Addiction II

Question 1

describe the etiology of addiction

Answer 1

1. drugs stimulate the brain’s reward circuitry, either directly or indirectly, signaling the person to repeat the behavior
   
   • reward circuitry:
     
     • dopaminergic pathway
       
       • mesolimbic pathway
       • ventral tegmental area to the nucleus accumbens
2. stimulation of the reward pathway affects functioning of the prefrontal cortex, altering self-control
3. drug use may cause brain changes that result in physical withdrawal symptoms upon drug cessation
   
   • this discomfort may drive relapse
4. repeated drug use decreases the availability of DA
   
   • this is associated with prolonged feelings of anhedonia aka “protracted abstinence syndrome”
5. drug use has been paired with environmental/internal cues; these cues cause physiological changes that trigger drug seeking

Question 2

describe vulnerability to addiction

Answer 2

• genetics: genes account for 40-60% of the vulnerability to addiction
  
  • what is inherited is still unknown; possibly less DA availability
• psychosocial factors (multiple)
  
  • age of first use
  • method of drug administration
  • presence of other mental illnesses

Question 3

explain CAGE questions about alcohol

Answer 3

• C: do you feel the need to CUT back on your drinking?
• A: do you get ANNOYED with others for criticizing your drinking?
• G: do you ever feel GUILTY about drinking?
• E: do you ever need an EYE opener (morning drink)?

yes to ≥ 2 of these is highly suspicious of addiction

Question 4

describe FOY questions in alcohol screening

Answer 4

“Has concern about your drinking behaviors been expressed by your Family, Others, or Yourself?”

yes to this single question is suggestive of addiction

Question 5

describe acceptable drinking limits in men and women

Answer 5

Question 6

describe drug rehabilitation

Answer 6

• in-patient setting
• usually ≥ 90 days (after this time, anhedonia is improved and relapse is less likely)
• recovery continues for a life time
• early intervention is important
  
  • deterrents (e.g. denial, costs, stigma) often treatment by many years
  • successful treatment does occur (even if treatment was legally compelled)

Question 7

describe what the acute phase of drug rehabilitation focuses on

Answer 7

• detoxification (getting person off drugs)
  
  • supervised drug tapering
  • pharmacological management of short-term withdrawal symptoms
• treatment of associated medical problems (e.g. skin ulcers)
• treatment of comorbid psychiatric problems (e.g. depression)

Question 8

decribe the recovery phase of drug rehabilitation

Answer 8

• recovery phase of treatment focsues on preventing relapse
• challenges:
  
  • difficulty reversing habits (and enduring the protracted abstinence syndrome)
  • the Abstinence Violation Effect (AVE)
    
    • relapse causing shame and further non-sobriety
    • avoid AVE by:
      
      • preparing addict for relapse
      • not viewing relapse as sign of failure
      • immediate return to treatment (modified plan)

Question 9

describe CBT in drug rehabilitation

Answer 9

• CBT helps patients learn to recognize, avoid or cope with high-risk relapse situations
• cognitive component:
  
  • emphasize importance of abstinence
  • learn to identify and correct self-defeating thoughts leading to relapse
  • have action plan ready to implement for high-risk situations

Question 10

describe stimulus control, contingency management programs and aversion therapy in drug rehabilitation

Answer 10

• stimulus control: i.e. remove/recondition cues that trigger drug-seeking behavior
• contingency management programs:
  
  • voucher system
  • reports to licensing body/employer after failing to achieve treatment goals
• aversion therapy: emetic (associate cues with nausea) and faradic (associate cues with electric shock)

Question 11

describe self-help groups (patient)

Answer 11

• not formal treatment but therapeutic
• includes inspirational testimony and moral support from others in recovery
• provides a source of impulse control (via sponsors)
• typically uses a 12-step framework
  
  • 1st step = admitting there is a problem
  • 12th step = helping others with their addictions

Question 12

describe medication-assisted therapies

Answer 12

• used as adjunctive treatment:
  
  • to act as substitute for a more harmful drug (replacement therapy)
  • to decrease craving or to block the effect of a drug of abuse
  • for aversion therapy

Question 13

describe vaccinations for drug addiction

Answer 13

• research on vaccines is in progress for cocaine and nicotine addiction
• theory: following vaccination, when a substance of abuse is used, antibodies bind to the drug, making it too large to enter the CNS
  
  • thus, the durg does not have reinforcing effects