Addiction

Question 1

Addictions

Answer 1

-Clinically-impairing pattern of inflexible reward pursuit and consumption

-Patient must participate actively in “getting” this disorder
o Similar to type 2 diabetes, cardiovascular disease, etc.
o Genetic and environmental factors influence susceptibility

-Best understood as a clinical brain disorder with observable physiological manifestations that underlie pathological aspects of behavior

Question 2

Progression of relapse

Answer 2

Use (abstinence then relapse) then heavy use (abstinence then relapse) then early dependence (abstinence then relapse) then late dependence neuroadaptation

Question 3

First time use of a drug

Answer 3

euphoria, feel good, reduces stress

Question 4

After many times of using the drug…

Answer 4

I need this drug to get by - depression, agitation, anxiety

Question 5

Progression of drug addicition

Answer 5

-motivation increases
-negative reinforcement increases
-positive reinforcement decreases

Question 6

Substance Use Disorder

Answer 6

describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress

Question 7

Symptoms of Substance Use Disorder

Answer 7

-11 symptoms total
-physical dependence symptoms
-loss of control symptoms
-clinical impairment symptoms
-2 to 3 symptoms = mild
-4 to 5 symptoms = moderate
-6+ symptoms = severe

Question 8

Physical dependence symptoms

Answer 8

-“Craving” the substance (alcohol or drug)

-Building up a tolerance to the alcohol or drug
o needing to use noticeably larger amounts over time to get the desired effect
OR
o noticing less of an effect over time after repeated use of the same amount

-Experiencing withdrawal symptoms after stopping use

Question 9

Loss of control symptoms

Answer 9

-Consuming more alcohol or other substance than originally planned

-Worrying about stopping or consistently failed efforts to control one’s use

-Spending a large amount of time using drugs/alcohol, or doing whatever is needed to obtain them

-Continuing the use of a substance despite health problems caused or worsened by it

Question 10

Clinical Impairment Symptoms

Answer 10

-Use of the substance results in failure to “fulfill major role obligations” (home, work, or school)

-Continuing the use of a substance despite its having negative effects in relationships with others

-Repeated use of the substance in a dangerous situation

-Giving up/reducing activities in a person’s life because of the drug/alcohol use

Question 11

Manifestations

Answer 11

-illicit
-licit
-non chemical

Question 12

illicit manifestations

Answer 12

Cannabis (in most states), stimulants, narcotics, hallucinogens

Question 13

licit manifestations

Answer 13

Cigarettes, alcohol, cannabis (legal in over 20 states + DC)

Question 14

non chemical manifestations

Answer 14

-Gambling disorder (in DSM5)
-Internet gaming disorder (possible)
-Food, pornography, sex, shopping, exercise (under study)

Question 15

Marijuana is most misused by who?

Answer 15

ages 12-17

Question 16

Prescribed drugs are most misused by who?

Answer 16

ages 18-25

Question 17

alcohol is most misused by who?

Answer 17

ages 26+

Question 18

Alcohol Use Disorder

Answer 18

-loss of control over drinking
-negative emotions when not drinking
-have to drink more for the same effects

Question 19

Risk Factors

Answer 19

-men > women
-adolescents > adults
-co-morbidity with other psychiatric illnesses
-pain disorders, other “somatic” diseases
-genetics
-environment

Question 20

Environmental risk factors

Answer 20

-exposure to adverse events during early-life and adolescence leads to affective disorders and increases the risk of developing alcohol and substance use disorder

Question 21

What are drugs?

Answer 21

Drugs are chemical ligands that interact with brain neurotransmitter systems and that can change the way people “feel” by altering neural signaling

Question 22

When consumed, drugs produce…

Answer 22

-internal feeling states/stimulus effects
o Positive, negative, mixture
o E.g., cocaine produces euphoria, energy, sympathomimetic activation and anxiety

Question 23

What causes drugs to produce stimulus effects?

Answer 23

These stimulus effects are due to the pharmacological actions of the drug (what receptors the drug interacts with)

Question 24

What system does the stimulus effects of drugs involve?

Answer 24

mesolimbic dopamine system

Question 25

Are the effects of drugs learned?

Answer 25

-No, liking the positive reinforcing stimulus effects of the drug, or disliking the aversive effects, is not “learned”

-These effects mean that drugs can act as unconditioned stimuli

Question 26

Dopamine

Answer 26

a neurotransmitter that is released during a happy event or in the presence of a rewarding stimulus

Question 27

Mesolimbic Dopamine System brain regions

Answer 27

1. Ventral tegmental area (VTA)
2. Nucleus Accumbens (NAc)

Question 28

Ventral tegmental area (VTA)

Answer 28

Dopamine is produced here and flows outward along neurons distributed throughout the brain’s reward system

Question 29

Nucleus Accumbens (NAc)

Answer 29

amplifies the response to pleasure and is involved in stress processing

Question 30

Where is the presynaptic terminal in the mesolimbic dopamine system?

Answer 30

-Nucleus Accumbens (NAc)
-Presynaptic terminals from the Ventral tegmental area release dopamine in the Nucleus Accumbens

Question 31

Fewer dopamine receptors means…

Answer 31

-less response
-in addicts, less receptor availability, overstimulation of dopamine terminals (Post-synaptic side, there’s neural activation where D2 receptors are becoming deactivated, less binding)

Question 32

Dopamine as causal influence

Answer 32

-6-OHDA = neurotoxin that kills catecholaminergic neurons and/or their terminals

-Dopamine depletions within the ventral striatum (aka Nucleus Accumbens) reduce cocaine taking, but similar lesions of other parts of the brain are ineffective

Question 33

Is addiction learning?

Answer 33

Because drugs have unconditioned stimulus properties,
they support learning (Action-outcome)

Question 34

Drug Associated Cues

Answer 34

Pavlovian (stimulus-stimulus) association learning

Question 35

Drug Paired Cues

Answer 35

-Drugs can be the unconditioned stimulus in an stimulus-stimulus association

-Drug associated cues can gain “incentive value” and elicit craving
o Sight of drug and paraphernalia, people with whom drugs are used, places where drugs are used, smell and/or taste of drug

Question 36

Other brain areas involved in addiction

Answer 36

1. Basal Ganglia - learning & memory
2. Prefrontal Cortex - control over behavior
3. Extended Amygdala - reward & motivation

Question 37

Drug paired cues cocaine example

Answer 37

Showing cocaine addiction patients pictures of things that remind them of cocaine (syringes, white powder, etc) dramatically increases blood flow in the amygdala and the anterior cingulate cortex

Question 38

Instrumental Learning

Answer 38

-Because drugs are rewards, they support instrumental learning

-Actions associated with drug intake are reinforced, occurring with increasingly higher probability

Question 39

Non-associative learning

Answer 39

-Tolerance
-Certain aspects of the drug’s effect diminish with repeated intake
-Tolerance to the rewarding effects is a common phenomena (re: DSM diagnosis)

Question 40

Compulsive Habit Formation brain regions

Answer 40

1. Ventromedial Striatum (Nucleus Accumbens)
   -Greater dopamine response in week 1, which then reduces in week 2 and then reduces more in week 3
2. Dorsolateral Striatum (Caudate)
   -No dopamine response in week 1, but we start to see a dopamine response in week 2 and 3 – when drug seeking is becoming habitual