Addiction

Question 1

What percentage of the U.S. are current users of illicit drugs?

Answer 1

~9%

Question 2

What are the 3 components of addiction?

Answer 2

1) Drug use starts out because it is pleasurable and/or helps avoid pain 2) Drug use pursued in such a way that negative consequences follow 3) Drug use persists in the face of negative consequences and the desire to quit

Question 3

What are some signs of substance use disorders?

Answer 3

Maladaptive pattern of drug use for >12 months: Tolerance Withdrawal More use than intended (loss of control) Unsuccessful efforts to quit Significant time spent in procurement, use, recovery Activities (occupational, social etc) given up Continued use in the face of adverse health effects Recurrent interpersonal problems from use Use under dangerous conditions Craving Failure to live up to obligations

Question 4

What is considered a mild substance use disorder?

Answer 4

2-3 patterns => mild

Question 5

What is considered a moderate substance use disorder?

Answer 5

4-5 patterns => moderate

Question 6

What is considered a severe substance use disorder?

Answer 6

6+ => severe

Question 7

Define classical conditioning.

Answer 7

Conditioned stimulus + Unconditioned Stimulus–> Unconditioned Response BECOMES Conditioned stimulus –> Conditioned Response

Question 8

Define operant conditioning.

Answer 8

Operant conditioning reinforces increasing the frequenting of a behavior

Question 9

What are two mechanisms of operant conditioning?

Answer 9

1) Positive reinforcement => the behavior makes a good feeling start 2) Negative reinforcement => the behavior makes a bad feeling stop

Question 10

What is the common theme between natural rewards?

Answer 10

They all act to propagate the species Examples: Eating Drinking (water) Sex Certain behaviors - Nurturing - Aggression

Question 11

Describe the reward circuit (brief).

Answer 11

Question 12

How do addictive drugs affect the reward circuit differently than natural rewards?

Answer 12

Addictive drugs trigger the reward circuit orders of magnitude more powerfully than natural rewards

Question 13

What are the slowest/fastest methods of administration of drugs/substances?

Answer 13

Intrapulmonary>>Intravenous>Intranasal> Oral

Question 14

What makes addiction a disease?

Answer 14

1) It has identifiable symptoms.
2) It has a predictable course.
3) It has a treatment that is as successful as that of many chronic diseases
4) All addictive substances act an one area of the brain (the ventrotegmental tract or reward system)

Question 15

What are the 3 types of relapse?

Answer 15

1) Cue-induced relapse
2) Stress-induced relapse
3) Drug-induced relapse

Question 16

How does cue induced relapse occur?

Answer 16

1) Condition a response to a drug with an association (ie drug plus room with checkered floor)
2) Decondition the response (remove access to drug)
3) Reintroduce the association (room with checkered floor)
4) Drug relapse

Question 17

How does stress induced relapse work?

Answer 17

1) Addiction to the drug (that causes euphoria)
2) Remove drug/remission
3) Give stressor to push need for relief (euphoria)
4) Stress induced relapse

Question 18

How does drug induced relapse occur?

Answer 18

1) Drug addiction
2) Remission/Extinguish access to drug
3) Given similar drug or the drug itself (opiates, cold medicines, etc)
4) Drug induced relapse

Question 19

Describe the effects of full opiod agonists.

Answer 19

• Binds to the receptor and activates the receptor
  - Increasing doses of the drug produces increasing effects until a maximum effect is achieved
• Most abused opioids are full agonists

Question 20

Describe the effects of partial opiod agonists.

Answer 20

• Binds to the receptor and activate the receptor
  - Increasing the dose does NOT lead to as great an effect as does increasing the dose of a full agonist- less of a maximal effect is achieved

Question 21

Describe opiod addiction.

Answer 21

• Tolerance develops quickly (except constipation/gut)
  - Use gets perpetuated by:
   - Positive reinforcement
   - Get euphoria (high)
   - Negative reinforcement
   - Get withdrawal when wears off
   - Withdrawal is pretty unpleasant

Question 22

What is methadone used for?

Answer 22

Methadone is a full opiod agonist and is used to help opioid abusers taper down

—

Question 23

How does methadone treatment work?

Answer 23

• Works on the same receptor (mu opioid receptors) as heroin and other abused opioids
  — - Can use it to maintain people as well
  — - Put on same dose of methadone as heroin
  — - Stops withdrawal
  — - Ratchet up dose to way past how much heroin they used
  — - Price it out of reach
  — - Stops positive and negative reinforcement

Question 24

What is buprenorphine used for?

Answer 24

Buprenorphine is a partial opioid agonist used for prolonged therapeutic effect for opioid dependence treatment

Question 25

How does buprenorphine work?

Answer 25

• High affinity for the mu opioid receptor
  
  • Prevents positive reinforcement
• Competes with other opioids and blocks their effects
  - Slow dissociation from the mu opioid receptor (long half life)
  
  • Prevents negative reinforcement