Lecture 13: Substance-use Disoders Flashcards
Why do people use substances? (4)
- To produce pleasure
- To reduce pain
- To explore reality
- To escape reality
Substance use is _____ and also _____-_______
Ancient and cross cultural
DSM-5 defines substance use disorder as:
A constellation of behaviors involved in compulsive drug seeking (and it includes 4 things)
What are the 4 things included in compulsive drug seeking behaviors?
- Impaired control of substance use
- Impaired social interactions with others because of substance use
- Risky drug use
- Pharmacological changes
What are some typical characteristics of the addictive process (12).
- Start in adolescence of early adulthood and is chronic
- Progressive narrowing of behavioral repertoires
- Continuing despite negative consequences
- Subjective experiences of craving, anticipation, excitement
- Progressive increase in tolerance
- Physical and psychological discomfort from withdrawal
- Tendency to relapse
- Behavior substitutions, i,e., during recovery, alternative addictions often develop
- Neglect areas of life other than addictive behavior
- Difficulties with self-concept and self-esteem
- Psychological defense like denial and rationalization
- Conflicts with others regarding addictive behavior
Risk factors for developing a substance use disorder include (14) List is as many as you can
- Childhood neglect or abuse
- Trauma
- Poverty
- Substance availability
- Lack of adult supervision
- Heredity
- Social isolation
- Being male
- Having an older sibling who uses substances
- Having peers who use substances
- Family conflict
- Using substances with severe withdrawal symptoms
- Personality traits
- Other mental health problems
Personality risk factors for developing a substance use disorder (6)
- Low levels of conscientious ness
- Low levels of agreeableness
- high levels of neuroticism
- High levels of sensation-seeking
- High levels of impulsivity and disinhibition
- Antisocial traits
Some personality traits are protective factors against developing a substance use disorder, including (2)
- High levels of extraversion
- High levels of inhibition
Substance use disorders are often ____ with other mental health problems
Comorbid
COMORBIDITY
People use substances to “self-medicate” in response to other mental health problems eg. (3)
- Depression
- Anxiety
- Trauma
Substance use increases the activity of the ______ ______ in depression
REWARD SYSTEM
A cardinal feature of depression is the _______ reward system and the ____ ___ _______
Under active
Lack of pleasure
A cardinal feature of anxeity is an _________ threat system
OVERACTIVE
Substance use often ______ the activation of the threat system
DECREASES
Cardinal features of trauma related disorders include an ________ reward system and a ________ threat system
UNDERACTIVE
OVERACTIVE
Reward system dysregulation results in (3)
- Restlessness
2.Emptiness - Anhedonia
Emotion dysregulation results in (2)
- Negative emotion
- Emotional instability
Behavioural disinhibition results in (1)
Prioritizing short term rewards over long term rewards
eg. Prioritizing pleasure over health
Substance use disorders are largely a consequence of _______ ________
EVOLUTIONARY MISTMATCH
Evolutionary mismatch
Discrepancies between ancestral and modern environments that contribute to maladaptive behaviors in modern environments
In ancestral environments the reward system contributed to (3) because it oriented and motivated humans to pursue _______ eg. Food, social alliances, sex, care giving
- Health
- Survival
- Reproduction
Pursue rewards!
In modern environments the reward system also contributes to the orientation and motivation to pursue rewards eg. (3) that diminish (3)
- High fat/high sugar foods
- Alcohol
- Drugs
- Health
- Survival
- Reproduction
Who is more likely to develop substance use disorders between men and women?
MEN
Evolutionary factors might contribute to men taking more risks and discounting future rewards eg. (2)
- Mutualistic hunting
- Reproductive variance
Mutualistic hunting
Hunting of large prey was disproportionately done by men and so men who took risks were more likely to be successful in hunting = more likely to survive
Reproductive variance is far greater for who between men and women?
Men
Historically half of all men did not ______
Reproduce
Because 50% of men tend to not reproduce this incentivizes men to ___ ___ ____ and to _____ _____ _____ which are risk factors for excessive substance use
Take more risks and to discount future rewards
Many substances impact an important part of our neurological system: the _____ ____ ____
Mesolimbic dopamine pathway
The MDP is a neural circuit that connects the _______ which is located in the midbrain to the ______ ______ which is located in the forebrain
Ventral tegmental area to the nucleus accumbens
The VTA has multiple efferent projections including (2)
(Pathways that connect them to something)
- Mesolimbic pathway connects VTA to nucleus accumbens
- Mesocortical pathways connects VTA to cortex
the MDP mediates (4)
- Pleasure
- Positive emotion
- Reinforcement learning
- Approach behavior
Substances ______ MDP dopamine levels
Increase
Initially peak MDP dopamine levels occur ______ substance use. Then after repeated use, peak MDP dopamine levels occur ______ substance use
I.e. ?
During
Before
When exposure to cues associated with imminent substance
Objectively high MDP dopamine levels are correlated with strong motivation to seek out substance aka substance _____
Cravings
In animal models, lesions in the MDP ______ some substance seeking behavior
DECREASE
Administrations of _____ ______ decreases some substance seeking behavior
Dopamine antagonists
After repeated use substance typically have a decreased ______ ____ correlated to lower levels of dopamine release during use
Hedonic effect
After repeated substance use, tonic (baseline) MDP dopamine levels ______ which is experiences as _____ and ____ motivation when not using or preparing to use a substance
Decrease
Anhedonia
Low
Behaviorally people who use substances chronically often lose ______ in activities that are unrelated to the substance
interest
How is substance use positively reinforced
It add something gratifying eg. Namely the pleasure induced by the substance
How is substance use negatively reinforced? And in what type of disorders do we see this? (4 and more)
It subtracts something aversive namely withdrawal symptoms, and distress caused by psychiatric symptoms
- Anxiety
- Depression
- PTSD
- Psychotic disorders
Chronic substance use remodels _____ _______ in the MDP and prefrontal cortex so that there is a strong association between substance related _____ and substance related _______.
Synaptic connections
Cues
Actions
A common approach to treatment of substance use disorder is to minimize _______ to substance related cues especially for the early stages of recovery
Exposure
Hypofrontality
The evidence of impaired executive functioning in prefrontal cortex evidenced by difficulty inhibiting substance seeking behavior and increased impulsivity
Prefrontal cortex also mediates _____ _____
Goal selection
Impaired executive functioning contributes to _____ goal selection focused on substance use
Narrow
Many people with substances use disorders have low levels of a certain hormone
Serotonin
Decreased serotonin contributes to (3) risk factors for substance use
- Emotional instability
- Behavioral disinhibition
- Pain sensitivity
Heritability
The proportion of phenotypic variance in a population that is attributable to genetic variance
The remainder of phenotypic variance not attributable to genetic variance is attributable to what instead?
Environmental variance or chance
Heritability is a measure of (2)
- Phenotypic differences (heritability tells you how much a trait value is attributable to genes vs environment)
- Population differences (heritability tells you nothing about individual organisms)
Treatments of substance use disorders (6)
- Social integration
- Alternative rewards
- Motivational enhancement
- Medication
- Cognitive behavioral therapy
- Insight oriented therapy
Social integration is based upon what theory?
Social control theory
Social control theory
Suggests that people are more likely to resist chronic substance use if they are integrated into a community where the cultural norms disincentivize excessive substance use
How is social control theory supported as a treatment for substance use disorders? (EVIDENCE)
People who are socially isolated are at greater risk of chronic substance use
Example of Social integration in real life
Peer support groups!
What theory supports the treatment of substance use disorders through alternative rewards?
Behavioral choice theory
How does Behavioral choice theory explain why we treat people with substance use disorders through alternative rewards?
Suggests people are more likely to resist chronic substance abuse if they have ways of achieving alternative rewards
Provide evidence for treatment of substance use disorders through alternative rewards.
People who have greater barriers to achieving adaptive goals are at greater risk for chronic substance use
Name an approach to treatment through alternative rewards
Promote the pursuit of goals unrelated to substance use!
In motivational enhancement as a treatment for substance use disorders there is a collection of techniques used! What’s the name?
Motivational interviewing!
What is motivational interviewing
A collection of techniques in which a clinician facilitates a client/patients:
1. Exploration of their own reasons to change
2. Strengthen their intrinsic motivation to change
What medications can be used to treat substance use disorders?
- SSRI’s
- Opioid receptor antagonists
How can SSRI’s help treat people with substance use disorders? (3)
- Stabilizes mood and emotion regulation
- Reduces anxiety
- Enhances a person’s capacity for goal directed behavior
How can Opioid receptor antagonists help treat people with substance use disorders? (For alcohol)
Prevents the release of endogenous opioids that alcohol produces!
How can CBT help treat substance use disorders? (2)
It helps people by:
1. Identifying/modifying maladaptive cognitions and behaviors
2. Incorporating training for people in recovery to develop coping skills as an alternative to substance use
How can insight oriented therapy help people with a substance use disorder?
Helps people
1. Make unconscious cognitions conscious which brings those cognitions and behaviors under greater conscious control
2. With relationship problems and personality development
