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Medicine in Society > Addictive behaviour > Flashcards

Addictive behaviour Flashcards

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1
Q

What is addiction?

A

Any substance use or reinforcing behaviour that

  • has an appetitive nature
  • has a compulsive and repetitive quality
  • is self-destructive
  • is experienced as difficult to modify or stop
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2
Q

How many people develop addictions?

A

1 in 20 people - often develop addiction to more than one thing

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3
Q

Define: misuse

A

use of a drug other than directed

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4
Q

Define: harmful use

A

use resulting in problems at work/home or legal problems
use in risky situations (e.g. driving)
Continued use despite adverse consequences

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5
Q

Define: dependence

A

tolerance = physiological adaptation of the body to consumption of large amounts of alcohol - brain adapts and down-regulates receptor systems
withdrawal = stopping drinking, causes the body to be out of kilter due to downregulation of receptor systems leading to the hangover effects
relief usage = because you have the craving and you have withdrawal symptoms you tend to want to drink during the day
compulsion = sense of being driven to drink even though you dont need to - strong urge or craving
stereotyped pattern = lose the subtle nuanced way of drinking alcohol - basically drink what gets as much alcohol into the system as quickly as possible
salience of substance use = constant craving and drive and unpleasant symptoms if you don’t, means you stop worrying about other things in your life e.g. work

Closest to addiction

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6
Q

What is the ICD-10 definition of dependence?

A

A strong desire or compulsion to take a substance
Difficulties in controlling substance taking behaviour
Physiological withdrawal state when the substance is reduced
Evidence of tolerance
Progressive neglect of alternative interests
Persistent use despite clear evidence of harm

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7
Q

What is the most common substance people get addicted to?

A

Alcohol

There are likely to be a lot of people below the iceberg in terms of alcohol consumption but they are on their way to dependence

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8
Q

At what point do you start changing the way you treat people?

A

once you cross the line from harmful use to dependence is when you start changing the way you treat a person

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9
Q

What are the symptoms after stopping drink between 3-12 hours?

A

weakness and faintness
insomnia
tremor
sweating

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10
Q

What are the symptoms after stopping drink between 8-48 hours?

A

Illusions and fleeting hallucination
seizures
cardiac dysrhythmias

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11
Q

What are the symptoms after stopping drink between >72 hours (delirium tremens)?

A 
gross tremor
tachycardia
sweating and raised temperature 
insomnia 
agitation and restlessness 
confusion and disorientation 
delusions and hallucinations
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12
Q

How is the economy and alcohol consumption linked?

A

consumption is linked to how well the economy is doing

- affordability of alcohol is linked to consumption - increase in alcohol cost = decrease in consumption

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13
Q

What is one unit of alcohol?

A

8g of pure ethanol

%ABV - a litre of that drink would be how many units you’ve drunk

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14
Q

What is binge drinking?

A

if you drink twice the daily recommended limit - based more on epidemiological findings and accidents

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15
Q

What is the publics perception of alcohol risk?

A

Most people are unaware that they are drinking above the lower-risk guidelines
Many do not see drinking above the lower-risk guidelines as a problem
Many aware that alcohol caused liver problems but few are aware it contributes to cancer

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16
Q

What are the health conditions does alcohol increase risk of?

A 
Hypertension - men(4x) and women (2x)
Stroke - men (x2) and women (x4)
CHD 
Pancreatitis
liver disease - 13x
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17
Q

What are the different models for understanding addiction?

A 
social/environmental 
Coping/social learning 
conditioning/reinforcement behavioural
biological/genetic
an integrated biopsychosocial model
18
Q

What is the social/environmental model?

A

Availability of illegal drugs…

  • drug dealing is a business - subject to supply and demand
  • droughts and floods can occur naturally or deliberately
  • trends, fashions, new technology
  • impact of legislation and the success of supply reduction initiatives = countries boundaries, resources available for enforcement /customs priorities
19
Q

How does culture influence alcohol habits?

A

Mediterranean vs northern europe
Med = wine based, wine is part of the diet, drunk with meals, strong information sanctions against public drunkeness
Northern = beer based, less frequent, social activity, drinking an end in itself, public drunkeness is the biggest issue

This model is slightly breaking down because of globalisation - nowadays all the brewers have been brought up by a few larger companies and therefore they are sold across the globe

20
Q

How does socioeconomic status affect alcohol consumption?

A

low socioeconomic status
- living in poor and stressful neighbourhoods
- drug salient mileu - more drug users and drug using social networks
- neighbourhood social disorganization - lack of cooperation of local residents towards common goals and higher rates of gang activity
experiences of discrimination in ethnic minorities

Alcohol harm paradox - people in lower groups appear to suffer far more harm compared to those in higher groups drinking similar amounts

21
Q

How is occupation linked to alcohol consumption?

A

High work demand and low control over work induces greater stress and predicts higher rates of substance use disorders among employees

  • availability of alcohol at work
  • frequent absence from home
  • lack of supervision
  • long and irregular working hours
  • very high or very low income
  • social pressure to drink at work
  • social isolation
  • very high stresses or hazards in the workplace
22
Q

What models come under coping/social learning models?

A

Social control theory
Behavioural economics
Stress and coping theory
Social learning theory

23
Q

What is the social control theory?

A

strong bonds with family, friends, work, religion etc motivate individuals to engage in responsible behaviour and refrain from substance use / other deviant pursuits

  • monitoring or supervision
  • directing behaviour towards acceptable goals/pursuits

Main cause of weak attachments to social standards is inadequate monitoring/shaping of behaviour

  • families lack cohesion and structure
  • friends who promote deviant values and engage in disruptive behaviour
  • lack of supervision and vigilance in school/work
24
Q

What is the behavioural economics theory?

A

Focuses on involvement in protective activities
The key element of the social context is the alternative rewards provided by other activities
Rewards protect from exposure or opportunity to use, and from escalating or maintaining use
Choice of one rewarding depends in part on lack of effective access to alternative rewards through involvement in school and work pursuits, religious engagement and participation in physical activity

25
Q

What is the stress and coping theory?

A

stressful life circumstances lead to distress and alienation and eventually substance misuse

Stressors are most likely to impel substance use among individuals that lack confidence and coping skills and who try to avoid facing problematic situations and escape from experiencing distress and alienation

26
Q

What is the social learning theory?

A

Substance originates in the substance-specific attitudes and behaviours of the adults and peers who serve as an individuals role model
Observation and imitation of substance specific behaviours - social reinforcement for and expectation of positive consequences from use

27
Q

What is the snowball effect?

A

if a mother smokes cigarettes during pregnancy it can impede foetal and early development which can lead to cognitive deficits and poor school adjustments leading to social aggression with other poor school achieving youths

28
Q

What is the moral model?

A

Predominated until 19th century
Ascribes aetiology to personal responsibility or sin
Treatment tended to concentrate on punishment or on “saving” the person by religious conversion

29
Q

What is the temperance model?

A

Alcohol itself is the cause of alcoholism and society is responsible for allowing alcohol to be available

30
Q

What is the medical model?

A

drinker is seen as victim suffering from disease

31
Q

Why is addiction known as a compulsive behaviour?

A

behavioural syndrome including dyscontrol, salience and neuroadaptation and compulsive behaviour

Normal flexibility of human behaviour guided by neocortex is eroded to a dehumanised state of compulsive behaviour

Mediated by a compulsive circuit - nucleus accumbens, ventral pallidum, thalamus, orbitofrontal cortex

32
Q

What appears to be lower in addiction in the brain ?

A

DA2 receptors

33
Q

What is compulsive drug seeking initiated by?

A

Initiated outside of consciousness

  • cues are registered and acted upon by evolutionary primitive regions of the brain before consciousness occurs
  • decision making occurs without conscious initiation
34
Q

If compulsive behaviour is initiated outside of consciousness, do people exercise free will to use drugs?

A

Free won’t = is half a second behind the “decision” as there is a delay required to crank up consciousness in response to cues
This process is exaggerated in people with addiction
- initiation of drug seeking behaviour is engaging a well-worn pattern of learned compulsive behaviour
- the ability to alter course when anticipated negative consequences are finally realised is over-ridden

35
Q

What is different in a addictive person’s brain circuitry compared to someone who’s not addicted?

A

Excessive drive - through development of conditioned craving

Bad brakes - through failure to learn effective coping and emotional regulation strategies or to seek rewards that are incompatible with drug use
Pre-existing or substance induced impairment of impulse control/emotion regulation regions of the brain

36
Q

How do genetics effect alcohol effects?

A

level of consumption of alcohol
- subjective effects less in alcohol dependent
- protective flushing effect of alcohol
Vulnerability to complications of alcohol consumption
- social and psychological
- end organ damage
Vulnerability to physical dependence to alcohol
- increase in calcium channels

37
Q

What are the genetic variations in metabolism of alcohol?

A

variation in metabolising enzymes

  • aldehyde dehydrogenase
  • polymorphisms at the ALDH2 gene
  • 50% of asians have the ALDH2*2= decreased elimination of acetaldehyde and flushing response
38
Q

What is genetic predisposition with alcoholism?

A

alcohol misuse in family is up to 50% having an affected first degree relative
genetic component in aetiology of alcohol misuse but there is wide individual variation

39
Q

What strategies are use to improve bad brakes ?

A

Achieve better control
Interrupt and change learned pathways
Altering reinforcing aspects of abused substances
Strengthening countervailing reinforcers

40
Q

What are some effective psychosocial treatment interventions?

A

Motivational interviewing
Contingency management - provide incentive
CBT - fosters executive control
Family therapy models - alternative rewards through re-engagement with fam

41
Q

Can drive be reduced?

A

Substance abuse associate with neuroadaptation is at least partially reversible - any treatment can foster abstinence can provide brain with some time to recover
reduced frequency of craving
De-conditioning of cue-induced craving
Most agonist therapies have their primary impact on drive reduction
- methadone, diazepam
- craving reduces = acamprosate
- antagonists - naltrexone

Work best when combined

42
Q

What are conditioning principles and treatment

A

CUE EXPOSURE: reduce the strength of drug-related conditioned stimuli through classical extinction (repeated presentation of the CS not followed by drug admin)

Counter-conditioning - pair other responses with same drug related CS

Medicine in Society (29 decks)

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