Addictive Disorders

Question 1

Diagnosis of substance use disorders

Answer 1

Mild: 2-3 of the criteria
Severe: 6+ of the criteria
1. Large amounts are consumed
2. Persistent desire or unsuccessful attempts to reduce substance use.
3. Large amount of time spent obtaining, using or recovering from the effects.
4. Strong desires or cravings.
5. Failure to fulfil major role expectations (Eg work, school).
6. Continued use even though it causes social or interpersonal difficulties.
7. Interferes with ability to engage in social or occupational activities.
8. Occurs in places where physically hazardous (eg driving).
9. Continued use despite knowledge its bad.
10. Tolerance is present; need more to achieve same effect, diminished effect for same amount.
11. Withdrawal is present; physical and psychological symptoms emerge after cessation or reduction, taking substance to alleviate symptoms.

Question 2

Withdrawal

Answer 2

Development of set symptoms that occur upon cessation of using the substance, especially after heavy or prolonged use of the substance.

Question 3

Prevalence of substance use disorders

Answer 3

Alcohol is the most commonly used drug in Australia.
Opioid, cannabis and stimulant disorders are less prevalent.
Opioid and stimulant dependence have a high risk of harm, such as paranoid psychotic states and opioid-related deaths.

Question 4

Substance use disorders age of onset

Answer 4

Occur predominantly in younger people.
Younger generations have been exposed to the easier availability of alcohol and drugs compared to older generations.
Earlier first use of a drug increase the chance of developing a substance use disorder in later life.

Question 5

Substance use disorder: associated psychological problems

Answer 5

Comorbidity of substance use disorders and other mental health disorders is a major challenge of treatment.
In Australia, approx 35% of those with a substance use disorder also have other mental disorders.
Have worse outcomes on a range of measures including physical health, social and occupational functioning, self-harm or suicide, violence, homelessness and relationship problems.

Question 6

Substance use disorders: associated medical problems

Answer 6

Substance use disorders are associated with increased physical problems and heightened mortality (people dying 14 years earlier).
Older people face particular risk: age-related changes in body composition cause higher blood alcohol level, greater use of prescription drugs. More susceptible to intoxicating effects of alcohol and increased mortality from falls, car accidents and suicide.
Also effects others, 75% of Australian effected by others drinking.

Question 7

Aetiology of substance use disorders: impaired control versus choice theories

Answer 7

A loss of control is one of the central characteristics underpinning substance use disorders.
Individuals cannot cut down or stop drug use, despite it causing them harm.
In contrast, choice theory posits that apparent loss of control is the individual changing their mind, no loss of control.

Question 8

Disease model of addiction

Answer 8

View that alcoholism (or another behavioural addiction) is an incurable physical disease, like epilepsy or diabetes, such that only total abstinence can control it.

Question 9

Aetiology of substance use disorders: biological factors

Answer 9

Strong genetic component.
Substances that can lead to dependence act on the brains reward systems.
Major reward systems are the dopaminergenic reward system and the endogenous opioid system.
Inhibition dysregulation theory argues that addictions are the result of a failure of an inhibitory system.

Question 10

Aetiology of substance use disorders: psychological factors - behavioural theories

Answer 10

Classical conditioning: sight of related stimulus (eg syringe) elicit response that prepares the body for drug.
Proposed reason for tolerance, body compensated for effects of drug before it is even administered.
Operant conditioning: pleasure or ‘high’ positively reinforces use of drug. Withdrawal a negative reinforcer.
Incentive-sensation theory: proposes that drugs of addiction change the areas of the brain responsible for the incentive to use the drugs.

Question 11

Aetiology of substance use disorders: psychological factors - personality theories

Answer 11

Tri-dimensional personality theory.
Suggests that an interaction between three dimensions of personality influences vulnerability to substance use.
Traits: novelty seeking, harm avoidance, reward dependence.

Question 12

Aetiology of substance use disorders: psychological factors - cognitive theories

Answer 12

Outcome expectancy theory: states that an individual’s expectation of positive consequences from substance use increases propensity to use.
Relapse prevention theory: argues individuals in high-risk situations will use substances if they do not have appropriate coping strategies, they have positive expectations of effects of substance, they have a low degree of self-efficacy (confidence they can maintain abstinence).

Question 13

Aetiology of substance use disorders: psychological factors- motivation

Answer 13

PRIME theory

Plans, responses, impulses, motives and evaluations.

Question 14

Aetiology of substance use disorders: social and cultural factors

Answer 14

Family functioning, parental modelling, low levels of parental monitoring, and permissive or harsh disciplinary approaches are linked to substance use.
Peer influences are important.
Substance use disorders in Indigenous communities need to be placed within a historical framework. Effects of social and economic marginalisation must be considered.

Question 15

Treatment of substance use disorders: appropriate therapeutic goals

Answer 15

Set up goals of therapy: complete abstinence or reduced or controlled use of substance.
Abstinence is obviously best, but reduction of substance can have important health benefits.

Question 16

Treatment of substance use disorders: detoxification and inpatient treatment

Answer 16

Detoxification: a useful first step but not sufficient on its own to ceasing substance use.

Question 17

Treatment of substance use disorders: pharmacological interventions

Answer 17

Antagonist medications can be used to block the rewarding effects of the substance.
May be used as a substitute for the abused substance to reduce the harms (eg deaths from overdose and infection through shared needles).
May be used to reduce severity of withdrawal symptoms eg nicotine patches.

Question 18

Treatment of substance use disorders: motivational approaches

Answer 18

Motivational interviewing: a valuable approach for individuals experiencing low motivation to change.

Question 19

Treatment of substance use disorders: brief and early interventions

Answer 19

Brief interventions entail only limited contact with a health professional for those whose substance use is not yet severe.

Question 20

Treatment of substance use disorders: skills training approach

Answer 20

Addressing unhelpful beliefs using CBT.

Train skill deficits that have lead to the use of drugs/alcohol.

Question 21

Relapse prevention of substance use disorders

Answer 21

Both psychological and pharmacological approaches.
Anticipating high-risk situations for substance use and developing coping skills.
Use medication to reduce cravings.

Question 22

Diagnosis of gambling disorder

Answer 22

Persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress as indicated by at least 4 of the following in a 1 year period:

1. Need to gamble to achieve excitement
2. Restlessness or irritability when trying to cut down.
3. Recreated unsuccessful attempts to cut down or stop.
4. Preoccupation with gambling.
5. Frequent gambling when distressed.
6. After losing money, frequent return on another day to ‘get even’.
7. Lying to conceal extent of gambling.
8. Jeopardising or losing significant relationship, job, education etc.
9. Relying on others to provide money to relieve desperate financial situation caused by gambling.

Question 23

Gambling disorder as an addiction

Answer 23

Gambling is conceptualised as an addiction on the basis that individuals repeatedly engage in a behaviour to achieve a euphoric state.

Question 24

Epidemiology of gambling disorder

Answer 24

Approx 5% of adolescents meet the criteria for pathological gambling - 2-5 times the rate for adults.
Adolescent and adult males gamble more frequently and intensely than adolescence and adult female gamblers.
The ratio of male to female problem gamblers seeking treatment is 3:2.
Females are motivated by dealing with negative emotional states.
Males are motivated by winning, excitement and chasing losses.
90% of problem gamblers begin before 20 years.

Question 25

Aetiology of gambling disorder: biological factors

Answer 25

Disturbances in serotonin, dopamine and noradrenaline neurotransmitter systems may play a role in the mechanisms involved in behavioural inhibitory control, reward mechanisms and arousal in impulsive and addictive disorders.

Question 26

Aetiology of gambling disorder: psychological factors - personality

Answer 26

Certain personality traits such as impulsivity are associated with problem gambling.

Question 27

Aetiology of gambling disorder: psychological factors - learning

Answer 27

Operant conditioning: positive and negative reinforcement (feelings of excitement, escape emotional distress).
Classical conditioning: environmental cues become conditioned stimuli for eliciting excitement/arousal associated with winning.

Question 28

Aetiology of gambling disorder: psychological factors- cognitions

Answer 28

Cognitive model emphasis errors in perceptions and beliefs of probabilities leading overestimation of chances of winning.

Question 29

Aetiology of gambling disorder: social and cultural factors

Answer 29

Parental modelling and early negative childhood experiences can contribute to the development of problem gambling.
Cultural attitudes towards gambling and the availability of opportunities to gamble are influential.

Question 30

Aetiology of gambling disorder: the integrated pathways model

Answer 30

Pathway 1: behaviourally conditioned problem gamblers
Pathway 2: emotionally vulnerable problem gamblers
Pathway 3: biologically based problem gamblers.

Question 31

Treatment of gambling disorder: psychoanalytic and psychodynamic approaches

Answer 31

Freud maintained gambling was the manifestation of primal addictions (sexual), which all later addictions are substitutes.
Not used in current treatments.

Question 32

Treatment of gambling disorder: gamblers anonymous

Answer 32

Self-help organisation.

Emphasis is on shared common experiences provided by mutually supportive peers in a group setting.

Question 33

Treatment of gambling disorder: behavioural and cognitive interventions

Answer 33

CBT: aims to challenge dysfunctional beliefs that are thought to result in problem behaviours.
Identify common cognitive errors (probabilities).
Cognitive restructuring: replace irrational beliefs with rational ones.

Question 34

Treatment of gambling disorder: pharmacological interventions

Answer 34

No approved pharmacological treatment specific to pathological gambling.
SSRI’s, opioid antagonists and mood stabilisers may be effective in some cases.

Question 35

Treatment of gambling disorder: the public health model

Answer 35

Designed to reduce population-based risk factors by implementing strategies designed to restore exposure to gambling and to promote a climate of responsible gambling.