addiction Flashcards
historical definition of addiction
- addicere
- “to bind”
- latin term for enslavement
19th century definition for addiction
- “inebriety”
- Alcohol Use Disorder
main ideas for addiction
Jellinek - 1960
- addiction is a disease
- predisposition (genetic;biological)
- considered a permanaent condition
- not caused by any given drug, but merely activated
- loss of control over use
- drugs produce uncontrollable cravings which lead necessarily to uncontrollably use
- progression through stages
addiction theories
later
- emphasis on the importance of drug exposure rather then predisposition
exposure theories
addiction
- addiction by repeated exposure to the drug alone
- extended exposire to a drug causes changes in brain or biochem mechanisms that make drug use highly compulsive
modern casual definition
addiction
- something so fun you don’t want to stop
- used for commercial for things like food or gaming
modern medical definition on addiction
- chronic relapse disorder
- compulsion to seek and take drugs
- loss of control in limiting intake
- emergence of a -‘ve emotional state when access to the drug is prevented
DSM-5
impaired control - addiction
- greater amounts being used for a longer time than intended
- multiple (unsuccessful) attempts at cutting back
- a lot of time and effort will go into getting, using, and recovering from the substance
- cravings
DSM-5
social impacts - addiction
- the drug is getting in the way of important responsibilities
- the person uses the drug dispiet the -‘ve impact on relationships
- spending more time using the drug then having time with ppl, work, leisure, ect
DMS-5
risky use - addiction
- repeated use despite -‘ve physical effects
- knowledge of -‘ve physical effects and they still use it
DMS-5
drug effects - addiction
- tolerance us rising and the person is using more of the drug
- withdrawal of the drug
what does DMS-4 have that DMS-5 doesn’t have
addiction
- legal problems as an imporant diagnostic element of addiction
DSM-5
severity - addiction
- mild = 2-3
- moderate = 4-5
- severe = 6-11
important distinction
addiction
- substance use disorder =/= substance-induced disorder
- remission =/= recovered
- addiction =/= overdose
- addict =/= a person experiencing SUD
- addiction =/= drug use
gambling disorder
- not a drug
- can not affect a person like alc or a drug
- it can trigger similar effects like a drug
ICD-11
gaming disorder
- persistent or recuurent gaming behaviour
- impaired control over gaming
- increasing priority over gaming
- gaming, even with -‘ve consequences
- can be continuous or episodic
- impairment in functioning
- happens over 12 months for a diagnosis
how addiction develops
modern theories - incentive sensitization theory
- mesolimbic dopamine system have incentive salience (noticed and motivate behaviour)
- drugs activate and sensitize it over time
- repeated use causes neutral stim paired with drug use to have value in the stim
addiction development
modern theories - hedonic dysregulation theory
- repeated drug use has a shift in balance between reward and antireward
- reward: +’ve reinforcement and controls happiness and pleasure (A process)
- antireward: -‘ve hedonic balance that limits sensation of reward through dysphoria and stress (B process)
- repeated use causes A process to become dysfunctional and B process strengthened
- Allostasis trys to find a balance, but the body keeps shifting
- changes in the set point means they have to take larger and larger dose for the same euphoric feeling
addiction development
modern theories - the brain disease model
- more influential model
- control dimishes over time
- 3 stage effect: 1. take a bunch of the drug and feel the effect, 2. effect wears off and feel the withdrawal, 3. withdrawal wears off and anticipating when to use it next
- do this several times and feel less in control over it
- goes from liking the drug to wanting the drug
addiction development
modern theories - the biopsychosocial model
- bio/genetic, psyo, and sociocultural factors contribute to substance use and all must be taken into consideration in prevention and treatment efforts
- bio - drug effect, genetic predisposition
- psyo - personality, associative learning, self-efficacy
- social - culture, family, peer and partner influences
treatment of addiction
detoxification
- medically-managed withdrawal from drug use
- 1st stage treatment
- addresses bio, but not psyo, behavioural, or social issues related to drug use
treatment of addiction
outpatient treatment
- less costly
- focus on tools and strategies to maintain abstinence
treatment of addiction
inpatient treatment
- short term: brief (3-6 weeks) residency in hospital, followed by outpatient care and participation in self-help group
- long term: long (6-12 months) residency in hospital, aims to correct harmful beliefs, self concepts, and behaviour patterns, moving towards resocialization and return to the community
treatment of addiction
behavioural
- 12 step programs (ex. AA, NA, GA) (most common)
- CBT (cognitive behavioural therapy) (thoughts and behaviours) (learn to identify harmful thought and behaviour problems) (increase self control)
- motivational enhancement therapy (EMT) (conflicts with treatments) (motivational interviewing, a persons interests and desires)
- couples therapy (supports person experiencing addiction) (show up to treatment and stick to it)
treatment of addiction
pharma
- substitution therapies and medically-managed withdrawal (ex. patches) (transdermal, very slow absorbtion, reduces cravings)
- reward patches (ex. naltrexone) (similar to naloxzone but long release)
- craving reduction (acamprostate) (alters receptor of glutamade receptor gene with alc )(tries to specifically target and reduce craving)
- treating comorbid conditions (2 diagnosable conditions at 1, very likely for those with addiction) (treating 1 can sig improve the other)
classical conditioning of tolerance
on test day
- all rats given a dangerously high dose of heroin
- dependent measure: rate of mortality due to the high dose of heroin
classical conditioning of withdrawal explains drug craving
- withdrawal is intensified in the presence of stim that usually signal drug is coming (B process alone)
- exposure to enviromental cues while drug abstinent can trigger withdrawal symptoms (increases risk to relapse into addiction and/or dependence)
- conditioning effects will only dissipate through repeated extinction learning (CS paired with no drug)
how do we know some drugs are addictive
self administration studies
- in the drug self administration model, animals are required to elicit a response (Such as a lever press) in order to obtain drug
- many lever presses = drug desire = higher abuse potential = more addictive
- fewer lever presses = no drug desire = lower abuse potential = less addictive
- all familiar drugs of abuse (and more) see increased responding on self administered studies
how do we know some drugs are addictive
neuroimaging of mesolimbic DA pathway
- increase activity
how do we know some drugs are addictive
epidemiological studies of drugs capture rate
- ask ppl about experience with drugs
- capture rate (% of users of any drug who report being dependent on that drug at some point)
- self report study = correlational
how do we know some drugs are addictive
case study and 1st hand accounts
- carl fisher - developed, recovered, and wrote about the experience
recreational drug use
conceptualizing addiction
- for pleasure/excitement
- to socialize
- to escape -‘ve feelings/symptoms (self medication)
- starts with this
- risky behaviour
- don’t want to use a drug as a medicine
- toxic side effects
medical use
conceptualizing addiction
- can start with this
- some prescription medications can be habit-forming if not carefully monitored
traits vulnerable for substance use disorder
conceptualizing addiction
- genetic factors
- demographic factors (young adulthood) (brain still developing until ~25) (low in executive control)
- personality factors (impulsive, compulsive, sensation-seeking, risk taking)
comorbid mental disorders
conceptualizing addiction
- addiction often doesn’t occur by itself
- anxiety disorders, depression, bipolar disorder
- ADHD
- schizophrenia, psychosis
- personality disorders (borderline and ASPD)
- other SUDs or gambling disorder
symptom check
- increasing amounts and/or time spent using drug
- unsuccessful attempts to quit
- substantial time spent acquiring and using drug
- cravings
- drug use interferes with responsibilities
- continuing use despite -‘ve consequences
- neglecting other spheres of life
- drug use despitr dangerous situations
- drug use despite health problems
- tolerance to increasing amounts
- withdrawal upon abstinece from drug use
neurophysiological processes
addiction formation
- habit forming
- the response is stim-driven, and unaffected by outcome/reward
- habit becomes stim driven
- outcome becomes devalued
escalating frequency of drug use
addiction formation
- -‘ve health effects become more severe and harder to ignore (likely to see toxic health effects)
- tolerance and withdrawal symptoms may become obvious
- learned associations strengthen
- a drug habit begins to form
neurophysiological processes
addiction formation
- habit and reward
- shifting activity from ventral striatum (less activity) to dorsal striatum (more activity, where habit exists)
neurophysiological processes
addiction maintenance
- neuroadaptation to high drug presence in body
withdrawal and early attempts to quit
addiction maintaince - neurophysiological processes
- B process longer and stronger
- A is offset
cue-reactive craving
addiction maintaince - neurophysiological processes
- classical conditioning
- pavlov instrumental transfer
- anytime conditional stimuli exert motivational influence over instrumental performance
- still press a lever operant response
- activates previous classical conditioning
- affects motivation and behaviour in an operant task
- Transfer (CS-baseline) helps understand relapse
externalities
addiction maintaince - neurophysiological processes
- highest point of addiction
- mounting health problems
- drug effects only seen at high doses
- overdose injury
spontaneous remission - vietnam war cohort
addiction remission
- follows some gorup of ppl over long period of time
- drafted by the war
- high drug use back to the US, quit drug use without treatment
- no withdrawal - cold turkey
- enviroment change - no ques, setting (easier to quit)
goal
addiction remission
- to maintain abstinence
- reduce use below problematic level
treatment could include
addiction remission
- inpatient
- outpatient
- community support
- medically managed withdrawal
- other pharmacotherapies
- success = total stop of drug or not problemaric or distressing anymore
relapse
addiction remission
- natural
- reinstatement of substance use following abstinence
- addiction symptoms may return as well
- average # of relapses at rehab intake: 1.92 +/- 2.40 (hard to determine)
- chronically relapsing condition
full remission - the relapse prevention model
addiction remission
the 5 rules of recovery
1. change your life so that its easier to not use
2. ask for help and develop a recover circle (self help group and substance abuse program)
3. be completely honest with urself and everyone in ur recovery circle (no hiding addiction)
4. practive self care
5. dont bend the rules or try to negotiate ur recovery (dont resist or sabatoge recovery)
