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Abnormal Psychology 3018 > Addictive Disorders: Substance Abuse > Flashcards

Addictive Disorders: Substance Abuse Flashcards

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1
Q

In 2018 the American Society for Addiction (ASAM) stated that addiction is a ‘primary, chronic disease of ___, ___, ___ & ___, with potential for both ___ & ___’.

A

Addiction: ‘a primary, chronic disease of brain reward, motivation, memory & related circuitry, with potential for both relapse & recovery.

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2
Q

In terms of neurology, why do people become physically and psychologically dependant on drugs?

A

Because they adapt to the drugs, resulting in tolerance & withdrawal (with cravings and urges).
Can also be considered ‘neuro-adaption’.

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3
Q

Why is addiction considered chronic?

A

Because the person must use the substance(s) over and over again, as opposed to the occasional use of a substance.

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4
Q

The circuitries involved with addiction are typically associated with normal behaviours. What behaviours do the circuitries become associated with in addiction?

A

The circuitries become associated with behaviours that induce the need for survival or pleasure.

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5
Q

What is psychological dependance?

A

The desire for a substance because it fulfils some particular need within the individual.

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6
Q

What is the evidence of addiction?

A

Repeated drug use despite negative consequences.

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7
Q

What does it look like when reward-seeking becomes out of control?

A

The person repeatedly trying to stop but can’t.

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8
Q

Addiction is when ‘the drive to use, overwhelms…’ what?

A

‘When the drive to use overwhelms the desire to stop.’

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9
Q

What are the six common components in the concept of addiction?

A
  1. Salience (person becomes preoccupied with the drug).
  2. Mood modification.
  3. Tolerance.
  4. Withdrawal (and the craving for more drugs to stop withdrawal symptoms).
  5. Conflict (‘will I take it?’ vs. ‘I shouldn’t take it.’)
  6. Relapse.
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10
Q

There were two models of addiction, what were they?

A

The brain disease model vs. psychosocial factors.

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11
Q

What are two major problems with the brain disease model of addiction?

A

It minimises the impact of social, environmental and psychological factors that play a role in the development of addiction.

And it deflects the responsibility over actions.

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12
Q

What are the two types of motivating factors behind addiction as posited by the brain disease model?

A 
'I want something' vs. 'I need something.
Or:
Irresistible urge vs. compulsive drive.
Or impairment in either:
Desire centred vs. control centred.
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13
Q

What is the dominant theoretical framework in addiction?

A

The biopsychosocial framework.

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14
Q

The dominant theoretical framework of addiction includes almost everything, except…?

A

Spirituality.

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15
Q

Addiction is considered a ‘syndrome’ rather than a ‘unitary disorder’, why is that?

A

Because it involves a combination of signs and symptoms that stem from a multifactorial interaction between biopsychosocial factors.

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16
Q

The biopsychosocial model indicates that addiction is a complex disorder to treat. Why is that?

A

Because there is no single cause, there are multiple pathways and multiple reasons why a person may develop an addiction.

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17
Q

According to the dominant model, addiction is caused by an interplay between bio/psycho/social factors. Give an example of each factor.

A

It is an interplay between:

  • Biological vulnerabilities, (i.e., high impulsivity, reward sensitivity).
  • Psychological factors, (i.e., high anxiety, depression, low self esteem).
  • Social factors, (poverty, lifestyle, trauma exposure).
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18
Q

For young people, what is an important cultural factor that might influence the development of an addiction?

A

Peer pressure.

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19
Q

Biologically (or genetically/neurologically), if someone is highly responsive to reward, what does it mean they have a low sensitivity to?

A

They probably have a low sensitivity to punishment.

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20
Q

What often leads to heavy alcohol use?

A

PTSD.

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21
Q

What are distal antecedents of addiction syndrome? And what do they lead to within an individual?

A
  • Neurobiological factors.
  • Psychosocial factors.
  • Intrapsychic factors.
  • Environmental factors.
    They lead to a vulnerability within an individual.
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22
Q

If an individual is vulnerable (involving biopsychosocial factors), what needs to happen for them to potentially develop an addiction?

A

Exposure.

If a vulnerable person is exposed to drugs, it might lead to a subjective shift.

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23
Q

After a vulnerable person has been exposed to a drug, what needs to happen for it to develop into a premorbid addiction syndrome?

A

More exposure and repeated use.

24
Q

In terms of classical and operant conditioning, what does repeated exposure to a drug bring?

A

Either positive reward (the rush) or negative reinforcement (the loss of something unpleasant like anxiety).

25
Q

What does premorbid addiction syndrome lead to?

A 
Health problems (cancer, liver cirrhosis). 
Longterm social, psychological and biological effects (social drift, comorbid conditions & neuroanatomical changes).
26
Q

What is symptom substitution in Addiction Disorder?

A

Moving from one drug to another (e.g., marijuana to alcohol).

27
Q

So the mapping of Addiction Disorder involves what?

A

Distal antecedants (biopsychosocial factors) creating a vulnerability. The vulnerable person being exposed. The exposed person starting repeated use due to conditioning (premorbid addiction syndrome). Then developing health problems and long-term biopsychosocial problems.

28
Q

There are two main addiction models of BEHAVIOUR. What are they?

A
  • Medical/disease model: impaired control over urges/cravings.
  • Rational choice model: voluntary behaviour that can be controlled.
29
Q

What are some pros and cons of the medical/disease model of BEHAVIOUR in addiction theory?

A

+ reduced stigma.

- reduced personal responsibility (people are more prone to relapse if treated under this model).

30
Q

What are some pros and cons of the rational choice model of BEHAVIOUR in addiction theory?

A

+ increased personal responsibility.
+ increased sense of control.
The majority of people characterised in this model will cease without treatment.

31
Q

How many people with a serious addiction problem will cease without treatment?

A

About 70%.

32
Q

What are the two main reward systems in the brain that drugs affect?

A
  1. The dopaminergic system.

2. The endogenous opioid system.

33
Q

Which drugs cause dopamine to increase?

A

Most drugs including alcohol, nicotine, cannabis, opioids, cocaine, amphetamines.

34
Q

How do the drugs increase dopamine? And what happens afterwards?

A

By blocking the re-uptake of dopamine receptors. The overflow of dopamine causes pleasure and euphoria.

35
Q

Because dopamine levels increase so much when a drug is taken, what happens when the drug is taken away?

A

The dopamine levels plummet to be much lower than normal.

36
Q

Heavy cocaine use is associated with lower levels of the dopamine D2 receptors in the brain. After cessation, do the receptors come back straight away?

A

No, even after 4 months the receptor levels may have increased a little but they still remain low.

37
Q

What is the Opponent Process Theory of addiction?

A

There are two states: A state & B state.
The A state is the euphoria experienced after taking a drug.
The B state is the process attempting to bring the body back to homeostatis.
The higher the A state, or the more drugs needed to achieve an A state, the more intensely B process will work to pull the body back to homeostatis. In doing so, the body will come to dip way below homeostatis and withdrawal symptoms (or comedown) will become stronger.

38
Q

Describe tolerance based on the Opponent Process Theory of addiction.

A

The B-process (or opponent process) is trying to balance the A-process (or drug activation) by bringing the body to homeostatis. Over time, the B-process brings the body lower and lower in an ‘allostatic level’. The A-state then requires more and more of the drug to achieve a high. It is a vicious cycle.

39
Q

What is ‘allostatic load’?

A

The ‘wear and tear on the body’ that accumulates as the individual is exposed to repeated or chronic stress. This is evident in chronic drug use.

40
Q

What is I-RISA? (Goldstein & Volkow, 2002).

A

Impaired Response Inhibition and Salience Attribution.

41
Q

Which parts of the brain are I-RISA attributed to?

A
  • Mesolimbic (amygdala, nucleus accumbens & hippocampus) related to the impairment of ‘response inhibition’.
    Mesocortical (prefrontal cortex, orbito-frontal cortex & anterior cingulate) related to the impairment of ‘salience attribution’.
42
Q

What are the two elements of I-RISA associated with?

A
  1. Impaired - Response Inhibition: changes in motivation, bad decisions.
  2. Impaired - Salience Attribution: enjoying the conscious experience of intoxication.
43
Q

In I-RISA theory, what are the four clusters of behaviours and what processes do they involve?

A
  1. Intoxication/excitement: higher dopamine concentrations in limbic circuits and frontal lobe.
  2. Craving: conditioning to the cues of pleasure, memory of pleasure consolidated in amygdala & hippocampus.
  3. Compulsive Use: when the drug is continued even though it is no longer pleasurable.
  4. Withdrawal: dysphoria, anhedonia & irritability which may contribute to a relapse. Involves the frontal cortical circuits.
44
Q

In addiction theory, what is a ‘incentive salience’?

A

The reasons that lead me to use the drug, ending in a binge or intoxication period.

45
Q

Dopamine is released to all regions, including the Amygdala, Hippocampus, Prefrontal Cortex, Nucleus Accumbens & Reward System. What is each brain region’s response to the release of Dopamine, when a piece of cake is eaten?
And what is the risk (apart from weight gain) if the behaviour is repeated too often?

A
  • Amygdala: ‘this is great… making me very happy right now’.
  • Hippocampus: remembers the experience and the context.
  • Prefrontal Cortex: focuses attention to the cake.
  • Nucleus Accumbens: ‘pleasure centre’, stimulated causing you to want another bite.
  • Reward System: reactivated with each bite.

If the action is repeated too often, addictive behaviours emerge.

46
Q

In the Biological Model of drug use, what are the initial processes involved in chronic substance abuse, the two types of abstinence and the the elements that may lead to relapse?

A

Chronic substance abuse –>
Sensitisation (neuro-adaption, involving initial negative affect and the exposure to cues) –>
Changes in Neurotransmitters (e.g., dopamine dysregulation).

That can lead to Initial Abstinence OR Prolonged Abstinence.

Relapse occurs in:

  • Initial Abstinence due to withdrawal symptoms, which lead to cravings and then relapse.
  • Prolonged Abstinence due to reward memory, which leads to cravings and then relapse.
47
Q

Why do people relapse after being abstinent/sober for a long time?

A

Often it is when memories come back, the experience of negative emotions or the exposure to old cues that may trigger the relapse.

48
Q

The Addiction as Choice model differs from the Medical model (which focuses on impaired control) as it is about the inability to resist a drug due to the desire that coerces a person to CHOOSE the behaviour.
So, instead of ‘compulsive behaviour’, it is … ?

A

‘Compelled behaviour’, (or a chosen behaviour).

49
Q

The Addiction as Choice model views addiction (obviously) as a choice. But do people choose to become addiction? Why/why not?

A

No (generally not). But it is the initial choice to engage in the drug that can trigger a biological addiction.
So the person IS initially choosing to take the drug.

50
Q

In the Addiction as Choice model, what is rationality/utility?

A

Rationality/utility is understanding how subjective short term benefits outweigh long term costs.

51
Q

In the Addiction as Choice model, when the opportunity to take a drug arises, the perceived benefits are balanced the perceived costs. What are they both associated with?

A

Perceived benefits: short-term benefits, associated with urges.
Perceived costs: long-term costs, associated with self-control.

52
Q

What are the main Public Health Approaches to preventing addiction?

What can’t be done?

A

Socioeconomic constraints on drug-taking.
Limiting access to and patterns of drug taking (sniffer dogs at parties).

Can’t do anything about genetic predisposition or peer group pressure.

53
Q

What are six common barriers that limit successful treatment? Or stop someone from getting better?

A
  1. psychiatric comorbidities (feel depressed and don’t want help/want to keep self-medicating).
  2. acute or chronic cognitive deficits (can’t make the decision to get better).
  3. medical problems (unwell, want the drugs to feel better).
  4. social stressors (living in poverty).
  5. lack of social resources (not enough support).
  6. stigma (don’t want to admit they have a problem).
54
Q

What are the best ways to prevent addiction?

A

Identify high risk situations and events and steer people away from partaking in those events (reduce the likelihood they will encounter these events by providing different activities).
Find alternatives then taking a drug when experiencing a cue (change patterns of behaviour and rehearse non-drug alternatives).

55
Q

What are the six principles of the effective treatment of addiction?

A
  1. No single treatment is sufficient.
  2. Treatment must be readily available and accessible.
  3. Address multiple psychological/medical/social interventions and needs.
  4. Comormid conditions are treated in an integrated manner.
  5. Mandated treatment can lead to produce initial change.
  6. Recovery is a long term process and frequently requires multiple episodes of treatment for relapse.

Abnormal Psychology 3018 (29 decks)

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