Module 4 - Addictions Flashcards
What constitutes a ‘binge’ (alcohol)
5 standard drinks for males, 4 for females in 2 hour period. OR blood alcohol of 0.08%
What is the latin word for addiction?
‘Addicere’ - to give or bind a person to one thing or another
What is the Psychiatric View of Addiction?
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
What is the Psychodynamic view of addiction? What is the core element?
- 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.
What is the core element of the Psychodynamic view of addiction?
a dysregulated emotional system in individuals who are vulnerable to addiction
What are Social Psychological and Self-Regulation Views of Addiction ?
- 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,
What is Brown’s (1993) criteria for addiction?
(SET WCR) o 1. Salience o 2. Euphoria o 3. Tolerance o 4. Withdrawal o 5. Conflict o 6. Relapse and reinstatement
what is the lifetime prevalence of substance dependence among people who began using drugs under the age of 14
34%
What % of genetic factors account for total variability?
40%
What are the Involved brain structures in addiction?
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)
What brain chemistry is involved in addiction?
- Dopamine (reward and motivation)
- Orbito Frontal and Anterior cingulate (interconnected for sensory modslities)
- Alcohol: GABA-A, NMDA, serotonin
What is the role of the hypothalamus in addiction?
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.
What is the mesolimbic pathway?
- Ventral Tegmental Area (VTA)
- Median Forebrain bundle (MFB)
- Nucleus Accumbens (NAcc)
- Limbic System
Starts at VTA -> prefrontal -> cingulate -> Perirhinal cortex
Neurocognitive Processes Underpinning Addiction:
- Attentional Bias (hyperattentive)
- Reward Processing
- Error Processing (insensitivity to future negative consequences)
Explain the bottom up and top-down system:
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
what do Stevens and colleagues (2014) argue is the core pathological feature of substance use disorders?
impulsivity
Neuropsychological Assessment for addiction
Motor disinhibition (Stop signal test, go/no go task) Cognitive disinhibition (Stroop test) Delaying discounting (delay discounting task) Impulsive decision-making (iowa gambling task)
Guidelines for safe drinking:
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)
What are the alcohol related disorders in DSM-5?
alcohol use disorder (AUD) alcohol intoxication alcohol withdrawal other alcohol-induced disorders unspecified alcohol-related disorder.
How many diagnostic criteria need to be met for AUD?
2 for 12-month period
What are the symptoms for alcohol severity in DSM5
Mild : 2-3
Moderate: 4-5
Severe: 6+
What is the areas for CAGE Questionnaire (screening tool):?
C: Cut down
A: annoyed (criticism)
G: guilty (about drinking)
E: Eye opener: (question for realisation)
How much does alcohol issues cost australia?
$36 billion annually
What are the proposed theories for gender differences for gambling disorder?
- Gender Role Theory (women more nurturing)
- Venue Factors (undesirable for women)
- Activity preference (most valid, role socialisation - boys more skilled base games)
What are the two types of cognitive disorders for gambling?
the illusion of control (confusion of skill and chance)
the gambler’s fallacy (random sequences)
Gambling - what is the role of the insula?
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)
How many diagnostic criteria need to be met for DSM-5 diagnosis of gambling disorder?
4 or more per 12 month period
(Mild = 4-5)
(Moderate = 6-7)
(Severe= 8-9)
Gambling - what elements do psychs need to consider?
Environment
Cognition
Emotion
Interpersonal context
What are the % rates of co-morbidities with gambling disorder?
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%)
What are the 3 substance use preventions?
- Public Policy and legislation
- Health promotion and education
- Early intervention
What are the Research and Action for Teams (RAFT) Program principles:
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
Effective suggested treatments for alcohol use disorder?
o CBT, integrated therapies (i.e., models combining different approaches) and continuing therapies (i.e., those with ongoing care to sustain recovery), motivational interviewing
What is motivational interviewing? What does it focus on?
- 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
what are the Motivational Interviewing Principles?
Rolling with resistance Express Empathy Avoid Arguing Develop discrepancy Support Self-efficacy
What is the spirit of Motivational Interviewing ?
Partnership
acceptance
compassion
evocation
What are the core skills of Motivational Interviewing ?
(OARS) Open Questions Affirmations Reflections Summaries
What are the treatments for gambling disorder?
CBT Cue Exposure Motivational Interviewing Family Therapy Medication- opioid antagonists Natural recovery Gamblers anonymous Brief Advice
Scott, Moore and Miceli (1997) define workaholism as consisting of three core elements:
- A great deal of time spent in work activities;
- Preoccupation with work even when the individual is not working; and
- Working beyond what is reasonably expected of the individual to meet their job requirements
For workaholism: what is the only test instrument to use core addiction criteria?
Bergen Work Addiction Scale
what is introjected regulation?
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
