PSY1003 WEEK 8

Question 1

why do we no longer tend to use the term of addiction

Answer 1

implies character weakness/moral failures - replaced by dependence to imply emphasis on biological adaptation moer

Question 2

how does DSM-5 criteria define an SUD

Answer 2

doesn’t tell us what an SUD is
meet 2/11 criteria
3 severity categories: mild, moderate, severe but 2036 possible combination so can have shared diagnosis but no commonality

Question 3

how does Heather define addiction

Answer 3

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

Question 4

what statistic on the British population is a limitation of SUD diagnostics criteria

Answer 4

British Government (2013) = 39% men 27% women drink unsafe levels of alcohol and meet SUD criteria but only 5% has diagnosis

Question 5

give some examples of epidemiology of SUD around world

Answer 5

highest prevalance alcohol (women) = Russia, North-east Asia, Australia, South America
(men) = South-east Asia, South America
any SUD in men + women = UK, South America, North America
UK = decline in numbers of young people drinking

Question 6

what political factors can influence addiction

Answer 6

introduction of law = smoking ban meant more quits

Question 7

explain comorbidity and addiction

Answer 7

higher SUD in those with Bipolar, depression, GAD, social anxiety, PTSD and Sz

Question 8

heritability estimates for SUD ranges between 30-70%. explain why this is (with factors)

Answer 8

shared environment, epigenetics, easy access, modelling, poverty

Question 9

explain both adoption studies and gene evidence for heritability in SUD

Answer 9

adoption studies = adoptee with alcoholic parent more likely, as well as any SUD
but no single gene identified for addiction. candidate gene polymorphisms (mutations) found for addict characteristic (such as alcohol metabolisms rate, disinhibition)

Question 10

explain traumatic life event link to SUD

Answer 10

sexual abuse in childhood
drug use to supress emotion, warp reward system (alters brain formations)
unable to cope with negative emotion and suppress addiction drives

Question 11

name 6 addict theories

Answer 11

1. take drugs due to outcomes of what drug produce
2. compulsive drug use
3. addiction is a brain disease
4. habits
5. dual-process theories
6. choice

Question 12

explain conditioning theories for addiction (taking drugs due to the outcomes they produce)

Answer 12

outcomes = to get high, increase alertness, reduce fatigue, social faciliation, alleviate distress
operant conditioning (voluntary, is maintained by consequences)
classical conditioning (drug acts as UCS and taken in presence of drug-related cues eg: pair alcohol (US) with pub (CS) and need drink when see it (CR)
positive reinforcement thought to work for drugs producing euphoria and have little withdrawal effects (cocaine, cannabis)
negative reinforcement for drugs with large withdrawal effects (smoking)

Question 13

explain conditioning theories of addiction with the rat research example

Answer 13

a rat learns to press lever if means they are given cocaine

Question 14

however, what is a defining characteristic of addiction that occurs, reducing reliability of conditioning theories

Answer 14

continued use even though individual wishes to stop, even when positive effects diminish and negative effects start (withdrawal, poor health, marital breakdown, prison)

Question 15

define compulsion

Answer 15

need to persist despite behaviour producing negative consequences

Question 16

explain the compulsive (biological) drug use theory

Answer 16

compulsion to take drugs despite consequence due to brain disease (dopamine reward system disruption)
most of drugs stimulate dopamine reward system
addiction to drugs instead of natural dopamine spikes (food) because natural stimuli become habituated so spikes become consistent
dopamine contributes to classical conditioning
dopamine reward is shown when expecting drugs, not during

Question 17

name the brain areas involved in dopamine reward system

Answer 17

nucleus accumbens, ventral tegmental area and prefrontal cortex

Question 18

explain incentive sensititsation theory (biological theory)

Answer 18

repeated use leads to sensitised spike in mesolimbic dopamine systems
dopamine response shown when drug cues present, so dopamine sensitivity manifests itself as ‘incentive salience’, causing craving

Question 19

explain Hedonic homeostatic dysregulation theory (biological theory)

Answer 19

repeated drug use leading to dopamine spikes result in a suppressed dopamine function so brain adapts to repeated dopamine spikes and decreases in dopamine cause withdrawal = lowered set point results in lower mood (as dopamine regulates mood)
lab evidence showing craving even when drug effects no longer liked

Question 20

give limitations of biological theories for addiction from brain studies on mesolimbic system (which supports hedonic homeostasis dysregulation)

Answer 20

dopamine in mesolimbic system is suppressed in addict meaning is closer to HHD = when addicts given drug, raises dopamine level and shows a lower response

Question 21

what is the overall thought of roles played by both the hedonic homeostasis dysregulation theory and incentive sensitisation theory in addiction

Answer 21

IST involved in earlier stages of addiction, HHD in later

Question 22

explain the theory of addiction being brain disease (including research evidence on effect of drugs on children and adolescents)

Answer 22

grey matter decreased in prefrontal regions in addict
in children of drug addicts, some of these effects have already developed before using
long term drug use in adolescences can lead to brain damage in adulthood (changes in prefrontal cortex, structural changes, gene expression, reduced neurogenesis) linked to behavioural changes of increased risk taking and impulsive behaviour, anxiety

Question 23

give a research example of addiction brain change mirroring emotionally and motivationally loaded experiences (Fisher et al, 2010)

Answer 23

brain change resulting from addiction mirrors those seen when highly rewarding behaivours are repeated like romantic love (activation in ventral tegmental area when looking at image o current romantic partner)

Question 24

explain the habit theory = “model of automaticity”

Answer 24

drug using is voluntary, then with experience it becomes automatice

Question 25

evaluate automaticity habit model

Answer 25

1. intuitive appeal for certain addictions: common to see chain smoke without thought, but in other addictions planning is needed (obtaining drugs etc
2. assumes addictions are automatic but doesn’t include role of motivation (only use S-R habits)

Question 26

explain the SOR instrumental learning perspective of habit theory

Answer 26

Stimulus - heroin paraphernalia
anticipated Outcomes - getting high
Response - injecting heroin

when repeated outcome is lost, so S directly form R (habit causes a shift in SOR to SR)

Question 27

evaluate the SOR learning theory of habits (including research)

Answer 27

lab rats become habitual an persist despite negative consequence (but is this applied to humans)
can only study role of habit in addicts who really want to stop, and difficult to do

Question 28

explain the dual-process (cognitive) theories

Answer 28

controlled and automatic cognitive process contribute to addiction
1. controlled are outcome experience and intentions to use
2. automatic are attentional biases, spontaneous memory associations, automatic approach tendencies

in a novice, controlled cognitive processes occur so using is voluntary
outcome expectancies (positive drug experience) formed during youth, affecting beliefs and then intentions with using
experienced users have imbalance, so automatic are stronger than controlled meaning activates reward system, habitual using

Question 29

what does evidence in dual-process theory suggest may be a positive treatment

Answer 29

automatic cognitive processing bias for substance-related cues means re-training cognitive processing biases is effective treatment. can also predict future
using cognitive bias modification = simple motor response (see cues, initate response) - see alcohol, drink, but try reprogramming by use of avoidance move
using joystick to train patient to push cue away, is more effective than a standard

Question 30

how can dual-process theories account for individual differences

Answer 30

individual executive functions difference determines how we can flexibly modify behaviour as response to environmental demand = memory capacities moderate automatic and controlled process relationship, impacts drug use, with poor working memory linked to drug use

Question 31

outline defence of choice theory

Answer 31

1. motivation to change is best recovery prediction - use of motivational interviewing resolve ambivalence, increases change motivations and is effective
2. drug use is sensitive to economic factors (politics, prices changing) so means contingency management (receive small incentive) is a effective treatment
3. if SUD is cureable by raising price/motivation, then is not disease

Question 32

what are flaws of choice theory, and why is it sometimes applied

Answer 32

1. ICD and DSM state addicts wants to quit but cant
2. doctors and politicians go along with addiction as medicalises low moral parts of society

Question 33

what influences our choice on treatment

Answer 33

depends on goal (reduction or abstinence) and assessing SUD severity, potential court outcome , use case formualtion to decide if detox, CBT/MI, meds AA is useful

Question 34

how does CBT work

Answer 34

focus on how thoughts leads to feeling, then behaviours through identifying distorted thoughts leading to negative feelings that lead to drug use
improve coping skills, so works if addict formualtes and practices skills

Question 35

how does motivational interviewing work

Answer 35

resolves individual ambivalence regarding drug use
works as changes motivational balance and increases client change talk (change from I could, to I can)
doesn’t involve clinician providing structured advice, but encourage addict to see negatives, generate own motivation

Question 36

what are self-help addiction groupd

Answer 36

not part of mainstream medicine (is free to taxpayer)
each member paired with sponsor - a recovered addict who provides moral support and encouragement
helps achieve and maintain sobriety
effective as increases self-efficacy and brings about social network change

Question 37

explain contingency management

Answer 37

paying people to abstain from usage, but tend to have more relapses

Question 38

why is pharmacotherapy usually rare

Answer 38

cannot address dopamine reward systems dysfunction

Question 39

explain pharmacotherapy for smoking (nicotine replacement therapy, varenicline, bupropion)

Answer 39

NRT - vaping etc, is harm reduction, effective as doubles chances of success (but 90% still cannot quit)
varenicline - alleviates withdrawal
bupropion - antidepressant

Question 40

explain heroin pharmacotherapy (methadone, buprenorphine)

Answer 40

stimulates opiod endogenous receptors so minimise withdrawal
methadone - safer subsitute
buprenorphine - long-lasting, blocks effects of heroin, blocks opiate receptors, reduce danger of overdosing

reduces risky behaviours of needle sharing but means some addicts will not ever quit, forever using subsitutes

Question 41

explain alcohol pharmacotherapy (naltrexone, acamprosate, disulfiram)

Answer 41

naltrexone- block opiod receptors so blocks positive effect
acamprosate- resets GABA and glutamate function
disulfiram- prevents metabolism of alcohol so becomes ill

Question 42

evaluate pharmacotherapy

Answer 42

if an operant conditioning approach is being used, drug should work (reduces reinforecemnts) but other approaches proposing dopamine brain circuit damage suggest that a dopaminergic drug would have more effect (this has been tried in clinical practice with minimal success’)

Question 43

outline cue exposure therapy

Answer 43

repeatedly exposed to drug related cues and not able to take drug, should initiate extinction between CS, CR and US, however there is limited clinical evidence to suggest it helps people stay sober
link usually immediately eradicated when client returns to old, drug using environment