neuro: SUD

Question 1

what did early versions of DSM and ICD that used the term ‘addiction’ imply later on?

Answer 1

addiction implied character weakness and moral failure

Question 2

what term does ICD-10 now use in replacement of addiction?

Answer 2

dependence

implied emphasis on biological adaptations → tolerance/withdrawal

Question 3

what term does DSM-5 now use in replacement of addiction?

Answer 3

substance use disorder

has combined abuse and dependence into a single diagnosis of substance use disorder

broader and more inclusive

Question 4

how many criteria do patients have to meet with DSM5 to be diagnosed with substance use disorder?

Answer 4

2/11

Question 5

both ICD-10 and DSM5 diagnostic criteria have the usual requirement that substance use leads to:

Answer 5

distress/impairment of social/occupational functioning

Question 6

what are the 3 severity categories of the DSM5?

Answer 6

mild = 2/3 criteria, moderate = 4/5 criteria, severe = 6+ criteria

Question 7

how many possible combinations of symptoms are there?

Answer 7

2036
→ some people could have completely unrelated symptoms
→ but symptoms do tend to cluster together

Question 8

what are the limitations of the DSM5 with substance use disorder?

Answer 8

→ 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

Question 9

what is the consensus that someone is addicted?

Answer 9

if they continue to use drugs despite a sincere intention to do otherwise

Question 10

in what countries is alcohol use disorder common in women and men?

Answer 10

women = US, russia, australia 
men = russia, UK, china, south america

Question 11

where in the world is alcohol use disorder less common in women?

Answer 11

south east asia → muslim countries

africa

Question 12

what is the epidemiology of tobacco smoking

Answer 12

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’

Question 13

estimates fluctuate over time in response to changes in government policies. give some examples

Answer 13

→ ban on smoking in public places/car with children 
→ substance norms
→ pricing and taxation
→ changes in drug legal status
→ discovery of new drugs

Question 14

what are some risk factors for SUD

Answer 14

comorbidity, genetic influence, traumatic life events

Question 15

traumatic life events:

Answer 15

childhood sexual abuse = increased risk of developing SUD

traumatic life events combined with comorbidity suggests its a disorder of EMOTION REGULATION

Question 16

how attributable to genetic factors =

Answer 16

heritability

estimated range with SUD between 30-70%

Question 17

describe basic learning theories as theories of SUD

Answer 17

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

Question 18

how does positive reinforcement work with drugs?

Answer 18

perform behaviour of taking drug → positive outcome/reward of euphoria → more likely to repeat behaviour

Question 19

how does negative reinforcement work with drugs?

Answer 19

addicted → experience unpleasant withdrawal syndrome when stop taking drug → take drug to remove withdrawal symptoms

Question 20

which drugs are more likely to show positive reinforcement and why?

Answer 20

more important for drugs that produce euphoria and have mild withdrawal syndrome
→ cocaine, cannabis, MDMA

Question 21

which drugs are more likely to show negative reinforcement and why?

Answer 21

heroin and nicotine → more severe withdrawal effects

Question 22

at what stages is positive reinforcement more important and at what stages is negative reinforcement more important with a drug user?

Answer 22

early stages → + more important → enjoyment

as progresses with severity → more withdrawal → - is more important

Question 23

why are learning processes not sufficient to explain addiction?

Answer 23

not everyone that tries drugs becomes addicted

Question 24

what are reasons for taking drugs?

Answer 24

to get high, to increase alertness and reduce fatigue, social facilitation, alleviate stress

Question 25

choice vs. compulsion?

Answer 25

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

Question 26

give evidence that addiction is a brain disease

Answer 26

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)

Question 27

give evidence that addiction is NOT a brain disease

Answer 27

→ our brains change all the time and the change is reversible
→ evidence for widespread recovery often without any treatment

Question 28

describe key features of the biological theories of SUD

Answer 28

→ stimulates dopamine release in brains reward system
→ mesolimbic D system includes nucleus accumbens, ventral segmental area, regions of prefrontal cortex
→ dopamine system = pleasure centre

Question 29

discuss the dual processing theory of SUD

Answer 29

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)

Question 30

controlled processes features include:

Answer 30

→ outcome expectancies
→ intensions to use
(thought out process)

Question 31

automatic processes features include:

Answer 31

→ attentional biases
→ spontaneous memory associations
→ automatic approach tendencies

Question 32

type and intensity of treatment depends on what 2 things?

Answer 32

→ persons goals (reduce substance use or give up completely)

→ severity of their SUD

Question 33

give a list of different treatments for SUD

Answer 33

substitute medication, self help groups, CBT, motivational interviewing, contingency management

Question 34

heroin users are required by court to aim for ______ _______. what are the steps to achieve this?

Answer 34

complete abstinence

first step = detoxification (also alcohol)
2nd step = CBT or motivational interviewing

Question 35

what is the substitute for heroin?

Answer 35

methadone

→ minimises withdrawal effects
→ produces mild euphoria
→ reduces amount of heroin used
→ avoids risky sharing of syringes → reduces HIV risk

Question 36

what are different forms of nicotine replacement?

Answer 36

chewing gum, patches, vapes, varenidine drug (reduces severity of nicotine withdrawal), anti-depressants

Question 37

what are the 3 different alcohol substitutes?

Answer 37

altrexone, disulfiram, acamprosate

Question 38

blocks opioid receptors which blocks pleasure that people feel when drinking alcohol

Answer 38

altrexone

Question 39

partially resets GABA

Answer 39

acamprosate

Question 40

prevents alcohol metabolism so makes you feel sick and deters you from drinking alcohol

Answer 40

disulfriam

Question 41

list the benefits of motivational interviewing

Answer 41

→ 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

Question 42

what is client change talk

Answer 42

record sessions and count times user volunteers a desire to change

Question 43

how does CBT work to treat SUD

Answer 43

→ coping skills
→ modify beliefs
→ provide repeated practice techniques in order to counteract cognitions → change behaviour through conditioned learning

Question 44

as age increases, % of remission ______

Answer 44

increases

most people who have ever been addicted will recover

Question 45

more likely to be in remission from a ____ disorder than any other _______ disorder

Answer 45

drug, psychiatric

Question 46

why are self help groups effective?

Answer 46

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

Question 47

what is contingency management?

pros and cons?

Answer 47

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)

Question 48

SUV treatment aims to:

Answer 48

→ 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

Question 49

habit =

Answer 49

shift from S-O-R → S-R

stimulus → (anticipated) outcome → response

Question 50

explain SOR → SR

Answer 50

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)

Question 51

why does the SOR habit model suggest drug use is a voluntary choice?

Answer 51

because the anticipated outcome is thought through

Question 52

describe evidence for how habits develop

Answer 52

in lab animals → drug seeking becomes habitual → persist taking drug despite negative consequences such as feeling sick → keep on pulling lever to self administer