Module 4 - Addictions

Question 1

What constitutes a ‘binge’ (alcohol)

Answer 1

5 standard drinks for males, 4 for females in 2 hour period. OR blood alcohol of 0.08%

Question 2

What is the latin word for addiction?

Answer 2

‘Addicere’ - to give or bind a person to one thing or another

Question 3

What is the Psychiatric View of Addiction?

Answer 3

Drug addiction has aspects of both:

• Impulse control disorders
• compulsive disorders

Drug addiction progresses from impulsivity to compulsivity in a collapsed cycle of addiction that consists of three stages: preoccupation/anticipation, binge/intoxication, and withdrawal/negative affect

Question 4

What is the Psychodynamic view of addiction? What is the core element?

Answer 4

• focus on the factors that produce vulnerability to addiction.
• Two critical elements (disordered emotions and disordered self-care) and two contributory elements (disordered self-esteem and disordered relationships)
• the core element of this psychodynamic perspective is a dysregulated emotional system in individuals who are vulnerable to addiction.

Question 5

What is the core element of the Psychodynamic view of addiction?

Answer 5

a dysregulated emotional system in individuals who are vulnerable to addiction

Question 6

What are Social Psychological and Self-Regulation Views of Addiction ?

Answer 6

• Underregulation, reflected by strength deficits, a failure to establish standards, conflicting standards, attentional failures, and misregulation (misdirected attempts to self-regulate) can contribute to the development of addiction- like behavioral patterns
• can be facilitated by lapse-activated causal patterns
• Executive function deficits, self-regulation problems, and frontal lobe dysfunction or pathology constitute risk factors for biobehavioral disorders, including drug abuse.
• Deficits in frontal cortex regulation in children or young adolescents predict later drug and alcohol consumption,

Question 7

What is Brown’s (1993) criteria for addiction?

Answer 7

(SET WCR)
o	1. Salience
o	2. Euphoria
o	3. Tolerance
o	4. Withdrawal 
o	5. Conflict
o	6. Relapse and reinstatement

Question 8

what is the lifetime prevalence of substance dependence among people who began using drugs under the age of 14

Answer 8

34%

Question 9

What % of genetic factors account for total variability?

Answer 9

40%

Question 10

What are the Involved brain structures in addiction?

Answer 10

o Nucleus accumbens (learning)
o Limbic structures (learning/conditioning)
o Orbitofrontal cortex (motivation/drive)
o Anterior cingulate gyrus (inhibitory control)
o Prefrontal cortex (inhibited in gambling)

Question 11

What brain chemistry is involved in addiction?

Answer 11

• Dopamine (reward and motivation)
• Orbito Frontal and Anterior cingulate (interconnected for sensory modslities)
• Alcohol: GABA-A, NMDA, serotonin

Question 12

What is the role of the hypothalamus in addiction?

Answer 12

 critical for motivated behaviour (eating, drinking, sex).
 Primarily consummatory behaviours (not goal directed).
 Activation of the HPA xis during times of stress can trigger need for reward.

Question 13

What is the mesolimbic pathway?

Answer 13

• Ventral Tegmental Area (VTA)
• Median Forebrain bundle (MFB)
• Nucleus Accumbens (NAcc)
• Limbic System
  Starts at VTA -> prefrontal -> cingulate -> Perirhinal cortex

Question 14

Neurocognitive Processes Underpinning Addiction:

Answer 14

• Attentional Bias (hyperattentive)
• Reward Processing
• Error Processing (insensitivity to future negative consequences)

Question 15

Explain the bottom up and top-down system:

Answer 15

The bottom-up system, reflecting the impulse or reactive system, encourages rewarding, habitual behaviours and prioritises responding to available cues above consideration of long term consequences.
In contrast, the top-down system, reflects executive or reflective functions, including self-control, planning, memory and resistance to temptation
- In healthy individuals top down processing over runs bottom down but in an addict it’s the other way

Question 16

what do Stevens and colleagues (2014) argue is the core pathological feature of substance use disorders?

Answer 16

impulsivity

Question 17

Neuropsychological Assessment for addiction

Answer 17

Motor disinhibition (Stop signal test, go/no go task)
Cognitive disinhibition (Stroop test)
Delaying discounting (delay discounting task)
Impulsive decision-making (iowa gambling task)

Question 18

Guidelines for safe drinking:

Answer 18

Constitutes a safe level of drinking?
Guideline 1: Reducing the risk of alcohol-related harm over a lifetime (no more than 2 standard drinks a day)
Guideline 2: Reducing the risk of injury on a single occasion of drinking. (no more than 4 standard drinks)
Guideline 3: Children and young people under 18 years of age. (No alcohol)
o Guideline 4: Pregnancy and breastfeeding. (no alcohol)

Question 19

What are the alcohol related disorders in DSM-5?

Answer 19

	alcohol use disorder (AUD)
	alcohol intoxication
	alcohol withdrawal
	other alcohol-induced disorders 
	unspecified alcohol-related disorder.

Question 20

How many diagnostic criteria need to be met for AUD?

Answer 20

2 for 12-month period

Question 21

What are the symptoms for alcohol severity in DSM5

Answer 21

Mild : 2-3
Moderate: 4-5
Severe: 6+

Question 22

What is the areas for CAGE Questionnaire (screening tool):?

Answer 22

C: Cut down
A: annoyed (criticism)
G: guilty (about drinking)
E: Eye opener: (question for realisation)

Question 23

How much does alcohol issues cost australia?

Answer 23

$36 billion annually

Question 24

What are the proposed theories for gender differences for gambling disorder?

Answer 24

• Gender Role Theory (women more nurturing)
• Venue Factors (undesirable for women)
• Activity preference (most valid, role socialisation - boys more skilled base games)

Question 25

What are the two types of cognitive disorders for gambling?

Answer 25

 the illusion of control (confusion of skill and chance) |  the gambler’s fallacy (random sequences)

Question 26

Gambling - what is the role of the insula?

Answer 26

o Key reception zone for bodily input and arousal o The insula has a key role in what is called interoception. This is detecting and perceiving what is going on in your body. o Gambling associated with increased physiological arousal (heart rate, cortisol) o Insula overactivity in pathological gambling? Target for bodily treatments (mindfulness/biofeedback)

Question 27

How many diagnostic criteria need to be met for DSM-5 diagnosis of gambling disorder?

Answer 27

4 or more per 12 month period (Mild = 4-5) (Moderate = 6-7) (Severe= 8-9)

Question 28

Gambling - what elements do psychs need to consider?

Answer 28

Environment Cognition Emotion Interpersonal context

Question 29

What are the % rates of co-morbidities with gambling disorder?

Answer 29

depression (75% of gamblers are also depressed), suicidal ideation (40%) and other addictions including alcohol use disorder (73%), nicotine dependence (60%) and drug use (38%)

Question 30

What are the 3 substance use preventions?

Answer 30

- 1. Public Policy and legislation - 2. Health promotion and education - 3. Early intervention

Question 31

What are the Research and Action for Teams (RAFT) Program principles:

Answer 31

o 1. Community engagement and collaboration o 2. Continuum of care o 3. Widespread applicability o 4. Professional teamwork across epidemiology, nursing, psychiatry, psychology, social work and health administration disciplines and community-based services across youth-serving sectors

Question 32

Effective suggested treatments for alcohol use disorder?

Answer 32

o CBT, integrated therapies (i.e., models combining different approaches) and continuing therapies (i.e., those with ongoing care to sustain recovery), motivational interviewing

Question 33

What is motivational interviewing? What does it focus on?

Answer 33

- designed to alter or elicit the client's motivation to change - client-centred therapy - is focused more on whether and why to change than on the how

Question 34

what are the Motivational Interviewing Principles?

Answer 34

``` Rolling with resistance Express Empathy Avoid Arguing Develop discrepancy Support Self-efficacy ```

Question 35

What is the spirit of Motivational Interviewing ?

Answer 35

Partnership acceptance compassion evocation

Question 36

What are the core skills of Motivational Interviewing ?

Answer 36

``` (OARS)  Open Questions  Affirmations  Reflections  Summaries ```

Question 37

What are the treatments for gambling disorder?

Answer 37

``` CBT Cue Exposure Motivational Interviewing Family Therapy Medication- opioid antagonists Natural recovery Gamblers anonymous Brief Advice ```

Question 38

Scott, Moore and Miceli (1997) define workaholism as consisting of three core elements:

Answer 38

1. A great deal of time spent in work activities; 2. Preoccupation with work even when the individual is not working; and 3. Working beyond what is reasonably expected of the individual to meet their job requirements

Question 39

For workaholism: what is the only test instrument to use core addiction criteria?

Answer 39

Bergen Work Addiction Scale

Question 40

what is introjected regulation?

Answer 40

results from partially internalizing external standards of social approval and self-worth; hence, the standards have been internalized but individuals do not fully identify with them and can be at odds with other personal values