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PSYC3018 Abnormal Psychology > Lectures 12 & 13 - Addictive Disorders: Alcohol & Drugs > Flashcards

Lectures 12 & 13 - Addictive Disorders: Alcohol & Drugs Flashcards

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1
Q

What should I know for this topic?

A
  • 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?
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2
Q

What is a drug?

A

Any substance that exerts an effect on body or mind (prescription, legal and illicit)

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3
Q

What kinds of effects can drugs have? (4)

Provide egs.

A
  1. Neurophysiological
    - Tachcardia, dilation, respiratory
  2. Behavioural
    - Aggression, disinhibition
  3. Emotional
    - Euphoria, confidence
  4. Cognitive
    - Confusion, memory, paranoid
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4
Q

How are drugs generally classified?

A

By their induced effect.

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5
Q

Name 6 classifications of drugs.

Although the last one is just like a list of others…

A
  1. Depressant (downers)
    - Alcohol, barbiturates, inhalants, benzodiazepines, sedatives
  2. Stimulants (uppers)
    - Cocaine, amphetamines, caffeine, nicotine, MDA (ecstasy)
  3. Hallucinogen
    - Altered perceptions – mescaline, LSD, psilocybin
  4. Opioid/narcotics
    - Analgesia – Morphine, heroin, codeine, methadone
  5. Cannabinoids:
    - Marijuana, hash, ganja
  6. Tobacco, steroids, volatile solvents, prescription drugs
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6
Q

Routes of drug administration

A
  1. Inhalation (most rapid)
  2. Intravenous
  3. Oral
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7
Q

FIX CARD

slide 7

A

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
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8
Q

What % of people will sample illicit drugs at least

once?

A

60%

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9
Q

Name 7 Models of addiction.

West, 2013

A
  1. ‘Automatic processing’ (associative learning, drives, inhibitory processes and imitation
  2. Reflective choice: (conscious decisions to consume after ‘rational’ or ‘biased’ evaluation of costs & benefits)
  3. Different types of goal (positive reward, acquired & pre-existing needs)
  4. Integrative theories combining elements of automatic & reflective choice
  5. Biological theories based on neural mechanisms
  6. Social network theories
  7. Economic, marketing (consumption – public health models)
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10
Q

What is meant by ‘addiction’?

A
  • Latin addictio(n-),from addicere ‘to assign’

* Late 16th century (denoting a person’s inclination or proclivity: “tendency,” of habits, pursuits”

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11
Q

Substance related disorders
Covers diagnostic criteria for 10 separate classes of drugs

These are….

A
  1. Alcohol
  2. Hallucinogens
  3. Opioids
  4. Hypnotics
  5. Stimulants
  6. Cannabis
  7. Inhalants
  8. Sedatives
  9. Anxiolytics
  10. Tobacco

+ Other

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12
Q

What are the key features of substance addiction? (7)

(WHO,1992; DSM-5; ICD-10; American Society for Addiction Medicine)

**Really important to know!

A
  1. Chronic disease of brain reward, motivation, memory & related circuitry
  2. Excessive pursuit of reward (+ve reinf.) &/or relief (-ve reinf.)
  3. Diminished control:
    • repeated unsuccessful efforts to reduce or control use
    • persistent use despite harmful consequences
  4. Compulsion/craving
  5. Salience: focus on use superseding other interests
  6. Increased tolerance & withdrawal syndrome on discontinuation
  7. Cycles of relapse & remission common
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13
Q

Outline the 11 items of criteria A (the only criterion) for substance related disorders.

What four categories may these form?

A

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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14
Q

FIX CARD

Outline the Choice theory of addiction.

(West, 2006)

A

~30 mins into lecture

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15
Q

FIX CARD

*Debate

A

Habit (choice) versus addiction (impaired control): Debate exists over nature & even existence of addiction (Dalrymple, 2006)

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16
Q

FIX CARD

l *Slide 19

A

› Neurotransmitter disrupted volition = 19th Century disease of the will

› Neurobiology not destiny: capacity for choice affected but not destroyed

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17
Q

*Slide 20

A

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

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18
Q

What are some common barriers to successful treatment?

A
  • Psychiatric comorbidity,
  • Acute or chronic cognitive deficits
  • Medical problems
  • Social stressors
  • Lack of social resources
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19
Q

Which 3 areas of the brain do drugs of dependence work on?

Slide 35

A
  1. Basal ganglia: Reward & formation of habitual use
  2. Extended amygdala: Irritability, anxiety & withdrawal (fight-flight stress reactions)
  3. Prefrontal cortex: Decision-making/control
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20
Q

Which 2 (neuro) systems do drugs of dependence work on?

Slide 35

A

1) The dopaminergic system

2) The endogenous opioid system

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21
Q

*West, 2006

slide 19

A

Choice theory of addiction

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22
Q

*

Chen & Jacobson, 2012

A

Developmental trajectories of substance use

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23
Q

What are the Recommended Levels of Standard drinks ?

Answer for both men and women standard drinks daily, and associated risk factor.

Slide 22

A

Low Risk:
Female: 2 or less Male: 4 or less

Hazardous:
Female: 3-4 Male: 5-6

Harmful
Female: 5+ Male: 7+

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24
Q

*slide 23

A

glop

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25
Q

*slide 24

A

bop

26
Q

*slide 25

A

skipped

27
Q

What are the Contributory risk factors?

Slide 26

A
  • 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
28
Q

How many substance users have a co-morbid psychiatric disorder?

A

60%

29
Q

*Co-Morbidities of Substance Use
Compared to general population

and why?

A
  • 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
30
Q

*Heritability of addiction

slide 28

A

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

31
Q

FIX SLIDE

What is Neural sensitisation?
is it same as tolerance?

A

• Once sensitized, individuals often show cross- sensitisation

go to another drug with same effects

32
Q

*Concentrations of dopamine increase (directly/indirectly) following most drugs, including:
Alcohol, Nicotine, Cannabis, Opioids, Cocaine, Amphetamines

A

slide 31

33
Q

Explain the ‘kitchen sink analogy’

slide 31

probs imp. to know

A

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)

34
Q

*I-RISA: (Goldstein & Volkow, 2002)

A

slide 32

35
Q

Explain the pathway in the Dopaminergic Reward System

A

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

36
Q

*slide 34

A

› 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?

37
Q

How do the American Society of Addiction Medicine describe addiction?

Slide 36

A

As a primary, chronic disease of the brain reward, motivation, memory & related circuitry.

38
Q

*

A

slide 37

39
Q

*

A

slide 38

40
Q

*slide 39

Biological Model

A

?

41
Q

*

A

slide 40

42
Q
  • slide 41

Learning theories as psyc model

A

slide 41

43
Q

*

A

slide 42

44
Q
  • Slide 43

Opponent Process Theory of Addiction

A

slide 43

45
Q

*

A

slide 44

46
Q

*

A

slide 45

47
Q

*

A

slide 46

48
Q
  • slide 47

Principles of effective management

A
  1. No single treatment is appropriate
  2. Treatment needs to be readily available & accessible
  3. Effective treatment involves & attends to multiple psychological, medical & social interventions & needs (CBT, naloxone, antabuse, methadone, peer support)
  4. Dual diagnosed clients should have both disorders treated in an integrated fashion
  5. Treatment does not need to be voluntary to effect change
  6. Recovery from drug addiction can be a long term process & frequently requires multiple episodes of treatment
49
Q

CBT for addiction
Learning-based approaches to target:
(3)

slide48

A
  1. Maladaptive behaviour patterns
  2. Motivational & cognitive barriers to change
  3. Skills deficits
50
Q
  • slides 49-50

Cognitive/Motivational Strategies

A

• 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”)

51
Q

*

A

slide 50

52
Q
  • Slide 51

Shifting Contingencies

A

• 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)

53
Q

*What does ‘skills training’ involve?

Slide 52

A

• 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)

54
Q

*Slide 36

A

Addiction

Involves three stage cycle:
•  Binge/intoxication
•  Withdrawal/negative affect 
•  Preoccupation/anticipation 
•  Craving/compulsive usage
55
Q

Why do some individuals undergo a transition from casual drug use to compulsive patterns of drug use?

A

good question…

56
Q

Once addicted, why is it so hard to stop?

A

dno

57
Q

Why are there different models?

Do they overlap?

A

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

58
Q

What are the differences between DSM-IV and DSM-5 in relation to Substance Use Disorders?

A

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

59
Q

FIX CARD

A

something about the impaired control model

60
Q

whatever he was saying around 35 mins

A

priming- acts as barrier?

PSYC3018 Abnormal Psychology (29 decks)

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