Quiz 1 Flashcards
Explain the components of addiction.
Initial use: pleasure and reward
Escalating use/binge/intoxication
Increasing dependence, tolerance, and loss of control
Adverse effects if substance use ceases (physical and psychological)
Craving
Relapse
How is cognition implicated in addiction?
Attention, memory, and perception
Incentive-sensitization theory
Associative learning and sensitization (over time, a greater effect is observed) of brain motivational systems to drug and drug associated cues
What mediates pleasurable effects of drugs?
Mesotelencephalic DA system
What NTs are associated in initial reinforcing effects of most drugs?
DA, ST, glutamate, and GABA
What 4 factors influence the transition to addiction?
Genetic predisposition
Developmental factors
Social context
Stress and co-occurrence of other psychiatric disorders
How does genetic predisposition influence the transition to addiction?
Sensitivity and subjective experience, heritability
How do developmental factors influence the transition to addiction?
Adolescents are particularly sensitive to drug effects and external pressures
Distribution theory of addiction
Attributes the current increase in both substance and behavioural addictions to a lack of psychosocial integration (social dislocation) in the modern world
Psychosocial integration
Interdependence between an individual and their society, and is proposed to fulfill the human need for both individual autonomy and social belonging
How does stress influence the transition to addiction?
Hypothalamic-pituitary adrenal axis (HPA axis) is the hormonal system involved in regulating the stress repsonse and is important in drug use, relapse and addiction
What are common co-morbidities with addiction?
Mood disorders, anxiety disorders, and personality disorders
5 models/theories of addiction
Moral model
Choice model
Medical/disease model
Indigenous perspective
Biopsychosocial model
Moral model briefly
Addiction as character flaw
Choice model briefly
Addiction as adaptation to personal environment
Medical/disease model briefly
Addictive drugs cause LT progressive changes in the brain
Indigenous perspectives briefly
Balance of physical, mental, emotional, and spiritual health
Biopsychosocial model briefly
Interplay of biological, psychological, and social factors
When was the moral model most prevalent?
18th and early 19th century
Explain the cultural context setting for the moral model
Addiction was common
Cocaine was viewed as a wonder drug
Opioids were a cure all
What movement took place during the moral model
Temperance movement
Temperance movement
Preaching moderation/abstinence pledge
Led by the clergy
Moral failure/sin: “just stop”
Public shaming
When was the disease model most prevalent?
End of the 19th century
What was the intention behind the disease model?
To shift the view of addiction from moral failure to disease
Intended to reduce stigma, but largely failed
3 important points about the disease model of addiction
Categorical approach
Can’t be cured
12 step programs
Explain choice model
Social recovery should be used –> foster connection
Emphasizes the role of society and community
What is the backbone behind the Indigenous perspective?
The Medicine Wheel
What does the Indigenous perspective recognize?
Colonial-linked stressors and cultural resilience factors
What is used as intervention in the Indigenous perspective?
Culture
Albert Marshall view
Two-eyed seeing
Recognizes Indigenous knowledge as a distinct and whole knowledge system that exists alongside mainstream/Western science
3 factors of biopsychosocial model
Biological
Psychological
Social
Biological aspects in biopsychosocial model
Genetics: moderate to high
Individual differences in reward sensitivity
Psychological aspects in biopsychosocial model
Mental health
Impulsivity
Social aspects in biopsychosocial model
Adversity
Social determinants of health
How is addiction diagnosed?
DSM-5 and ICD-10
Classification of addiction in DSM-5
Substance-related and addictive disorders
How many categories of addictions are included in DSM-5
10 substances
1 behaviour
Criteria for diagnosis in DSM-5
Pattern of engagement in past 12 months that causes clinically significant harm
2 of 11 symptoms
Severity as it relates to number of symptoms
Mild: 2-3
Moderate: 4-5
Severe: 6+
DSM-5 diagnostic guidelines
Larger amounts/longer period than intended
Desire/efforts to cut down
Time spent to obtain, use, or recover
Craving
Use results in failure to fulfil role obligations
Continued use despite social/interpersonal problems caused/exacerbated by effects
Activities given up/reduced
Use in hazardous situations
Use despite known psychological/physical problems resulting
Tolerance, with either of: need for increased amount to get effect, or diminished effect with use of same amount
Withdrawal, with either of: characteristic withdrawal syndrome for substance, or substance taken to relieve or avoid its’ withdrawal symptoms
Addiction name in DSM-5
Substance Use Disorder
What 10 substances are included in the DSM-5?
Alcohol
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedatives/Hypnotics/Anxiolytics
Stimulants
Tobacco
Other
Conditions for further study
Caffeine use disorder
Gaming use disorder
4 main classes of criteria for DSM-5
Impaired control
Social impairment
Risky use
Pharmacological criteria
Impaired control
Use more than intended
Want to cut down
Time devoted to substances
Cravings
Social impariment
Cannot fulfill major obligations
Use despite problems
Reduce/stop important activities
Risky use
Use in physically dangerous situations
Use despite physical or psychological consequences
Pharmacological criteria
Tolerance
Withdrawal
What is the only behavioural addiction included in the DSM-5?
Gambling
Similarities between gambling and substance use
Risk factors
Neurological
Treatment
ICD-10 diagnostic guide for dependence syndrome
3 or more of the following present together at some time during previous year:
Strong desire/compulsion to take substance
Difficulties controlling substance-taking behaviour
Withdrawal
Tolerance
Neglect of alternative pleasures or interest because of substance use/procurement/recovery time
Persistent use despite harmful consequences
What is an important distinguish in the ICD-10
Harmful use is distinguished from dependence syndrome
Shaffer transdiagnostic model
Addiction as syndrome
Shared risk factors
Manifests as different substance use and behaviours
Same underlying disorder/vulnerability manifests differently depending on: availability, social acceptance, peer influence
Griffiths transdiagnostic model
Salience
Mood modification
Tolerance/withdrawal
Conflict
Relapse
Three classifications of continuum model
Addiction
Problematic use
Recreational use
Addiction classification of continuum model
Compulsion
Negative consequences
Show symptoms of addiction
(Activity is no longer pleasurable, just use to avoid negative feelings)
Problematic use classification of continuum model
Habit
Some negative consequences
Begin to show symptoms of addictions
(Attempts to quit)
(Impacting daily routine)
Recreational use classification of continuum model
Casual
Negligible health or social effects
May have some positive effects
Why does terminology matter when describing individuals living with addiction?
Ways of describing people with substance use concerns can perpetuate or diminish stigmatizing attitudes
Kelly & Westerhoff study design
Randomized, between-subjects, cross-sectional design
Clinicians attending two mental health conferences were asked to read a vignette
Kelly & Westerhoff study findings
Clinicians exposed to “substance abuser” term were more likely to judge the person as deserving blame and punishment than the same individual described as “having a substance use disorder”
Instead of “addict”, “abuser”, and “junkie”
Use “habitual user”, “person with substance use disorder”, “active in addiction”
Instead of “abuse”, “habit”, “drug habit”
Use “Misuse”, “harmful use/problem use”, “risky use”
Instead of “clean”, or “dirty”
Use “sober”, “abstinent”, “drug-positive or -negative”, “substance-free”, “addiction free”, or “remission”
Instead of “replacement” or “substitution therapy”
Use “treatment”, “medications”
Prevalence of addiction in Canada
21.6% of Canadians meet criteria for a lifetime Substance Use Disorder
Which drug results in the largest cost to Canada?
Alcohol
In order, name the four largest total overall costs attributable to substance use in Canada
Lost productivity
Healthcare
Criminal justice
Other
Are males or females more harmed by substance use at a young age?
Females
Heyman claim to fame
Hyperbolic discounting
Delay discounting
Human tendency to prefer smaller but more immediate rewards over delayed rewards
Hyperbolic discounting
Increased delay discounting exacerbated by addictive process
How did Heyman view addiction?
A disorder of normal choice processes (compulsive nature of addiction)
Cognitive bias
Selective info processing, mental heuristics/shortcuts that aren’t always helpful
3 types of cognitive bias related to addiction
Outcome expectancies
Self-efficacy
Cue reactivity
Outcome expectancies example
I’ll have an easier time socializing if I get drunk
Self-efficacy example
I can stop whenever I want
Cue reactivity
Drug-related cues induce powerful effects
Cognitive model of drug urges and drug-use behaviour author
Tiffany