Alcohol and other Drugs of abuse

Question 1

About the nucleus accumbens

Answer 1

Reward centre. dopamine acts on this. we have this because it allows behaviour regulation - biology way of showing what actions are good and should be repeated.

Question 2

About dopamine

Answer 2

The dose of dopamine released is relatable to your experience of the pleasure - it is titratable.
Highest release of dopamine: sex, exercise, success.
Success because an external things has rewarded you and internally your biology has reacted to that award.

Dopamine is excitatory. (GABA is inhibitory, eg alcohol)
Heroin, cocaine work on dopamine.
Brain developed so that drugs attack cortical part, which is good as means critical functions of brainstem eg breathing and heart rate are not affected.
If inhibiting critical function, eg alcohol through GABA. Ability to reason critically is turned off. All that’s left are biological urges (eat, sleep, sex).

Drugs of abuse work in three main ways - increase release of dopamine (amphetamine), block reuptake (cocaine) or bind directly to the receptors.

Question 3

Basic idea of theories of motivation

Answer 3

Most theories of motivation cite hedonism. Pleasure go towards, pain avoid - found that you avoid pain more than you seek pleasure. We hate losing more than we love winning. Means that we are set up to not be remarkably happy - hypersensitive to loss not to gain.

Question 4

Basics: classical conditioning

Answer 4

Pavlov’s dogs. Chose a behaviour which is a natural re-inforcer - eating, salivation. Noticed that if give food they salivate - this response did not have to be learned, biologically hardwired and can’t be turned off, is not under volitional control. He then took a bell which has no biological meaning to the dog and paired it with the food. He rang the bell and then gave the food. After doing this enough times then the dogs learn that the bell indicates that food is coming, and this works the same in humans. Introduces predictability. Another example of this is the seasons. Learning by association - always associating two things together.

Question 5

Basic: operant conditioning

Answer 5

learning by reward or punishment. Reward is stronger in its reinforcing properties. Punishment doesn’t really work in terms of rewarding properties - people still commit crimes and go to jail even though we know that our whole law system is based around punishment. Even death penalties don’t deter people from committing murders etc, as seen in America and Mexico. If a psychologist designed a legal system it would be very different - would be rewarded for good behaviour instead.

Question 6

What is tolerance?

Answer 6

a person’s diminished response to adrug, which occurs when thedrugis used repeatedly and the body adapts to the continued presence of thedrug.

Tolerance makes drugs of abuse very dangerous as to get the same high have to take more and more and more. These drugs are also relatively expensive. Also the environment acts on this, tolerance can be somewhat dependent on the environment, if you always drink in one place your tolerance will develop to that environment, if you had the same amount to drink elsewhere then you would experience a stronger effect. This is a problem for drugs of abuse and overdose as this often happens in a different place eg on holiday. Tolerance causes physiological changes in the brain but also changes that precede the ingestion of the drug which prepare your brain to receive it, and if you’re in a different environment these changes don’t occur so causes overdose.

Question 7

What is withdrawal?

Answer 7

negative effects in the absence of the drugs. We know that humans do more to avoid loss, so once hooked on a drug you’re in a bad position as need more and more of it to feel good, everything else in life now makes you feel less good, and if you stop taking the drug then you feel awful.

Pharmacologically, we have legalised the two most dangerous drugs - alcohol and tobacco. Historically they were easy to find and in history alcohol was safer to drink than water because of sanitation. Would water it down and the alcohol would kill bacteria in the water. Tobacco was also easy to discover as just needed to be dried.

Heroin is the most addictive, followed by nicotine, but the difference between them not even statistically significant. Rates of smoking cessation is terrible, only 3% quit. Even with every medical assistance available, only 22% quit.

Rate of alcohol quitting is around 50% with medical help, without its around 20%.

Question 8

What is operant conditioning?

Answer 8

Habit and learning
Mechanisms that don’t require conscious decisions
- Development of habitual behaviour patterns independent of conscious evaluation of pros/cons
Operant conditioning (Skinner)
· Positive reinforcement - increases probability of a behaviour occurring by presentation of reward, behaviour (take drug): reward (get high)
· Negative reinforcement - increases probability of a behaviour by removing discomfort, stimulus (withdrawal, depression): Response (take drug)

We raise children telling them not to do things that we do as parents. Not good. Eg smoking/drinking alcohol.

There is nothing in natural human life that you get immediate rewards from. In education, dating, cooking etc we build the motivation to continue through short term goals, eg continued assignments in education which you get results back for. Drugs bypass the whole thing and give much more reward than you get any other way, instantly.

Negative reinforcement studies: have small animal in cage and play a loud aversive noise to it which it dislikes. There is a level which stops the noise and the rat learns that this is what the lever does. This also operates in withdrawal - take drug regularly, then don’t take it and feel rubbish, to stop this you take the drug again.

In terms of reinforcement, the most effective is given straight after.

We see that IV give as massive initial hit with quite a rapid decline. Feels phenomenal for a short amount of time.

IM doesn’t give such a high immediate peak but the feeling is experiences for a much longer period.

Oral administration is a sustained high over time but just not as high.

Some people may naturally prefer longer lasting lower effects, but IV is likely to be the most addictive as it has such a high amount of reinforcement.

• Intermittent reinforcement strengthens a behaviour
• Animals learn to avoid as well as escape discomfort
• Cues (discriminative stimuli) are important and ties in well with classical conditioning
• Strength of learning is influenced by the nature of the reinforcer, the schedule of reinforcement and for how long the schedule is in place
• Underpinning this is the release of dopamine in the meso-limbic pathway

One of the most common examples of this is fruit machines in pubs. These give random reward of money. The possibility of winning keeps you putting money into the machine. Flashing and noise when you win is also conditioning you to want to play more when you walk past and hear the noise or see the lights.

The problem with human behaviour is that rewards are not easy to come by, we have to work for them. The problem with this is that we don’t enjoy this work for the rewards.

Cues can include walking past pubs for regular drinkers.

There are two types of reinforcers - primary (biologically reinforcing, don’t have to learn its reinforcing. The only three are food, water, sex) and secondary reinforcers (eg money which enables you to BUY food water etc).

Historically would have gone more for primary reinforcers, but now for secondary. The most rewarding thing that people want nowadays if money as it allows you to get all of the other reinforcers.

Random reinforcers that you don’t know when they’re coming often more rewarding than regular expected rewards.

Have also found that if you start paying someone to do something you already enjoy doing, then you end up hating doing the task.

Question 9

What brain parts does operant conditioning work on?

Answer 9

• Mesolimbic dopaminergic pathway
  
  • ventral midbrain, via medial forebrain bundle, to limbic region
• Limbic system
  
  • involved in emotional responses
  • Forebrain (Amgydala, nucleus accumbens, striatum)
• All dependence producing drugs appear to increase dopamine in the nucleus accumbens
• Chemical or surgical interruption of dopaminergic pathway impairs drug seeking behaviour in experimental situations

If you sever the dopaminergic neurones, the drugs are no longer seeked as it is no longer rewarding.

Question 10

What is a summary of drug dependence?

Answer 10

Experimentation&raquo_space; positive reinforcement&raquo_space; repeated use&raquo_space; tolerance&raquo_space; withdrawal&raquo_space; dug seeking (negative reinforcement)&raquo_space; drug dependence

There are some other worrying features about experimentation. Some predisposing factors cause some to seek drugs more than others. If bot parents smoke, you are very likely to smoke, same with alcohol.

Question 11

What is classical conditioning?

Answer 11

Stimulus&raquo_space; Response
• Unconditioned stimulus (UCS) elicits an Unconditioned Response (UCR)
• Neutral stimulus (NS) found that doesn’t elicit UCR
• Neutral stimulus repeatedly paired with UCS
• Neutral stimulus becomes a Conditioned Stimulus (CS) that can elicit the Conditioned Response (CR)

Best known example in humans is if diagnosed with cancer and get put on chemotherapy, causes nausea, if keep eating same diet as normal on chemotherapy, you are pairing the regular diet with feeling nauseous then when stop the chemo still have the nausea after. This is why when put on chemo sent to a dietician to change what you eat so that when the treatment stops can go back onto normal foods and not feel sick.

Alcohol is the odd one out though - every time drink to excess causes vomiting but doesn’t lead to aversion. This is partly due to a memory thing, having deactivated the thinking centres of the brain you don’t link the things so much.

Question 12

What is the little albert experiment?

Answer 12

JB Watson (1920)

• Infant Albert initially demonstrated no fear of a tame white rabbit
  
  • Watson paired the white rat with a loud BANG!
  • White rat began to elicit a fear response
  • Other similar objects elicited anxious responses
• The Little Albert experiment demonstrated classical conditioning in humans
  
  • The strongest applications of classical conditioning involve emotions
  • Classical Conditioning underlies some phobias

Child has learnt that fear comes with the rat.

Also child conditioning eg spiders, falling over, colours, toys

Question 13

What are potential conditioned stimuli for classical conditioning?

Answer 13

• Injecting equipment
• Location/Environment
• Cook-up ritual
• Psychological state
• Physical State

Merely setting up the injection equipment is a reinforcer. Same with alcohol.

We develop a cognitive bias towards that stimulus - if you injest a lot of alcohol for a long time you reduce the brain mass by 3% BUT develop very fast processing systems for recognising alcohol.

Primary enforcer - relationship or sex.

Similarly, all naturally conditioned to look at attractive people.

Question 14

What are the categories of conditioned drug responses?

Answer 14

CRs can be drug-like or drug-opposite depending on the circumstances and the drug
Drug-Opposite Conditioned Responses
• Conditioned Withdrawal
• Conditioned Tolerance
Drug-Like Conditioned Responses
• Conditioned euphoria (‘needle freak’ phenomenon)
• Placebo effects (under certain circumstances)

Conditioned tolerance - eg in a certain environment
Conditioned withdrawal - similar but felt more in certain environments

This conditioned withdrawal can help you to stop taking the drug as if always drink in one place then all the cues are in that environment. Therefore one of the easiest ways to stop is to get away from that environment as you remove the cues. This is why rehab doesn’t continue to work when you get home.

Conditioned euphoria - just on seeing the paraphernalia associated with drug use can get a high

Question 15

What are drug opposite conditioned responses?

Answer 15

• Withdrawal symptoms are compensatory reactions that oppose the primary effects of the drug
• Drug opposite CR can mimic withdrawal symptoms
• If occur before drug they will attenuate the drug effect (form of tolerance)
• These reactions can produce relapse in abstinent people, and contribute to tolerance in drug users

Question 16

What is conditioned withdrawal (drug opposite conditioned responses)?

Answer 16

• Abraham Wickler
  
  • 1940s
  • Examined relapse among heroin users
  • Observed opioid withdrawal signs and symptoms when heroin free individuals talked about drug use during group therapy
• Heroin users may experience withdrawal several times per day
  
  • Thus, ample opportunities for pairing withdrawal symptoms with environmental stimuli

Talking about it is giving them a return of withdrawal symptoms which is weird. Cravings not always biologically driven and can be driven by other factors eg seeing cues or talking about it.

Question 17

What is conditioned tolerance (drug opposite conditioned responses)?

Answer 17

• Drug opposite CRs may also contribute to the development of tolerance
• Tolerance:
  
  • Effects of a drug diminish with repeated use
  • A compensatory mechanism to maintain homeostasis
• Siegel (1979)
  
  • It is the body’s homeostatic response in advance of drug administration that becomes conditioned
  • Environmental cues signal the body to prepare for administration
• Risk of OD may be greater in novel environments
  
  • drug tolerance conditioned to cues in normal environment
  • in novel environments won’t have the same degree of tolerance
• Some evidence to support this hypothesis
  
  • Interviews with OD survivors (Wikler, 1948)
  • Rats: OD occurs when injected morphine in novel environments (Siegel, Hinson, Krank & McCully, 1982)
  • Humans: Unsignalled morphine produces greater response than when expected (Ehrman, Ternes, O’Brien & McLellan, 1992)

Environment cues signal to the body to prepare for the drug coming.

Question 18

What are the major categories of addiction treatment types?

Answer 18

• Overview of major categories
• First contact
○ By far the biggest barrier to treatment is making the initial contact with patients
○ Primary healthcare workers, GPs and outreach teams are well placed to do this
○ Strategies are required to help individuals view treatment as something ‘for them’
• Detoxification (Detox)
○ The earliest stages of abstinence can be very tough, and so detox programmes are designed to support individuals through this phase of the treatment process
• Drug substitution treatment
○ Though at first it may seem paradoxical, providing drugs to drug users can be a useful strategy to help them quit
○ For example, methadone is prescribed as a long-acting opioid therapy to heroin dependent patients, and it acts to alleviate the aversive symptoms associated with heroin withdrawal
○ This both allows for a controlled ‘weening’ off of the substance, and also minimises some of the problems associated with illegal drugs (e.g. unknown/unhealthy contents, unsafe administration practices)
○ Not currently available for all forms of drug dependence (esp. alcohol) nor for most behavioural dependences
• Blocking and Aversive Pharmacotherapy
○ Involves the administration of drugs which minimise or totally counteract the effects of a drug of abuse (blocking- naltrexone for heroin) or interacts with the drug of abuse to create extremely aversive effects (aversive- disulfiram or ‘Antabuse’ for alcohol)
• Psychosocial interventions
○ Addressing the problems of physical dependence is less difficult than dealing with the psychological dependence that individuals develop towards their drug or behaviour
○ These interventions are designed to support an individual in the longer term, and to deal with underlying issues which lead to, or have resulted from, their addiction

The biggest barrier is making initial contact with patients.

70% of people with depression don’t seek help.

Alcohol withdrawal can kill you, so is probably the worst biologically.

Other eg nicotine can make you feel awful and like you’re going crazy but wont die.

Methadone replacement treatment - given a biologically equivalent substance to heroin which is given under medical supervision, and although may then be addicted to this for the rest of their lives it stops associated behaviours with the heroin eg diseases, stealing, etc while alleviating withdrawal symptoms as it acts in the same way. All you are doing essentially is switching one addiction for another.

Alternatives for alcohol eg antabuse are really nasty as if you drink whilst on them get really ill and can die. If really addicted then will just stop taking them. To avoid this they can be put in you in an implant which slow releases the drug to stop you drinking and you cant take it out.

Question 19

What are some psychosocial interventions for addiction treatment?

Answer 19

• Motivational Interviewing
• Aimed at increasing motivation to change
• Creates ‘psychological squirm’ (Saunders et al., 1991) whereby an individual feels conflicted between their view of themselves ‘as an addict’
• This can be an effective and powerful motivator for change
• Behavioural Therapy
• Basic idea is that addiction is learned, and therefore can be unlearned
• Use of aversive pharmacotherapies is an example of the use of punishments to decrease the likelihood of future use
• Careful consideration of the factors which precipitate drug use can help the individual to avoid ‘triggers’, and make plans for what to do if they are encountered
• Contingency management involves providing rewards for non-use, and is an effective but controversial intervention
• Cognitive Behavioural Therapy
• A more broad-based approach than traditional behavioural therapies
• Involves identifying triggers to drug use, and provides patients with training in various key skills
○ Relaxation training
○ Drug refusal skills
○ Problem solving skills
○ Cognitive restructuring
○ Relapse prevention training
• Peer Support/Mutual Help
• Residential treatment centres
○ Priory, PROMIS, etc.
• Alcoholics Anonymous/12-Step organisation
• Aim to provide wider social support, often from individuals who are at further stages of the recovery process

Try to show them that there are other routes to pleasure than the drugs, which are healthier.

The what the hell effect: when you trip up on something, eg a diet, instead of going back to it and carrying on the diet, people go and buy loads of the food and just eat everything and think as they’ve broken the diet they may as well go all out. This can be easily prevented just by changing the way of thinking

Drug refusal skills - contingency planning - you plan for scenarios and develop a strategy of dealing with these things. Its critical that the person develops these strategies ahead of time.

Peer support/mutual health seems to work but not for everyone.

Question 20

What is project MATCH?

Answer 20

• Matching Alcoholics to Treatment based on Client Heterogeneity
• Largest ever clinical trial of psychotherapies
• Recruited 1726 alcohol dependent patients into either an aftercare or outpatient treatment arm, receiving one of:
○ 12 step facilitation therapy
○ Cognitive behavioural therapy
○ Motivational enhancement therapy
• Predicted that patient characteristics would predict treatment success (recovery?)
• Operationalised as the number of days abstinence, number of drinks per drinking day, post-treatment completion, psychosocial functioning, quality of life measures, utilisation of treatment services
• Assessed at 1 year follow-up in 3 monthly intervals
• Primary Findings from MATCH (Project MATCH Research Group, 1997a)
• MATCH participants demonstrated improvements in abstinence and reduced drinks per drinking day across all conditions
• That is, all treatments were (equally) effective
• Furthermore, there was no evidence that matching patients to different treatments would be more or less effective
• ‘Everybody wins’
• Secondary Outcomes from MATCH (Project MATCH Research Group, 1997b)
• Those treated in outpatient settings who were (a) high in anger and (b) received MET had better drinking outcomes than those given CBT
• Patients receiving aftercare who had high severity of dependence scores had better outcomes if given TSF; low dependence patients did better in CBT
• However, these results were inconsistent over time (i.e. at 3, 6, 9, & 12 month follow-ups), and at 12 months were statistically non-significant
• 3-year Outcomes from MATCH (Project MATCH Research Group, 1998)
• Included 952 clients across the 5 outpatient sites
• Client anger was the most consistent predictor of treatment outcome, in terms of matching effects
○ High-anger clients responded better to MET in contrast to CBT and TSF
○ Amongst the top third of clients (in terms of high-anger), MET was associated with 76.4% abstinent days over three years compared to 66% abstinent days in CBT and TSF
• 3 year outcomes correlated well with initial 1 year outcomes
• Still no major differences between matched and unmatched clients, or between different interventions
• TSF demonstrated slight (but non-significant) advantage
○ Possibly simply due to the availability of many TSF (i.e. AA) groups which provide more consistent support
• Follow up analysis of MATCH data
• Cutler and Fishbain (2005, BMC Public Health) reanalysed the MATCH data and suggested that treatments only accounted for around 3% of drinking outcomes
• Led some to suggest that the biggest predictor of success may in fact be the simple motivation to overcome an addiction (Ryan, 2006) – the treatment context provides a ‘stage’ for the addict to recover upon

Good that it had a big follow up - 1 year at 3 monthly intervals.

Found that all treatments are equally effective.

Similarly, in the 1990s they thought that if you were British but with Indian heritage, you’d do better with Indian therapists. They tried matching people on this basis but found there was no difference.

MET: motivational enhancement therapy

Client anger most consistent predictor.

MATCH data follow up analysis: only accounted for 3% of drinking outcomes which suggests that it is more to do with the individual and relapse being the most likely outcome even when treatment works so not responsible for a huge amount of recovery.

Question 21

What is UKATT?

Answer 21

• United Kingdom Alcohol Treatment Trial
  
  • Was developed, and therefore informed by, the findings from MATCH
  • Aimed to investigate whether less intensive (and therefore more cost effective) treatments (MET) should replace the more favoured CBT in the UK, given that MATCH data suggested that treatment intensity did not predict more positive outcomes
  • Randomised participants to MET and Social Behaviour Network Therapy (SBNT – a novel treatment designed for the study) using hi- and lo-intensity variants (3 vs. 8 sessions) to assess health economic benefits
  • N = 742
• UKATT Findings
  
  • Again, no significant difference in outcomes for either MET or SBNT were found, with both demonstrating positive effects on drinking reduction and abstinence
  • Again, no measured patient characteristics predicted better outcomes in either of the two treatments

CBT is expensive and time intensive, so this study is looking at if shorter quicker and cheaper treatments are better then these would be used more.

Question 22

What is project COMBINE?

Answer 22

• Combined Pharmacotherapies and Behavioural Interventions for Alcohol Dependence
• Aimed to evaluate pharmacotherapies, behavioural interventions and their combinations in the treatment of alcohol dependence
• 1,383 harmful drinkers
○ Drinking >21/14 units per week (m/f) and also meeting diagnostic criteria for alcohol dependence
• Randomised 1383 recently abstinent alcohol dependents across 8 treatment conditions
• Naltrexone (100 mg/d) or Acamprosate (3 g/d), both, and/or both placebos, with or without a combined behavioural intervention (CBI), or CBI alone
○ CBI involved components of cognitive behavioral therapy, 12-step facilitation, motivational interviewing, and external support systems
• Findings from COMBINE
• During active treatment
○ Participants given Naltrexone, CBI or both had more days abstinent than placebo groups
○ Acamprosate did not appear efficacious in reducing the risk of heavy drinking days or increasing days of abstinence, either alone or in combination with Naltrexone and/or CBI
○ Placebo pill patients experienced more positive outcomes than CBI only patients
• At 1-year follow-up
○ Similar trends were observed as above, but were not statistically significant
• Recommendations of COMBINE? Prescribe Naltrexone…

Benzodiazepine is basically just a sedative

Drugs seemed to work in terms of abstinence

Question 23

Findings of MARCH, UKATT and COMBINE…

Answer 23

• MATCH à ‘Careful’ matching of patients to different treatments does not improve outcome
• UKATT à MET was not found to differ significantly from a novel intervention (SBNT)
à Patient characteristics failed to predict outcomes based on intervention type
• COMBINE à Combinations of pharmaco- and behavioural therapies seemed to produce some positive treatment effects, but placebos were also efficacious in some cases, and overall effects were small and short-lived

Overall this means its not looking great for treatment

Question 24

What were the criticisms of MATCH, UKATT and COMBINE?

Answer 24

“Two sizeable controlled trials of psychological treatment for alcohol [MATCH and UKATT] were each unable to reject the idea that the treatments they compared were equivalent in their effects despite contrasting theories underlying the treatments employed and unparalleled statistical power.”
Jim Orford, 2007

“The major absence in the discussions of the results from the COMBINE study… is any discussion of the treatment mechanisms that are supposed to have generated the improvement in the participants’ drinking practices.”
Anders Bergmark, 2007

“To overcome our impression that ‘everything works’, and to improve treatment outcomes generally and treatment allocation procedures specifically, we have to open the black box to understand the processes of change and the factors which stimulate or impede them.”
	Gerhard Bühringer & Tim Pfeiffer-Gerschel, 2007 [writing about the results of COMBINE]

Question 25

Does addiction treatment work?

Answer 25

• In idealistic terms? Arguably not:
• Gossop et al. (2003) demonstrated 5-year recovery among opiate users ranging from 25-38%
• Other estimates on recovery rates vary above and below this range. Why?
○ Dependent on time to follow-up (6mths, 1yr, 3yrs, 5…)
○ ‘Outcome’ can be measured in various ways (reduced drinking, total abstinence, improvements in social functioning), and failure to ‘recover; in one area is not necessarily failure to recover at all
• In Health Economic Terms? Yes:
• Estimates on the ‘cost-effectiveness’ of treatments in this field suggest an overall saving to society of £2.50 for every £1 put in by the taxpayer (Davies et al., 2009)
• Complete recovery may not always be the outcome, but lower engagement with the CJS, health services and so on leads to benefit for the individual and society
• Putting this in context:
○ Gossop et al. (2001) showed that the costs to society from a group of 1075 drug users, just in terms of criminal activity, totalled £5,000,000 in ONE YEAR

If it doesn’t work very well than why do we invest so much into it? Works on a small number of people but also it is cost effective for society as even if you don’t stop them drinking entirely but reduce it or to a point where need less contact with hospitals and other services etc which makes it cheaper for society, the same for needle replacement services.

Question 26

Evaluating addiction treatment efficacy…

Answer 26

• Not a clear-cut task
• Requires consideration of the many facets of ‘addiction’ itself
• Arguably, addiction is about more than the problematic behaviour, but also about the consequences of the behaviour which can become self-perpetuating
• Research in to ‘what works’ has to then focus on a broad definition of ‘improvement’
○ If an injecting drug user continues to inject heroin after treatment, but begins to do so safely (i.e. using clean equipment), this is a real benefit, even though they have not ‘recovered’
□ E.g. 95%of Hep C infections in the UK are amongst populations of injecting drug users; Hep C can be fatal, and is very expensive to treat

Question 27

The theory behind ‘think positive’

Answer 27

When you have certain psychological emotions eg anxiety or fear we release cortisol and other hormones that have an effect on the body.

People say things like ‘think positive’ and this was founded in neuroscience. Constant negative thoughts and emotions cause the neural pathways in your brain to become stronger. This positive thinking psychological therapy tries to combat this, making the negative pathways weaker and positive stronger. Can have effect son physical health recovery.

Has an effect on the immune system and with the repeated negative emotions we have it buckles the immune system. Research has shown that pessimists get ill earlier and die younger than people who have positive emotions.

Question 28

Cortisol in anxiety and fear

Answer 28

Cortisol released in response to anxiety/fear and too much of this is a risk factor for vascular diseases. Interferes with T-lymphocytes and cytokines which are needed to fight infection.

Question 29

About the sympathetic andrenomedullary (SAM) system

Answer 29

Releases adrenaline (gets muscles ready for action) and noradrenaline (attention and concentration). The release of these chemicals are more from physical demands than emotional demands.

Research has found that over-activation of this system can cause narrowing of blood vessels and thickening of arteries which can lead to vascular diseases.

Question 30

About proinflammatory cytokines

Answer 30

2 main types of cytokines - proinflammatory and antinflammatory.

Antinflammatory facilitate healing.

Proinflammatory cytokines increase inflammation in infection and reduce immune responses. Has been shown to be associated with heart failure.

Question 31

About social support

Answer 31

Social support is quite an abstract concept.

Perceived is often found to be better than actual.

Social support can also be negative - for example encouraging drinking/drugs etc. Also could be through negative relationships with parents.

The most protective thing.

Question 32

What is a mediator of social support?

Answer 32

Mediates stress illness link - between stress and illness and having causal affect.

Recover from illness better with high social support.

Direct effect.

Question 33

What is a moderator of social support?

Answer 33

Between stress and illness, social support will have an indirect effect on illness recovery, progression and whether it occurs in the first place.

Question 34

What is negative social support?

Answer 34

Could be as simple as not being valued in a friendship group or being ignored. Undermining, insensitivity.

Question 35

The biology of social support

Answer 35

People with positive social support have bene reported to have a decrease in the HPA system. They secrete less cortisol. This is because there seems to be some sort of protective factor that social support has which suppresses its release. Some researchers have tried to explain this by saying the release of oxytocin suppresses the cortisol release which we get from physical contact and genuine boding with other people. People on the surface can feel fine but not actually be.

Decreased social support has also been associated with higher activation of the SAM system, and so they have more signs of physical stress. This agrees with the psychological theories.

Couple in conflict produce less cytokines and positive social support has been related to an increase in cytokine production.

Our social networks have a physiological effect on us.

Question 36

About social support and diseases

Answer 36

Social support has been related to all kinds of unhealthy behaviours and illnesses such as smoking, diet, exercise etc… these ones are quite obvious, feeling lonely might mean engaging in unhealthy behaviours such as drinking or smoking or not eating well, but these will then have effects on their long term health - hypertension, cancer, HIV, risky sexual behaviours, cardiovascular disease and stroke.

Question 37

About coping

Answer 37

Problem focused coping - the individual comes up with practical ways to combat stressful situations.

This is the best way of coping with things - use common sense first.

Emotion focussed coping is when someone tries to change their emotional reaction to the stressful situation and that is how they cope with the event.

There are other ways of coping such as avoidance styles.

Question 38

About repressive coping

Answer 38

A disposition to repress or avoid negative affect. They actively avoid negative emotions like fear and anxiety. Typically repressive copers are defined as having high defensiveness and low trait anxiety.

High defensiveness means that they say they’re fine when they’re not. Low trait anxiety means that (state: something that changes, trait: something that doesn’t really change, it’s something that you have) they are generally not anxious. The person doesn’t always know that they are repressing, so can be very difficult to know when someone exhibits repressing coping.

They also show lower signs of distress, but physiologically do show signs of stress eg increased HR etc.

Has been research that repressive coping might be psychologically healthy to a point, as the ability to separate feelings so that you’re not hit by a wave of emotion has been hypothesised to be psychologically healthy. However they do become physically unhealthy.

Myers is the leading expert on repressive coping.

Increased levels of cortisol and adrenaline.

Question 39

About repressive coping and disease

Answer 39

Non-repressors able to absorb information better than repressors - better outcomes.

Non-adherence - because repressive coping style think that everything is ok (indirect effect of disease)

Repressors with cardiovascular disease - fid it difficult to absorb the information and if they do absorb it they report more complications afterwards. Patients that seem good but actually end up recovering slower than other patients who are honest.

The Montreal heart attack readjustment trail

Interventions for repressive coping. As repressors don’t have conscious awareness of anxiety there are no standard interventions that the health system/psychology has been able to develop so far, they don’t realise they have a problem so hard to get them to go for help.

Question 40

How does tolerance develop?

Answer 40

Happens because of up/down regulation of receptors depending on the drug.

Question 41

About heroin addiction

Answer 41

Heroin is injected as you get more of it into the system than smoking. It is more pure. Has a short half life, have to inject 4 times a day, up to 2 bags each time so up to £80 a day. This is why addicts turn to crime.

Potent full agonist on the mu receptors in the brain - opioid system.

Risks of infection from injection - Hep B, C and HIV. There is also risk of crime and violence to others and self.

The main cause of death in addiction is overdose causing respiratory depression. To reduce these risks, harm reduction, we can clean needles, methadone substitution. The lesser evil. An individual on methadone is still an addict but the addiction has shifted from heroin and its associated effects to methadone. Has a longer half life and lasts 24 hours, can be done in front of a nurse.

Half life is important as it determines how addictive a substance is.

Question 42

About opiate OD deaths - prevention

Answer 42

Prevention:

- Give advice, psycho-education, eg only inject when someone is there so they can make sure ok, only inject a small amount first, when released from prison and tolerance has gone down need to be careful about how much using
- Naloxone - an opiate antagonists which blocks the mu receptors and can save a patients life similar to an epipen. Can be prescribed to patients to take home, although cant be injected themselves once they have started to overdose, but a friend could do it and then call 999. this reverses the effect also immediately. However if you give a heroin addict naloxone they experience dreadful withdrawal symptoms.

Question 43

What can be done in terms of harm minimisation in drug addiction?

Answer 43

Can treat HIV but not cure
Vaccinate for hepatitis
Clean needles and education
Condoms 
NRT eg e-cigarettes
Methadone - syrupy and sugary, given this way because if injected it is really painful so less likely to inject it.

Question 44

What is the value of brief interventions in addiction?

Answer 44

Often helps people move from the pre-contemplation to contemplation phase