L22 substance use disorder

Question 1

Substance use disorders

Answer 1

• Repeated use of a psychoactive substance or substances, to the extent that the user
• is periodically or chronically intoxicated;
• shows a compulsion to take the preferred substance (or substances);
• has great difficulty in voluntarily ceasing or modifying substance use;
• exhibits determination to obtain psychoactive substances by almost any means

Question 2

Brain disease model of addiction (BDMA)

Answer 2

• a chronic brain disease characterised by compulsive use of substance(s) despite adverse consequences.
• the brain reward systems are altered following chronic drug use

Question 3

DSM-4

Answer 3

• substance abuse and substance dependence

Question 4

DSM-5

Answer 4

• substance use disorder
• addiction is not a diagnostic term

Question 5

Substance-Related and Addictive Disorders

Answer 5

Substance-Related and Addictive Disorders
* Substance-Related Disorders
– substance use disorders
– substance-induced disorders

Question 6

Diagnostic criteria for alcohol use disorder

Answer 6

1. Impaired Control
2. Social impairment
3. RIsky Use
4. Pharmacological criteria

Question 7

SUD: Impaired control

Answer 7

• Taken in larger amounts over longer periods
• Desire or unsuccess in cutting down on it
• Craving it

Question 8

SUD: Social Impairment

Answer 8

• Failure to fulfill roles in work, school or home
• Continued use despite problems
• outside things given up

Question 9

SUD: Risky use

Answer 9

• Recurrent drug use in hazard situations
• Continued use despite knowledge

Question 10

SUD: Pharmacological criteria

Answer 10

• Tolerance: increased amounts of alcohol
• Withdrawal

Question 11

Operant (instrumental) conditioning

Answer 11

organisms learn to associate a behaviour and an outcome, and adjust the frequency or probability of a behaviour to achieve or avoid that outcome

Question 12

Reinforcement

Answer 12

Increase the probability of a behaviour → outcome

Question 13

Punishment

Answer 13

Decrease the probability of a behaviour → outcome

Question 14

Positive reinforcement

Answer 14

• add a desirable outcome to increase the likelihood of a behaviour
• e.g., a driver receives a discount on car insurance for safe driving

Question 15

Postivit punishment

Answer 15

• add an undesirable outcome to decrease the likelihood of a behaviour
• e.g., a driver gets a fine for speeding

Question 16

Negative reinforcement

Answer 16

• remove an undesirable outcome to increase the likelihood of a behaviour
• e.g., a driver stops the “beeping” sound by fastening the seatbelt

Question 17

Negative punishment

Answer 17

• remove a desirable outcome to decrease the likelihood of a behaviour
• e.g., a driver loses licence for unsafe driving

Question 18

• primary rewards

Answer 18

(food, water and sex) - survival of organism
* the consummatory behaviour associated with these rewards is most rewarding

Question 19

• non-primary rewards

Answer 19

, social rewards, can enhance the functions of primary rewards

Question 20

produce learning

Answer 20

produce learning - a behaviour is required to obtain a reward

Question 21

motivate approach behaviour and decision-

Answer 21

making - seek, obtain and consume a reward, and choose between different rewards

Question 22

generate positive emotions,

Answer 22

• e.g., pleasure - experience pleasure from consuming a reward

Question 23

In operant conditioning, a reward functions as a____ (pos or neg) reinforcer

Answer 23

positive

Question 24

The brain reward systems

Answer 24

• ventral tegmental area (VTA)
• prefrontal cortex (PFC)
• nucleus accumbens (NAc)

Question 25

Outcome of the reward systems

Answer 25

• produce pleasure
• form associative learning and memory
• stimulate the release of dopamine and predict the value of a reward

Question 26

Positive reinforcement and SUD

Answer 26

• linked to euphoria;
• compulsive drug taking and its associated cravings dopamine mediates reward pleasure (“liking”)
• mesolimbic dopaminergic pathway

Question 27

Pos reinforcement opioids and benzodiazepine

Answer 27

inhibition of VTA GABAergic neurons (green-slides) removed their inhibitory effects on VTA dopaminergic (DA) neurons (red)

Question 28

Nicotine and psychostimulants in DA

Answer 28

• nicotine - depolarise DA neurons (red)
• psychostimulants - inhibit dopamine reuptake

Question 29

Issues with positive reinforcement

Answer 29

Liking is not the same and wanting (this on is linked with the mesolimbic pathway)

Question 30

“liking”

Answer 30

• behavioural or neuronal hedonic (pleasant) reactions
  – mediated by endogenous opioids

Question 31

“wanting” (or incentive salience)

Answer 31

• a form of desire that involves the mesolimbic dopaminergic pathway
  – mediated by dopamine

Question 32

learning

Answer 32

cues are associated with drug-related rewards - trigger “wanting” without necessarily producing “liking” for the same reward

Question 33

Incentive-sensitisation theory

Answer 33

• Repeated drug use
• tolerance to “liking”
• sensitised mesolimbic dopaminergic pathway
• hyperreactive to incentive stimuli (e.g., drug-related reward cues- previous associative learning)

Question 34

Negative reinforcement SUD

Answer 34

• linked to dysphoria; to remove unpleasant experience of withdrawal effects or anxiety
• cycle of Binge, withdrawal, and preoccupation (intox, neg, anticipation)
• Signif varies In order - psychostimulant, opioids, tobacco

Question 35

Negative reinforcement: binge/intoxication

Answer 35

• brain reward systems, (mesolimbic pathway), leads to incentive salience (“wanting”):
• associate neutral cues with drug-related reward (learning)
• motivate approach behaviour (seek and consume a reward)

Question 36

Negative reinforcement: withdrawal/negative affect

Answer 36

• amygdala produces negative emotions
• reduction in neurotransmission associated with acute drug reward effects, but drug-opposite response persists

Question 37

Negative reinforcement: preoccupation/anticipation

Answer 37

• Impaired decision-making and self control
• prefrontal cortex provides excitatory control (med by glutamate) over the mesolimbic pathway
• deficits in executive functions (med by GABA in prefrontal cortex)