8. Substance Use Disorders Flashcards
How has diagnostic labels changed by evolution?
- addiction originally was seen as a weakness/moral failure
- this was replaced by dependance
- DSM 4 had a distinction between substance abuse and dependance
- DSM 5 combined abuse and dependance into a single diagnosis of SUD (substance use disorder)
Why does DSM 5 criteria not tell us what SUD is?
- low threshold: only need to meet 2/11 criteria
- three severity categories
- across all severity categories there is 2036 possible combinations of symptoms
- possible to have no shared diagnostic criteria: how useful is the diagnosis?
What is a definition of addiction?
someone is addicted if ‘they continue to use drugs despite a sincere intention to do otherwise’
What is epidemiology?
prevalence of substance use disorders
What level of comorbidity is there between those with SUD and other disorders?
Give examples of other disorders
high comorbidity with disorders such as…
- bipolar disorder
- major depression
- GAD
- social anxiety disorder
- PTSD
- Sz
What are the two risk factors for SUD?
heritability
- twin studies show a heritability range between 30% and 70%
traumatic life events
- particularly sexual abuse increase the risk of developing SUD
Why do people take drugs?
- to get ‘high’ e.g alcohol
- to increase alertness and reduce fatigue e.g nicotine and caffine
- social facilitation e.g alcohol
- to alleviate distress e.g heroin
What type of behaviour is drug use?
operant behaviour
- voluntary, not a reflex
- maintained by consequences
Explain compulsive drug use
Explain why this happens
compulsion is explains addictive behaviour when negative consequences outweigh the positives
- addicts are compelled to use drugs
WHY?
- dominant view is that addiction is a brain disease
How do ‘addicted’ brains differ?
they are less hypoactive and have less grey matter
Could the difference in ‘addicted’ brains due to factors other than drug use?
Explain
Yes
- this abnormal brain function could be a risk factor to addiction rather than the other way round
How is the original habit formed?
- Stimulus in environment
- anticipated outcome e.g getting high (stimulus activates thought of outcome)
- response: taking drug
What happens with repetition of addicted behaviour?
anticipated behaviour becomes less important
- mental process becomes bypassed
- as association strengthens, a direct relationship happens between stimulus and response
Is there evidence for habits?
yes: in laboratory animals drug seeking comes habitual despite negative consequences
- however in humans the importance of ‘habit’ in addiction is disputed
Explain the dual process theory
a comination of:
- controlled cognitive processes e.g outcome expectancies
AND
- automatic cognitive processes e.g spontaneous memory
lead to substance use
What evidence is there for the dual process theory?
- addiction is characterised by automatic cognitive processing biases for substance related cues
- ‘re-training’ of this may be an effective treatment
What is the treatment of talking therapy?
a client centred motivational interview
- list pros and cons of stopping
- prompts own thoughts
Do talking therapies work?
both interviewing and CBT are effective treatments for SUD
- increase % of patients who remain abstinent
How are ‘self help’ groups used as treatment?
- not a mainstream medicine
- free to tax payers
- help people to achieve and maintain abstinence
- effective as they increase self-efficacy and bring changes in social networks
