L12, 13 - Addiction - Alcohol & Substance Flashcards
What is the definition of addiction?
- Behaviours characterised by compulsion, loss of control and continued patterns of use despite perceived or objective negative consequences.
What is the difference in classification of Substance Addiction between DSM-IV and DSM-5?
DSM-IV:
- Substance dependance.
- Substance abuse.
DSM-5:
- Substance-related and Addictive Disorders.
- Substance-induced Disorders.
- Non-substance related behavioural Addiction (gambling).
What is the DSM-5 Criteria for Substance Use Disorder?
- Impaired control (1-4)
- Social impairment (5-7)
- Risky use (8-9)
- Pharmacological (10-11).
What are some common comorbidities with substance disorders?
- 60% of substance users have a comorbid psychiatric disorder.
- Patients with Substance Disorders are 2x as likely to suffer mood/anxiety disorder.
What percentage of substance users don’t require treatment?
70% of users give up of their own accord and do not require treatment.
What are some of the contributing risk factors to substance use?
- Genetics and comorbidities.
- Age of commencement.
- Availability
- Family/peer dynamic.
- Cultural norms.
- Trauma exposure.
- Poverty.
- Social support.
What is the heritability of substance use disorder?
- Twin research suggests a strong genetic component.
- MZ twins show higher concordance rates for alcohol, cannabis, tobacco, stimulants, hallucinogens, opioids, and sedatives.
What is the primary method of addiction?
- Addiction is a result of the dopaminergic and endogenous opioid system.
- Addictive drugs usurp neural circuitry normally involved in pleasure and motivation.
What is the Impaired Response Inhibition and Salience Attribution Theory (I-RISA) (Goldstein & Volkow, 2002)?
- Dopamine involvement in drug addiction is mediated by structural and functional changes in circuits modulated by dopamine.
What are the 4 clusters of behaviours involved in I-RISA?
- Intoxication/excitement (high levels of dopamine) Mesocortical.
- Craving (cue-induced, memory, conditioning) Mesolimbic.
- Compulsive use (when no longer pleasurable).
- Withdrawal (dysphoria, anhedonia, irritability).
What is the kitchen sink analogy of drug use?
- Drugs act like a plug in the sink.
- Drug blocks dopamine transporter and stops re-uptake -> causes large excess of dopamine in synapse -> pleasure and euphoria.
What is the biological model of Substance Use Disorder?
Chronic substance use -> Sensitisation (neuro-adaptation) -> Changes in NT’s -> initial abstinence and withdrawal or prolonged abstinence triggers reward memory -> Cravings -> Relapse.
What is the learning theory model of addiction?
Experimental drug use or Circumstantial drug use.
↓
Casual Use
↓
Compulsive Use
↓
Addiction
(Motivational strength increases down the chart).
What is the Opponent Process Theory of Addiction?
Drug activates euphoric ‘a-process’ in brain reward circuits which in turn activates an opponent ‘b-process’ (attempts to restore homeostasis).
Once ‘b-process’ is strengthened, even a small dose can instate it, triggering withdrawals.
What are the principles of effective management of substance disorders?
- No single treatment is appropriate.
- Treatment needs to be readily available and accessible.
- Effective treatment attends to multiple psychological, medical, and social interventions.
- Treatment does not have to be voluntary to effect change.
