7 - Neurobiological and behavioural mechanisms of addiction (L7, Volkow)

Question 1

What kind of cues tend to provoke craving? (Q)

Answer 1

By the substance itself, by substance-associated cues (paraphernalia, ‘scene’), and by stress. It’s often a combination of these.

Question 2

Which characteristics of addictive behavior can be studied in animal models? (Q)

Answer 2

• Rewarding and motivational properties of substances
• The role of substance associated cues in addictive behavior
• Relapse to substance use
• Loss of control over substance use

Question 3

Which five mechanisms play a role in the development of addiction? (Q)

Answer 3

1. Positive reinforcement theory
2. Negative reinforcement theory
3. Incentive sensitization theory
4. Cognitive processing (habit) theory
5. Disinhibition/impulsivity theory

Question 4

Which aspects of addiction can be explained by positive reinforcement? (Q)

Answer 4

Acquisition of use (ventral striatum, amygdala)
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Question 5

Which aspects of addiction can be explained by negative reinforcement? (Q)

Answer 5

Maintenance of use (ventral striatum, amygdala, stress system)

Question 6

Which aspects of addiction can be explained by incentive sensitization? (Q)

Answer 6

Exaggerated motivation for substances (ventral striatum)

Question 7

Which aspects of addiction can be explained by cognitive processing (habit)? (Q)

Answer 7

Automated use (dorsal striatum, prefrontal cortex)

Question 8

Which aspects of addiction can be explained by disinhibition/impulsivity? (Q)

Answer 8

Lack of inhibition of use, aberrant decision making (prefrontal cortex).
Theory: Frontal cortical brain regions are involved in executive functions: attention, planning, decision making, working memory. Chronic substance use compromises frontal cortical functions, leading to impaired inhibitory control over behaviour. Substance-directed behaviour becomes difficult to inhibit.

Question 9

What is substance addition? (HC)

Answer 9

Substance addiction is a brain desease. Addiction results from changes in brain function. These changes are long-lasting, whose are the substrate of relapse.

Question 10

How does the DSM describes a substance addiction? (HC)

Answer 10

As a pattern of substance use leading to significant harm or suffering, as manifested by two or more of the DSM criteria, occurring within a 12-month period.

Question 11

Vul in/aan (HC). Relapse is often precipitated by …(1). And this persist after…

Answer 11

1: craving
… discontinuation of use, outlasts withdrawal symptoms

Question 12

What does ‘progressive ratio schedule of reinforcement’ say in animal studies? (HC)

Answer 12

a. Motivation for substance is measured.
b. Incremental number of responses required for every subsequent reward.
c. Animals are willing to actively response for a reward (in this case, a substance).

Question 13

What does ‘cues and addiction measurements’ say in animal studies? (HC)

Answer 13

• Importance of conditioned stimuli:the animal does something for the second stimulus, not for the substance itself. The cue (second stimulus) has become associated with the substance.
• Substance seeking under control of conditioned stimuli, under substance-free circumstances. Substance is released after a certain time, while the cue is released after pressing the button. Pressing the button is due to the cue, rather than substance.

Question 14

What does ‘loss of control over cocaine seeking in rats’ say in animal studies? (HC)

Answer 14

• With prolonged use, control over substance intake is lost: intensivity to external interference (warning signals)
• The power of an interference signal to influence substance seeking declines with the substance intake (loss of control)

Question 15

What does ‘loss of control over alcohol drinking in mice’ say in animal studies? (HC)

Answer 15

• With prolonged use, insensitivity to bitter taste
• Lack of control

Question 16

What is the positive reinforcement theory of substance addiction? (HC)

Answer 16

Addiction is maintained because the euphoria of substances induces. Substances act as positive reinforcers because they produce pleasure and are therefore addictive.

Question 17

What are shortcomings of the positive reinforcement theory of substance addiction? (HC)

Answer 17

• There is no clear relationship between the euphorigenic and addictive potential of substances;
• The negative consequences of addiction are enormous relative to pleasure;
• Substance taking can be maintained in absence of subjective pleasure

Question 18

What is the negative reinforcement theory of substance addiction? (HC)

Answer 18

Addiction is maintained because the aversion of withdrawal is alleviated (=verlicht) by the substance. Substance is used to self-medicate, relieving pre-existent symptoms such as pain, anxiety or depression.

Question 19

What are shortcomings of the negative reinforcement theory of substance addiction? (HC)

Answer 19

• Substances are used in the absence of withdrawal symptoms
• Relief of withdrawal is minimally effective in treating addiction
• High tendency to relapse after withdrawal has subsided

Question 20

What is the incentive sensitization theory of substance addiction? (HC)

Answer 20

Substances cause hypersensitiviy of the brain structure of motivation (nucleus accumbens dopamine) to substances and substance cues. Wanting (motivation), not liking (pleasure) is enhanced (craving).

Question 21

What are shortcomings of the incentive sensitization theory of substance addiction? (HC)

Answer 21

• Behavioural sensitization can be evoked by a single substance exposure
• Sensitization also results in enhanced motivation for natural reinforces

Question 22

What is the cognitive processing (habit) theory of substance addiction? (HC)

Answer 22

During early stages of use, substance drug taking is voluntary and goal directed. After prolonged use, substance taking gains automatic, habitual quality, it is driven by cues, but no longer voluntary or goal directed. Automatic use with abundant availability. Narrowing of behavioural repertoire by substance cues.

Question 23

What is the disinhibition/impulsivity theory of substance addiction? (HC)

Answer 23

?? The prefrontal cortex is involved in executive functions (attention, planning, decision making, working memory). Chronic substance use compromises frontal functions (impaired control of behavior)

Question 24

What are five aspectes / stages of addiction? (HC)

Answer 24

• Initial sampling and ‘social’ use
• Escalation of substance use
• Withdrawal
• Recurrent relapses
• Loss of control

Question 25

What are historical changes in views on addiction? And how were these changes treated? (HC)
1800:
1920:
1975:
1990:

Answer 25

1800: moral model - people are the problem. Treatment: incarceration.
1920: pharmalogical model - the substance is the problem. Treatment: prohibition.
1975: learning model - addiction is learned. Treatment: psychotherapy, cue exposure.
1990: brain disease model - addiction is a disorder, mediated by adaptations in the brain. Treatment: psychotherapy, pharmacotherapy.

Question 26

What are the aspect(s) of addiction in the five theories? (HC)
Positive reinforcement:
Negative reinforcement:
Incentive sensitization:
Habit:
Disinhibition/impulsivity:

Answer 26

Positive reinforcement: hedonia (=een door prikkels gedreven geluksgevoel die door factoren buiten jezelf wordt veroorzaakt.)
Negative reinforcement: (an)hedonia
Incentive sensitization: adaptations/drive to seek
Habit: cognitive
Disinhibition/impulsivity: cognitive
Thats why there is a complexity of addiction.

Question 27

What does animal study ‘intracranial self-stimulation’ measures? (HC)

Answer 27

Reward sensitivity

Question 28

What does animal study ‘conditioned place preference’ measures? (HC)

Answer 28

Motivational aspects

Question 29

What does animal study ‘operant self-administration’ measures? (HC)

Answer 29

• Simple to complex schedules of reinforcement.
  Press a button and they get some reward?
  Widely used in addiction research.

Question 30

What does animal study ‘two-bottle choice test’ measures? (HC)

Answer 30

They choose between water or alcohol
Consumption of substances of abuse
Mostly alcohol
Reward / motivation not distinguishable

Question 31

Vul in (HC). Alcohol exposure during adolescence enhances …(1), …(2) and …(3)

Answer 31

1: alcohol consumption
2: incentive salience
3: cue reactivity in adulthood

Question 32

How does Pavlov learning works with addiction? (Volkow)

Answer 32

Drugs activate reward regions in brain by causing increases in release of dopamine. Those increase a reward signal that triggers associative learning or conditioning. Repeated experiences of reward become associated with environmental stimuli that precede them. With repeated exposure to same reward, dopamine cells stop firing in response to the reward itself and instead fire in anticipatory response to the conditioned stimuli (cue) that in a sense predict the delivery of the reward.

Question 33

What is an important result of the conditioned physiologic processes involved in drug addition? (Volkow)

Answer 33

Ordinary, healthful rewards lose their former motivational power. It triggers smaller increases in dopamine levels. They will take the drug to obtain transient relief from dysphoria (withdrawal and negative emotions).

Question 34

What are factors that increase vulnerability to addiction? (Volkow)

Answer 34

Family history, early exposure to drug use, exposure to high-risk environments, and certain mental illnesses.

Question 35

Where do prevention interventions need to focus on with addiction? (Volkow)

Answer 35

To enhance social skills and improve self-regulation.

Question 36

What happens when prevention has failed with addicted individuals? (Volkow)

Answer 36

Medical treatment can help to restore healthy function in the affected brain circuitry and lead to improvements in behavior.

Question 37

How can behavior change interventions be defined? (Michie)

Answer 37

Coordinated sets of activities designed to change specified behavior patterns.

Question 38

Why is the Behavioral change wheel constructed? (Michie)

Answer 38

This framework could prevent policy makers and intervention designers from neglecting important options.

Question 39

What is the starting point of intervention design? (Michie)

Answer 39

Behavior in context.

Question 40

What is a key difference between intervention mapping and Behavior change wheel? (Michie)

Answer 40

Intervention mapping aims to map behavior on to its theoretical determinants in order to identify potential levers for change, whereas BCW approach recognizes that the target behavior can in principle arise from combinations of any of the components in the behavior system.

Question 41

What are 9 forms of interventions (Michie)

Answer 41

1. Education
2. Persuasion
3. Incentivisation
4. Coercion
5. Training
6. Restriction
7. Environmental restructuring
8. Modelling
9. Enablement

Question 42

Defintion Persuasion (Michie)

Answer 42

Using communication to induce positive or negative feelings or stimulate action (e.g. using imagery to motivate increases in physical activity)

Question 43

Defintion Incentivisation (Michie)

Answer 43

Creating expectation of reward (e.g. using prize draws to induce attempts to stop smoking)

Question 44

Defintion Coercion (Michie)

Answer 44

Creating expectation of punishment or cost (e.g. raising the financial cost to reduce excessive alcohol consumption)

Question 45

Definition Restriction (Michie)

Answer 45

Using rules to reduce the opportunity to engage in the target behavior (e.g. prohibiting sales of solvents to people under 18 to reduce use for intoxication)

Question 46

Definition Enablement (Michie)

Answer 46

Increasing means/reducing barriers to increase capability or opportunity (e.g. behavioral support for smoking cessation, medication for cognitive deficits, surgery to reduce obesity, prostheses to promote physical activity)

Question 47

What are 7 forms of policies (Michie)

Answer 47

1. Communication/marketing
2. Guidelines
3. Fiscal
4. Regulation
5. Legislation
6. Environmental/social planning
7. Service provision

Question 48

Definition Fiscal policies (Michie)

Answer 48

Using tax system to reduce or increase financial cost

Question 49

Definition regulation policies (Michie)

Answer 49

Establishing rules or principles of behavior or practice (eg voluntary agreements on advertising)