Lecture 6-Addiction day Flashcards
What is addiction?
Addiction is a chronic but treatable brain disorder in which people lose the ability to control their need for alcohol or other drugs.
The brains of addicted people “have been modified by the drug in such a way that absence of the drug makes a signal to their brain that is equivalent to the signal of when you are starving.”
Symptoms of addiction include tolerance (development of resistance to the effects of alcohol or other drugs over time) and withdrawal, a painful or unpleasant physical response when the substance is withheld. Many people with this illness deny that they are addicted. They often emphasize that they enjoy drinking or taking other drugs.
When is someone addicted–The American Psychiatric Association says that a person is dependent if their pattern of substance use leads to clinically significant impairment or distress shown by three or more of the following in a 12-month period:
- Tolerance as defined by any of the following:
a need for markedly increased amounts of the substance to achieve intoxication or desired effect
markedly diminished effect with continued use of the same amount of the substance - Withdrawal, as manifested by either of the following:
the characteristic withdrawal symptom of the substance
the same or a closely related substance is taken to relieve or avoid withdrawal symptoms - The substance is often taken in larger amounts or over a longer period than was intended (loss of control)
- There is a persistent desire or unsuccessful efforts to cut down or control substance use (loss of control)
- A great deal of time is spent in activities necessary to obtain the substance, use the substance or recover from its effects (preoccupation)
- Important social, occupational or recreational activities are given up or reduced because of substance use (continuation despite adverse consequences)
- The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (adverse consequences)
Discuss addiction and the brain.
For example, all drugs of abuse affect the dopamine pathway in the brain. Dopamine is a kind of neurotransmitter - a chemical produced by nerve cells that process and transmit information in the brain. The dopamine neurotransmitter’s job is to produce feelings of pleasure so this pathway is commonly known as the “pleasure pathway.”
What happens when people develop a substance use disorder is that they tax the ability of their dopamine system to keep up.
“The amount of dopamine we have in our brain is limited by the substances that the brain uses to make dopamine. And if we release it too often, we get into a situation where the brain has less dopamine. What that means is that an individual who has depleted their dopamine source in their brain has a difficult time feeling pleasure from even the normal events that would make someone happy - a mother seeing her child, or having a good meal.”
Substance Abuse?
A maladaptive pattern of substance use over at least 12 months that leads to decreased functioning.
Dependence?
Substance abuse + withdrawal symptoms, tolerance, or compulsive use.
Note that dependence is the more severe form of abuse.
withdrawal?
Physical and psychological symptoms after the reduction or cessation of intake of a substance.
intoxication?
Intoxication is an abnormal state that is essentially a poisoning or it can refer to being drunk with alcohol.
What are the 12 steps of alcoholics anonymous?
- We admitted that we were powerless over alcohol–that our lives had become unmanageable.
- Came to beleive that a power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of god as we understood him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to god, to ourselves, and to another human being the exact nature of our wrongs.
- Were entirely ready to have god remove all these defects of character.
- Humbly asked god to remove our shortcomings.
- Made a list of all persons we had harmed and became willing to make amends to them all.
- Made direct amends to such peple whenever possible, except when to do so would injure them or others
- Continued to take personal inventory and when we were wrong promptly admitted it.
- Sought through prayer and meditation to improve our concious contact with god, as we understood him, praying only for knowledge of his will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.
Nucleus _____ is the The “reward center” of the brain. It Integrates VTA (dopamine) and PFC (_____) inputs to determine motivational output.
accumbens; glutamate
Name some functions of the prefrontal cortex?
Exerts executive control over midbrain structures
Judgment
Cost-benefit analysis
What is the function of the Dorsolateral prefrontal cortex?
DLPFC-= statistical analysis, prioritizing, top down control center:(failure to assess the risks of a behavior ie drunk driving)
What is the function of the Ventromedial prefrontal cortex?
VMPFC= assigns emotional valience (drinking feels good, less stress, more social)
What is the function of the Orbitofrontal cortex?
OFC- impulse prevention ( I can beat up that football player, grope that model, drive my car)
What is the function of the Anterior cingulate cortex?
ACC= vigilance(Scanning environment for next beer, vodka, bar…)
Decision Making is ______ Driven via PFC structures
Glutamate
Limbic Drive is Dopamine Driven
D_ receptors govern static levels of DA neuronal activity to allow homeostatic wakefulness, alertness, etc
D_ receptors are pulsatile depending on motivation, drive, reward expectations
3; 2
Drugs and addictive begavior All act in brain limbic reward pathways to either:
_____ dopamine (DA) release
enhance DA effects in the Nucleus ____ (Nac) or related structures
produce effects similar to DA
enhance; Accumbens
The ______ supplies DA to the nucleus accumbens (NAc).
The _____ assigns a pleasure, threat, or an emotional value to the linkage between VTA & NAc.
This is the Limbic Addiction Pathway that is _____ in addictive behaviors.
VTA; Amygdala; excessive
- The ____ should suppress doing dangerous or addictive things
- The ______ should attach positive feelings to not doing dangerous things
- The _____ should calculate the true risk/benefit ratio of doing addictive things
- VMPFC, OFC, & DLPFC are in the cortex and are trying to control the _____ and manage the VTA.
Orbitofrontal Cortex (OFC); ventromedial prefrontal cortex (VMPFC); dorsolateral prefrontal cortex (DLPFC); NAc
With increasing addiction, frontal lobe structures can become less active (less glutamate) and even _____ allowing increasing, maladaptive addictive (more DA) behaviors to occur. (risk calculations are in error, emotional valence is put onto the addictive substance and response prevention falters
atrophy
Psychotherapy may strengthen the ______ in addicts.
prefrontal cortex
