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Risk Behavior and Addiction in Adolescence > 1 - An introduction to risk behaviour and the development of substance and behavioural addictions during adolescence (L1, Sussman CH1, Gladwin, Trucco & Hartmann, Hall) > Flashcards

1 - An introduction to risk behaviour and the development of substance and behavioural addictions during adolescence (L1, Sussman CH1, Gladwin, Trucco & Hartmann, Hall) Flashcards

1
Q

Which developments take place during adolescence? Name early adolescence, mid adolescence and late adolescence. (Q)

A
  • Early adolescence: physical growth, sexual maturation, psychosocial development, social identity formation
  • Mid adolescence: experimenting with (risk) behaviours, personal identity formation
  • Late adolescence: practicing adult roles
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2
Q

Which neurological developments take place during adolescence? (Q)

A
  1. Strong grow in brain volume: increase in white matter, decrease in grew matter
  2. Increase in white matter: communication between brain regions strongly improves
  3. High plasticity of the brain
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3
Q

Why is there a peak in risk behaviors during adolescence? Name the neurological part (Q)

A
  1. Affective-motivational system (emotional brain) is overactive in early and mid adolescence - develops fast
  2. Control system (rational brain) develops slowly (until about 25y)
    Hierdoor reageren adolescenten vanuit emotiebrein, en denken minder goed na voordat ze iets doen.
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4
Q

How do we define risk behavior? (Q)

A
  • Risk behavior: Behaviors that pose a risk to a healthy physical, cognitive, psychosocial development of adolescents
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5
Q

How do we define psycho-active substances (drugs)? (Q)

A

Psychoactive substances are chemical substances that cross the blood-brain barrier and affect the function of the central nervous system thereby altering perception, mood, or consciousness.

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6
Q

What are characteristics of psychoactive substances? (Q)

A
  • They often induce craving after (regular) use
  • They often evoke loss of control after they have been used (on a regular basis)
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7
Q

How do we define addiction? (Q)

A

Sussman (2017) differentiates between intensional and extensional definitions of addiction:
* Intensional: these definitions aim to describe a causal addiction process (see Sussman, Table 1.2)
* Extensional: a classification of characteristics of an addiction (e.g. DSM-5)

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8
Q

What are the four categories of the DSM-5 looking at substance use disorder? (HC)

A
  1. Loss of control (e.g. wanting to cut down or stop using, but not managing to)
  2. Social and other impairments (e.g. continuing to use, even when it causes problems in relationships)
  3. Continuation despite knowledge of risky use (e.g. using substances again and again, even when it puts you in danger)
  4. Pharmacologica effects (e.g. tolerante and withdrawal)
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9
Q

Which learning principles play a role in the development of addiction? (Q)

A
  1. Positive reinforcement occurs when the rate of a behavior increases because a desirable event (e.g., euphoria, relaxation) is resulting from the behavior. You want these positive effects.
  2. Negative reinforcement occurs when the rate of a behavior increases because an aversive (negative) event is prevented from happening (e.g., prevention of withdrawal symptoms).
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10
Q

Which neurobiological mechanism play a role in the development of tolerance and withdrawal symptoms? (Q)

A

???

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11
Q

Which behavioral addictions are now officially recognized by diagnostic classification systems such as the DSM-5 and the ICD-11? (Q)

A
  • Substance related and addictive disorders
  • Non substance related disorders (gambling disorder, internet gaming disorder)
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12
Q

How do we define behavioural addictions? (Q)

A

engaging in types of behaviours repetitively which are not directly taken into the body such as gambling or sex. . “Repeated behaviour leading to significant harm or distress of a functionally impairing nature, which is not reduced by the person and persists over a significant period of time”

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13
Q

Do social media disorder symptoms lead to significant harm to adolescents’ wellbeing and functioning, and if so, what are the exact consequences of social media disorder symptoms? (Q)

A

Digital Youth Project: Yes there is increasing empirical evidence that gaming and social media use are (repeated) behaviours leading to significant harm or distress of a functionally impairing nature, which is not reduced by the person (and persists over a significant period of time). Consequences: negative effect life satisfaction, small negative effect school grades. No effect perceived social competence.

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14
Q

Why is it important to obtain official recognition for internet-related addictions by diagnostic classification systems for DSM-5 and the ICD-11? (Q)

A

??? Since the DSM-5 recognition of behavioural addictions, there is an expanding body of research classifying rather common behaviours as possible behavioural addiction

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15
Q

What is the general developmental process in substance use? (HC)

A

Contact with a substance -> Experimenting with a substance -> Integrated use -> Excessive use -> Addicted use

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16
Q

What we tend to regard as ‘risk behavior’ depends on three points. What are these three points? (HC)

A
  1. Characteristics of the particular substance or behavior (e.g. smoking vs. gaming)
  2. Cultural and societal norms (e.g. alcohol use in western vs. Islamic cultures)
  3. Scientific knowledge (e.g. knowledge on the risks of alcohol use for the cognitive development of adolescents)
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17
Q

Is smoking a risk behavior in the experimental fase? And gaming? (HC)

A

Smoking yes, gaming no. Smoking is developing early, e.g. if your parents smoke, you can already experiment with smoking yourself. Gaming is not a risk behavior in experimental fase, it is a risk behavior in excessive use.

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18
Q

What are the predictors of substance use (COM-B model; HC)

A
  1. Capability
  2. Motivation
  3. Opportunity
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19
Q

What is the Behavior Change Wheel? (HC)

A

It’s a framework designed to create a change in behaviour, such as encouraging customers to be healthier or more sustainable.
- Middle layer: what explains risk/addictive behavior (Capability, Motivation, Opportunity)
- Second layer: behavioural interventions to prevent/change these behaviors
- Outer layer: policy measures to prevent risk/addictive behaviour

Bronfenbrenner lijkt erop

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20
Q

Definition Social identity formation (HC)

A

Takes place in early adolescence. Develop a certain part of identity, how do my friends see me, acceptance of importance.

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21
Q

Definition Personal identity formation (HC)

A

Takes place in mid adolescence. Not how peers see them, but how they see themselves, want to be unique, strengths/weaknesses.

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22
Q

There is an increase in white matter during adolescence. What does the ‘white matter’ mean? (HC)

A

It’s the connection between brain cells.

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23
Q

Definition Pruning (HC)

A

Pruning of gray matter. If you don’t use it, you lose it.

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24
Q

Is there a difference between boys and girls in the loss of gray matter in adolescence? (HC)

A

Girls will loss at 11y, boys at 12-13y

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25
Q

What happens when the white matter increases during adolescence? (HC)

A

Communication between brain regions strongly improves:
- Long term memory increases
- Capacity for abstract thinking/metacognition increases (thinking about thinking/yourself).
That’s why adolescents get more critical on themself, the world and their parents. Conflicts will increase.

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26
Q

How do we call the affective-motivational system? (HC)

A

Emotional brain / reward center.

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27
Q

How do we call the control system? (HC)

A

Rational brain.

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28
Q

What does enhance the experience of stronger positive emotions by adolescents when they receive a reward? (HC)

A

Testosterone. Its in the emotional brain (affective-motivational system).

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29
Q

In what does the rational brain play an important role in the development of executive functions? (HC)

A
  • Risk estimation: better estimate the risk
  • Monitoring long-term goals (e.g. it’s sunny outside, but you’re going to a lecutre because you want to pass the exam in a few weeks)
  • Inhibit the tendency to respons to (short-term) possibilities for feward (e.g. impuls control, behavioral inhibition, self control)
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30
Q

What is the Maturational Imbalance Model? (HC)

A

Increased risk-taking during adolescence is a result of an imbalance between reward sensitivity (the affective-motivational system) and impulse control (control system).

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31
Q

Which system is reflective and controlled? (HC)

A

Control system, includes topdown processes, behavioral inhibition (BIS).

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32
Q

Which system is automatic and impulsive? (HC)

A

Motivational system, includes bottom-up processes, behavioral activation (BAS)

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33
Q

Why isn’t sugar a psychoactive substance? (HC)

A

Sugar doens’t cross the blood-brain barrier, drugs do.

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34
Q

Where does psychoactive substances differ in? (HC)

A
  • Type and strength of the psychoactive effect
  • The degree to which they elicit craving and loss of control
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35
Q

What substance is most likely to get addicted to after using it once? (HC)

A
  1. Nicotine 32%
  2. Heroïne 23%
  3. Cocaïne 17%
  4. Alcohol 15%
  5. Cannabis 9%
  6. Benzo 9%
  7. Paddo 0%
  8. XTC 0%
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36
Q

What types of drugs can be divided into:
- Hallucinogens
- Downers (depressants)
- Uppers (stimulants)

A
  • Hallucinogens: LSD/magic mushrooms
  • Downers (depressants): heroin/GHB, alcohol
  • Uppers (stimulants): cocaine/amphetamine/speed, nicotine
    Cannabis/ketamine: between hallucinogens and downers
    XTC: between hallucinogens and uppers
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37
Q

What does ‘downer’, ‘upper’ and ‘hallucinogens’ mean? (HC)

A

Downer makes you more relaxed. Upper makes you more energized. Hallucinogens change the way you perceive the world, the way you feel.

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38
Q

Definition Intensional addiction (HC)

A

These definitions aim to describe a causal addiction process

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39
Q

Definition Extensional addiction (HC)

A

A classification of characteristics of an addiction (e.g. DSM-5)

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40
Q

How do withdrawal symptoms work? (HC)

A

Drug use -> Dopamine release in the nucleus accumbens (what leads to brain adaptation; the sensitivity of the reward system is decreasing) -> Reward

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41
Q

What does brain adaptation mean? (HC)

A

The sensitivity of the reward system is decreasing.

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42
Q

The decrease in the sensitivity of the brain reward system results from… (HC)

A
  • Reduction number of dopamine receptors
  • Making the existing receptors less sensitive to dopamine
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43
Q

What is the result of brain adaptation? (HC)

A
  1. Tolerance (needing a higher dose of the drug to have the same effect)
  2. Withdrawal symptoms (during abstinence)
  3. A reduced sensitivity to natural incentives
    - Reduced sexual interest in cocaine users
44
Q

What does associative learning mean? (HC)

A

Classical conditioning??
1. Repeated use of drugs is having rewarding outcomes (= positive reinforcement)
2. Stimuli related to drug use (drug-cues) get associated with its’ rewarding outcome (surrounding associations are linked to the rewarding outcome of the drug)
3. Drug-cues itself become salient (“opvallend”) because of its’ association with reward (Incentive salience)

45
Q

What are the three categories from Internet Gaming Disorder/Social Media Disorder? (HC)

A
  1. Loss of control (e.g. persistence, preoccupation)
  2. Social and other impairments (e.g. conflict, displacement, problems, deception)
  3. Pharmacologica effects (e.g. withdrawal symptoms, tolerance)
46
Q

What is the difference between substance addiction and behavioural addiction? (Sussman)

A

Substance is repetitive intake of a drug or food, and behavioural is engaging in types of behaviours repetitively which are not directly taken into the body (e.g. gambling)

47
Q

Which ligand functions does drugs cross? And behavioral addictions? (Sussman)

A

Drugs: exogenous ligands or endogenous ligand functions
Behavior: endogenous ligand functions

48
Q

Definition Exogenous ligand function (Sussman)

A

Ligands (=molecuul) added from an external source, such as CO or O2.

49
Q

Definition Endogenous ligand function (Sussman)

A

A compound naturally produced by the body which binds to and activates that receptor

50
Q

Why is it useful to obtain a measurable description of addiction? (Sussman)

A

To be able to make inferences regarding how the concept is related to other concepts, and subsequently how the concept can guide the development of useful application.

51
Q

What are the two concepts of addiction? (Sussman)

A
  1. Intensional definition of addiction: causal or process model type statements of addiction (addictive behavioural process, etiology)
  2. Extensional definition of addiction: taxonomy of addiction elements, which subsequently might by organized into a intensional theorybased perspective
52
Q

What does the physiological and psychological dependence definition of addiction states? (Sussman)

A

An addiction is a prolonged engagement in addictive behavior that results in its continued performance being necessary for physiological and psychological equilibrium (=psychische balans)

53
Q

What are the three hallmark criteria of a dependence definition of addiction? (Sussman)

A

Tolerance, withdrawal and craving

54
Q

Definition Tolerance (Sussman)

A

Refers to the process in which more of the behaviour is required to achieve a level of mood modification. The need to engage in the behaviour at a relatively greater level than in the past to achieve previous levels of appetitive effects

55
Q

What happens when tolerance increases? (Sussman)

A

One likely spends more time locating and engaging in the addiction

56
Q

Definition Withdrawal (Sussman)

A

Are the unpleasant feeling states or physical effects of not engaging in the addictive behaviour. Abstinence syndrome, which involves intense physical disturbance in the case of some types of drug abuse.

57
Q

Definition Craving (Sussman)

A

Refers to an intense desire to engage in a specific act. Craving might be considered part of the withdrawal syndrome in a dependence model of addiction.

58
Q

What is Impulsive obsessive/compulsive behavior? (Sussman)

A

Engaging in the behaviour due to a building up of tension which is released, resulting in pleasure or relief.

59
Q

Definition Compulsions (Sussman)

A

Spontaneous desires to act a particular way, a subjective sense of feeling temporarily out of control, psychological conflict pertaining to the imprudent behaviour, settling for less to achieve the same ends, and a disregard for negative consequences.

60
Q

Vul in (Sussman). OCD-related behaviours are defined as an intense …(1) urge to engage in a simple, repetitive activity, to remove anxiety.

A

ego-dystonic

61
Q

Is the following intensional or extensional:
1. Physiological and psychological
2. Addiction entrenchment
3. Six-compontent perspective
4. DSM-5
5. Five-component perspective
6. Impulsive obsessive/compulsive behavior
7. Self-medication
8. Self-regulation

A
  1. Physiological and psychological: intensional
  2. Addiction entrenchment: intensional
  3. Six-compontent perspective: extensional
  4. DSM-5: extensional
  5. Five-component perspective: extensional
  6. Impulsive obsessive/compulsive behavior: intensional
  7. Self-medication: intensional
  8. Self-regulation: intensional
62
Q

What is a self-regulation model? According to this model, how do people get addicted? (Sussman)

A

The present state of being cues attempt to reach a standard at which point satiation is achieved, until the present state is no longer at the desired standard state. In this sense, people engage in addictive behaviour in order to achieve an immediate temporary sense of comfort.

63
Q

What is the BAS-BIS model? (Sussman)

A

Affects individual differences in behavioral responses to cues for reward. Influences whether an individual is likely to withdraw from or avoid situations that involve novel/threating cues or whether a persons is likely to get involved in risky behavior.

64
Q

Where does BAS/BIS stand for? (Sussman)

A

behavioural approach system and the behavioural inhibition

65
Q

Where is an active BAS linked to? (Sussman)

A

More impulsive-type behaviors.

66
Q

Where is an active BIS linked to? (Sussman)

A

Inhibiting behavior.

67
Q

What is the incentive-sensitization theory? (Sussman)

A

Focuses on the influence of neural adaption to addictive behaviors and addictive behavior-conditioned stimuli as the underlying mechanism perpetuating the addictive behaviors.

68
Q

Vul in (Sussman). The incentive-sensitization theory differentiates between …1 and …2

A

1: wanting - neural processes involved in motivational mechanisms or incentive salience to addictive behavior cues
2: liking - neural substrates of pleasurable effects

69
Q

What is allostasis? (Sussman)

A

Addictive behavior leads to dopamine opponent-process counteradaptation (=reduced dopamine and activation of brain stress systems) that masks the effects of the addictive behavior.

70
Q

What does the addiction entrenchment model mean? (Sussman)

A

Someone has an over-attachment to a drug, object, or activity. Intrinsic and extrinsic incentives addiction-promoting cognitive beliefs and expectancies drive the addictive behavior forward.

71
Q

Definition Salience (Sussman)

A

Refers to the tendency for the addiction to dominate one’s thoughts, feelings, and behaviour

72
Q

Definition Mood modification (Sussman)

A

Refers to the rush, escape, or satisfaction that the addictive behaviour serves.

73
Q

Definition Conflict in addiction (Sussman)

A

Refers to the discord between engaging in the addictive behaviour and relations with others, oneself, or engagement in other activities.

74
Q

Definition Relapse (Sussman)

A

Refers to the tendency to return to out-of-control addictive behaviour after periods of trying to stop or control it.

75
Q

What is ‘hot CCT’? (Gladwin)

A

Heightened involvement of affective processes (= handelen uit emotie) in risky decision-making leads to increased risk taking in adolescents, compared to children and adults.

76
Q

What is ‘cold CCT’? (Gladwin)

A

When risky decisions are made involving mainly deliberative (=doordacht) processes and no or little affect, adolescents show the same levels of risk taking as children and adults.

77
Q

Neurobiological models characterize the adolescent brain by which two interacting systems? (Gladwin)

A
  1. Affective-motivational system
  2. Cognitive top-down control system
78
Q

What kind of areas does the Affective-motivational system involve? (Gladwin)

A

Involves subcortical brain areas, incl. dopamine-rich areas and the striatum and the medial prefrontal cortex (rewards)

79
Q

What kind of regions does the Cognitive top-down control system involve? (Gladwin)

A

Involves prefrontal regions and posterior parietal brain regions, which have been implicated in self-control, planning, abstract thinking, working memory, and goal-directed behavior.

80
Q

What is the Frontostriatal model of adolescent decision making? (Gladwin)

A

Describes a potential for imbalance in motivational bottom-up versus controlling top-down processes.

81
Q

What are two types of neuroadaptations that result from repeated alcohol and drug use? (Gladwin)

A
  1. Neural sensitization leads to strong impulsive to classically conditioned cues that signal alcohol or drugs, which occurs more rapidly during adolescence.
  2. Heavy alcohol and drug use results in impaired control functions, especially when it takes place during adolescence
82
Q

What has strong effects on subsequent brain developing involving cognitieve and emotional regulatory processes? (Gladwin)

A

Binge drinking

83
Q

What kind of substance use is associated with abnormalities, both regarding white matter structure and functional properties (stronger cue- reactivity and impaired executive functions)? (Gladwin)

A

Binge drinking and heavy use of marijuana

84
Q

What does the dual process model of addiction emphasizes? (Gladwin)

A

The importance of drug-related consequences on the relationship between impulsive and reflective processes.

85
Q

Why does the intervention training the working memory will work for substance use? (Gladwin)

A

Training of the working memory revolves around the ability to appropriately delay responding.

86
Q

Where does the intervention ‘cognitive bias modification’ aims to? (Gladwin)

A

To modulate biases that could underlie failures of controlled processing.

87
Q

What is the most important issue with giving training to adolescents who are addicted? (Gladwin)

A

Motivation to participate in the training. They don’t believe they have a problem. And if they recognize they have a problem, they have to be convinced that it makes sense to do the training.

88
Q

What do cascade models posit? (Trucco)

A

Dynamic, multilevel transactions between the youth and the environment in emergent behaviors characterized by a sequential progression from temperamental differences in childhood (eg impulsivity) to problem behaviors (intern/externlizing) in early adolescence to riskier behavior in midadolescence.

89
Q

Vul aan (Trucco). Childhood temperamental traits affect…

A

the emergence of behavior problems, most commonly conceptualized as externalizing (eg delinquency) and internalizing (eg anxiety, depression) symptoms.

90
Q

What are two riskfactors in biological factors on alcohol use? (Trucco)

A
  1. Family history of substance disorder, heritability 50%
  2. Genes encoding metabolizing enzymes: adolescents with aldehyde dehydrogenase genes experience nausea, flusing and headaches when consuming alcohol.
91
Q

What does the externalizing pathway promotes? (Trucco)

A

Adolescents substance use. Its characterized by marked deficits in behavioral inhibition.

92
Q

What does externalizing symptomatology promotes? (Trucco)

A

Deleterious socialization processes (eg affiliation with substance using peers) that set the stage for adolescent substance use.

93
Q

What does the dual failure hypothesis posits? (Trucco)

A

That externalizing symptoms in early adolescence may lead to later co-occurring symptomatology resulting primairly from peer rejection and alienation from parents. Together, they increase the risk of affiliation with peergroup that promotes substance use.

94
Q

What does the stable co-occurring hypothesis proposes? (Trucco)

A

Adolescents characterized by co-occurring symptomatology across development are at increased risk for substance use given disturbances in executive function and impairments in social adaption.

95
Q

Vul in (Trucco). ..(1) refers to an adolescent’s decision to join certain peer groups based on similarity in attitudes or behaviors related to substance use, whereas …(2) reflects an adolescent’s change in attitudes or behaviors related to substance use to assimilate to peers.

A

1: Selection
2: socialization

96
Q

Vul in (Trucco). …(1) and …(2) influences had a strong effect on adolescents’ use of soft drugs (e.g., alcohol, marijuana, tobacco), but only a moderate to average effect on their use of hard drugs.

A

1: Modeling
2: socialization

97
Q

Which two processes posits the social norms theory? (Trucco; Azjen & Fishbein)

A
  1. Descriptive norms (eg an adolescents’ belief about the prevalence of substance use)
  2. Injunctive norms (eg an adolescents’ belief about approval of substance use
98
Q

Are users of cannabis more likely to use other drugs? (Hall)

A

Yes, because they obtain cannabis from the same black market and hence have more opportunities to use other illicit drugs.

99
Q

Are individuals who use cannabis at an early age more likely to use other drugs? (Hall)

A

Yes

100
Q

Does the pharmalogical effects of cannabis increase the change of using other drugs? (Hall)

A

Yes

101
Q

What does the social environmental hypothesis states? (Hall)

A

Affiliating with peers who used drugs predicted an increased risk of using them, but it did not wholly explain the relationship between cannabis and other illicit drug use.

102
Q

What states the selective recruitment hypothesis? (Hall)

A

Regular cannabis use and use of other illicit drugs could arise from early cannabis use of socially deviant young people who have a high likelihood of using cocaine and heroin. Its a sequence of drug involvement.

103
Q

What do twin studies suggest on association between cannabis and other illicit drug use? (Hall)

A

May be explained by genetic contribution to dependence on alcohol, cannabis, tobacco and other drugs.

104
Q

Vul in (Hall). Cannabis use is one of the causes of poor…(1) . And poor …(2) is a risk factor for cannabis use.

A

1: educational performance
2: school performance

105
Q

What are reduced educational achievements of adolescent cannabis users due to? (Hall)

A

Combination of:
- Pre-existing poor educational attainment
- Acute cognitive impairment from cannabis intoxication
- Affiliation with peers who reject school
- Early transitions to adulthood without adequate preparation

106
Q

What role does cannabis use play in the precipitation and exacerbation of psychosis? (Hall)

A
  • Cannabis use precipitates schizophrenia in people who are otherwise vulnerable to the disorder
  • Cannabis use is a form of self-medication for schizophrenia
  • The association arises from uncontrolled residual confounding by variables that predict an increased risk of cannabis use and of schizophrenia
107
Q
A

Risk Behavior and Addiction in Adolescence (10 decks)

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