Lectures 12 & 13 - Addictive Disorders: Alcohol & Drugs Flashcards
What should I know for this topic?
- How psychologists conceptualise and diagnose addiction to alcohol & other substances
- Learning
- Biological/disease
- Socio-economic-cultural
- How psychologists explain the development & maintenance of addiction
- What are the core clinical components & issues for intervention?
What is a drug?
Any substance that exerts an effect on body or mind (prescription, legal and illicit)
What kinds of effects can drugs have? (4)
Provide egs.
- Neurophysiological
- Tachcardia, dilation, respiratory - Behavioural
- Aggression, disinhibition - Emotional
- Euphoria, confidence - Cognitive
- Confusion, memory, paranoid
How are drugs generally classified?
By their induced effect.
Name 6 classifications of drugs.
Although the last one is just like a list of others…
- Depressant (downers)
- Alcohol, barbiturates, inhalants, benzodiazepines, sedatives - Stimulants (uppers)
- Cocaine, amphetamines, caffeine, nicotine, MDA (ecstasy) - Hallucinogen
- Altered perceptions – mescaline, LSD, psilocybin - Opioid/narcotics
- Analgesia – Morphine, heroin, codeine, methadone - Cannabinoids:
- Marijuana, hash, ganja - Tobacco, steroids, volatile solvents, prescription drugs
Routes of drug administration
- Inhalation (most rapid)
- Intravenous
- Oral
FIX CARD
slide 7
Drugs can be viewed as neutral substances but restricted/banned due to their impacts
- Value judged by use & effects
- Alcohol: socially acceptable in moderation
- Tobacco: legal despite nil beneficial effects
- Illicit drugs: varied social/legal condemnation (Netherlands; California, Australia – trials for medical use)
- Prescription drugs: accepted but can be abused
What % of people will sample illicit drugs at least
once?
60%
Name 7 Models of addiction.
West, 2013
- ‘Automatic processing’ (associative learning, drives, inhibitory processes and imitation
- Reflective choice: (conscious decisions to consume after ‘rational’ or ‘biased’ evaluation of costs & benefits)
- Different types of goal (positive reward, acquired & pre-existing needs)
- Integrative theories combining elements of automatic & reflective choice
- Biological theories based on neural mechanisms
- Social network theories
- Economic, marketing (consumption – public health models)
What is meant by ‘addiction’?
- Latin addictio(n-),from addicere ‘to assign’
* Late 16th century (denoting a person’s inclination or proclivity: “tendency,” of habits, pursuits”
Substance related disorders
Covers diagnostic criteria for 10 separate classes of drugs
These are….
- Alcohol
- Hallucinogens
- Opioids
- Hypnotics
- Stimulants
- Cannabis
- Inhalants
- Sedatives
- Anxiolytics
- Tobacco
+ Other
What are the key features of substance addiction? (7)
(WHO,1992; DSM-5; ICD-10; American Society for Addiction Medicine)
**Really important to know!
- Chronic disease of brain reward, motivation, memory & related circuitry
- Excessive pursuit of reward (+ve reinf.) &/or relief (-ve reinf.)
- Diminished control:
- repeated unsuccessful efforts to reduce or control use
- persistent use despite harmful consequences
- Compulsion/craving
- Salience: focus on use superseding other interests
- Increased tolerance & withdrawal syndrome on discontinuation
- Cycles of relapse & remission common
Outline the 11 items of criteria A (the only criterion) for substance related disorders.
What four categories may these form?
Criterion A
Impaired control (items 1-4)
- Use of amounts or for longer periods than intended
- Repeated unsuccessful attempts to cut back/cease
- Excessive time obtaining drug or recovery from use
- Craving
Social impairment (5-7)
› Failure to meet obligations: Home, work, school
› Social & interpersonal problems
› Social, occupational or recreational activities reduced
Risky use (8-9) › Use in physically hazardous situations › Persistence despite awareness of physical or psychological problems exacerbated by use
Pharmacological (10-11) (Indicative of neuro-adaptation)
• Tolerance
• Withdrawal
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Outline the Choice theory of addiction.
(West, 2006)
~30 mins into lecture
FIX CARD
*Debate
Habit (choice) versus addiction (impaired control): Debate exists over nature & even existence of addiction (Dalrymple, 2006)
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l *Slide 19
› Neurotransmitter disrupted volition = 19th Century disease of the will
› Neurobiology not destiny: capacity for choice affected but not destroyed
*Slide 20
Addiction & dependence often used interchangeably: no consensus on definition & distinction
Physiological dependence:
Associated with physical symptoms of tolerance & withdrawal on cessation
Psychological addiction/dependence:
Cravings/desire leading to repetitive (compulsive) use
What are some common barriers to successful treatment?
- Psychiatric comorbidity,
- Acute or chronic cognitive deficits
- Medical problems
- Social stressors
- Lack of social resources
Which 3 areas of the brain do drugs of dependence work on?
Slide 35
- Basal ganglia: Reward & formation of habitual use
- Extended amygdala: Irritability, anxiety & withdrawal (fight-flight stress reactions)
- Prefrontal cortex: Decision-making/control
Which 2 (neuro) systems do drugs of dependence work on?
Slide 35
1) The dopaminergic system
2) The endogenous opioid system
*West, 2006
slide 19
Choice theory of addiction
*
Chen & Jacobson, 2012
Developmental trajectories of substance use
What are the Recommended Levels of Standard drinks ?
Answer for both men and women standard drinks daily, and associated risk factor.
Slide 22
Low Risk:
Female: 2 or less Male: 4 or less
Hazardous:
Female: 3-4 Male: 5-6
Harmful
Female: 5+ Male: 7+
*slide 23
glop
*slide 24
bop
*slide 25
skipped
What are the Contributory risk factors?
Slide 26
- Genetics & co-morbidities
- Age commence use (maturity & risk taking)
- Availability
- Family & peer dynamics (conflicts, vicarious learning) (set up schemas)
- Cultural norms
- Exposure to trauma
- Social support
- Poverty
How many substance users have a co-morbid psychiatric disorder?
60%
*Co-Morbidities of Substance Use
Compared to general population
and why?
- Patients with mood/anxiety disorders twice as likely to suffer substance dis.
- Patients with substance disorders twice as likely to suffer a mood/anxiety
combined directions of comorbidities
often as Self-medication
Why? • Overlapping genetic vulnerabilities • Overlapping environmental triggers • Involvement of similar brain regions • Interactive effect: Drug/other disorders can increase vulnerability to the other
*Heritability of addiction
slide 28
Twin research: Strong genetic component to substance disorders
Monozygotic twin show higher concordance rates for:
• Alcohol; Cannabis; Tobacco (Young et al., 2006)
• Stimulants (Kendler & Prescott, 1998)
• Hallucinogens; Opioids (Kendler et al., 2003)
• Sedatives (van den Bree et al., 1998)
Likely that the genetic basis for substance dependence is largely non-specific, rather than unique to specific substances
FIX SLIDE
What is Neural sensitisation?
is it same as tolerance?
• Once sensitized, individuals often show cross- sensitisation
go to another drug with same effects
*Concentrations of dopamine increase (directly/indirectly) following most drugs, including:
Alcohol, Nicotine, Cannabis, Opioids, Cocaine, Amphetamines
slide 31
Explain the ‘kitchen sink analogy’
slide 31
probs imp. to know
Drugs act like rubber stopper: molecules block dopamine transporter & stop natural reuptake of dopamine into neurons
This causes a large excess of dopamine in synapse & “overflow” of dopamine causes pleasure & euphoria
(dopamine as water)
*I-RISA: (Goldstein & Volkow, 2002)
slide 32
Explain the pathway in the Dopaminergic Reward System
See slide 33 for diagram
VTA (ventricle tegmental area) sends dopamine
> amygdala - regulates emotions;
> nucleus accumbens - controls motor functions
> hippocampus - memories formed
> prefrontal cortex - decision-making & attention
*slide 34
› Eating a piece of cake: Take a bite > VTA releases
dopamine to all regions:
- Amygdala: “This is delicious…this makes me very happy right now”
- Hippocampus: Remembers experience & context
- Prefrontal cortex: Focus attention on cake
- Nucleus accumbens: “Pleasure centre,” stimulated, causing you to take another bite
- Reward system: Reactivated with each bite
Addictive behaviors emerge if repeated too often ?Inability to control or failure of motivation?
How do the American Society of Addiction Medicine describe addiction?
Slide 36
As a primary, chronic disease of the brain reward, motivation, memory & related circuitry.
*
slide 37
*
slide 38
*slide 39
Biological Model
?
*
slide 40
- slide 41
Learning theories as psyc model
slide 41
*
slide 42
- Slide 43
Opponent Process Theory of Addiction
slide 43
*
slide 44
*
slide 45
*
slide 46
- slide 47
Principles of effective management
- No single treatment is appropriate
- Treatment needs to be readily available & accessible
- Effective treatment involves & attends to multiple psychological, medical & social interventions & needs (CBT, naloxone, antabuse, methadone, peer support)
- Dual diagnosed clients should have both disorders treated in an integrated fashion
- Treatment does not need to be voluntary to effect change
- Recovery from drug addiction can be a long term process & frequently requires multiple episodes of treatment
CBT for addiction
Learning-based approaches to target:
(3)
slide48
- Maladaptive behaviour patterns
- Motivational & cognitive barriers to change
- Skills deficits
- slides 49-50
Cognitive/Motivational Strategies
• Identify high risk situations & events
• (including people, places, internal cues such as
changes in affect)
• Reduce likelihood that these events are encountered (providing alternative activities)
• Rehearsing non-drug alternatives to cues
• Enhance motivation for alternative activities
• Target cognitions that enhance likelihood of drug use
• Motivational interviewing (i.e., exploration of ambivalence)
• Strategies to target cognitive distortions specific to
substance abuse, including, rationalising use
(“I will just use this once,” “One drink won’t hurt me,” “It has been a bad day; I deserve to use”)
• …and giving up (“Why even try,” “I will always be an addict”)
*
slide 50
- Slide 51
Shifting Contingencies
• Eventual aim to increase reinforcing consequences for drug reduction, but before
naturally-occurring rewards are available (e.g., greater employment, relationship, and social success)…
• Artificial rewards may be used (monetary prizes, vouchers for goods, or treatment “privileges” e.g., take- home doses of methadone)
*What does ‘skills training’ involve?
Slide 52
• Emotion regulation: distress tolerance skills
• Non-drug alternatives to coping with negative affect
e.g., eliciting social support, engaging in pleasurable activities; exercise
• Rehearsal in session of socially-acceptable responses to offers of drugs; with imaginal exposure or emotional
induction (to simulate client’s actual experience of high risk situations)
*Slide 36
Addiction
Involves three stage cycle: • Binge/intoxication • Withdrawal/negative affect • Preoccupation/anticipation • Craving/compulsive usage
Why do some individuals undergo a transition from casual drug use to compulsive patterns of drug use?
good question…
Once addicted, why is it so hard to stop?
dno
Why are there different models?
Do they overlap?
They may have different focusses and yes they overlap and are not mutally exclusive.
e.g. the biological model relies on the public health model
What are the differences between DSM-IV and DSM-5 in relation to Substance Use Disorders?
DSM-IV: did not use the word ‘addiction’. Still is debated.
• Substance Dependence
• Substance Abuse
DSM-5:
Substance-related & Addictive Disorder
• Substance use disorders
• Substance-induced disorders
Non-substance-related behavioural addictions
• Gambling
FIX CARD
something about the impaired control model
whatever he was saying around 35 mins
priming- acts as barrier?
