Madde Kullanım Bozukluğunda Yürütücü İşlevlerin Rolü

Öz

Bu derlemenin amacı, yürütücü işlevlerin madde kullanım bozukluğundaki kritik rolüne dikkat çekmek, güncel bulguları paylaşmak ve bu alanda yapılacak ulusal araştırmalara olan ihtiyacı vurgulamaktır. Derlemede, madde kullanım bozukluğunun tanısal evrimi ve toplumsal boyutları ışığında, yürütücü işlevlerin rolü ve önemi kapsamlı bir şekilde ele alınmıştır. Yürütücü işlevler, temel bileşenleri olan inhibisyon kontrolü, çalışma belleği ve bilişsel esneklik aracılığıyla, bireylerin planlama, karar verme, dürtü kontrolü ve problem çözme süreçlerinde hayati rol oynamaktadır. Madde kullanım bozukluğunda gözlenen yürütücü işlev kayıplarının, madde kullanımının başlaması ve bozukluğun ortaya çıkışında önemli bir risk faktörü olduğu ve madde kullanımı ilerledikçe bu kayıpların şiddetlendiği tartışılmıştır. Ayrıca, yürütücü işlev bozukluklarının tedavi sürecinde, uyum ve devamlılık gibi klinik sonuçlar üzerinde belirleyici etkileri olduğu ve yüksek nüks oranlarının bu kayıplarla yakından ilişkili olduğu belirtilmiştir. Güncel yaklaşımlar, madde kullanım bozukluğundan kaynaklanan bilişsel bozuklukları değerlendirirken yürütücü işlevlerin kapsamlı bir şekilde incelenmesini ve bu işlevlerin iyileştirilmesine yönelik bilişsel rehabilitasyon programlarının tedavi protokollerine dahil edilmesini önermektedir. Bu bağlamda, madde kullanım bozukluğu olan bireylerin bilişsel değerlendirmelerinde kullanılan öz-bildirim ölçekleri, nöropsikolojik testler ve genel bilişsel tarama araçlarının avantajları ve sınırlılıkları tartışılmıştır. Sonuç olarak, madde kullanım bozukluğunda yürütücü işlev bozukluklarının daha iyi anlaşılmasının, klinik uygulamalar ve gelecek araştırmalar için kritik bir öneme sahip olduğu değerlendirilmiştir

Anahtar Kelimeler

• madde kullanım bozukluğu
• madde bağımlılığı
• yürütücü işlevler
• yönetici işlevler
• nöropsikoloji

Role of Executive Functions in Substance Use Disorder

Öz

This review aims to emphasize the critical role of executive functions in substance use disorder (SUD), share recent findings, and highlight the need for further national research in this field. The review comprehensively examines the role and significance of executive functions in light of the diagnostic evolution and the social aspects of SUD. Executive functions—comprising the core components of inhibitory control, working memory, and cognitive flexibility—are essential for planning, decision-making, impulse control, and problem-solving. The review discusses evidence that deficits in executive functions not only serve as significant risk factors for the initiation and progression of SUD but also exacerbate as substance use advances. Furthermore, deficits in executive functioning have been shown to exert a decisive influence on clinical outcomes, including treatment adherence and continuity, and are closely associated with high relapse rates. Current approaches advocate for a thorough evaluation of executive functions when assessing the cognitive impairments related to SUD, and they recommend incorporating cognitive rehabilitation programs aimed at improving executive functions within treatment protocols. In this context, the advantages and limitations of self-report scales, neuropsychological tests, and general cognitive screening tools used in the cognitive assessment of individuals with SUD are discussed. Ultimately, a better understanding of executive functioning deficits in SUD is deemed crucial for improving clinical practices and guiding future research.

Anahtar Kelimeler

• substance use disorder
• substance addiction
• executive functions
• neuropsychology

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