Problem 2 Flashcards
Phenomenological models
They have been influential in classification systems of addictive disorders and in the development of pharmalogical therapies
cognitive models
have been influential in the development of cognitive therapies of addiction
conditioning models
have been influential in the development of cue exposure treatments
Craving
Standard definition: a strong desire
WHO: graving is the underlying basis of the onset of addiction, excessive drinking, loss of control and relapse
Conditioning theories: Conditioned withdrawal model
–> cues become associated with withdrawal symptoms following drug use.
–> cues elicit CR (conditioned response) that resembles drug withdrawal.
–> drug use to alleviate (verlichten) unpleasant conditioned withdrawal
–> negative reinforcement (subtracting something to increase behavior)
proposed that neural stimuli in the environment can, over the course of many pairings with drug taking, come to elicit conditioned responses through a process of conditioned learning.
Proposed that the conditioned responses elicited by cues (e.g. the sight of a needle) would resemble drug withdrawal. This conditioned withdrawal would lead to relapse to drug taking through the addicts desire to relieve the unpleasant conditioned withdrawal experience.
Conditioning theories: Conditioned opponent proces model
–> homeostatic responses to counteract the drug effect.
–> Body will respond to that drug effect by activation processes that counteract that drug effect –> It reduces the effect to the drug.
–> Cues elicit opponent process (CS) in anticipation of drug effect.
- your body reacts by adding strength and duration to the drug, netto effect = you develop tolerance.
–> CR = negative and opposite to drug effect.
–> drug use to alleviate unpleasant state
–> negative reinforcement
So, when you are in an environment where you are used to take the drugs, you will experience tolerance. If you take the drugs In an unkown environment, your opponent processes will not react to the cues simply because they are not there. Thats why your body can suffer from overdose because your body is not prepared for what is to come.
what do these negative conditioning models represent (3)
- Predict responses to drug related stimuli that are psychologically negative, and withdrawal like
- Physiological responses activate craving, urge to use substances
- Substance use to reduce these (negative) physiological changes.
- Negative models cannot explain the whole cue reactivity
Conditioning theories: Positive incentive model (incentive salience model)
- The positive reinforcing value of drugs is involved in drug seeking behavior (rather than negative)
According to this theory, what happens in addiction = neural sensitization of dopamine-related systems, the systems wants the substance.
They propose that the neural system is responsible for drug seeking, and drug taking becomes sensitized by repeated drug use. This system is responsible for incentive (stimulans) motivation and reward and is separate from systems that mediate the pleasurable effects of drugs. Thus, they make a distinction between liking and wanting the drugs.
- Wanting is associated with the sensitized inceptive motivational system and may not always be conscious and hence (vandaar) relapse may occur without consciousness awareness.
- Liking is synonymous with craving.
- Strong craving, motivational respons to try to obtain the substance = cue-reactivity to this model
- Both substance and cue trigger wanting.
The expression of sensitization is said to be ‘cortex-specific’ and hence mediated by conditioning processes.
This model provides an essentially pessimistic view of craving (liking), namely that it is epiphenomenal (bijproduct) to the hypothesized unconscious process (wanting) driving addition and relapse.
–> evidence based on animal research.
3 components to drug reward
- Liking: pleasure
- Wanting: urge to obtain
- Learning: conditioning
3th class of learning theories: habit
–> Automatic habit
–> behavior is not goal directed, it depends on CS-US relationship - behavior is triggered by the environment.
so, no matter the outcome of you using the substances, when you are in the environment where you used to take the substances, the cues will automatically trigger substance use with no underlying motivation and no sensitivity to the outcome of that behavior.
Goal-Directed vs. habit
Goal-directed: always a function of outcome and value of that outcome
stimulus –> outcome –> response
Habit: independent of outcome, even if outcome is negative. (only develop with much repetition)
stimulus –> response
Limitations habit theory
- Evidence for habitual (addictive) behavior in humans is scare. (drug seeking seems to be primarily goal-directed).
- Compulsion (compulsive nature of additions) –> when do habits come compulsive? A habit will stop when it cannot be executed.
- A habit isn’t flexible, what addicts seem to do
Predictor relapse - treatment (exposure)
Cue- reactivity: might be a predictor.
Thats why cue-exposure has developed.
The main idea is: cue reactivity was once learned, so is it possible to unlearn and how do we do that?
Extinction: the CS predicts the US, we need to break this relation by exposing the person to cues without the US. Extinction is not unlearning, it is learning that CS+ may also predict no UCS
Extinction = context dependent
CS= ambiguous
this technique is effective –> but not more effective than other treatments.
Recommendations for cue exposure
- Personalized cues and context
- Variability - do exposure in multiple context
- Retrieval cues to bridge context
Cue-reactivity
Entails responding to cues that signal the availability of reward.
- Psychological: craving
- Physiological: heart rate
It is a response to learning. Cue reactivity measures the effect of both discrete (glass of wine) and contextual (the pub) cues on a range of measures.
