Chapter 5 Flashcards
The DSM does not pathol-ogize the casual or recreational use of a drug
t
The DSM uses the term addiction
f the DSM-5 includes diagnostic criteria for substance use disorders and substance-induced disorders
…. disorders are characterized by a cluster of cognitive, behavioral, and physiological symptoms that manifest with compulsive drug-taking.
Substance use
…disorders include drug-specific physiological and behavioral symptoms of intoxication, withdrawal, and other possible mental disor-ders resulting from the use of a drug
Substance-induced
a mild substance use disorder is suggested by the presence of … symptoms, moderate by … symptoms, and severe by … symptoms
two to three
four to five
six or more
the drug abuse criteria fit into what 4 categories
individuals impaired control over substance use.
Criteria 5 through 7 encompass social impairment associated with substance use.
Criteria 8 and 9 indicate risky use of a substance.
Criteria 10 and 11 are pharmacological in nature.
how did the DSM-IV-TR characterize sub problems
substance dependence and substance abuse.
…` entails intense preoccupation, strong desire, or an overwhelming urge to use a substance. T
Craving
The greatest conceptual shift presented in the DSM-5 chapter on addictive disorders is the inclusion of a non-substance-related disorder, what was it
gambling disorder
why is gambling disorder with the substance use disorders?
the same brain and behavior mechanisms responsible for drug addic-tion appear also to be involved in non-drug-related addic-tions
Individuals with non-substance and sub-stance-related addictions also share common neurobiological underpinnings, deficits in …3
decision making, personality traits, and negative personal consequences.
how is tolerance presented in gambling disorder
Needs to gamble with increasing amounts of money in order to achieve desired excitement
withdrawal in gambling?
Is restless or irritable when attempting to cut down or stop gambling
what are the neuroscience behind gambling addiction
impairments in the mesolimbic reward circuitry
simi-lar changes in the brain activity underlie gambling urges and cocaine craving
t
how are gambling and substance addictions similar
-sion of incentive sensitization theory to gambling disorder includes evidence that: a bias of attention toward gambling-related cues exists in compulsive gamblers, a positive correla-tion between striatal dopamine release and gambling disorder severity, and increased striatal activity in problem gamblers in response to reward-related stimuli.
The opioid antagonist naltrexone, used in the treat-ment of alcoholism and heroin addiction, reduces gambling behavior in highly impulsive individuals
t
how does the WHO classify addictions (ICD)
Harmful use and dependence syn-drome.
what do the DSM and ICD 10 have in common
(a) the addicted individ-ual demonstrates a loss of control, as indicated by an escala-tion in dose and sustained use of a drug and that (b) the drug use has harmful consequences
impaired control and drug-related harm are really different indicators of the same …
process
what is the hard part of drug categorization to notice
control: how can you tell if someone is in control
how can we tell if animals have a lack of control l
harm behavior must be out of control because no person or animal who has control of their behavior would deliberately injure themselves
what are the 5 types of harm
physical, psychological, occupational, social, or inter-personal.
the correlation between craving and subsequent drug use is poor
t , suggesting that the experience of drug craving may be used as an after-the-fact explanation of drug relapse
specifications are made as to the …—whether the individual is in early or late (sustained) remission.
course of the disorder
when did we start referring to addiction (medical) as exclusively to the excessive use of drugs and to replace such terms as intemperance and inebriety
Toward the end of the nineteenth century,
DSM worked to get addiction from disorder to …
disease
what are the 2 theories for how addiction is a disease
predisposition theories and
exposure theories
(a) predispo-sition theories, say what about how drugs are a disease
which say that people are either born with the disease or acquire it at some time before they begin abusing the drug.
what do exposure theories say
addiction is a dis-ease that is caused by repeated exposure to the drug.
who compared drug addition to an allergy
Jellinek proposed that alcoholism is not caused by alcohol. It is a disease that is inherited; people are born with it. People with an allergy to cats will have no allergic reaction if they do not go near cats.
did Jellinek propose a cure
said there wasn’t one
T: these theories propose that addiction is caused by exposure to the drug alon
drug exposure diseases
does this mean that addiction is a disease?
can be understood in terms of disease pathol-ogy, rather than lifestyle.
Like a broken leg, if we think of addiction as an outcome, it may be more appropriately conceptualized as a type of …, rather than a disease
injury but its up to you
the fact that the DSM uses the term disorder acknowledges such conceptual distinctions because a disorder can include .. resulting from a disease or an injury.
disabling outcomes
theory that was disproven: Avoidance of the autotoxin’s effects was widely proposed as an explana-tion for compulsive opium use. what kind of reinforcement is this
negative
The ability of a drug to cause … (and, consequently, withdrawal) became accepted as the universal indication of an addicting drug, and the presence of …became the defining feature of an addict and an addiction
physical dependence
what is this well supported dependence model 2 criteria for addiction
(a) the state in which a drug pro-duces physical dependence (withdrawal symptoms occur when the drug is stopped) and (b) the compulsive self-administration of a drug (addiction).
serious flaw of dependance model
it is possible to have an addiction in the absence of dependence and to have dependence without addiction
e.g. of addiction without withdrawl
Powerful addictions can develop from intake of substances such as cocaine and cannabis, which cause only relatively mild withdrawal symptoms
dependance without addiction e.g.?
people can be physiologically dependent on medicines such as pain relievers and yet show no addictive behaviors such as craving and loss of control.
These people often became physically dependent on their medication, demonstrating signs of tolerance and withdrawal. is this the same as addiction
no, use to be used intergangably now not
he fact that people could become addicted to substances that did not cause severe physiological withdrawal was noted very early and created a much bigger problem for the ..
depen-dence model.
what emerged from dependance without addiction discovery
This alternative was later developed into the concept of psychological dependence (focused on mental, as opposed to physical, withdrawal symptoms)
what would be psychological symptoms
irrita-bility, negative affect, dysphoria, or craving
problem with the theory of psychological dependance?
may be used to describe a state of affairs, but it cannot also be used as an explanation (explained now)
. This problem does not arise with physical dependence because there is independent evidence—…—that physical dependence exists
withdrawal symptoms
One of the mysteries of casual drug use is that it does not seem to be associated with
any known motivation.
there is a natural drive to use drugs; that is, humans have a need to alter their state of consciousness.
t
why did animal addiction go unnoticed for lots of research
thought only humans vcould be addicted so never studied rec use :conditioned taste aversion meant they weren’t liking drug
how did animals not developing addictions lead to social dilemmas of addicts
must be something defining humans from animals that make them addicts because humans had free will and nonhumans did not, humans could “sin” by choosing to take drugs and that this sinning was punished by the misery of addiction.
With this single development, our whole view of drug self-administration and addiction changed, what development
injecting animals
Similarities and Differences in Self-Administration between Humans and Animals: types of drugs
very similar
how do patterns of administration compare
similar
animals that were not physically dependent would self-administer doses of morphine so low that no physical dependence
ever developed It was also demonstrated that rats would press a lever to give themselves infusions of cocaine and other stimulants that do not cause marked
withdrawal symptoms
t
… theory, postulates that addictive behavior arises in part from avoidance of drug withdrawal symptoms.
hedonic dysregulation
Drug addiction is conceptualized as a disorder that develops when behavior initially maintained by positive reinforce-ment (…) progresses to being motivated by nega-tive reinforcement (…)
intoxication
alleviating the unpleasant emotional state experienced during withdrawal
The model of drug taking that has developed as a result of self-administration studies we shall call the ….
positive rein-forcement model.
do positive reinforcers always have pleasant effect
there are plenty of examples of stimuli that can act as positive reinforcers but do not cause pleasure even electric shock
is any stimulus that increases the frequency of a behavior it is contingent upon:T
positive reinforcer
To demonstrate that an event can be a positive reinforc-ing stimulus, it must be shown that it will …
increase the frequency of a response it is contingent upon
how does positive reinforcement models explain behavior motivated by positive reinforcement should persist in the face of such punishing consequences
they are immediately experienced after behavior, whereas the punishing and painful effects are often delayed
most positive reinforc-ers, including drugs, can have negative and destructive effects that can motivate people to seek treatment to help them quit
t
…. theory, which shows that drugs can sensitize certain parts of the brain that control positive reinforcement, and this too can explain addiction.
incentive sensitization theory
what is the problem of circularity with positive reinforcement?
?P 97
Various drugs differ in their capac-ity to act as positive reinforcers. This property of a certain drug is sometimes referred to as its …
abuse potential or abuse liability
larger doses of any drug are generally more reinforcing than smaller doses
t up until a point
Human
… between individuals may be respon-sible for variations in drug use
genetic differences
there is a causal link between drugs and its use to exastrabate pain
f just correlational
the idea that a drug of abuse is specifically chosen to dampen particular symptoms of mental illness is widely supported in experimental research with humans.
f
diazepam is an extensively prescribed drug that is suspected of being overused. but in doubt blind studies its not preferred how is this explained
not sure but doesn’t support drug as pain relief
anticipated relief of unpleasant symp-toms is reinforcing
t but not a lot of evidence for self medication theory
It seems clear from human experience that the decision to use or not to use a drug often depends on the …
expected demands of a situation.
task demands can either enhance or diminish the reinforc-ing value of a particular drug.
t
stress not only enhances the acqui-sition of the … of a number of drugs, including cocaine, opiates, and alcohol, but also has been shown to increase the … of these drugs as determined by rate of responding and progressive ratio breakpoint
self-administration
reinforcing value
increases in drug intake do not involve relief from stress so why does it increase drug use
stress directly activates and sen-sitizes brain mechanisms responsible for the reinforcing value of a drug
how does history of stress influence
stress not only increases drug use when it is experi-enced during drug self-administration, but a history of stressful experiences is also able to sensitize brain rein-forcement mechanisms, elevating an individual’s predis-position for drug abuse.
how does hunger influence drug abuse
increases it maybe due to stress
slower-acting drugs in the benzodiazepine family, such as diazepam (Valium), are not self-administered by humans and nonhumans what humans will self admin
those with past experience with sedative-hypnotic or depressant drugs such as barbiturates (-revious experience with other drugs)
how does past experience with the same drug influence
repeatedly that a history of either self-administration or passive exposure to a drug can enhance that drug’s reinforcing ability
how does past experience with a drug influence reinforcement
general sensitiza-tion to the reinforcing effects of drugs and permenant changes of brain from withdrawal
longer access to drug=
consumption does not stabilize like it does when presented in short doses
extended cocaine access also appears to elicit an increase in …3
motivation (drug-seeking) in rats, an increased sensitivity to reinstatement, and a reduced sensitivity to punishment of cocaine-seeking
reestablishment of operant responding for a reinforcer, following a period during which responding had been extinguished, by a noncontingent presentation of that reinforcer (
priming effect or reinstatement
what does reinstatement explain
It is known that such relapses are sometimes triggered by the drug itself, stress, or even people and situations that have been associated with previous drug use.
only occasionally presenting the drug and the stimulus together makes it possible to maintain much more behavior than if the drug were administered alone and no stimulus was used:T
second order schedules
difference between conditioned reinforcement and second order schedules
?
Any system that controls motivation must have at least two components.
It must be able to energize or activate behavior, and it must be able to direct that behavior toward a particular goal and ensure the organism acts appropriately to obtain that goal
In the case of motivation, the organism has a …3 (e.g., hunger or thirst), which is the rocket engine that gets the animal moving.
need, drive, or motivation
what is the human guidance system like
We are attracted to specific targets
programmed based on past experience
This attraction to a specific stim-ulus is called …
incentive.
… provides a good model for studying how animals learn to make a response in order to obtain food or some other reinforcer, and change their behavior as a result of changes in the environment or the delivery of the reinforcer.
Operant behav-ior
do humans have a reinforcement centre
no
what do they have instead of reinforcement centre
a number of brain regions form an integrated cir-cuitry responsible for learning, motivation, and the control and direction of behavior
T: a number of brain regions form an integrated cir-cuitry responsible for learning, motivation, and the control and direction of behavior
motivational control system
when an organ-ism is hungry, this input stimulates the … area in the midbrain
ventral tegmental
Axons from the ventral tegmental area are connected to the nucleus accumbens, and the ven-tral tegmental area stimulates the nucleus accumbens by releasing … at its synapses
dopamine
the connec-tion between the ventral tegmental area and the nucleus accumbens is known as the …
mesolimbic dopamine system,
activation of the … by a homeostatic imbalance, such as hunger, will stimulate the motor system and cause a general increase in the activ-ity of the organism
mesolimbic dopamine system
dopamine mediates general arousal, physical effort, and motor activity formed the basis of the activation–… of dopa-mine function
sensorimotor hypotheses (can’t explain reinforced behaviour just activity)
the output of the nucleus accumbens normally pro-vides continuous inhibition of the motor system so how does the sensorimotor hypothesis explain this
it actually inhibits the inhibitory output to the motor system,
review figure 5.2
?
3 systems that make up motivation control system?
learning and memory
motor loop
reinforcement system
sensory information is processed by the thalamus and cortex and then sent to the …2, which are part of a learning and memory system
amygdala and the hippocampus
how does the motivation control system enhance survival
Behavior is acti-vated and directed so that the organism approaches objects in the environment and performs acts that have resulted in the restoration of homeostatic balance in the past.
Learning and memory circuitry provides the basis for the reward learning hypotheses of dopamine function, which implicate … in the acquisition of operantly condi-tioned response
dopamine
reward actions, classically conditioned stimulus–reward associations, and the coding of predictions about reward availability based on the pres-ence of conditioned stimuli make up the…
the guidance system
motivation control system works as follows.: When a need state occurs (e.g., hunger), the mesolimbic system is acti-vated. This causes an increase in general activity. The outcome of reaward lets say food outcome (the accidental discovery of food) causes the release of mesolimbic dopamine, and neurons in the …become active. Information associated with the discovery is stored in the …
nucleus accumbens
hippocampus and the cortex
what is incentive salience
finding reward The salience part means that these stimuli will be able to grab the animal’s attention in the future. The incentive part means that the animal will be attracted to them.
what system controls for guidance
mesolimbic dopamine system
It may be that dopamine contributes to learning indirectly, through the enhancement of attention, motivation, rehearsal, and memory consolidation
how exactly does dopamine guide behavior?
dopa-mine surge is not responsible for actually acquiring the stimulus–reward association
can dopamine deficient mice still learn stimulus–reward associations
yes
mice with more dopamine learn faster
f
The dopamine surge may be a consequence, rather than a cause, of …
associative learning and reward prediction
what is the hedonia hypothesis of dopamine
the rewarding value of brain stimulation (and any other reinforcing stimulus) was derived from the pleasure it produced.
why should we not think of dopamine as the pleasure NT
Pleasure is a subjective state that often accom-panies activation of the mesolimbic dopamine system, but this does not make dopamine the pleasure neurotransmit-ter it was traditionally thought to be
can parkinsons pt experience renforcement since they have a lack of dopamine
yes
increasing levels of dopamine in the nucleus accumbens of Parkinson’s patients through administra-tion of L-DOPA does increase feelings of pleasure or liking
f
Increases in “liking” reactions result from the activation of these hotspots, whereas damage to these hotspots corresponds with “disliking” reactions, even to sweet tastes what are these hotspots called
hedonic hotspots in the nucleus accumbens
what is suprising about hedonic hotspots
no dopamine required to stimulate hotspots
—animals demonstrate pleasure, despite a lack of dopamine function what does this tell us
dopamine is not responsible for “liking” or for the subjective feelings of euphoria and drug-related high
If dopamine is not responsible for “liking” or for the subjective feelings of euphoria and drug-related high, what is?
“Liking” reactions to sweet rewards are potentiated by stimulation of hedonic hotspots by opioids endocannabinoids , and GABA
the meso-limbic dopamine system has two roles in motivating behav-ior.
The first role is general activation.
second is to direct behavior toward a particular goal
by which process does the body direct behavior toward a particular goal
incentive salience; that is, various stimuli in the environment have or acquire spe-cial motivational properties that cause us to notice them, be attracted to them, and do something to them.
stimuli and actions associated with these natural incentives acquire incentive value of their own and come to guide behavior. This is how … operates
reinforce-ment
do some stimuli have natural incentive salience
yes sweets and good looking people for eg
This is how reinforce-ment operates. It is not a matter of the rat remembering that pressing the lever causes food to appear. That may well happen, but the behavior of the rat appears to depend on..
the attractive motivational properties of the lever and the act of pressing it; that is, the lever becomes wanted
The crucial role of the nucleus accumbens in reinforce-ment is in the formation of …
incentive salience. turning neutral stim into something we want
dopamine is not involved in liking but is involved in…
wanting
people receiving dopamine are at what risk
of developing compulsive behaviours due to wanting
mesolimbic dopamine system is a this system is there to make …, not to make you feel good; it is a … system, not a pleasure system
you repeat certain actions
do-it-again
even stimuli associated with an aversive consequence can gain incentive salience and become wanted why is this
incentive salience of stimuli are malleable and depen-dent upon the interaction of learning, memory, and physi-ological state (e.g. could need salt in diet drink something not pleasurable but salty”
Drugs could even become ‘wanted’ under conditions where their experi-ence is known to be unpleasant. explain from incentive sensitization theory
the incentive sensitization hypothesis of addiction, such mesocorticolim-bic amplifications of incentive salience create compulsively intense levels of motivation in drug addiction
how do drugs use reinforcing natural mechanisms
Even though they are not natural reinforcers, drugs control behavior by using the same brain mechanisms as other natural positive reinforcers= increase extracellular dopamine
what are the 3 ways reinforcing drugs activate the mesolimbic dopamine system
either directly via stimulation of the nucleus accumbens or indirectly via facilitation of excit-atory input or blocking of inhibitory input to motivation circuitry
Drug-associated cues also have the capacity to elicit dopamine surge
t
… that occur in response to drug use, and perhaps to the behavioral addictions, are a necessary occurrence for the development of conditioned responses to addiction-related cues
The fast bursts of dopamine release that
some important differences
between drug reinforcement and reinforcement by more natural stimuli. what are
- under normal conditions, natural reinforcers have a satiation mechanism that terminates their reinforcing effect. drugs no limit to their reinforcing abilities
- reinforcing effect more intense immediacy and intensity of the latter’s effect. Drugs are capable of getting to the brain in high concentrations very soon after they are administered, making drug reinforcement more immediate than natural reinforcers.
the greatest subjective drug high comes from drug classes and routes of administration that result in the …
fastest and highest peaks in dopamine activity
dopamine surges cause euphoria
f these surges ensure that any stimulus that elicits extreme pleasure also gains incentive salience and is embla-zoned in the motivational system.
what causes the pleasure then
Increases in the activity of other neurotransmitter systems, such as opioids and endo-cannabinoids, which are highly implicated in liking, may in fact be causing the pleasure
aversive events like stress and pain can release dopamine
t
…, both past and present, increases the strength of a reinforcing stimulus.
stress
what does repeated exposure to stressful stimuli do to the mesolimbic dopamine system
sensitizes it increasing incentive value of drugs even after stress removed
what causes sensitization
It is now known that the cause of the animal’s heightened activity is an increase in sensitivity of the mesolimbic dopamine system to the drug (behavioural sensitization).sensitization of motivational circuitry
how does incentive sensitization theory explain addiction
there is a sen-sitization of incentive motivation. The incentive sensitization theory uses this change in motivational sensitivity to explain addictive behavior.
how does incentive sensitization explain cravings
pathologically intense feelings of wanting, which can be produced when incentive salience (or core [uncon-scious] ‘wanting’) is translated into conscious awareness
craving is hard to operationalize, how did they do it in incentive sen theory
manifestation of incentive salience toward drug-associated stimuli measured behaviourally
2 things needed for something to have incentive salience
a) The stimu-lus is easily noticed and attended to by the organism, and (b) the stimulus motivates behavior that is directed toward it.
When Olds and Milner first demonstrated the reinforcing properties of stimulation of certain brain centers, people started to call these centers … partly because when these centers were stimulated in individuals, they reported experiencing extreme pleasure
pleasure centers,
The rewarding properties of a drug drive behavior so that the animal will work to obtain it, which makes the drug a …
positive reinforcer
With repeated use, a drug will acquire greater incentive value (and be a stronger rein-forcer) because of ..
sensitization
the reward processing system isn’t influenced by limited drug use
f is seen up to a year later with only 3 uses
even used drug related cues can activate the nucleus accumbans
t
incentive sensitization is even stronger when stressed
t
presentation of alcohol-related pictures induced craving for the drugcna you see this in brain?
increased activity in the prefrontal and anterior cingulate cortices and lower D2. receptor density
a positive correlation between the … and the degree of cerebral blood flow in the orbitofrontal cortex
intensity of drug craving
According to incentive sensitization the-ory, the subjective consequence of activation of this system is …, and the subjective experience of a sensitized system is intense wanting or …
wanting
craving
so what is happening when addiction is developing according to incentive sensitization
with repeated administration, the drug acquires increased reinforcing properties—it has more pull.
if an addiction is extinguished is the person still at greater risk of relapse
Sensitization of incentive salience can also explain the priming effect described earlier wherein a single exposure to a drug can restart more drug use even if it has been extinguished
Repeated drug use sensitizes only the neural circuitry of the …, not that of a sys-tem mediating the pleasurable effects or “liking” of drugs
motivational system
what model :
neurobiological/psychological dependence model predi-cated on a continually shifting balance between the activ-ity of brain reward systems and the recruitment of antireward systems that results from recurrent drug use.
hedonic dysregulation
according to hedonic dysregulation when is drug use addiction
stage 2 the progression toward drug addiction entails a compul-sivity of substance use (that is, a loss of control) and the recruitment of negative reinforcement processes. reward centres require more stimulation
stage 3 in hedonic dis is characterized by …
a preoccupation with, and an anticipation of, drug use.
opponent process theory aligns with hedonic dis what is opponent process theory
proposes that emotional states, once initiated, are automatically modulated by central nervous system mechanisms that reduce the intensity of the experience.
does the slow B process in opponent theory remain constant through drug use
f gets larger and faster with repeated exposure, more activity and sensitized (pleasure or A processes become dysregulated)
elevations in reward threshold can appear within a single session of drug self-administration
t
The overall affective state experienced by the user is argued to be the sum of both … processes.
A and B
do the second half of chapter 3 414
…
