Addictive Behaviours

Question 1

Difference in diagnosis of Substance Use Disorders in DSM-4 and DSM-5

Answer 1

In DSM-4 the word addiction did not appear, but does in DSM-5.

Question 2

In SUBSTANCE RELATED DISORDERS, how many separate classes of drugs does it cover?

Answer 2

10 separate classes of drugs

Question 3

What are some key features of substance addiction?

Answer 3

• Chronic disease of brain reward, motivation, memory and related circuitry
• Excessive pursuit of reward and/or relief
• Diminished control
• Compulsion/craving
• Increased tolerance and cycles of relapse

Question 4

DSM-5 SUBSTANCE RELATED DISORDER criteria

Answer 4

A.
Impaired control
- use of amounts or for longer periods than intended
- repeated unsuccessful attempts to cut back/cease
- excessive time obtaining drug or recovery from use
- craving

Social impairment

• failure to meet obligations
• social and interpersonal problems
• social, occupational or recreational activities reduced

Risky use

• use in physically hazardous situations
• persistence despite awareness of physical or psychological problems exacerbated by use

Pharmacological

• tolerance
• withdrawal

Question 5

Substance Use Comorbidities

Answer 5

60% of substance users have a co-morbid psychiatric disorder.

Usually with mood or anxiety disorders

Question 6

Kitchen sink analogy with water as dopamine

Answer 6

Drugs act like rubber stopper: molecules block dopamine transporter and stop natural reuptake of dopamine into neurons.

This causes a large excess of dopamine in synapse and ‘overflow’ of dopamine causes pleasure and euphoria.

Question 7

What 3 areas do drugs of dependence operate on?

Answer 7

Basal ganglia; extended amygdala; prefrontal cortex

Question 8

Define Addiction

Answer 8

A primary, chronic disease of the brain reward, motivation, memory and related circuity.

Question 9

What is the 3 stage cycle of addition?

Answer 9

1. Binge/Intoxication
2. Withdrawal/Negative Affect
3. Preoccupational/Anticipation

Question 10

Define Gambling

Answer 10

Risking item of value on outcome of events determine by chance.

Question 11

Define Problem Gambling

Answer 11

Personal or social harm resulting from excessive gambling behaviour

Question 12

Prevalence of gambling in general population

Answer 12

60-85% of general population

Question 13

Which country has the lowest pathological gambling prevalence rate?

Answer 13

Norway at 0.2%

Question 14

Which country has the highest pathological gambling prevalence rate?

Answer 14

Hong Kong at 5.3%

Question 15

Average age of onset of gambling

Answer 15

12-15 years

Question 16

Association percent between alcohol abuse and dependence in pathological gambling?

Answer 16

30-40%

Question 17

Pathological Gambling comorbidities

Answer 17

Substance use disorder; mood disorder; anxiety disorder

Question 18

What percent of problem gamblers seek formal treatment?

Answer 18

Less than 10%

Question 19

DSM-5 SUBSTANCE RELATED DISORDERS criteria

Answer 19

A. four or more

• preoccupation (psychological dependence)
• increased amount gambled (tolerance)
• irritability/restlessness on cessation (withdrawal)
• escape from stress (negative reinforcement and motivation
• chasing losses
• lying
• repeated failure to cease (impaired control)
• risked significant relationship
• bailout

Question 20

What are the 3 stages of Gambling?

Answer 20

1. Early winning phase
2. Losing phase
3. Desperation phase

Question 21

What is the early wining phase for gambling?

Answer 21

2/3 of pathological gamblers experience large wins prior to developing problems; this facilitates cognitions (this is so easy)

Question 22

What is the losing phase for gambling?

Answer 22

Heightened preoccupation with gambling.

Growing losses and attempts to recoup (‘chasing losses’).

Increased stress, irritability, withdrawal.

Question 23

What is the desperation phase for gambling?

Answer 23

Efforts to survive financially and psychologically become increasingly extreme.

60% have committed an offence to finance gambling. Suicide is also a real risk.

Question 24

What are the 3 main pathways of Pathological Gambling?

Answer 24

Pathway 1 = behavioural conditioned problem gamblers

Pathway 2 = emotionally vulnerable problem gamblers

Pathway 3 = antisocial impulsivist problem gamblers

Question 25

Describe Pathway One of Pathological Gambling and treatment for it

Answer 25

Behaviourally Conditioned Problem Gamblers - “I’m going to make money by gambling”

Motivation to generate excitement, winning; briefer history of excessive gambling; childhood and family stability; substance abuse is minimal (onset after gambling problems); BEHAVIOURAL CONDITIONED - positive reinforcement

Treatment = CBT; teaching them the true statistics of gambling

Question 26

Describe Pathway Two of Pathological Gambling and treatment for it

Answer 26

Emotional Vulnerable Problem Gamblers - “I’m going to ease the pain by gambling”

Poor coping skills and substance use contribute to gambling; anxiety, depression, lack of social support, gambling used as means of emotional escape; poor stress-coping and problem-solving strategies; negative reinforcement because it is the removal of an aversive stimulus

Comorbidities are SAD and depression

Treatment = find the underlying cause of the problem and address that

Question 27

Describe Pathway Three of Pathological Gambling and treatment for it

Answer 27

Antisocial Impulsivist Problem Gamblers - “Gambling just feels awesome”

Deficits in reward pathways and impulsive; the most severe group; most defining aspect is their impulsivity, they are after the thrill of gambling; they don’t do a lot of consequential thinking; early history of family instability, abuse/neglect; high levels of impulsivity, anti-social behaviour

Comorbidities - manic disorder, ADHD

Treatment = they don’t respond to treatment very well, but maybe drugs