Lecture 4 Flashcards
Prevalence of substance use during pregnancy
Prevalences for entire pregnancy: Smoking - 25% Drinking - 50% Marijuana - 2.5% Illicit drugs - < 1%
Highest prevalence in first trimester.
Risk factors for SU in pregnancy
Demographic Factors:
- eduction, income, age, ethnic background
Relational Factors:
- being married or single, Partner substance use, family functioning, social support
Psychological factors:
- such as life events, childhood trauma, psychopathology, stress
Other risk factors:
- comorbidity (HIV, Hepatitis)
- poor nutrition
Why is it so difficult to stop using during pregnancy?
Physiological changes:
- auch as increase in blood volume, cardiac input, increased serotonin
- hormonal
Psychological changes:
- stringer cravings - appetitive desire
Why should women stop using during pregnancy?
Harmful for mother,
BUT more harmful for development of baby and it’s brain
Placenta and substances
Placenta is the placenta passage for substances.
- higher substance levels in fetus than mother
- possible reuptake through amniotic fluid
- longer circulation in fetus
E.g. alcohol and nicotine cross the barrier of the placenta.
Neonatal Abstinence Syndrome
Def.:
Syndrome that can appear after substance abuse during pregnancy that have affected the development of the child
- CNS: tremors, jitteriness, irritability, excessive crying etc.
- Metabolic and respiratory: hypertonia, temperature instability, sweating etc.
- Gastrointestinal: feeding problems, diarrhea, vomiting
Fetal alcohol syndrome
Def.:
Affected development of the child after alcohol abuse during pregnancy of the mother.
- underdeveloped brain
- later cognitive functioning impairment
El Marroun er al. (2009) Study:
Brain development in substance use fetuses
Longitudinal cohort studies
- generation R study
- investigated THC levels in mothers
Prenatal cannabis use:
- Physiological:
- saw fetal growth and head growth reduction in children after reduced cannabis exposure and constant exposure
- there was no catchup growth of the fetus - Psychological:
- increased risk for externalizing problems
- Aggressive behavior
- impulsivity
- attentional problems
Prevention of substance use during pregnancy
General:
- tax policies
- smoke free areas (public, work etc.)
Targeted:
- general practitioners, gynecologists, and obstetricians
- pregnancy logo on alcohol beverages
- warnings packages towards offspring
Brain disease model of addiction
Simplified:
Imbalance between approach-oriented motivational system and regulatory control system
Brain networks:
- Salience network - mainly vACC and OFC
- emotional regulation, salience attribution, and integration of affective information - Reinforcement learning network - medial prefrontal cortex
- associative learning from positive and negative behavioral outcomes
- development of automatic/ habitual behavior - Executive control network - prefrontal cortex areas, dACC, preSMA
- cold processing of events with low emotional salience
- attention, working memory, inhibition
Brain structures most sensitive to prenatal alcohol exposure
Corpus callosum:
- problems with retrieving information, problem solving, attention and verbal memory
Cerebellum:
-problems with controlling movement, maintaining balance, and fine motor skills
Why is the field of alcohol abuse in pregnancy so complex?
Confounding.
- multiple substances used in combination
- substance co-occurs with man other problems
- timing of use and effects
- postnatal factors, upbringing
- genetic factors
Prevalence of adolescents binge drinking
44% of the 16 year olds binge drink (>5 glasses) monthly
Consequences of adolescence binge drinking
- violence and risk behavior
- physical harm and death, such as drowning, crashes, alcohol poisoning
- addiction
Adolescence brain development
- gray matter thins, white matter increases, connectivity improves
- evolutionary older areas mature first (sensorimotor areas)
- areas involved in more complex functions mature later
Why are adolescence at risk for substance use?
Hypersensitive salience network
Facilitates brain plasticity and learning flexibility
Suboptimal control in temping situations
Neurotoxicity during period of brain development
Hypersensitive salience network
Adolescence marks surges in emotional and reward sensitivity, stimulating exploration and independence
Adolescents are known to get themselves involved in risky behavior
Hypersensitivity to the social environment
- Sensitivity to, complexity of, and reliance on peer relationships
- Less involvements from parents
- Paralleling improvements
- the capacity to understand and care about other improves
- more likely to take other individuals perspective into account
- more sensitive to peer exclusion
- more risk-taking in front of peers
UNCONSCIOUS SENSITIVITY TO PEERS
Facilitated brain plasticity and learning flexibility
Addiction can be seen as extreme case of neuroplasticity.
The earlier the onset of addiction the worse the prognosis.
Brain plasticity
Dynamic biological capacity of the brain changes in repose to the environment, supporting, brain maturation, as well as brain recovery after injury
- involves modulation of neural connection
- complex interaction between genes and environment
Suboptimal control in tempting situation
Different sub-processes mature at different ages but stringed development before adolescence
- poor cognitive control predicts substance use and problem in both adolescent and adults
- poor cognitive control relegated to many disorders
Neurotoxicity during period of brain development
Drug and alcohol use is related to change in brain volume of areas important for behavior control
- related to poor cognitive performance
Adolescence resilience to addiction
Hypersensitive to social environment:
SOCIAL DEVALUATION
- Social devaluation of alcohol and drug use
- transition to adult roles (finding a job, partner)
- less cool to drink
- less opportunities to go out
- less cool to smell like drugs/alcohol
- less cool to have a hangover or Tuesday dip
