Problem 1

Question 1

Difference abuse and dependence

Answer 1

Drug abuse/misuse/problematic use: repeated use of a drug despite negative consequences or excessive, inappropriate use

Drug dependence: chronic misuse characterized by compulsive drug seeking and use despite harmful.

Question 2

What are addictive substances? (psycholeptica, psychoanaleptica, psychodysleptica)

Answer 2

an addictive substance is a chemical compound with intoxication effect i.e. substances have an effect on body. substances with a rewarding effect i.e. that will make you feel good.

psycholeptica: substances that suppress CNS –> alcohol, benzodiazepinen, GHB, opiates

Psychoanaleptica: Substances that stimulate CNS –> amphetamine, cocaine, XTC, nicotine, coffee.

Psychodysleptica: cause hallucinations –> LSD, cannabis.

Question 3

WHO definition of addiction

Answer 3

Repeated use of a psychoactive substance, to the extent that the user:
- is periodically/ chronically intoxicated
- Shows a compulsion to take the preferred substances
- Has great difficulty to voluntarily stopping substance use
- Exhibits determination to obtain psychoactive substances.

Question 4

Tolerance

Answer 4

After repeated administration, a given dose of a substance produces a decreased effect or increasingly larger doses must be administered to obtain the effect observed with the original dose.

Question 5

Withdrawal

Answer 5

Set of uncomfortable symptoms that occur when an abused substance is no longer available or use is discontinued abruptly

Question 6

DSM-5 addiction

Answer 6

• loss of control
• difficulty stopping or cutting down
• spending a lot of Time getting, using or recovering from use or substance
• continuing despite problems
  cravings and urges to use the substance
  -interferring with responsibilities at work or home
  -Giving up important social, occupational or recreational activities
  Using substances even when it puts one in danger
  -Continuing to use even when you know you have a problem
  -Tolerance
  -Withdrawal.

Question 7

Severity addiction based on

Answer 7

0/1 criterion: no diagnosis
2-3: Mild substance use disorder
4-5: Moderate substance use disorder
6 or more: Severe substance disorder

Question 8

Risk factors for developing addiction

Answer 8

• Low SES
• Childhood abuse
• Psychopathology
• Religion

Question 9

Difference between heavy use and addiction

Answer 9

Control:
- using more than was intended
- Persistent desire or unsuccessful efforts to control use
- Continued use despite knowledge or resulting or recurring physical or psychological problems.

Question 10

What is control

Answer 10

Only focusses on wants and claims that an agent has control over a type of action if and only if:
1. they want overall to perform that type of action, then usually they do it: and
2. They want overall not to perform that type of action, then usually they don’t do it.

addiction is a strong a habitual want that simnifically reduces control. Though it is important to remember that the strong habitual want is usually only part of what causes the reduction in control.

Question 11

Difference DSM4 and DSM5

Answer 11

Largest question was whether to keep abuse and dependence as two different disorders. DSM4 placed dependence above abuse by deciding that abuse should not be diagnosed when dependence was present.

problems DSM4
- By definition, a syndrome requires more than one symptom, but nearly half of all abuse cases were diagnosed with only one criterion.
- Reliability and validity for abuse were much lower than for dependence.
- Common assumptions about the relationship of abuse and dependence were shown to be incorrect in several studies
- ‘Diagnostic orphans’ –> the case of two dependence criteria and no abuse criteria, is ineligible for a diagnosis, although there is really something going on.
- Although abuse is more often assumed to be milder than dependence, some abuse criteria indicate clinically severe problems.

Conclusion
The large body of evidence supported removing the distinction between abuse and dependence. so for the DSM5, abuse and dependence are combined into one disorder, with two additional changes indicated below.

Question 12

self medication theory

Answer 12

Usage as alleviation for specific symptoms

Question 13

Explanation for comorbidity mental disorders

Answer 13

1. psychopathology increases the risk of substance use, abuse, dependence or withdrawal (eerst ziekte, dan verslaving)
2. Substance abuse, dependence or withdrawal increases the risk of psychopathology (eerst verslaving dan ziekte)
3. overlapping genetic vulnerabilities
4. Bidirectional model is well in line with a developmental view of co-occurence, wherein a developing brain that is exposed to either drugs or mental illness, changes in such a way that it is left vulnerable to the other, and vice versa.

Question 14

When can we diagnose behavior as addiction

Answer 14

• If the behavior leads to a fundamental impairment
• Is persistent overtime
• Is not due to another disorder, coping/wilful choice.

Question 15

What is the difference between substance and behavioral addiction

Answer 15

• the behavior is better explained by an underlying disorder
• the fundamental impairment results from an activity that is the consequence of a willful choice
• the behavior can be described as a period of prolonged intensive involvement that detracts time and focus from other aspects of life, but does not lead to significant functional impairment or distress for the individual.

Behavior is the result of a coping strategy.