘾者渴求体验的维度和诱因。实验二依据实验一的结果，并在认知一情绪理论的《渴求体验问卷》基础上，构建适合毒品成瘾者渴求体验特征的访谈问卷。基于该问卷再次访谈之后，运用潜在剖面分析法描述了毒品成瘾者的渴求体验在群体中的异质性及其与成瘾程度的关系。研究二运用问卷评估，首先了解了渴求体验与性别、物质类型、冲动、情绪调节能力等特质因素的关系。然后采用生态瞬时评估法评估了情绪、压力以及实验一发现的共同性渴求诱因在毒品剥夺期(强制隔离所环境)和毒品可得期(日常生活环境)对渴求的预测作用。 实验一共招募了174名在强制隔离戒毒期间的毒品成瘾者，进行一对一深度访谈，结果表明:(1)渴求的诱因来源于个体内部和外部，内部诱因包括情绪、睡眠、压力等因素;外部诱因包含与吸毒相关的环境、毒品相关线索、人际关系等。(2)渴求的体验包含了4个方面，寻求药物的急迫感、毒品相关想象、侵入的想法、身体感受。其中，身体感受是前期《渴求体验问卷》中未被涉及的维度。此外，毒品成瘾者的多感官想象内容丰富，包含了视觉、嗅觉、味觉、听觉、触觉等多种想象。根据上述结果，我们在《渴求体验问卷》的基础上增加了身体感受的维度和渴求多感官想象的题目，并优化其他维度的题目，形成毒品渴求体验访谈问卷。渴求体验包含强度和频率两个维度，其中每个维度包含急迫、想象、侵入、身体感受(负性生理体验)四个子维度。 实验二运用该问卷访谈了262名成瘾者。为了保证该问卷能够较好地反映上述维度，经探索性结构方程检验该问卷的结构效度良好，强度问卷x²=178.503 ,SRMR = 0.024, CFI一0.970, TLI = 0.941, RMSEA = 0.085;频率问卷x²=173.235,SRMR=0.020, CFI=0.972, TLI=0.945, RMSEA=0.083。经过可靠性分析，强度和频率分问卷的Cronbach's a分别为0.94和0.95，具有良好的信度。 在问卷信效度良好的基础上，运用潜在剖面分析探索了不同渴求体验组合的潜在亚群体。渴求在群体中表现为混合型渴求、想象型渴求、急迫型渴求、身体感受型渴求、微弱型渴求。分析发现五组群体成瘾程度均处于重度水平。另外，对这五个组吸毒年限、冲动、情绪调节效能、焦虑、抑郁水平进行比较分析，吸毒年限发现了显著差异伽< 0.05)，冲动性接近显著沙一0.057)，其余指标未发现显著差异。 研究二纳入了在毒品剥夺期(强制隔离戒毒中)的47名学员，采集了14天情绪、压力、渴求数据。运用广义估计方程的方法，以渴求的强烈程度为因变量，其余指标为自变量建立了回归模型，发现负性情绪对渴求有预测作用(a = 0.480,p < 0.001)，未发现压力等特征对渴求显著的影响。另外，考虑到戒毒所内不具备药物可得性，为更进一步提升生态效度，搭建了可以在日常生活中实时、动态采集数据的移动智能平台。该程序集成了心理评估、生理监测和心理干预三个部分，支持对用户下发个性化任务，存储和导出数据等功能，能够满足渴求、情绪的主观评估，以及压力、睡眠的客观测量。试图利用该平台采集戒毒人员日常生活状态下的渴求内外部诱因。但由于戒毒人员的高戒备心、生活地点分散、担心真实报告将受到处罚等现实因素的限制，采集了7名戒毒人员数据。发现日常生活中渴求的出现会伴随睡眠状态的不稳定和吸烟行为。 综上所述，本研究结果表明，毒品成瘾者的渴求体验不仅包含急迫的情绪、生动的想象、侵入性的想法，还应包含身体感受。渴求体验在群体中并不是同质的，可分为五种亚型，包括混合型渴求、想象型渴求、急迫型渴求、身体感受型渴求、微弱型渴求，进一步研究发现在重度成瘾患者中，这些体验类型均有可能出现。除此之外，渴求体验类型的差异可能受到性别、物质类型、吸毒年限、冲动性等因素的影响。最后，在日常生活中负性情绪是预测渴求的重要目标。 这一研究为评估多种体验类型的渴求提供了可能，也提示了诊断过程中应该考虑多种渴求类型。后续研究可以在此基础上进一步确定毒品渴求体验量表。探索渴求的内部心理过程及外部诱因对于为个性化精准干预提供有效靶点，降低复吸风险有重要的意义。未来研究有必要进一步验证不同渴求体验群体用药的风险同时考虑对渴求相关生理指标的监测。 |
| 语种 | 中文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/46652]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | 李丹阳. 毒品使用障碍者渴求的体验特征及影响因素[D]. 中国科学院心理研究所. 中国科学院大学. 2023. |
入库方式： OAI收割
来源：心理研究所
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