Lecture 2 and 3 Flashcards
What is the scope of the problem of drug overdose?
- The drug overdose epidemic continues to worsen in the U.S
- More than one million people have died since 1999 from a drug overdose
- 2021: 106,699 overdose deaths occurred in the U.S
- The age- adjusted rate of overdose deaths increased by 14% from 2020 (28.3 per 100,000) to 2021 (32.4 per 100,000)
What are dual diagnosis?
A dual diagnosis refers to two or more illnesses (one mental health diagnosis, and one substance use diagnosis) that occur at the same time, with no solid cause-and-effect relationship
- AKA: Co-occuring disorders
What are some examples of at risk populations with dual diagnosis?
- Bipolar disorder and AUD or OUD
- OCD and cannabis use disorder
What is the prevalence of dual diagnoses?
Over one third of adults aged 18 or older who had AMI also had an SUD in the past year
- Many aren’t properly treated
- Lack of affordable, evidence-based programs
What are some common dual diagnoses?
- PTSD and any drug use
- AUD and major depression -> dangerous
- AUD and bipolar
disorder -> dangerous because of increased hospitalization and suicide - Schizophrenia and nicotine use
- Cocaine use and anxiety disorders
What is the takeaway from the substance use: among adults aged 18 or older, by mental illness status, 2021?
Illicit drugs (50.2%) and marijuana (41.6%) are highest among individuals who have serious mental illness
What is the takeaway from substance use: among youths ages 12 to 17: by past year major depressive episode status, 2021
Illicit drugs (27.7) and marijuana (20.3) are highest among individuals who had a major depressive episode
What is NAS?
Neonatal Abstinence Syndrome refers to a condition in newborns who experience withdrawal symptoms after being exposed to drugs (typically opioids) during their mother’s pregnancy
What is the scope of the problem with NAS?
According to 2020 HCUP data, the occurrence of NAS ranged from a lot of one newborn diagnosed with NAS per 1,000 newborn hospital stays to a high of 43 newborns diagnoses with NAS per 1,000 newborn hospital stays
Do babies born with NAS have developmental problems?
YES.
Data suggest that infants with a diagnosis of NAS are more likely to need special education services in preschool and elementary school
What factors does addiction involve?
Biology
Environment - Are they available? Stress? Peers?
Age- Plasticity during the developmental years
Specific drug
Does everyone who uses drugs become addicted?
Not everyone who uses drugs becomes addicted
What quote does the prof really like?
“Heroin is stronger than any human bond, or any compelling argument”
What are the ways to measure addiction?
- Positron Emission Tomography
- Event-Related Potentials (ERPs)
- Magnetic Resonance Imaging
- The Neuropsychoimagaing Method
What is the response inhibition part of the iRISA model?
Ability to suppress actions that are inappropriate in a given context and that interfere with goal-driven behavior
What is the salience attribution part of the iRISA model?
The process by which certain stimuli come to selectivity garner one’s attention
What is dopamine involved with?
Involved in rewarding, reinforcing and remembering behaviors that sustain life
- Conditioning - when we eat dopamine is released
What does cocaine do to dopamine transporter?
The dopamine transporter usually reuptakes dopamine back into nerve terminals after signaling. Cocaine blocks dopamine transporter, preventing dopamine from being taken back into cells which increase dopamine
What role does the PFC play in decision-making processes?
- PFC plays a key role in optimizing the decision-making processes underlying goal-directed action selection
- Neuroimaging studies provide evidence of functional and structural abnormalities in orbitofrontal cortex (OFC) in substance dependent/addicted individuals
What does testing of the PFC show in correlation to gray matter?
Tests involving self-control and goal directed behavior show correlations with gray matter deficits in the PFC of addicted individuals
What does low front metabolism in “comparison subject” compared to cocaine abuser contribute to?
Low frontal metabolism may contribute to the loss of control seen in addiction
What are D2 receptors?
Also known as dopamine D2 receptors, are a type of protein found in the brain and other parts of the nervous system
- They help control the release and reuptake of dopamine, maintaining a balance in dopamine levels
What are decreases in D2 receptors associated with?
Decreases in D2 receptors are associated with decreases in prefrontal cortical activity
What are the deficits in decision making and decreased PFC in addicted participants? Playing cards
Less gray matter is correlated with playing bad cards. Medial orbital frontal cortex
What are the cue elicited responses from the PET study about cocaine interview?
During the cocaine them interview participants:
- Reported increase craving for cocaine
- Had higher heart rates blood pressure
- Metabolic activity in the OFC increased
- Metabolic values in the right insular region were significantly correlated with self reports of cocaine craving
- More brain activity when cocaine participants were looking at cocaice theme things compared to control
Can the brain reward circuity respond to drug outside awareness?
- Researchers demonstrated, for the first time, limbic brain activation by “unseen” drug and sexual cues of only 33 msec duration in cocaine addicted individuals.
- These findings represent the first evidence that
brain reward circuitry responds to drug and
sexual cues presented outside awareness.
Does gray matter correlate with year of substance use? (Alia-Klein (2011)
The more years using the drug, the greater the gray matter decrements in PFC
- Also seen in the hippocampus
- When controlled for gray matter loss with aging in the regression
How can you measure drug-cue reactivity?
- Tasks can assess the degree to which substance related cues garner attention and evoke craving in drug-addicted subjects
- Examine the dysfunctional motivational significance of drugs/cues
- Compare/contrast activation in brain regions to drug cues to neutral stimuli
Does gray matter increase when you stop taking drugs?
Yes
Does structural recover PFC correlate with increased sores IGT and WCST?
- Improvements in cognitive control/flexibility by increased accuracy on the WCST, a neuropsych measure of executive function, such as planning, cognitive flexibility (ability to shift behavior to achieve a goal) etc.
- Increase in advantageous decision making defined by scores on the IGT
- These are functions suggested to be mediated by lateral and medial PFC subregions
What happens during addiction in relation to reward neurocircuitry, executive functioning and attentional bias
- Reward neurocircuitry is decreases to natural rewards in the environment and attention is increased for the substance and substance-related cues
- Executive functioning/ higher order cognitive impairments
- Attentional bias to drug-related cues
- Impairments and attenuated reward response to non-drug related stimuli
What did the attention bias to drug cues: salience study by Dunning et al, (2011) find?
Cocaine pictures elicited increased PFC electocortical activity in cocaine negative addicted subjects in ways pleasant and unpleasant pictures did in control subjects
How do you assess the capacity for response inhibition? Example?
Control ongoing behavior
- Tasks have consistently shown that addicted subjects have impairments in self control
Examples:
- Go/no-go tasks -> must respond as fast as possible to ‘go’ stimuli and inhibit responses to infrequent ‘no-go’ stimuli
- Stroop tasks
What is the stroop color word test?
- Ability to inhibit cognitive interference in incongruent conditions
- Once we see a word, if we are at an age that we can read, we automatically read it -> it overrides color-naming
- The amount of time can be measured- the better you do the less time it takes during incongruent conditions
- If you have EF difficulties, it takes longer
What is stroop showing?
- During incongruent condition - takes longer when it’s an addiction related word
- Differences were shown in cognitive conflict condition connected to areas of the brain associated with cognitive control in fMRI
Dorsal anterior cingulate
How is reward processing impaired in addiction?
- During control subjects when being rewarded their OFC showed activity
- Those who are addicted to cocaine showed no activity in OFC when given a reward
- The reward was money
What are the impairments in the six brain networks?
- Executive network: response selection
- Salience network: redirecting attentional resources
- Reward network: appraisal subject value
- Habit netwrok: automatization behavior
- Self-directed network: self-focuzed cognitive processes
- Memory network: Flexible learning
What are risk factors?
Biological, psychological, family, community, and socioeconomic factors that are associated with an increased likelihood of negative outcomes
What are protective factors?
Characteristics which are associated with a decreased likelihood of negative outcomes or that reduce the potency of a risk factor
- They can counter a negative factor
What are fixed or individual level factors compared to variable factors? Examples?
Fixed or individual level factors: they don’t change over time
Variable factors: can change over time
Example:
Peer group - variable
Exposure to alcohol in utero? - Fixed
What are the domains of risk and protective factors?
- Individual
- Family
- Peer
- Community
What are some individual protective factors?
- Perceiving drug use as risky.
- Having a negative attitude about drug use.
- Affiliating with a prosocial group.
- Parent relationships
- Emotion regulation skills
- Interests and activities that don’t involve SA
- Secure attachment
- Temperament (Easy)
- Social competence
- Healthy coping skills
