L1: Drug Craving & Neural Basis Flashcards
Name the DSM criteria for substance use disorder
problematic pattern leading to clinically significant impairment or distress, as shown by min 2 occuring within 1y
1. substance is taken in larger amounts or for longer than intended
2. persistent desire / unsuccessful efforts to cut down / control use
3. spending a lot of time getting/using/recovering from use
4. craving & urges to use the substance
5. recurrent use resulting in failure to fulfill major role obligation (work, school, home etc)
6. continuing to use, even when it causes problems in relationships
7. giving up/reducing important social, occupation, or recreational activities because of use
8. using substances again and again, even when it puts you in danger
9. continuing to use, even when you know you have a physical/psych problem that could have been cause/exacerbated by the substance
10. needing more of the substance to get the effect you want (tolerance)
11. dev of withdrawal symptoms, which can be relieved by taking more of the substance
How does the national institute on drug abuse define addiction?
a chronic, relapsing disorder, characterised by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain
What are the 4 main reasons why people use?
- to feel good (relaxation, confidence etc)
- to feel better (self medication)
- to do better (to perform better)
- to explore (new experiences, feelings etc)
What is the difference between use and abuse?
when user loses voluntary ability to control its use
in DSM, to qualify as ABUSE: a problematic pattern is required, leading to clinically significant impairment or distress
What is the prevalence of substance abuse according to NEMESIS?
17% of nl ppl lifetime prevalence of substance abuse (13% alcohol 6% drugs)
according to NEMESiS, what were some sociodemographic factors relating to substance abuse? somet hat didnt relate?
- younger age
- men
- living alone
- being unemployed
- very high degree of urbanization
unrelated to income & country o origin
What are some protective factors for substance use?
- parental monitoring & support
- positive relationships
- self efficacy (belief in self control)
- academic performance
- school anti drug policies
- neighbourhood resources
What are some risk factors for substance use?
- early aggressive behaviour in childhood
- early drug use (-> importance of prevention!)
- lack of parental supervision
- substance abuse by caregivers
- low refusal skills
- poor social skills
- drug availability
- community poverty
- genetic predispositions
- personality traits: sensation seeking, impulsivity, diff w self regulation
- other mental health issues (comorbidity w depression, trauma, anxiety, adhd etc)
- addicitvity differs between drugs & way of administration
How does vicious cycle define substance abuse?
negative consequences of abuse can maintain or worsen the abuse: chrnoic drug use increases DA levels, leading to D2 receptor down regulation, leading to anhedonia & tolerance, thus contributing to escalation of drug use
What are some barriers to seeking treatment for substance use?
- attitudinal (“didnt think anyone could help”)
- readiness for change (“thought problem wasnt serious enough”)
- stigma (“was embarassed to discuss it”)
- finanical/cost (“insurance x cover treatment”)
- structural (“didnt know where to go”)
What is the relapse rate in substance abuse?
40-60% despite treatment
What are common triggers for relapse?
- returning to place/seeing someone associated w drug use
- stressful circumstances
- pre existing emotional or mental health struggles
What is the history of the models of addiction?
19th century: moral model
from mid 19th century: pharmacological model
1930-1950s: symptomatic model
1940-1960: disease model
1960-1970: learning theory model
1970-1990: bio-psycho-social dev model
since 1990: brain disease model
How does the moral model see addiction & its treatment?
drug abuse & drug seeking behaviour labelled as immoral, sign of moral weakness
-> ppl w an addiction were imprisoned or put in (questionable) re-education institution
- not supported by scienitific evidence, but still appears sometimes in society (care farms)
How does the pharmacological model see addiction & its treatment?
- blame for addiction taken away from addicts and to the addictive substance
-> prevent ppl from becoming involved w these substances (war on drugs) - now, seen as one-sided (its not just the availability & use of potentially addictive substances that leads to addiction)
How does the symptomatic model see addiction & its treatment?
addiction no longer viewed as condition in itself, but rather as a symptom of an underlying character-neurosis or personality disorder
-> long term, insight-oriented psychotherapeutic tratment of character neurosis (still used someplaces today)
How does disease model see addiction & its treatment?
there are fundamental (premorbid) biological & psychological differences between addicts & non-addicts, which leads to the former being unable to use substances in moderation
- main features of the addiction disease are the uncontrolled use & physical dependence (tolerance & withdrawal symptoms)
-> moderate use by non-addicts is possible, wile for addicts complete absitence is the only option (AA)
how does learning theory model see addiction & its treatment?
form of maladaptive learned behaviour that could be unlearned again w help of behavioural therapeutic interventions
-> aversion therapy & cue exposure are main interventions
how does the bio-psycho-social development model see addiction
there are only relative differences between addicts & non-addicts & smooth transitions between use, abuse, addiction etc
does not solely assume substance (pharmacological model) or individual (moral, symptomatic, disease models) as cause of addiction.
see addiction as interaction between innate vulnerability (bio), personal dev (psych), and circumstances (social)
-> intervention in which attention paid to bio, psych, & social influences
What are the 3 main substances of abuse? What do they all have in common?
- sedatives: tend to make u feel calm & relaxed (alcohoo, opiatezs, benzodiazepines, barbiturates)
- stimulants: tend to be invigorating (caffeine, nicotine, cocaine, amphetamine (speed))
- psychedelics: altern state of consciousness & perception of world around you (cannabis, ecstasy, LSD)
-> directly/indirectly result in release of dopamine in nucleus accumbens, which plays an important role in their addictive effect
How does brain disease model see addiction & its treatment
- as acquired chronic relapsing brain disease.
- innate vulnerability is basis for repeated use of substances, while repeated use in turn -> changes in brain.
characterized by - compulsive drug seeking & use, despite harmful consequences
- hyperactive reward system, sensitized to drug reward: craving & habits
- cognitive dysfunction
- complex disease w genetic & environmental contributions
- puts the guilt aside so treatment can be prioritized
-> treatment needs to involve pharmacolocal & behavioural therapeutic interventions
What role does dopamine play in the reward system? what role does it play in substance abuse?
anticipation of rewards -> release of dopamine in the mesolimbic reward system
drugs lead to much stronger dopamine release than natural rewards (like food or sex) -> hijack reward system so addicts are less sensitive to natural rewards (related to deficiency of dopamine D2 receptors in the nucleus accumbens) could be both vulnerability factor (already are less sensitive so then seek out drugs to compensate, or the result of drug use)
so exposure to drugs & drug associated cues -> dopamine release in NA -> craving
what does the “reward deficiency syndrome (RDS) account say?
that ppl w chronic deficiency of dopamine D2 recepotrs in the nucleu accumbens are less sensitive to simple natural rewards so look for stronger stimuli to compensate this (like through drugs)
addicts have this: cause or consequence of drug addiction?
-> little of both! homeostatic account & PET scan research shows that drug use decreased D2 receptors, while family research shows that low D2 density can precede it
How does the homeostatic account explain the structural differences in dopamine system in addicts?
homeostatic account: the lower density of dopamine receptors in addicts is consequence of homeostatic compensatory brain changes after chronic drug use to lower dopamine transmission; increased dopamine activity due to drugs -> decrease of dopamine receptors
this down regulation may also underlie decreased (natural) reward sensitivity in addiction & tolerance in addiction
SO AS A CONSEQUENCE