Addiction Flashcards
Effects of drugs can be:
Neurophysiological
Behavioural
Emotional
Cognitive
The most rapid route of drug administration is, then..?
Inhalation, intravenous, oral
DSM-5 marks the first presence of the word
Addiction
What are the key features of an addiction?
- Chronic disease of brain reward, motivation, memory & related circuitry
- excessive pursuit of reward (either positive rft and/or negative rft)
- Diminished control
- repeated unsuccessful efforts to reduce or control use
- persistent use despite harmful consequences - Compulsion and craving
- Salience: rewarding qualities of the substance becomes predominant over other interests
- Increased tolerance and withdrawal syndrome on discontinuation
- cycles of relapse and remission common
the Choice Theory of addiction is in contrast to the
Impaired control model
Addiction and _______ often used interchangeably
dependence
What is the difference between physiological dependence and psychological dependence?
Physiological dependence is associated with physical symptoms of tolerance withdrawal
Psychological dependence is associated with cravings/desire leading to repeated (compulsive) use
What is the average age of onset for alcohol dependence?
23-33
What is the average of alcoholics entering treatment?
40
___ of substance users have a comorbid psychiatric disorder?
60%
Patients with mood/anxiety disorder _____ as likely to develop substance disorder, and vice versa
twice
likely that the genetic basis for substance dependence is largely ________, rather than unique to particular substances
non-specific
once sensitised, individuals often show…
cross-sensitisation
Majority of drugs are association with…
the dopaminergic reward system
What is the kitchen sink analogy?
Drugs act like a rubber stopper - stopping the reuptake of dopamine in the neurons
This causes an excess of dopamine in the synapse, this ‘overflow’ causes pleasure and euphoria
The mesolimbic system of the amygdala, nucleus accumbens and hippocampus is associated with…
acute reinforcing effects, memory and conditioning linked to craving, emotional and motivational changes during withdrawal
Arousal and euphoria
The mesocortical system of the PFC, obito-frontal cortex and anterior cingulate is associated with…
conscious experience of intoxication, salience, expectations, craving, inhibitory control/decision-making
Increased inhibition, bad decision-making
Ventricle tegmental area sends dopamine —> __________ —> regulates emotions; _________ —> controls motor functions —> __________, memories formed —-> __________, decision-making and attention
amygdala
nucleus accumbens
hippocampus
prefrontal cortex
eg eating a piece of cake
amygdala: this is delicious, making me happy
nucleus accumbens: pleasure centre activated, making u want to take another bite
hippocampus: remembers experience and context
prefrontal cortex: focus attention on cake, making the decision to take another bite
reward system = reactivated with each bite
Drugs of dependence operate on three areas:
- basal ganglia
- extended amygdala
- prefrontal cortex
1 = reward and formation of habitual use 2 = irritability, anxiety and withdrawal 3 = decision making/control
The four stage cycle of addiction involves
- binge/intoxication
- withdrawal/negative affect
- preoccupation/anticipation
- –> - craving/compulsive usage
What is incentive salience via conditioning?
With repeated use, there is increased salience for using that particular substance
- taking priority over other natural rewards, social activities
What happens when you take the drug away?
A state of depletion in the dopamine system; an aversive state, experienced with physical symptoms of withdrawal —> motivates individuals to continue taking the drug
Withdrawal —> ______ reinforcement
negative
How do neurotransmitters change in addiction?
compensate for excess dopamine - dopamine dysregulation
What is the violation effect?
person is abstinent for a long period of time, but then is exposed to stress (which they have in the past associated with usage) leading to relapse (negative reinforcement)
- reward memory in hippocampus
What are the different phases in learning theories of addiction?
Acquisition (experimental/circumstantial drug use —> casual drug use)
Motivational phase - compulsive drug use - motivation to use increases
—->Addiction
Opponent-process theory
A-process =
B-process =
A = euphoria from drugs B = bring back to homeostasis
With repeated usage, the ___-process becomes stronger, which results in _________ and requires ______
B
tolerance
increasing dosage of drug (A) to make it the same response as you previously had
Prolonged abstinence can ________ b-process. Once b-process returns to normal, addiction _______.
decay
ceases
How does antabuse work to treat alcohol addiction?
If you drink you become violently ill - lose positive association (counter-conditioning)
What are the targets of CBT?
- maladaptive behaviour patterns
- motivational and cognitive barriers to change
- skills deficits (eg improve capacity to say no thanks to alcohol)
- identify high risk situations (eg people, places, internal cues)
- reduce likelihood these situations are encountered
- rehearsing non-drug alternatives to cues
- enhance motivation for alternative activities
- target cognitions that enhance likelihood of drug use
- emotion regulation
- non-drug alternatives to reducing negative affect (social support)
What are the common barriers to effective treatment?
- psychiatric comorbidity
- acute or chronic cognitive deficits
- medical problems
- social stressors
- lack of social resources
90% of gambling disorder patients started gambling before the age of…
20
In DSM-IV, gambling was classified as an
Impulse control disorder (ICD)
Which sub-criterions in gambling disorder correlate with
- psychological dependence
- tolerance
- withdrawal
- negative reinforcement & motivation
- erroneous and distorted cognitions
- impaired control
- preoccupation
- increased amount gambled
- irritability/restlessness after cessation
- escape from stress
- chasing losses
- repeated failure to cease
2/3 of pathological gamblers experience _______ prior to developing problems
large wins
The cognitive model of gambling assumes
__________ beliefs and misunderstanding concepts of __________ and mutual independence of chance events contributes to overinflated estimates of winning
erroneous
probability
What is cognitive regret?
Gamblers persist to avoid the pain of missing a win
- like walking away from a bus stop
What is the gambler’s fallacy?
after a losing streak, a win is due - assume that there is memory involved in the machine
- assume that law of averages applies to a small window
The integrated bio-psycho-social model of gambling show multiple interactive vulnerability factors, that being
- neurobiological / genetic
- family history
- belief schemas
- peer group interactions
- coping strategies
- personality traits
The random ratio reinforcement schedule is highly resistant to…
extinction
Are the same brain regions activated in gambling and substance misuse?
yes
Pathway one of gamblers:
Symptoms are causal outcomes of gambling-related problems: amenable to ____________, ___________ and _____________
psychoeducation, brief interventions and brief CBT
Pathway two of gamblers:
____________, ___________ and ____________ contribute to gambling (dissociation and escape)
affective disturbances
poor coping skills
substance misuse
Pathway three of gamblers:
Deficits in ____________ and ________: treated with _________ and __________ interventions
reward pathways (dopaminergic), impulsive psychopharmacology, intensive
Pathway 2 gamblers prolong their sessions in order to…
allow continued emotional escape
Pathway 3 gamblers often show a history of..
family instability, abuse/neglect
In the Inhibition Dysregulation Theory (2004), parts of the frontal region of the brain such as the _____ and _________ are thought to compromise the _________ system. Impairment of the ______ system results from compulsive drug-taking as well as other compulsive behaviours.
obito-frontal cortex
anterior cingulate cortex
inhibitory
Medications for substance use disorders serve which three purposes?
- antagonist drugs can be used to black the rewarding effects of the substance
- — eg naltrexone for alcohol - agonist medication can be used as a substitute for the abused substance in order to reduce the harms associated with substance misuse (eg methadone for heroin)
- medication may be used to reduce severity of withdrawal symptoms
- nicotine patches
Females report gambling predominantly as a means to deal with _____, in contrast to males who report being motivated by factors related to ___.
negative emotional states
winning, excitement, chasing losses
It has been proposed that the same _________ pathway underlying substance dependence is also relevant for behavioural addictions such as gambling.
neurobiological
Decreased serotonergic activity has been consistently related to the personality traits of ________ and ____________.
impulsivity
sensation seeking
Severity of gambling-related problems was significantly correlated to _________.
impulsivity
The majority (80%-90%) of pathological gamblers have at least one..
personality disorder.
m,≤The _____ and ________ schedules of reinforcement associated with gambling are known to produce behaviours that are highly resistant to ______.
intermittent, variable
extinction
What is illusion of control?
Belief and over-magnification of one’s skills and ability to influence or predict the outcome of an event.
What is gambler’s fallacy?
A series of losses must be followed by a win
What is biased evaluation?
Successful outcomes are attributed to one’s skill; losses are discounted as due to unforeseen external reasons.
What is selective recall?
Selectively recalling wins and forgetting losses
What is gambling as a source?
The belief that one can win at gambling - over the long term one can come out ahead
What is illusory correlations?
misinterpretation of a correlation between mutually independent events
Pathway 3 refers to ‘biologically based problem gamblers’ with ________ dysfunctions that result in high levels of _________ and differential responses to _______ and ___________.
neurochemical
impulsivity
reward
punishment
