Lecture 5: cocaine consumption and addiction & Non substance use disorders

Question 1

The origin and history of cocaine use

Answer 1

German chemist albert nieman was the first to isolate cocaine extracted from coca leaves in 185
Cocaine became popular in the 1880 in the medical community. Used as an anesthetic for cataract surgery
Freud was fascinated with cocaine and promoted it as a “magical substance”
Cocaine and coca cola (originally had cocaine in it

Question 2

The american crack epidemic of the 1980’s

Answer 2

Increase of crack cocaine use in major cities across the united states between the early 1980s and the early 1990s
High with crack cocaine is much shorter and very intense, its very cheap
Increase in crime and violence in inner city neighbourhoods
Lead to “tough on crime” policies and the “war on drugs”

Question 3

Past year of cocaine use internationally

Answer 3

~300,000- age 15-64. More prevalent in North America. A lot of Canadian youth are using cocaine relative to adults who are 25+ , as age progresses cocaine use decreases. Grade 7-12 have used it at least once in the past year. Alcohol is most used, cannabis second, hallucinogens third and cocaine/crack is 4th

Question 4

What are the protective factors for drug use and abuse?

Answer 4

• High GPA
• Low depression
• Having supportive relationships at home
• Perceiving many sanctions for drug use
• High religiosity
• High self acceptance
• High law abidance

Question 5

What are the risk factors for drug use and abuse?

Answer 5

• Low educational aspirations
• High perceived adult drug use
• High perceived peer drug use
• Many deviant behaviours
• High perceptions of community support for drug use
• Easy availability
• Low perceived opportunity

Question 6

Describe the relationship between risk factors, drug use, and predictive factors

Answer 6

Risk factors lead to drug use and they are mediated by protective factors

Question 7

How did this study predict concurrent drug use?

Answer 7

Risk factor index X protective factor index interaction was not predictive of all outcomes
Only for hard drug frequency (both sexes)
Cocaine and cigarette use for women only
Found a Buffering effect: High risk and low protection linked to high drug use/ Low risk and high protection linked to low drug use

Question 8

How did this study predict prospective drug use 4 and 8 years later

Answer 8

Risk factor index X protective factor index interaction was not predictive of all outcomes.Predicted greater cocaine and cannabis use 4 years later. Predicted greater alcohol problems 8 years later

Question 9

Final conclusions of this study

Answer 9

Drug use nor addiction cannot be fully accounted for by any one or even a few etiological factors. Drug use and addiction increase as numbers of vulnerability conditions to which a person is exposed and with which they must cope increase Buffering effects

Question 10

MRI of the neurobiology of cocaine

Answer 10

Over time the receptors don’t seem to be restored, potentially neurological marker of impulsivity. The image shows low dopamine D2 receptors may contribute to the loss of control in cocaine users.

Question 11

How Cocaine effects the brain

Answer 11

Cocaine goes to the ventral tegmental area/nucleus accumbens: the reward area of the brain. Cocaine reaches the synapses and elicits the release of dopamine but prohibits/blocks the reuptake of dopamine so it forces the postsynaptic cell to absorb it all, creating a flood of dopamine and an intense high.

Question 12

What are the health consequences of cocaine?

Answer 12

Withdrawal (craving, deep sleep post binge, negative affect), Overdose (seizures, severe hypertension, rapid heartbeat, coma and death), Physiatric effects, delusions, paranoia, hallucinations, severe anxiety, Psychosis, suicidality. Symptoms can persist for months after abstaining

Question 13

History of tobacco use

Answer 13

Tobacco use has a very long history. James bonsack invented the cigarette making machine in 1881. Bonsack’s cigarette machine could make 120,000 cigarettes a day. Cigarette smoking became widespread

Question 14

Prevalence of tobacco smoking

Answer 14

Increasing in some countries but decreasing as a whole. In 2015, over 1.1 billion people smoked tobacco. More men than women smoked tobacco

Question 15

Prevalence of tobacco use among youth aged 15-19

Answer 15

26.7% of youth were using tobacco in the 12 months prior to the survey. Tobacco smoking in youth is associated with more frequent use of alcohol, cannabis, and other illicit drugs relative to youth who do not smoke and to adults who do or do not smoke.

Question 16

On days when alcohol was consumed…

Answer 16

Smokers (15-19) averaged 5 drinks

Non smokers averaged 2-3 drinks

Question 17

What does the data indicate about smokers under the legal drinking age?

Answer 17

Smoking under the legal drinking age (15-17) drank as frequently as those at the legal drinking age (18-19). The data do not speak to whether tobacco smoking is a gateway for use of other substances. Data indicate that tobacco smoking in youth is a good indication that youth may be engaging in other risky behaviour.

Question 18

Why are the results about underage drinkers concerning?

Answer 18

High rates of problematic drinking are as common in underage youth age as they are among those at the legal drinking age. Teenage smokers appear to have ready access to significant quantities of alcohol, despite being under the legal age for obtaining both tobacco and alcohol

Question 19

What are some limitations of the study on tobacco and other substance use?

Answer 19

Limitations = recall bias and motivation to misrepresent actual use of substances (retrospective study)

Question 20

How is nicotine dependence measured

Answer 20

The fagerstrom test for nicotine dependence Screening tool designed to provide an ordinal measure of nicotine dependence
Contains six items that seek information on the number of cigarettes smoked, compulsion to smoke, and dependence. Provides a severity rating that can be used to help plan treatment and assess the prognosis

Question 21

What is the most common SUD?

Answer 21

nicotine dependence

Question 22

Why is nicotine known as the chameleon drug

Answer 22

Acts as a sedative when the smoker is anxious and as a stimulant when the smoker is fatigued. Reaches the brain within seconds

Question 23

What is the neurobiology of nicotine?

Answer 23

When you inhale nicotine it effects the CNS and binds to certain receptors in the brain. It is a dopaminergic releasing drug, binds to Ventral tegmental area which sends a message to the nucleus accumbens to release dopamine

Question 24

What is Nicotine double effect on Dopamine Release?

Answer 24

Nicotine affects 2 neurons that modulate DA level in the NAcc: Nicotine stimulates the release of glutamate, which triggers additional DA release. Nicotine also blocks the release of GABA which sustains DA levels. Nicotine acts on these neurons to increase the ratio of glutamate to GABA in the VTA. This amplifies the rewarding process of nicotine

Question 25

Health consequences of tobacco

Answer 25

Strokes (however can lead to quitting) Lung cancer, heart problems

Question 26

what is nicotine withdrawal?

Answer 26

Characterized by fatigue, irritability, gastrointestinal upset and craving. Acute withdrawal resolves in ~5 days. But craving can last for many months
Relapse rates are high

Question 27

What is a non-substance based behavioural addiction?

Answer 27

People engaging excessively in problematic behaviours like gambling, gaming, sex, shopping etc.

Question 28

What is the difference between gambling and substance misuse?

Answer 28

Hidden addiction
Can't overdose- no saturation point
Huge financial problems
Cant function at work
Cant be tested (e.g., biometric test, urine test)
Doesn’t require ingestion

Question 29

What are the similarities between gambling and substance misuse

Answer 29

Preoccupation, Negative impact on major life areas, Tolerance, Immediate gratification, Loss of control

Question 30

A broader concept of addiction

Answer 30

Addiction is about enacting or performing a behaviour: Behavioural aspect of substance addiction (e.g., drug taking), Enactment of a behaviour that is addictive (e.g.,gambling).Treatment involves stopping or reshaping the behaviour and replacing it with alternate activities

Question 31

How are all addictions behavioural?

Answer 31

These behaviors are enjoyable when balanced with other activities. However, when a person becomes increasingly absorbed by and dependent on a behavior to the extent that it crowds out other involvements, a negative cycle can be initiated whereby other areas of life are neglected, and the person’s functioning and relationships come under pressure

Question 32

What does gambling involve?

Answer 32

“Gambling involves risking something of (perceived) value in the hopes of obtaining something of greater (perceived) value”

Question 33

How Did Freud view gambling?

Answer 33

Freud (1928) came to the conclusion that Dostoevsky’s irrational gambling was a substitute for masturbation, which was provoked by prima oedipal guilt.

Question 34

What was Edmund Bergler’s view on gambling?

Answer 34

published The Psychology of Gambling in 1957. He viewed the gambler as neurotic and who had an unconscious desire to lose and be punished and felt they were omnipotent and could control outcomes that are largely determined by chance.

Question 35

What happened in the 1950 in terms of gambling?

Answer 35

A medicalization of it, the disease model of gambling

Question 36

When was gambling legalized?

Answer 36

in the 80’s and 90’s

Question 37

What is gambling like today?

Answer 37

Gambling moves into the 21st century, online and app gambling. More access. Popular recreational activity
A lot of venues to gamble in and around Canada, the larger the province the more venues there are.

Question 38

Which provinces have the most and least gambling venues?

Answer 38

Quebec and Ontario have the highest number of venues and newfoundland has the lowest

Question 39

What are the 4 E’s of Gambling?

Answer 39

Entertainment: to have fun
Excitement: to get a rush from risk and uncertainty
Economic gain: to win money
Escape: to lose one’s self in play

Question 40

Why do people gamble?

Answer 40

Dream of hitting the jackpot
Intellectual challenge
Chance of winning
Social rewards
Mood change

Question 41

Gambling addicition in the DSM 3

Answer 41

In DSM 3 pathological gambling was listed

Question 42

Gambling addiction in the DSM 4

Answer 42

DSM 4 pathological gambling must meet at least 5 of the criteria and they added “committing illegal acts to sustain addiction, such as stealing money to gamble with”. Gambling was grouped with other impulse control disorders

Question 43

Gambling addiction in the DSM 5

Answer 43

In DSM 5 pathological gambling left the impulse control disorder and joined substance related and addictive disorder as a non-substance related disorder. The first formal recognition of a behavioural addictions. 9 vs 10 criteria (illegal activities dropped)

Question 44

How is the severity of gambling disorder measured?

Answer 44

Gambling disorder severity rated (9 criteria)
2-3 criteria will be indicative of a mild disorder
4-5 criteria will be indicative of a moderate disorder
6 or more will be indicative of a severe disorder

Question 45

Gambling disorder and psychiatric comorbidity

Answer 45

People living with GD have a high rate and wide range of comorbidities. More likely to have nicotine dependence (60.1%), substance use disorders (57.5%), mood disorders (37.9%), and anxiety disorders (37.4%). Gambling problems co-exist at a high rate with alcohol dependence and problematic substance use

Question 46

What is the prevalence of gambling disorder?

Answer 46

Low prevalence

1.4 % of population of manitoba were likely to be gamblers, the highest in Canada and Quebec/Ontario is the lowest

Question 47

The epidemic curve

Answer 47

People believe gambling follows this same Epi. Curve
(starts with rapid infection increase among the most vulnerable, infection among the resistant, and population evidence for recovery)

Question 48

What is the influence of consumption?

Answer 48

As exposure to a stimulus increases the most vulnerable are the first to be infected, we may see increases in gambling participation near epicenters of gambling, then there is a period of adaptation

Question 49

A biopsychosocial perspective of gambling: psychological aspects

Answer 49

Learning: operant conditioning and classical conditioning
The variable ratio of positive (winning) and negative (losing) reinforcement in gambling.Erroneous beliefs about probability of winning and personal skill: Odds of winning at games of chance Irrational thought (believing in luck)

Question 50

The odds of understanding odds

Answer 50

People fail to understand that most games involve sampling with replacement
The odds are fixed- they do not change even if you play again and again
Past wins or losses have no bearing on the outcome of the next gam

Question 51

What is illusion of control?

Answer 51

Belief that chance outcomes can be controlled through personal skill, effort

Question 52

What is double switch phenomenon?

Answer 52

The tendency for people to understand that the odds of winning aren’t in their favor before and after gambling, but a lack of understanding during gambling (once they start they abandon logical thought processes)

Question 53

What is the homogeneity bias?

Answer 53

all games are not created equal. The skill-luck continuum. Non rational thought: luck is a random event or luck Is a trait aspect

Question 54

Findings regarding personal luck and GD

Answer 54

Luck can be acquired and used to maximize outcomes. Ppl who believe in luck view gambling as a challenge. No need to stop if one has a skill (gamble, gamble, gamble)

Question 55

What is risk sensitivity theory?

Answer 55

A general theory of decision-making under risk that involves evolutionary considerations. Situations of high need (i.e. when there is a discrepancy between one’s current state and a desired state) induce a shift toward preferences for riskier goal attainment strategies. When people in a state of high need (e.g. relative deprivation) believe that they will come up short by pursuing low-risk options, they will prefer high-risk options that have a small chance of completely eliminating the need deficiency

Question 56

What are the biological aspects of involved gambling? The dopamine reward system

Answer 56

fMRI imaging has shown that chance monetary rewards (i.e., gambling) activate the brain’s dopamine reward system. As the reward is never predictable the gambler receives a burst of dopamine into the brain every time they play. reinforced by social environmental cues resulting in the development and maintenance of a strong response that is very resistant to extinction.

Question 57

What is the relationship with gambling and dopamine

Answer 57

DA release in the brain reward circuitry is evoked by reward but also by prediction of reward. Could be one of the driving forces in the obsessive need to gamble.Slot machine gambling is a good context to study DA in gambling

Question 58

What is the method of the study by Jousta et al. on DA and gambling?

Answer 58

12 GD and 12 non-GD
Underwent 3 Positron Emission Tomography Imaging) scans on the same day (3 hrs apart) under different conditions: High-reward, low-reward, and control tasks (counterbalanced)

Question 59

What were the key results of the study by Jousta et al. on DA and gambling?

Answer 59

DA release was observed in the right striatum in all participants while gambling. High reward also activated DA release in the ventral striatum for all participants.The high-reward task induced gambling “high” in all participants. DA release was associated with gambling addiction severity in the high-reward, but not in the low-reward, task

Question 60

Gambling addictions and genetics: twin studies

Answer 60

2,889 pairs of twins investigated the role of genetic and environmental factors in the development of gambling addiction.
Identical twins who were gamblerswere more likely to have a twin who was also a gambler than non-identical twins.
The researchers suggest that this association was more to do with agenetic link than environmental factors.

Question 61

What 3 subtypes did the pathways model identify?

Answer 61

• Behaviorally conditioned
• Emotionally vulnerable
• Anti-social impulsivist

Question 62

Describe the subtype behaviourally conditioned?

Answer 62

Do not have any etiological risk factors (e.g., premorbid psychopathology)
Develop gambling problems mainly in response to reinforcement contingencies of gambling. Cognitive distortions related to gambling (e.g., gambler’s fallacy, illusion of control, beliefs in luck)

Question 63

Describe the subtype emotionally vulnerable?

Answer 63

Like behaviorally conditioned, but…
Biological vulnerability (Family history of GD), Emotional vulnerability (Personality, Mood/Anxiety disorders, Life stress) ACEs

Question 64

Describe the subtype anti social impulsivist

Answer 64

Like the other 2, but also have: Impulsivity traits, Anti-social personality traits, Engage in many maladaptive behaviors (e.g., Drug taking, criminal behavior)