Lectures 44 + 45 - Neurobiology of Addiction

Question 1

The major reward centers in the brain are the Nucleus ______ and the Ventral _______ area, which have a high density of Dopamine receptors. Food and Sex increase the activity in this reward center by 150% and 200%, respectively.

Drugs of addiction and abuse cause a far greater increase in activity.

Answer 1

Nucleus Accumbens

Question 2

One of the big reasons drugs that “hijack” the reward system are so impactful is because the Nucleus Accumbens is essentially sandwiched between the _______ (involved in memory) and the ________ and _____ system (involved in emotion).

Another reason is that there is a disconnect between the Lateral _________ lobe (rational thinking) and the more primitive parts controlling emotion.

Answer 2

Hippocampus

Amygdala

Limbic system

Lateral Orbitofrontal lobe

Question 3

The Medial ________ cortex is involved with Motivation.

The _______ is involved with the Anti-reward pathway.

The ________ is involved with Interoception.

Answer 3

Medial Orbitofrontal cortex

Habenula

Insula

Question 4

As addiction progresses, there’s a shift from ______ pathway dominance to ______ pathway dominance. Essentially, the patient transitions from pleasure seeking to pain avoidance.

Answer 4

Reward pathway (nucleus Accumbens + Ventral Tegmental area)

Anti-reward pathway (Habenula)

Question 5

Keep in mind that all the craving and reward systems in the brain collectively get processed through the ________ (responsible for interoception), which provides focus, allows us to ignore, and gives meaning to all these signals right before action is taken. Essentially, it’s the gateway to action.

Answer 5

Insula

Question 6

The 3 pillars of Addiction treatment are:

1. ______
2. ______
3. ______

Answer 6

1. Medicine
2. Counseling/Therapy
3. Mutual Help

Question 7

There are 3 types of medications used to treat addiction:

1. _______ (Cut cravings)
2. _______ (block effect of tdrug)
3. ______ ______ (Combination of the other two)

Answer 7

1. Agonists (e.g. Nicotine patch)
2. Antagonists (e.g. Naltrexone)
3. Partial Agonists (e.g. varenicline for tobacco; Buprenorphine for opioids)

Question 8

What is paradoxical about the Motivational Interview approach to therapy?

Answer 8

At the early stages of a patient’s readiness to change, Motivational Interviewing introduces or increases ambivalence in the patient’s mind by asking them why their motivation isn’t Lower.

For example, a patient says their motivation is 2/10 for quiting smoking. You ask, why not a 1? And you essentially plant the seed of ambivalence and capitalize on the small bit of motivation they have that way.