7: Addiction & Substance Use Flashcards
Addiction defintion (WHO)?
- repeated used of psychoactive substances
= user periodically, chronically intoxicated - shows compulsion to find and obtain it
DSM Substance used disorder
Need at least 2: - determines intensity .... - intense craving - confused large amount - considerable time to obtain - continued use despite knowing negative consequences - increased tolerance - withdrawal symptoms
What are the major specific substance use disorder?
- Alcohol
- Tobacco
- Cannabis
- Opioid
What is the prevalence of substance used disorder?
16%
- starts early in life
9/10 start before 18
- 9% = multiple substance use disorder
What is the biggest substance used disorder killer?
- tobacco
- 20% of adults globally smoke, predominately men
Which 2 substance contribute/ cause more than 70 other conditions requiring medical care?
- Tobacco
- Alcohol
- drug use
Describe the characteristics of dependent substance users?
- LT use
- Solitary/ small group
- Loss of control
- Usually increasing quantities
What is the process of addiction?
- Tolerance
- Dependence
- shift in homeostasis response
- withdrawal - Compulsion
- Relapse
- high vulnerability
What are Addictive disorder?
There to show that it doesn’t have to be just substances which you are addicted to
- eg gambling
What is the Disease model of addiction?
Island approach: Genetics/ persistent drug-induced changes in brain affect psychological processes = addiction - incurable - only solution = abstinence
What is the medical model of addiction?
- symptoms of drug addiction are physiological + should be treated accordingly (substitutes)
- assumes psychological features of addiction are due to physiological causes
What support is there for the disease model?
Alcohol anonymous
- life long condition
- once you become an alcoholic = either an alcoholic abstaining or not
- no such thing as controlled drinking
According to Alcohol anonymous, how can u start recovery?
12 steps - bases for recovery
- admit helplessness
- trust in program + higher power
How effective is AA (Gossop et al, 2003)?
seems pretty effective
- significant improvements in drinking behaviours, psychological problems + Q of life
- frequent attendance = superior drinkning outcome
What are some problems with AA results?
- seem to only improve drinking problem and not other psychiatric problems that follow up
- often, people who don’t succeed kicked out
What neurotransmitter seems to be at the heart of Neuroscience of addiction?
Dopamine
- Psychoactive substances bind to receptor in brain = changing it
1. Heroin - binds to opioid receptors + triggers dopamine
2. Ecstasy (MDMA) - triggers serotonin + dopamine
3. Cocaine - stimulate dopamine release
- interfers with dopamine removal
What are the different ways drugs can take action?
- Direct agonists
- bind directly to receptors - Indirect agonist
- increase neurotransmitter binding to receptor - Antagonist
- bind to receptor but have no effect on their own
- just block receptors preventing agonist effect
What is the speed of impact?
- Cocaine taken nasally = speedy impact
2. Cocaine smoked = impact in seconds!
What is the dopamine theory of addiction?
- affecting reward system of brain
- makes things pleasurable + memorable
- dopamine being key messengers
- substances = more powerful + reliable than natural reinforcers
What did the removal/ damage of the nucleus accumbens decreased?
Self-administration of heroin in animals
(Willuhn et al, 2010)
What did they find about genetically engineered mice that lacked dopamine receptors? (Palmiter, 2008)?
starve to death
- restoring dopamine signalling in the reward pathway reversed effect
What brain changes can be observed overtime through repeated drug administration?
- enhances brain reactivity to drugs + reduces sensitivity to non-drug rewards
- Amphetamine = structural changes in dendritic spines
- changes lasted more than a month in rates
What are the LT consequences of the brain changes?
Build up of tolerance - neuron is adapting = resetting of reward threshold = increase in maintenance otherwise result in withdrawal - body only functions normally in the presence of drug
What other areas of the brain, other than the reward system, are affected by substance misuse addiction?
Reward system also connected with other brain areas
- PFC - hypoactivity
- loss of inhibitory control
- loss in decision making
How is the reward pathway and cognitive control relates?
- exposure to drug-related cues = memory of expected reward = over-activation of reward circuit
- whilst decreasing activity in cognitive control circuits
= inability drive to seek + consume drug
What are the 2 main focus of treatments?
- need to recalibrate brain structure/ reward system
2. increasing cognitive control
What conditioning treatment method is used?
Substitue drugs
- making them sick when they have alcohol
- conditioning
- only working with reward system tho!
- wanna combine with CBT
Experiments with skinner’s rats found that rats began to prefer drugs over natural reward. However, what was found when rats were put into social cages?
- caged = more morphine consumption vs social rats
- social rats - hardly affected and don’t really become addicted to it
- caged rats consumed 20x amount vs social rats
- psychological isolation?
Why is Vancouver thought be the most drug addicted city?
- majority of population born elsewhere (dislocation)
- overwhelming native Canadians
- natives’ culture removed
- alcoholism nearly 100% in some place where European culture has overpowered their culture
What is psychosocial intergration?
Cannot see individual without the role of relationships + environment
- state in which people flourish simultaneously as individual + members of their culture
What can insufficient psychosocial integration be a precursor to?
addiction via
- dislocation, free market economy, trauma, imprisonment etc
- they adopt substitute lifestyle
What can be concluded about addiction according to research on rats and psychosocial intergration?
- Drugs do not have high addictive value as such
- rats becoming addicted due to being isolated - Addiction need not be limited to drugs
- general condition in western society
What was found to be desired by people in a survey?
basic bodily needs
- food, sleep, need to belong
- addictive substance were rated as below average
Most addicted Vietnam soldiers gave up their narcotic use voluntarity/ w/ brief detoxification (Robins et al, 1974), how?
- heroin readily available
- variety of drugs used before entering service related to likelihood of drug use in Vietnam
- after 1 year of addiction, still only small portion remained addicted
What does the findings of the Vietnam soldiers suggest about addiction?
- addicts not doomed for life
- supports view that addiction is an adaptation related to psychological circumstances
Trauma is a significant risk factor to…?
- Psychological integration
- later substance use
In survey of adolescents receiving treatment for substance abuse, what % of patients had a history of trauma exposure?
70%
Deykin + Buka, 1997
Historically, the word ‘addiction’ means being given over/ devoted to something. How has the societal structure causing people to adopt certain unhealthy lifestyles which we cling onto?
- Social structures causes people to priorities certain rewards over other
- could be unhealthy life style - Cling onto it because there is no way of achieving psychosocial integration
What relationship is there between power and cocaine?
Power has similar effects to cocaine on the reward system (Robertson, 2013)
- much potential for harm
What is thought to be key to understanding addiction?
Psychology of desire + pleasure
- addiction = temporary relief for what we are missing in life
What is an alternative treatment approach for addiction other than trying to rewire reward pathway and increasing cognitive control?
- What is causing the pain?
- Take into consideration society + people’s lives
- Consider psychological interventions
What is the biopsychosocial approach?
Continent approach
- bio
- psychological
- environment
