Gambling Addiction Flashcards
1
Q
Neurophysiological basis of addiction
A
- If you continue to do something for a long period of time, neurophysiological changes in the brain occur
- Different areas of the brain activates during pleasurable activities
- Ex. alcohol floods the brain with NTs, but the more you do it, the less responsive your system is -> brain no longer responds in same way -> can constitute a disease process (b/c you need more and more of that thing to stimulate brain and get feeling of excitement)
- – Over time, brain can go back to normal state
2
Q
Psychological factors contributing to addiction
A
- Early childhood experiences
- Trauma
- Mental health issues
- Affect regulation
- Impulsivity/sensation seeking
- Cognitive distortions (ex. Illusion of control, Attributional bias, Gambler’s fallacy)
3
Q
Sociological factors
A
- Access to desirable alternatives
- Social norms (ie. modeling, culture)
- Exposure (accessibility/availability, habituation/social adaptation)
- Implications of punitive action
4
Q
Research on access to desirable alternatives
A
- Bruce Alexander: looked at old experiment (rats in cage with cocaine/morphine, rats self-administered until they died -> perpetuated idea that addiction was chronic and inevitable); Bruce hypothesized it was because they had nothing else to do -> created experiment where he build rat park in cages, then put rats in, and rats didn’t self-administer -> reinforced sociological component of addiction
- Carl Hart: had people come into lab who were already users of cocaine/heroin -> gave them choice of injecting in the lab or getting a desirable alternative -> many chose desirable alternative over the substance
5
Q
Biopsychosocial model of addictive processes
A
- Biological: genetics, neurophysiological reward system, changes in neurochemical action, development brain changes, learning
- Social: social norms, access to desirable alternatives, access to money
- Psychological: early childhood experiences, trauma, mental health conditions, impulsivity/sensation-seeking, affect regulations, cognitive distortions
- PLUS repeated exposure that produces a desirable subjective shift
6
Q
Gambling in the DSM
A
- In DSM-IV, put with kleptomania, trichotillomania, pyromania, intermittent explosive disorder
- In DSM-5, under substance-related and addictive disorder -> conceptualized as addiction
7
Q
Hallmarks of gambling disorder
A
- Needs to gamble with increasing amounts of money in order to achieve the desired excitement
- Is restless or irritable when attempting to cut down or stop gambling
- Has made repeated unsuccessful efforts to control, cut back, or stop gambling
- Is often preoccupied with gambling
- Often gambles when feeling distressed
- After losing money gambling, often returns another day to get even
- Lies to conceal the extent of involvement
- Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
- Relies on others to provide money to relieve a desperate financial situation caused by gambling
8
Q
Problem Gambling Severity Index
A
- used to measure severity of gambling problem
- includes questions, person ranks how often they occur from (0/never-3/almost always)
- ex. how often have you bet more than you could afford to lose? Borrowed money to gamble with? etc.
9
Q
Casino employee identification of problematic behaviour
A
- Direct solicitation of advice
- Direct behaviour
- Indirect behaviour
- What level of responsibility should employees have?
- When to intervene?
- What to do?
- What to say?
10
Q
Red flag behaviours
A
- Signs:
- anger/aggression
- Signs of distress
- Myths and distorted thinking
- Signs of excessive involvement
- More than one time point
- Better in conjunction with quantitative data
11
Q
Definitions of addiction
A
- Comes from Latin “enslaved by” or “bound to”
- DSM-5 – Substance Use Disorders: a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress
- Repeated failure to refrain from drug use despite prior resolutions to do so; decision-making, ambivalence (part of you wants to do it, part of you doesn’t), and conflict as central features
12
Q
Delay discounting
A
- Drug users prefer immediate rewards -> steeper delay discounting
- Drug users discount money more steeply than controls, and discount drug of choice more steeply than money
- Robust findings across all studies of drugs of abuse (heroin, cocaine, alcohol, cigarettes)
13
Q
Delay discounting: evidence of ecological validity
A
- Odum et al: heroin users who admitted using dirty needles discounted more steeply than those who did not
- Field et al: 13-hour abstinence from smoking significantly increased discounting rates
- Krishnan-Sarin et al: steeper discounting predicted relapse in adolescent smokers starting smoking cessation program
14
Q
why do people use drugs?
A
- To feel good/euphoria:
- Positive reinforcement – response increased when a pleasant stimulus occurs (operant conditioning)
- To escape low mood or alleviate unpleasant withdrawal symptoms
- Negative reinforcement: response increases with an aversive stimulus is removed (also operant conditioning)
15
Q
intra-cranial self-stimulation (ICSS)
A
- related to brain mechanisms of operant reinforcement
- researchers put electrode in rat brain that stimulated medial forebrain bundle (driven by dopamine to nucleus accumbens)
- Rat can control it by pressing lever, and would spend hours doing it -> no satiation point
- ISCC curves: drugs of abuse shift the ICSS curve to the left -> rat will work harder for lower level of stimulation -> more sensitive to reward
- – Antipsychotic medication that blocks dopamine receptors has opposite effect
16
Q
how do drugs “hijack” brain reward system?
A
Drug-induced dopamine release is higher amplitude, more sustained, and robust to motivational state (as compared to dopamine release from natural rewards like food and sex) -> hits the same system, but much more potent
17
Q
dopamine theory
A
- Main example of brain disease model of addiction
- States that drugs of abuse act directly or indirectly to increase dopamine levels in nucleus accumbens
- These effects are greater and markedly stronger than effects of the natural rewards (although natural rewards do work on the same system)
- Animals will self-administer drugs of abuse at the expense of natural rewards
- Drugs “hijack” brain reward system to create an addiction system
18
Q
how to measure dopamine in humans
A
- Using PET (Positron Emission Tomography) -> relies on injecting a radioactive tracer
- Inject participant with [11C]raclopride (dopamine D2 receptor antagonist that is carbon labelled) -> will bind to D2 receptors in striatum
- PET scanner acts as camera to see how many dopamine receptors participant has in striatum
19
Q
Dopamine and addiction (Volkov study)
A
- Saw that people with substance use disorders have lower levels of dopamine D2 receptors in the brain
- Consistent across many substance use disorders (cocaine, meth, heroin, alcoholism, etc.)
- Seen during early and long-term abstinence (so not withdrawal-related)
20
Q
Dopamine receptors and activity in vmPFC - cocaine users study
A
Large group of cocaine users put in PET scan -> people with lower levels of dopamine receptors also had lower levels of metabolic activity in vmPFC -> could be linked to impaired decision-making
21
Q
influence of Pavlovian/classical conditioning
A
- Robins et al.: In Vietnam, it was estimated that 20% of US military were using opioids, but post-war, an addiction epidemic never happened
- This is because Vietnam became a conditioned stimulus -> without the cues of its sights, smells, and sounds, there were less urges to take the drugs back in the USA
22
Q
dopamine and pavlovian conditioning
A
- Think back to monkey/juice experiment
- “Hyper-learning” to exogenous drugs
- Someone who just starts smoking initially has no response to seeing cigarette packet, but eventually will release dopamine at sight of packet
- Dopamine won’t go away at the sight of cigarette though, because it’s designed to drive dopamine response -> double-hit of dopamine (contrasts with monkey, who stops showing dopamine to juice) -> perpetual increases of dopamine
23
Q
possible factors that make gambling addictive
A
- Early big wins sensitize reinforcement learning
- “State splitting”: separate learning rules applied to gains and losses
- Under maximal uncertainty, cognitive distortions take hold (ie. Gambler’s fallacy)
24
Q
fMRI of reward in addictions
A
Ventral striatum is underactive during reward anticipation (of money rewards) in groups with substance abuse disorders
25
Q
reward deficiency vs. incentive salience
A
- Reward Deficiency (Volkow): people with developmentally under-active reward system are drawn to intense and risky activities such as drug-taking
- Incentive salience: cues associated with the drug acquire value, so users are hyper-sensitive to these cues
- These theories do not sit easily together, but:
- Reward deficiency is a theory of vulnerability, incentive salience is a theory of disorder
- Reward deficiency is domain general (all rewards), incentive salience is domain specific (drug cues)
26
Q
low dopamine receptors: cause and effect?
A
- Drugs of abuse increase dopamine levels, and this may cause a drop in receptor levels as a compensation (“neuroadaptive changes”)
- Also possible that lowered dopamine is a risk factor for addictions - the reward deficiency hypothesis
27
Q
toxic effects of chronic drug use
A
Evidence from:
- Post-mortem tissue (ie. Methamphetamine users -> prefrontal cortex)
- Animal models (ie. Cocaine administration -> prefrontal cortex)
- Longitudinal MRI scans (ie. Alcohol dependence -> whole brain)
28
Q
evidence of vulnerability: individual differences in subjective effects
A
In health participants, lower D2 receptor binding is associated with a more pleasurable experience of Ritalin
29
Q
evidence of vulnerability: impulsive rats
A
- Highly impulsive rats show differences in ventral striatum
- Put high impulsive and low impulsive rats on cocaine self-administration session -> high impulsive administer more cocaine (impulsivity predicts drug use)
30
Q
evidence of vulnerability: “addictive personality” in prospective studies
A
- Measure people’s impulsivity through a personality questionnaire (Multidimensional Personality Questionnaire) at age 18
- 3 superfactors: “negative emotionality”, “positive emotionality”, “constraint” (opposite of reactivitiy)
- Reassessed at age 21:
- – 10% developed alcohol dependence, 9% developed cannabis dependence, 18% developed nicotine dependence, 6% became problem gamblers
- – Could we predict this based on their earlier results? -> People who go on to develop these problems have low levels of constraint and high levels of negative emotionality
31
Q
Drug use =/= drug addiction
A
- Across all drugs, only a minority of users become addicted -> Important to understand why some ppl are vulnerable
- A ‘bio-psycho-social’ model - some vulnerability seems to be hard-wired / inherited - Early environment and social factors also play important roles
