Pane zviratidzo zvizhinji zvinogona kuva chiratidzo chekushandisa zvinodhaka , uye zviratidzo izvi zvinowanzoonekwa kune vose vanobatwa uye neshamwari nemhuri. Vanhu vazhinji vanoshungurudza zvinhu vanoziva kukosha kunowedzera kwechinhu muupenyu hwavo, asi zvakaoma kukumbira rubatsiro. Iwe unogona sei, semunhu anodikanwa, kubuda uye kutsigira shamwari yako kana nhengo yemhuri?
Chinyiko Chimwe Chinhu Chichienderera Mberi?
Kuvimba nemishonga kunoreva kushandiswa kwekushandiswa nekutsvaga nekuwana chinhu, pasinei neruzivo rwunoramba ruchishandiswa runokonzera matambudziko muzvikamu zvakawanda zvehupenyu. Zvinetso zvinotarisana nevanhu vanoshandisa zvinhu zvakasangana nematambudziko, zvinetso zvemutemo, matambudziko emari, nemigumisiro inobata basa.
Vanhu vazhinji vanotenda dambudziko iro rinodzivirira vanhu vanovimba nezvinhu kubva kutsvaga rubatsiro kunoramba, asi chidhakwa chinowanzoziva kana chinhu chave chakakosha zvikuru. Vanogona kungotarisira kuvanza chirwere chavo kune vamwe nekuda kwekushorwa kunosangana nezvinetso zvekushandisa zvinhu. Uye kunyange zvazvo vakawanda vakadzingwa vanotenda kuti kupererwa kwavo kwakanyatsogadziriswa kana vachikwanisa kuwana basa, vanowanzowana shamwari, vashandi pamwe navo, uye mhuri vane hanya kwenguva refu vasati vaziva dambudziko.
Kunzwisisa Kushandisa Mishonga
Cherechedza kuti kushandisa zvinodhaka kunoonekwa sechirwere-American Medical Association yakayerwa mumakore anopfuura makumi mashanu apfuura ndokuzivisa kusagadzikana kuva chirwere, kwete chikonzero chetsika kana utera husina kunaka hwehutsika.
Kutsvakurudza kubva panguva iyoyo kwakatsigira muenzaniso wekushandisa zvinodhaka nekushandisa kune zvakakosha zvekushungurudzwa kwezvinhu zvakadai semagumisiro ezvibhedheni, zvinokonzera paudiki, rudzi, nezvimwe zvinhu. Kunyange zvazvo kutsvakurudza kusina kuwana chikonzero chimwe chete chekushandisa zvinodhaka kana kuvimba, kutsvakurudza kwakadzama kunoratidza kuti vamwe vanhu vari pangozi yakanyanya kupfuura vamwe, zvakadai sevamwe vanhu vari pangozi yepamusoro wehutachiwana hwemukari kana kenza yemukironi.
Kana iwe uine hanya pamusoro pekugona kushandisa zvinodhaka iwe pachako kana neshamwari kana nhengo yemumhuri, kune matanho mashomanana chaiwo aungatora kuti uendese bhora mberi.
Treatment Options
Kune maitiro akasiyana-siyana ekurapa kwekuchengetedza opioid uye kusashandisa zvisina kunaka.
Buprenorphine
Mutsara wokutanga wehutano ihofisi-based pharmacological kana mishonga-based therapy ne buprenorphine, mishonga inonyanya kushandiswa iyo inodzivirira maopioid receptors muuropi kudzivirira kudzivisa zviratidzo zvisingaiti kuenzana kwechimwechete chekugadzirisa kana kuwedzera kwechiitiko chinowanikwa neafioid agonist yakachena.
Buprenorphine maintenance therapy inotungamirirwa kuburikidza nekliniki yekuchengetedza. Imwe yongororo yakangobva kuBaltimore yakawana kuti mushure memwedzi 12, 57 kubva muzana yevarwere vakabatwa mumutambo wekuchengetedza kwekutanga vaive vachirapa. Pakati peboka iri, varwere vaiva ne 67 muzana maopioid-negative months. Varwere vanochengeterwa buprenorphine kana methadone havasi kungoshandura kune imwe mishonga yekushandiswa kwechisimba: ivo vose vari pamishonga inoshanda yakagadzirirwa nechiremba anokwanisa.
A DEA waiver inofanirwa kuisa buprenorphine kana Suboxone (buprenorphine pamwe naloxone, kudzivisa kujowa uye kushungurudzwa). Vanhu vanoteerera kurapwa vanogona kugadzirisa ukama, kubata mabasa, uye vari pangozi shoma yekupara mumugwagwa, chisimba, uye HIV.
Vanosvika pakugadzikana kunoita kuti zvive nyore kupinda muzviito zvekuita uye mamwe mazano ekupa mazano.
Methadone
Methadone inogadzirwa neopioid inogadzirisa migumisiro yekutambudzika pamusana pemaitiro emusana nekuderedzwa kwemaitiro uye sedation inobatanidza heroin uye opioid mishonga. Iyo inoshanda pakurapwa kwekuregererwa kubva kune opioid uye inoshandiswa mumishonga-inobatsira kurapwa kwehutachiona hwehupi hwehupi. Inogona kupiwa nejisi, mumvura, kana sehwendefa kana chepfu. Inofanira kugoverwa kuburikidza nepurogiramu inopupurirwa neSAMSHA (Dambudziko Dambudziko reMishonga uye Mental Health Administration Administration.) Kurapa kweMethadone kunobatsira zvikuru kana kushandiswa kwehuwandu hwemwedzi gumi nemaviri, kunyange zvazvo varwere vakawanda vanoda chirwere chenguva refu.
Naltrexone
Naltrexone imwe yeropa rezvemasipirini inoshandiswa nguva shoma shoma nokuda kwekuchengetedzwa kweipioid. Iyo inodzivisa zvachose maopioid receptors uye semugumisiro, kutevedza kunogona kuva dambudziko mune varwere vashoma vanokurudzirwa. Iyo injini yakareba kwenguva refu, Vivitrol, iyo inonzi naltrexone inoderedza kuterera, inoda mishonga yepamwedzi.
CBT uye Mimwe Mishonga
Mimwe mishonga yakaratidza humwe hutano hwega woga kana pamwe chete nemamwe maitiro ekurapa unosanganisira cognitive behavioral therapy uye zvinokurudzira kuwedzera therapy. Kurapa kwehutano hwemhuri kunopa mazano ekushandisa maitiro matsva ekuvandudza mamiriro ezvinhu epamba.
Contingency Management
Kuenderera mberi kwekutarisira dzimwe nguva kunoshandiswa apo vanhu vane chiremera chekushandisa zvinodhaka vanorayirwa kurapwa nevanoshandira kana dare rematare. Mune urongwa hwehutsananguro hwekutonga, kusakwanisa kutevera zvinogadzirwa nehutano mukurasikirwa kwebasa, kuiswa mutorongo, nekurasikirwa mukurumbira. Kuenderera mberi kwehutungamiri kunogona kubatanidzwa nevakaipa kana zvinokurudziro zvinokurudzira.
Kumi-gumi nematanho-Kutungamirira
Gumi nembiri-nhanho yekufambisa isarudzo yakavakirwa pamusana pekuti kusangana muboka rekutsigira pamwe chete seNarcotics Anonymous uye Alcoholics Anonymous kunogona kubatsira vanhu kuti varege kudzivisa. Kunyangwe pane humwe humwe uchapupu hwokuti nzira iyi inoshanda mukurapa kunwa doro nekudhakwa, uchapupu hwekubudirira kune vanhu vanoita maopioid hachiri pachena.
Mucherechedzo kana doro rinogona kubatsirwa noukama hutsva uye mabasa akangwara anogona kuitika kuburikidza nemapoka maviri ekutsigira seAA kana AA. Misangano ine rusununguko uye inowanika pasi pose. Aya mapurogiramu akavakirwa pakugamuchirwa kwechirwere chechirwere chekushandisa kushandiswa kwemishonga, kuzvipira kune simba rakakwirira, nekudyidzana pakati pezera risina hanya.
Mhuri Yakatarisa Kubatsira
Chimwe chidzidzo chakabudiswa muChinyorwa cheGeneral Psychiatry chakaratidza kuti kana varwere vaenzaniswa nemapurogiramu avakagamuchira zvidzidzo zvidzidzo zvitatu zvakakonzerwa kwavari uye zvinokosha mumhuri, matambudziko epfungwa nehutano akavandudzwa kusvika kusvika makumi matatu kubva muzana zvichienzaniswa neakaiswa mu " "Zvirongwa zvokurapa.
Kugadziriswa kwekugara kunokurudzirwa nevanopa mazano vakawanda-kunyanya kana mhuri inotsvaka rubatsiro kunoshanyira nzvimbo yekurapa yekugara kwekupa mazano. Asi, pane humwe uchapupu huripo hwokutsigira hutano hwekugara hwekuchengetedza opioid. Zvidzidzo zvidzidzo zvakaoma kuuya, asi chidzidzo chakabudiswa muna 2014 chakawana 29 muzana yevarwere muzera remakore gumi nemana makumi maviri namana makumi mana nemana rimwe chete raisina rimwe gore. Chidzidzo ichocho chakacherechedzawo kuti kukanganisa kunobatanidza nehutano hwekugara kwehutano hweapioid muvechiri kuyaruka uye vaduku vakuru ndiyo mikana yakawanda yekuwedzeredza shure mushure mehutano apo kushivirira kwevarwere kwakaderera zvikuru. Chimwe chekudzidza nezvevarwere mune gumi nemamwe kurapwa nzvimbo muNorway vakawana kuwedzera kwekufa kwevane 15.8 muvhiki mavhiki mana mushure mekusiya mishonga-isina nzvimbo yekurapa nzvimbo yekurapa. Vanyori vekudzidza vakagumisa kuti njodzi yekufa kubva kune opioid overdose panguva iyi yevhiki 4 yakange "inotyisa zvokuti nzira dzekudzivirira dzinofanira kutorwa." Izvi zvinoramba zvichiramba, zvichiita mungozi yekudarika kwepamusoro mushure mekubuda kwekunyanya kuitika kwekufunga.
Kuongorora Maitiro
Munguva yekurapa, zvidzidzo zvechikwata zvinotarisa kana munhu akabatwa akave nekugadzira kusakwana kwekudya kana zvimwe zvirwere zvine chokuita nekushandisa zvinodhaka. Nyaya yezvehutano yakakwana inotungamirira kurapwa, sezvo vazhinji vanovhiringidza vanoregeredza hutano hwavo uye kuzvitarisira chikamu chakakosha chekubudirira kupindwa muropa kwehutano. Nokudaro, kuvandudzwa kwehutano huzhinji hunodiwa.
Zvakakoshawo kufunga nezvemamwe matanho emigumisiro yehutano paunosarudza kana kana kwete mushonga unoshanda. Kunyangwe kuzvidzora kunoonekwa sekukosha, muchokwadi, zvakaoma kuti zvibudirire. Kugadziriswa kwekukuvadza, kusimbiswa kwehukama, nekudzoka kune vanhu kune zvibereko zvinobudirira uye zvinogutsa zvose zvinobudirira zvinobatanidzwa nemishonga-inobatsira kurapwa.
Kubvuma Rubatsiro
Chikamu chakareruka chekuongororwa kwechisimwa chekushandisa zvinodhaka kungangodaro kusarudzwa kwekufungidzirwa dambudziko. Kukurukurirana nevanochiremba ndeyekubvuma kusakanganisika. Kugamuchirwa kunogona kuva kwakaoma kumurwere pamwe nemhuri, asi ruzivo runobatsira runowanikwa runogona kunyaradza zvikuru kune wese ari kurwisana nekumanikidzwa kushandisa chinhu chinokonzera matambudziko munzvimbo dzakasiyana dzehupenyu hwavo.
Mamiriyoni evanhu vane kushungurudzwa kwezvinodhaka zvakashandiswa zvakajeka uye iye zvino vari kurarama hupenyu huzere uye hune mufaro, asi hapana hunovimbisa mumishonga. Kubudirira kuchaenderana nemhando dzakawanda, asi shanduko iwe unogona kuzvidzora semhuri yemhuri kucherechedza dambudziko nekuda kutsvaga mhinduro. Kuita zvinodhaka hakusi kutadza tsika-ndiyo chirwere chinofambira mberi uye chinogona kuuraya.
> Sources:
> McLellan AT, Woody GE, Luborsky L, O'Brien CP, Druley KA. "Kubudirira Kuwedzerwa Kwekushandisa Kushandisa Kushandiswa Kwemishonga: Inotarisira Kudzidza Yevarwere-Kurapa Kufananidza." Journal of Nervous and Mental Disease. 1983; 171 (10): 597-605.
> Nowinski J. Twelve-step facilitation. Mu: Maitiro ekushandisa zvinodhaka kushandiswa kwekupa mazano / ed. naKatherine M. Carroll. Bethesda: National Institute on Drug Abuse, (NIH Publ no. 00-4151), July 2000. http://www.drugabuse.gov/ADAC/ADAC1.html
> Ravndal E, Amundsen EJ. Kufa pakati pevashandisi vezvinodhaka mushure mokusununguka kubva mukurapa kwepfungwa: an 8- gore vanotarisira kudzidza. Doro Doro Rinotsigira. 2010; 108: 65-69.
> Volkow, N. D. (2012, December). Kutanga | | National Institute on Drug Abuse (NIDA).
> Webster LR, Webster R. Kufananidzira maitiro ekudzivirira muvarwere vane chirwere cheOpioid: kutanga kugadziriswa kwehutano hweOpioid zvakare. Pain Med. 2005; 6 (6): 4.