neuro: SUD Flashcards
what did early versions of DSM and ICD that used the term ‘addiction’ imply later on?
addiction implied character weakness and moral failure
what term does ICD-10 now use in replacement of addiction?
dependence
implied emphasis on biological adaptations → tolerance/withdrawal
what term does DSM-5 now use in replacement of addiction?
substance use disorder
has combined abuse and dependence into a single diagnosis of substance use disorder
broader and more inclusive
how many criteria do patients have to meet with DSM5 to be diagnosed with substance use disorder?
2/11
both ICD-10 and DSM5 diagnostic criteria have the usual requirement that substance use leads to:
distress/impairment of social/occupational functioning
what are the 3 severity categories of the DSM5?
mild = 2/3 criteria, moderate = 4/5 criteria, severe = 6+ criteria
how many possible combinations of symptoms are there?
2036
→ some people could have completely unrelated symptoms
→ but symptoms do tend to cluster together
what are the limitations of the DSM5 with substance use disorder?
→ doesn’t really tell us what SUD is
→ severity criteria doesn’t help us further understand or define addiction because the range of symptoms don’t always over link in patients
what is the consensus that someone is addicted?
if they continue to use drugs despite a sincere intention to do otherwise
in what countries is alcohol use disorder common in women and men?
women = US, russia, australia men = russia, UK, china, south america
where in the world is alcohol use disorder less common in women?
south east asia → muslim countries
africa
what is the epidemiology of tobacco smoking
developing countries = higher rates
higher in european countries
men = high in asia, russia women = low in africa, asia
in the uk → 22% of adults smoke → most meet the criteria for dependence ‘addicted’
estimates fluctuate over time in response to changes in government policies. give some examples
→ ban on smoking in public places/car with children → substance norms → pricing and taxation → changes in drug legal status → discovery of new drugs
what are some risk factors for SUD
comorbidity, genetic influence, traumatic life events
traumatic life events:
childhood sexual abuse = increased risk of developing SUD
traumatic life events combined with comorbidity suggests its a disorder of EMOTION REGULATION
how attributable to genetic factors =
heritability
estimated range with SUD between 30-70%
describe basic learning theories as theories of SUD
operant:
positive and negative reinforcement
classical:
alcohol = US,
when people drink they do it in the presence of drug related cues (smell, taste, sight, pub, friends)
cues = CS
US + CS → CR
how does positive reinforcement work with drugs?
perform behaviour of taking drug → positive outcome/reward of euphoria → more likely to repeat behaviour
how does negative reinforcement work with drugs?
addicted → experience unpleasant withdrawal syndrome when stop taking drug → take drug to remove withdrawal symptoms
which drugs are more likely to show positive reinforcement and why?
more important for drugs that produce euphoria and have mild withdrawal syndrome
→ cocaine, cannabis, MDMA
which drugs are more likely to show negative reinforcement and why?
heroin and nicotine → more severe withdrawal effects
at what stages is positive reinforcement more important and at what stages is negative reinforcement more important with a drug user?
early stages → + more important → enjoyment
as progresses with severity → more withdrawal → - is more important
why are learning processes not sufficient to explain addiction?
not everyone that tries drugs becomes addicted
what are reasons for taking drugs?
to get high, to increase alertness and reduce fatigue, social facilitation, alleviate stress
choice vs. compulsion?
choice:
→ drug use is sensitive to changes in price → if price of drug increases users are likely to switch or give up → shows they are rationale
→ don’t want to give up
compulsion:
→ drug use becomes compulsive → addicted people can’t stop
→ negative consequences outweigh positives but addicts are compelled to keep using even when there is desire to stop
e.g. heroin
give evidence that addiction is a brain disease
concept of addiction as disease due to changes in the brain → causes people to lose control of their control
→ dominant paradigm
→ clear evidence for changes in brain structure after long term chronic use
(extreme cases = looks like brain damage)
give evidence that addiction is NOT a brain disease
→ our brains change all the time and the change is reversible
→ evidence for widespread recovery often without any treatment
describe key features of the biological theories of SUD
→ stimulates dopamine release in brains reward system
→ mesolimbic D system includes nucleus accumbens, ventral segmental area, regions of prefrontal cortex
→ dopamine system = pleasure centre
discuss the dual processing theory of SUD
a new substance user will be largely controlled by CONTROLLED PROCESSES
(makes an informed decision to take the drug)
an experienced addict user switches from controlled processes to AUTOMATIC PROCESSES
(through a conditioning process and automatic habits)
→ imbalance between influence of controlled and automatic)
controlled processes features include:
→ outcome expectancies
→ intensions to use
(thought out process)
automatic processes features include:
→ attentional biases
→ spontaneous memory associations
→ automatic approach tendencies
type and intensity of treatment depends on what 2 things?
→ persons goals (reduce substance use or give up completely)
→ severity of their SUD
give a list of different treatments for SUD
substitute medication, self help groups, CBT, motivational interviewing, contingency management
heroin users are required by court to aim for ______ _______. what are the steps to achieve this?
complete abstinence
first step = detoxification (also alcohol)
2nd step = CBT or motivational interviewing
what is the substitute for heroin?
methadone
→ minimises withdrawal effects
→ produces mild euphoria
→ reduces amount of heroin used
→ avoids risky sharing of syringes → reduces HIV risk
what are different forms of nicotine replacement?
chewing gum, patches, vapes, varenidine drug (reduces severity of nicotine withdrawal), anti-depressants
what are the 3 different alcohol substitutes?
altrexone, disulfiram, acamprosate
blocks opioid receptors which blocks pleasure that people feel when drinking alcohol
altrexone
partially resets GABA
acamprosate
prevents alcohol metabolism so makes you feel sick and deters you from drinking alcohol
disulfriam
list the benefits of motivational interviewing
→ encourages client to see benefit of quitting
→ develops clients own motivation to quit
→ increases ‘client change talk’
→ encourages client to engage in more intensive treatment
what is client change talk
record sessions and count times user volunteers a desire to change
how does CBT work to treat SUD
→ coping skills
→ modify beliefs
→ provide repeated practice techniques in order to counteract cognitions → change behaviour through conditioned learning
as age increases, % of remission ______
increases
most people who have ever been addicted will recover
more likely to be in remission from a ____ disorder than any other _______ disorder
drug, psychiatric
why are self help groups effective?
help people achieve and maintain abstinence, effective increase of self-efficacy, new social groups where everyone can relate → provides alternatives and keeps away from temptation
what is contingency management?
pros and cons?
small financial inceptives for people that provide clean urine samples
pro = cheap treatment
con = after incentive stops only effective for a while
(but remained abstinent for longer than control group)
SUV treatment aims to:
→ reduce motivation to use drug
→ increase motivation to abstain (or reduce use)
→ provide people with resources they need to change their behaviour e.g. coping skills, social networks
habit =
shift from S-O-R → S-R
stimulus → (anticipated) outcome → response
explain SOR → SR
stimulus (drug) will make a person think about the outcome of using the drug (pleasure) which elicits them to respond by taking the drug
with repeated performance of this behaviour, direct links are formed between the stimulus and response without retrieving the outcome
S → R
(this is habitual behaviour → response becomes instant and thought process in the middle is no longer involved)
why does the SOR habit model suggest drug use is a voluntary choice?
because the anticipated outcome is thought through
describe evidence for how habits develop
in lab animals → drug seeking becomes habitual → persist taking drug despite negative consequences such as feeling sick → keep on pulling lever to self administer