16 Addiction – substances Flashcards
What is a drug/substance?
Anything that exerts an effect on body or mind –be it prescription, legal or illicit.
What four kinds of effects might a substance have?
- Neurophysiological –e.g. neurotransmitter dysregulation
- Behavioural –aggression, disinhibition
- Emotional – excitement, elation
- Cognitive – disorientation, focus
What is addiction?
Behaviours characterised by compulsion, loss of control and continued patterns of abuse despite perceived or objective negative consequences.
How is habit distinguished from addiction in the field of substance use disorders?
Habit –a free choice to do something habitually
Addiction –no choice, as self-control is impaired by the substance
Describe the choice theory of addiction (West, 2006)
The user balances up perceived benefits and costs, and makes decision.
What evidence is there for the choice theory of addiction?
That addicts can stop cold turkey in certain circumstances. E.g. when pregnant.
What’s the difference between addiction and dependence?
There’s no consensus –they’re often used interchangeably.
What are the features of physiological dependence?
Physical symptoms of tolerance and withdrawal. The substance is needed to restore homeostasis.
What are the features of psychological dependence?
Cravings lead to repetitive use. Drug used as coping mechanism.
The symptoms of the A criterion for a substance-related disorder are split into 4 categories. What are they?
- Impaired control
- Social impairment
- Risky use
- Pharmacological
What are the 4 symptoms in the Impaired Control category of criterion A of substance-related disorder?
- Social impairment
- Risky use
- Pharmacological
Impaired control
- Use of greater amounts or for longer periods than intended.
- Repeated unsuccessful attempts to cut back/cease.
- Excessive time obtaining the drug or recovering from its use.
- Craving.
What are the 3 symptoms in the Social Impairment category of criterion A of substance-related disorder?
Social impairment
- Failure to meet obligations: home, work, school
- Social and interpersonal problems
- Social, occupational or recreational activities reduced
What are the 2 symptoms in the Risky Use category of criterion A of substance-related disorder?
Risky use
- Use in physically hazardous situations (e.g. driving)
- Persistence despite awareness of physical or psychological problems exacerbated by use.
What are the 2 symptoms in the Pharmacological category of criterion A of substance-related disorder?
- Tolerance
2. Withdrawal
What percentage of substance users have a comorbid psychiatric disorder?
60%
What is the goal, when drinking, of 94% of males and 78% of females under the age of 19?
To get intoxicated. Duh.
Why is substance abuse so prevalent in the young?
- Younger individuals are more exposed to peer-related alcohol and drug use.
- Heavy substance users are less likely to survive into later life.
What evidence is there for a genetic basis for substance disorder?
Higher concordance rate in MZ twins than DZ twins.
Is the genetic basis for substance disorder specific to certain substances?
No, looks like it’s non-specific. More of an addictive personality kind of thing.
What neural systems are usurped by drugs in the process of neuradaptation (sensitization)?
Addictive drugs usurp neural circuitry normally involved in pleasure, incentive motivation and learning. They not only engage these reward systems, but change them.
What two systems do drugs of dependence operate on?
- The dopaminergic system
2. The endogenous opioid system
What 2 dopaminergic brain circuits experience functional and structural changes from substance use?
- Mesolimbic (amygdala, nucleus accumbens, hippocampus)
- Acute reinforcing effects
- Memory & conditioning linked to craving
- Emotional & motivational changes during withdrawal - Mesocortical (prefrontal cortex, orbito-frontal cortex & anterior cingulate)
- Conscious experience of intoxication
- Salience
- Expectations
- Cravings
- Inhibitory control/decision-making
What is ‘compulsive use’ of a substance?
Continued use when the substance is no longer perceived as pleasurable.
Describe the opponent process theory of addiction.
The drug activated a euphoric ‘a-process’ in brain reward circuits, which in turn activates an opponent ‘b-process’ –which serves to restore homeostasis. Subjectively, you feel the pleasant ‘a-state’, followed by the ‘b-state’, when you swing too far in the opposite direction.
According to the opponent process theory of addiction, how are the a and b processes realised in addicts.
Once the b process is strengthened, the a process is less powerful. So you get less pleasure and worse withdrawals.
What are the shortcomings of the opponent process theory of addiction?
An induced withdrawal state is LESS LIKELY to reinstate drug-seeking behaviour than re-exposure to positive drug effects.
Relative to positive incentive processes caused directly by drugs…withdrawal much less powerful at motivating drug-taking than previously thought.
And can’t explain why addicts often relapse even after they are free from withdrawal.
What single treatment is the best for substance use disorder?
There isn’t one. Multiple treatments are more appropriate, because of the multiple factors that lead to substance use.
How should dual-diagnosed clients be treated?
In an integrated fashion. If drugs are used to reduce anxiety, treating the addiction alone won’t solve the problem.
Does substance use treatment have to be voluntary to be effective?
No. Even when coerced – after being given a bit of MI – substance abusers may make positive changes.
What three learning-based approaches are used in CBT for addiction?
- Adjusting maladaptive behaviour patterns
- Breaking down motivational & cognitive barriers to change (e.g. I can handle it, I can control use)
- Skills deficits –poor coping strategies, distress tolerance, bad at dealing with stressors.
How could cues for substance use be targeted to reduce substance use?
Identify cues for drug use – people, places, internal cues –and reduce likelihood of their occurrence. Rehearse non-drug alternatives to cues.
What kind of cognitive distortions are typical of substance abuse?
Minimising –”one drink won’t hurt me”
Hopelessness –”why bother trying, I’ll always be an addict”
How can artificial rewards encourage drug reduction?
Before naturally-occurring rewards are available (e.g., greater employment, relationship, and social success) artificial rewards may be used (monetary prizes, vouchers for goods, or treatment “privileges” e.g., take-home doses of methadone).
What is motivational toxicity?
Motivational toxicity refers to the powerful drug-obsessed drive that takes control of a drug addict’s thoughts and behaviours at the expense of all other things. The toxic motivation of chronic, long-term drug abuse steals behavioural control away from the brain’s natural reward system and commandeers the associated cognitions into the endless pursuit for drug use (Esch & Stefano, 2004). Motivational toxicity is the combination of the over-valuing of the abused drug, reduced sensitivity to natural rewards, impaired inhibitory control and disrupted cognitive functioning (Volkow et al., 2004).
