Chapter 5: Substance Use and Addictive Disorders Flashcards
Substance Abuse?
how many symptoms needed?
- failure to fulfill major obligations at one’s job, at school or to one’s family, recurrent problems with the legal issues, and persistent social or personal problems..
- any one of these= diagnoses
What is Substance Dependence?
symptoms?
duration before diagnoses?
how many symptoms needed?
- increased doses of the drug, withdrawal symptoms, unsuccessful attempts to cut down on drug use and continued use in spite of the drug’s harmful effects.
- 12 months
- 3+
What has DSM-5 switched out Substance Dependence and abuse for?
- 2 to 3 symptoms?Diagnoses?
- four or more ?
-Substance Use Disorder
L> moderate or severe.
-moderate
-severe
The varying definitions of addiction have the following four elements in common:
- addicted person has impaired control over the use of the drug(crucial question is can they stop?)
- the drug use has harmful consequences
- tolerance has developed
- Withdrawal occurs upon cessation of drug use.
Craving refers to what?
subjective term meaning a strong desire to use the drug…
The criterion for addiction?
- loss of control
- harm
- craving
- tolerance
- withdrawal symptoms
Addiction is often considered a _______ disorder with a high probability of _____.Which varies from person to person in intensity.
- chronic, relapse.
When an addiction has been “beaten” or they have been free of the addictive symptoms for a prolonged period of time that individual is considered to have been in what?
remission
Sustained remission means?
early or late remission
By 1870 addiction to alcohol was labeled as a ______ rather than a sin, it came to be considered a _________ via humanitarian proposal.
- disease
- medical issue
What association called addiction to alcohol Inebriety disease in 1870?
American Association for the Cure of Inebriates.
The disease model after being established by the antiopium and temperance social movements faded away and was re-established during the 1950s by who?
Jellinek
Two major approaches based on the disease model came to be. What were they?
- Predisposition Theories
2. Exposure theories
Predisposition theories?
- people are born with the disease or acquire it at some time before they begin abusing the drug.
- jellinek believed there to be no cure for alcoholism
- one drink=one drunk
- genetic variations/damage, exposure to certain enviro conditions in childhood or later in life…
Exposure Theories?
- oops phenomenon
- developed by?
addiction is caused by exposure to the drug alone
- harmful outcome is in no way intentional
- virtually inevitable that prolonged drug use will lead to addiction.
- Alan Leshner
Why is disorder better than disease when referring to a term for substance addiction.
- Disorder can include both diseases and injuries
- something is wrong without it being a pathogen or genetic malfunction. (brain functioning? )
The disease concept became popular for particular reasons in the USA which was??
Insurance would pay for treatment
In the twentieth century research was geared at the use/stop of opium/morphine. Autotoxin meant what?
-a metabolite of opium that stayed in the body after the drug was gone. This had effects opposite to the drug and when left in the body caused sickness.
Autotoxin was disproved and later coined ?
-withdrawal or abstinence syndrome
Physical dependence became to be widely recognized because of?
the ability of a drug to cause dependence and consequently withdrawal.
Dependence model (physical dependence ) two components ? addicts crave the drug because...
-avoidance of withdrawal
2. compulsive self administration
it will prevent withdrawal….media version of addiction**
In the DSM-5 the word dependence is restricted to mean?
- a condition in which withdrawal syndrome occurs, in part b/c withdrawal can occur with/out compulsive use.
aka only to refer to physical dependence not addiction! due to people in the medical world prescribing drugs that make people physically dependent on meds because their body needs them…not addicted though.
Tatum and Seevers suggested what in the discovery that ppl could be addicted to substances that did not cause severe physiological withdrawal?
-psychic addiction/ psychological dependence
Originally it was thought that only humans exhibited addictive behaviour because? (5)
aka Conditioned Taste aversion ?
- animals generally avoid taking drugs orally due to bitterness
- animals formed
a conditioned taste aversion to the drug - there is a delay between the taking of an oral drug and its positive effects.
- tech required for IV self administration by animals had not been developed yet.
- Scientists believed that animals could not make the connection btwn drug injection and relief from withdrawal.
Mello and Mendelson in the 1970’s studied human volunteers with a history of drug abuse in the lab. Subjects were required to do some work to obtain a dose of a drug via
operant tasks
Lab observation of drug abusers is better than observing them in their natural environment because of?
3
- can measure diff drug doses and types and compare their effects to that of placebo
- manipulate administration and work required.
- check effects of other drugs administered at the same time and carefully measure the changes in behaviour that might be via test drug
There is what kind of a dilemma with lab work?
ethical
cannot give drugs that could give addictions to people that other wise would not have one !
In non lab experiments subjects are given a drug one day and a placebo the next. Then given the choice between them. This choice of drug indicates what?
-if they choose the drug it is a reinforcer
What are some similarities and differences between animals and humans in regards to drugs?4
- Most commonly, BOTH prefer the same types of drugs
- certain drugs taken by humans are aversive to animals ( ex: LSD, antipsychotics and some antidepressants)
- patterns of self administration are similar in both
- It is not necessary to create a physical dependance in order to get animals to self administer drugs,
Schuster and Thompson (1964) found what about physical dependence?
animals that were not physically dependent would self administer low doses of morphine so low that no physical dependence ever developed…aka the drug was acting as a positive reinforcer not a negative one to avoid withdrawal.
Positive reinforcement model?
-drugs that are self administered at least initially because they act as positive reinforcers and that the principles that gov behaviour are controlled by other positive reinforcers apply to drug self administration.
What is a positive reinforcement?
any stimulus that increases the frequency of a behaviour that closely precedes it.
Run through how the Pickens and Thompson experiment went and its findings in regards to positive reinforcement. 3
- activity?
- random infusion?
- switch bars
- extinction?
- FR ?
- rats were placed in a small Skinner box and lived in it. In this box there were two levers, one delivers an IV infusion of cocaine and another was only saline, a stimulus light was also there.
- eventually rats pressed only the cocaine lever at a rate of 8-12 infusions per hour.
- explanations other than + reinforcement were ruled out:
- increased activity by accidentally hitting the cocaine bar? : bar pressing was selective to the drug one
- bar presses stopped when the drug infusions occurred randomly and were not contingent on behaviour
- bar pressing switched when the lever did
- extinction occurred when cocaine was turned off
- pattern of responding for cocaine on a FR was = to that exhibited via food as a reinforcer.
Problems with the positive reinforcement model?
- Positive reinforcement paradox
- explanation?
- use of reinforcing drugs can have neg consequences yet animals and ppl continue to self administer?
- effects/reinforcers come first and - ones are delayed aka not immediate, the ones that are immediate become strongly associated with the drug and continue to influence behaviour more so than the neg ones.
Incentive sensitization theory?
drugs can sensitize certain parts of the brain that control positive reinforcement…
What are the 6 factors that alter reinforcing value of a drug?
- different drugs aka their abuse liability/ potential (cocaine is the standard with which all are compared to…psychomotor stimulants are the worst bruuuuutal)
- Dose of a drug
- Breeding and strain differences (genetic predispositions)
- Relief from unpleasant symptoms
- Task demands ( decision to use or not use a drug depends on the situation)
- Conditioned reinforcement : stimulus associated with drug use can increase its effects
Task Demands and Silvermans exp. GO
-volunteers ingested colour coded pills containing triazolam and d-amphetamine
-two activities: vigilance task, relaxation task
-7/8 picked amph when they knew they’d be doing a vig task
-8/8 picked triazolam when they knew they’d be doing relax
also caffeine over placebo for vig
Stress and reinforcement? 2
-stress increases drug use when its exp while self admin and also a past history of stress is able to sensitize the brain reinforcement mechanisms
Previous experience with other drugs and reinforcement?
-slower acting drugs such in benzodiazepine like diazepam
- not normally self administer by humans or nonhumans
- whether they have past exp with sedative hypnotic or depressant drugs determines self administration.
Previous exp with the same drug and reinforcement?
2
a history of abuse or passive exposure to a drug can enhance the drug’s reinforcing ability
-withdrawal as well past exp
Withdrawal symptoms and reinforcement?
withdrawal symptoms presence can reliably increase drug intake but its necessary for the animal to have had the opportunity to learn that obtaining the drug relieves withdrawal.
Extended Access and reinforcement?
- short daily sessions
- continuous access to the drug
- responding will quickly become stable
- intake exceeds that of the daily dose and within a few days the organism dies of over dose or other effects.
Priming or Reinstatement and reinforcement? (relapse)
- extinction
- stress
- stimulus
-extinguished responding for a reinforcer can be reinstated by a non contingent presentation of that reinforcer .
aka direct injection of a drug instead of working for it..will induce working behaviour for it
- stressful stim can cause this
-stim previously associated with the drug delivery
-withdrawal as well
Conditioned reinforcement and reinforcement of a drug?
conditioned place pref
second order schedules of reinforcement
Second Order schedules and reinforcement?
explain
explain a ex of this
- when a drug administered is preceded or accompanied by a distinctive stimulus such as a light. The animal will eventually learn to emit a response just to make the light turn on. aka it acquired reinforcing properties because of association with the drug.
- Light shown on FR10, drug is given on an FR20 aka light comes on every 10 and the drug comes on after 200 of the light responses.
Conditioned tolerance?
drug related stimuli produces compensatory responses they will lower the effect of a drug when they are presented along with the drug
Sensitization?
cond stim and the drug produce the same effect, presenting them together will enhance the effect of the drug
Motivational control system must have? (2)
- activate behaviour
2. direct that behaviour towards a particular goal
Explain Activation
VTA
NAcc
BasGang
- homeostatic imbalance (exp need of food) stimulates the ventral tegmental area
- axons from VTA stimulate the NAcc by releasing dopamine
- axons from VTA stimulate basal ganglia, general motor activity increases
Explain Guidance 2
-example
- sensory input to the cortex (via thalamus) is sent to the amygdala and hippo this loop forms part of the learning and memory syst.
- system ensures behaviours are repeated that have restored homeostatic balance in the past
- Ex… raccoon is hunger..motor loop is activated…by chance it finds a garbage can and gets food…..Next day raccoon is wandering around and gets hungery…..VTA–>NAcc>BG>Thal>Cort>Hipp and Amy>cortext>motor activity…goes to garbage can not by chance but via mem
Whats the role of Dopamine ? 3
- surge of DA in NAcc is correlated with changes in behaviour caused via reinforcement
- DA surge is not responsible for the stimulus reward association
- DA may be responsible for the acquisition of incentive salience by stimuli association with a reinforcer like food.
Mice experiment on genetically altered mice and dopamine
- hypodopaminergic mice did not learn any faster than normal mice
- dopamine deficient mice are still able to learn stimulus reward association
Dopamine contributes to?
learning indirectly via attention, motivation, rehearsal and memory consolidation
Liking in Reinforcement?3
- da and hedonia
- rep pres of stim with food
- variations in da and liking/disliking
- da is not responsible for hedonia
- after repeated presentations of stimuli associated with food, these stimuli rather than food itself prompts the release of DA via mesolimbic system.
- variations in DA lvls do not change liking or disliking responses to pleasurable and unpleasant stimuli
Hedonic Hotspots are in the ______ and the _________. They are stimulated by ____, ____ and ____. More explanation? 4
- NAcc, Ventral pallidum, opiods, GABA and endocannabinoids
1. stim of hotspots elicit liking reactions
2. destroyed hotspots, disliking reactions even to sweet tastes increase
3. hyperdopaminergic mice do not like sucrose more than norm mice.
4. injection of dopamine does not increase liking
aka liking is independent from dopamine
Wanting in Reinforcement?
- Stimulus can intrinsically have or can acquire ___________: they are or become wanted
- The crucial role of the NAcc in reinforcement is the formation of ________.
- Variations in DA lvls can Inc/Dec behaviouts intended to acquire reinforcers:
a. ?
b. ? - The mesolimbic dopamine system is the brains ____ sytstem.
- incentive salience
- incentive salience
- a. blocking DA receptor activity or destroying da axon terminals does not stop an animal from consuming sucrose but does reduce the behaviour aimed and getting it. (antipsychotics)
b. hypodopaminergic mice do not show an increase of liking sugar they are more motivated to get it. - do - it - again
Incentive Salience?
various stimuli in the environment have or acquire special motivational properties that cause us to notice them, attract to them and do something to them.
Drugs as reinforcers?
- Drugs behave much like other ______ reinforcers (food) that result in the stimulation of NAcc
- When non-drug reinforcers produce addictive behaviours the same changes in the __________ system produced by drugs can be seen.
- Drug-associated cues also elicit surges of_______.
- Diff btwn drugs and non drug enforevers?
a. Reinforcing drugs stimulate the ______ directly.
b. non-drug reinforcers have a ______ mechanism but drugs do not.
c. Drugs have an immediate and intense effect on the brain but non drug reinforcers generally __. - The speed and volume of dopamine surges correlate with the ______ of liking and wanting induced via reinforcing drugs.
- Stress ______ the reinforcing value of drugs and related stim.
- REPEATED stress _____ the mesolimbic system: its response to da intensifies.
- natural
- motivational
- dopamine
- a. NAcc
b. satiation
c. do not - intensity
- intensifies
- sensitizes
Stress is?
any event that triggers the release of the hormone cortisol
Incentive Sensitization Theory??WTF?
sensitization of motivational circuitry : individual develops an attentional bias towards and a compulsive wanting or craving for the drug.
The incentive sensitization theory was designed to explain what?
craving
Incentive salience qualities : (2)
a. stim is easily noticed and attended to by the organism
b. stim motivates behaviour that is directed toward it
Drug associated stimuli gradually come to elicit an increased amount of activity in brain regions that are a part of the ____ system.
wanting
Tolerance develops to the pleasurable effects of drugs while the wanting system becomes _______ aka ______ occurs and persists for a long time
a. A cure elicited craving can persist for ____ after drug taking has stopped
b. explains why addicts will say : I don’t like it anymore, it does not get me high like it used to but I still want to take it. It makes me feel normal
increased, sensitization
years
Nora Volkow et al purposes that drug addiction involves a dysfunctional _____ processing system among many ____ regions.
information, brain
The brain regions that are dysfunctional in drug addiction are : (4)
1.NAcc and VTA
2.Orbitofrontal cortext and motor cortex
3. amygdala and hippo
4.doralateral prefrontal cortex and anterior cingulate gyrus
what are these each involved in
- Reward/saliency
- Motivation/drive
- Memory/conditioning
- Inhibitory/control/executive functioning
The brain circuits involved in drug addiction:
receive direct input from _____ neurons.
are interconnected, mostly by ______ neurons
In high enough concentration _____ is toxic and will kill cells.
- dopaminergic
- glutamatergic
glutamate
During chronic drug use the brain circuits involved undergo changes aka ____ that lead to behaviour seen in addicts.
neuroadaptations
Some important neuroadapations are:3
and the last one is broken into 4.
- down regulation of D2 like receptors in the ventral striatum
- reduction in VTA dopaminergic neuron activity
- hypo-activity of the prefrontal cortex which leads to:
a. compulsions
b. impulsivity
c. impairment of decision making ability
d. reduced motivation towards natural rewards but PFC is super sensitive to drug associated stimuli
What is a possible neuroadaptation that causes addicts to often deny the presence or severity of their addiction?
cortical circuits that mediate insight and awareness
