Addiction Flashcards
1
Q
What are addiction disorders/dependency syndromes?
A
- Addiction disorders/dependence syndromes are a cluster of physiological, behavioural, and cognitive phenomena
- Characterised by use of psychoactive drugs, alcohol, or tobacco
- Takes higher priority above other behaviours of previously greater value (WHO, 1964)
- Significantly increases risk of physical and mental health comorbidities and suicide
2
Q
Describe the aetiology of substance dependence from a psychological aspect
A
- Relates to classical conditioning and memory
- Described as a learnt behaviour originating from the memory of an event that is often highly emotional and troubling (such as stress or bereavement) (Prados, 2018)
- Maladaptive behaviours develop to avoid the fear and anxiety when retrieving these memories
- Creates a rewarding effect that perpetuates them
3
Q
Outline some of the diagnostic criteria (ICD-10, 1992) for dependence syndrome
A
- Strong desire/compulsion to take the substance
- Difficulties in controlling substance-taking behaviour
- Withdrawal symptoms
- Neglect of other alternative activities
- Persistent use despite evident harm
- Tolerance
4
Q
Using the example of smoking, describe how addiction learning occurs
A
- Using example of tobacco dependence originating from work stress
- Cigarette smoking is the unconditioned stimulus (US)
- Stress relief due to nicotine as the unconditioned response (UR)
- Over repeated exposure to smoking whilst on break, the smoking becomes associated with the break via classical conditioning
- Break is now a conditioned stimulus (CS)
- Overtime it becomes sufficient to generate a conditioned response (CR) of cravings or withdrawal, in the absence of smoking (US)
5
Q
Discuss how the conditioned response (CR) develops
A
- CR is produces as a consequence of psychological acquired tolerance
- With successive exposure to a substance, the body pre-emptively counteracts (CR) the unconditioned response
- In an attempt to maintain homeostasis when the substance is taken
- This has been demonstrated in animal models (Lubkov & Zilove, 1937; Siegel, 1975)
- If no substance-taking occurs, this CR is not corrected
- Resulting in the body generating drug-seeking behaviours
6
Q
What is a craving? Discuss how they explain a number of symptoms of addiction
A
- Craving is the memory of the positively rewarding effects of a substance (Wise, 1998), created in the first instance of substance taking
- One of the most frequent causes of relapse
- Emotional arousal plays an important role in memory retrieval
- Emotional congruence is the tendency to recall memories that share the current experienced affect
- High emotionally arousing memory are recalled more easily and vivdly (Lane et al, 2015)
- Combined, this creates an emotional bias within memory
- The often-traumatic circumstances in which substance-taking begins, means that cravings are especially prone to recollection, with neutral or negative aspects of memory being forgotten
- Potency of cravings helps to explain why compulsion, loss of control, persistent use, and neglect in other areas occurs
7
Q
Outline the role conditioning plays in substance dependence
A
- Substance dependence results from the creation and reinforcement of drug-seeking behaviours due to a combination of classical conditioning (described above) and operant conditioning
- Succumbing to cravings (CR) is postively reinforced with stress relief (UR) and alleviation of withdrawal
- Negatively reinforced as this prevents withdrawal-like symptoms
- Abstinence is punished with withdrawal-like symptoms (CR) and loss of desired stress relief (UR)
- Cravings are one of the most frequent causes of relapse
8
Q
Discuss cue-exposure therapy
A
- Novel approach to treating dependence syndrome
- Based on theory of memory extinction
- Previous views stated that extinction caused deletion of original conditioning; more recent animal studies suggest it creates a new association of CR to no-reward, which overrides the original conditioning (Conklin & Tiffany, 2002)
- Key difference: original association is maintained in the latter
- New association results in a diminished impact and recollection of craving, subsequently reducing compulsions
9
Q
Discuss the evidence of effect for cue-exposure therapy
A
- Although theoretically promising, a review of 18 studies with meta-analysis of 9 failed to show a significant overall effect size for cue-exposure treatments (Conklin & Tiffany, 2002)
- Interestly, this finding was not considered surprising; practitioners of cue-exposure therapy note there has been little empirical evidence for its effectiveness
10
Q
Outline the barriers to practical use of cue-exposure therapy
A
- A key underlying difficulty is the retention and recollection of the original conditioning
- Renewal effect is one example of problematic recollection
- Reinstatement
11
Q
Describe the renewal effect
A
- The renewal effect is one example of problematic recollection
- The difference in context between the original conditioning and that of cue-exposure therapy provides two distinct pathways following re-exposure to a cue
- Context A: smoking and stress relief in workplace
- Context B: cue-exposure therapy in clinical setting
- This creates instances where the new learnt association that “cures their addicition” is only seen in Context B
- Upon return to context A, more likely to recall original cravings and relapse
- Additionally, introduction to a new context C also results in relapse (Conklin & Tiffany, 2002)
- Bouton (1994) summarises that conditioning is generalisable, but extinction appear to be largely-context dependent
12
Q
Suggest how cue-exposure therapy can be improved to overcome the renewal effect
A
- Provide cue-exposure therapy across multiple contexts to improve its generalisability
- This is supported by animal studies such as Gunther et al, 1998
- There have been suggests that the number of contexts for therapy must exceed the number of addiciton contexts (Chelonis et al, 1999)
- However, this may be impossible in addictions such as tobacco dependence
- Further research is required to determine the minimum necessary number of contexts (Conklin & Tiffany, 2002)
13
Q
Describe the reinstatement effect
A
- Reinstatement effect is a similar problem as the renewal effect
- Responses to a previously extinguished CS reappear upon exposure to a US (Conklin & Tiffany, 2002)
- This is largely context dependent
- Demonstrated in animal models (de Wit & Stewart, 1981)
- Particularly troubling for widely available and socially acceptable substances (alcohol and tobacco) as it is impossible to completely avoid exposure (for example, second hand smoking or lapses)
14
Q
Discuss improvements to cue-exposure therapy to overcome reinstatement
A
- Research has shown that initial lapses do not immediately cause re-addiction (Monti et al, 1993)
- Attenuation may be achieved by exposure to context alone after a lapse without providing the reward once again
- This minimises the likelihood of continued use after the lapse
- Those able to cope and return to abstinence may become less prone to future reinstatement (Conklin & Tiffany, 2002)
15
Q
Discuss the potential for combination therapy in addiction treatment
A
- Perhaps the way to improve cue-exposure therapy is through utilisation as part of combined pyschotherapy
- It has been suggested the duration of exposure to a conditioned stimulus determines if extinction occurs
- Prolonged or repeated exposure activates extinction learning
- Brief exposure leads to reconsolidation of memory (Torregrossa & Taylor, 2012)
- Reconsolidation therapy aims to alter the original memory/conditioning behind addiction
- Through interference with a memory’s labile nature in the early periods of memory creation (Lane et al, 2015)
- Unlike, cue-exposure therapy, there is significant empirical evidence in animals and humans for the use of propranolol to trigger memory alteration by reconsolidation (Nadel et al, 2000; Xue et al, 2017)
- Applauded for relevance to PTSD (Kimbrel et al, 2015) which shares a common pathway with addiciton stemming from a single traumatic event
