Addiction is a brain disease, and it matters & Drug addiction as incentive sensitization

Question 1

Over the past decades, there has been an advance in our understanding of drug abuse and addiction, especially in the brain. However, the application in practice or public policy settings lags behind.

Answer 1

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Question 2

focus on practice and policy: wat is het nu en wat zou het moeten zijn?

Answer 2

Often, clinical and policy focus is on the wrong aspects of addiction: namely on withdrawal symptoms.
The assumptions is often that the more dramatic the withdrawal symptoms, the more serious or dangerous the drug must be. This assumption is outdated: many of the most addicting and dangerous drugs (crack cocaine, methamphetamine) do not produce severe physical withdrawal.

-> The focus should instead be on compulsive drug seeking and use.

Question 3

argumenten voor addiction as a brain disease

Answer 3

• Although each drug has a different mechanism of action, all drugs of abuse have common effects (either directly or indirectly) on the mesolimbic reward system.
• Prolonged drug use causes pervasive changes in brain function that persist long after the individual stops taking the drug.

-> Addiction can be seen as a brain disease, and treatment must focus on that.

Question 4

addiction as more than a brain disease (argumenten en conclusie)

Answer 4

Of course, addiction is not just a brain disease. Social contexts in which it develops and is expressed are also very important: exposure to conditioned cues can have a major influence on persistence or recurrence of drug cravings and relapses.

-> Treatment for addiction should include biological, behavioral, and social-context elements.

Question 5

addiction as a chronic disorder: argumenten en conclusie

Answer 5

Addiction is rarely an acute illness. Rather, it is chronic and includes relapses. Total abstinence for the rest of one’s life is relatively rare.

-> Treatment is used to manage the illness, not as a cure.

Question 6

Incentive-sensitization theory =

Answer 6

the idea that the core feature of addiction is pathological motivation for drugs (wanting/craving), together with impaired cognitive control, which results from incentive sensitization.

Sensitization is associated with an increase in the ability of drugs to elevate dopamine activity in the brain.

Question 7

Incentive sensitization =

Answer 7

the sensitization of mesolimbic brain systems that mediate the incentive motivational effects of drugs rewards and drug cues, resulting in attentional bias towards these cues.

Question 8

sensitization=

Answer 8

Sensitisatie, sensitivering of sensibilisering is een vorm van niet-associatief leren waarbij een versterking van een reflex op prikkels plaatsvindt.

Question 9

incentive stimulus =

Answer 9

a stimulus that has been attributed with incentive salience: it is difficult to avoid noticing.
The incentive salience of drug-associated stimuli increases in substance abuse.

Question 10

Liking en wanting: relatie in rewards

Answer 10

in natural rewards: liking and wanting go hand in hand.
in drugs use: prolonged use leads to a decrease in liking, but an increase in wanting/craving.

Question 11

hoe komt het volgens de incentive sensitization theory dat drug use tot een decrease in liking en een increase in wanting leidt

Answer 11

repeated drug use sensitizes only the neural systems that mediate motivational processes of incentive salience (wanting) and not the neural systems that mediate the pleasurable efect of drugs (liking). thus, with prolonged use, the dissociation between wanting and liking gets progressively greater.

Question 12

2 types of wanting

Answer 12

• cognitive wanting: a conscious, explicit desire for a specific reward
• incentive salience “wanting”: a cue-triggered wanting that does not involve specific goals or rewards that one is aware of

Question 13

dus wanting can ook optreden buiten conscious awareness, wat betekent dat

Answer 13

one can cognitively want to abstain from drugs, but still be seized by a sudden, intense, cue-triggered wanting for drugs. when this incentive salience wanting is strong enough, it cacn take on compulsive properties, overruling the cognitive wanting.

Question 14

susceptibility is based on…

Answer 14

• general factors (genetics, hormones, gender differences, previous drug experiences, previous major stressful life events)
• drug specific factors: type of drug, dosage (high=more sensitization), duration of use (repeated but intermittent use = more sensitization) and route of administration

Question 15

withdrawal-based theory =

Answer 15

traditional view (heet ook wel opponent-processes theory)

= the idea that drugs are taken initially because of pleasant effect (positive reinforcement) but that repeated drug use results from trying to avoid unpleasant withdrawal symptoms (negative reinforcement)

Question 16

kritiek withdrawal-based theory

Answer 16

neither withdrawal symptoms nor conditioned withdrawal feelings (in response to drug-associated cues) seem to sufficiently explain relapse. there are often cases of relapse into drug taking long after these withdrawal symptoms have subsided.

Question 17

aberrant learning theory=

Answer 17

the idea that drugs alter learning processes, promoting abnormal learning, which causes the transition to addiction. it is suggested that compulsivity in addiction arises because drugs facilitate the learning of automatic stimulus-response S-R habits which confer compulsivity into actual behavior.

Question 18

kritiek abberant learning theory

Answer 18

• automatic habits are not intrusive, they appear only when there is no countervailing purpose to act otherwise, which is not the case in addiction (one often does not want to continue drug use and also does not accidentally take drugs)
• repetition alone cannot make an action compulsive, this requires something motivational
• addicts do what they have to do to get drugs, even if actions are routes that have never been performed are required.