Reward System and Substance Abuse Flashcards

1
Q

Name the four key processes of substance abuse on a psychological level

A

Negative affect:
(e.g. depression and anxiety): can trigger substance use; on the other hand substance sue can trigger negative affect -> circular downward spiral

Alternative rewards:
Other rewards, such as travel lose importance; reduced sensitivity

Behavioral/cognitve control:
Target of psychotherapy

Habit formation:
Drug use in the beginning is for calming effects etc. later usage is more compulsive

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2
Q

How can the four key processes of substance abuse be conceptualized on a neural level?

A

The ventral-to-dorsal striatal shift
Increased effects of drug cues and priming are initiated by sensitization processes toward drug cues as well as priming doses in brain regions related to reward processing.

With reward processing chronic drug intake is associated with increased dopamine release and reorganization of the ventral-to-dorsal striatal loops

This again promotes habitual drug intake and impairs behavioral flexibility

Striatum
This region is important to shifts from alternative awards to drug-intake awards

Limbic brain areas
Neuroadaptive processes take place within the limbic and stress hormone system that contribute to negative affect

Frontal Cortex
Impaired cognitive control is attributed to vulnerability factors interacting with neurotoxic and adaptive changes in the PFC

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3
Q

Can alcohol-related disorders be understood as a single category or rather as a continuum

A

Alcohol-related disorders exist in a continuum, where a certain amount of criteria met (from DSM-V) refers to the severity of the alcohol use disorder

Mental disorders can be primary in developing SUD, as shown here also SUD can be primary in developing mental disorders

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4
Q

Name 5 of the 9 DSM V symptoms of alcohol use disorder

A

Tolerance
Withdrawal
More use than intended
Unsuccessful efforts to cut down
Spending a lot of time, getting, using or recovering from use

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5
Q

Do mental disorders (MD) cause substance dependence (SUD) or the other way around?

A

MD can cause SUD and SUD can cause MD

Then there is the possibility, that there is a third, common cause, for both MD and SUD

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6
Q

Name 3 pathogenic factors in substance abuse

A

Genetics (e.g. gene combinations)
Environment (e.g. sports-teams)
Substance (e.g. substance properties)

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7
Q

How are genetics and alcoholism linked?

A

see slide:

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8
Q

What percentage of the german population is alcohol dependent? Are there more alcohol or THC-dependent germans?

A

2 % of germans are alcohol dependent and 2% of the german population is THC-dependent.

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9
Q

What are the 2 main stages of treatment for patients with AUD?

A

Stage 1:Detoxification

Stage 2: Long term treatment

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10
Q

What are the central structures of the human reward system?

A

The mesolimbic dopamine system including the Nacc and the VTA.

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11
Q

What type of dopamine release is typical for addiction

A

All drugs directly or indirectly trigger exaggerated, transient increases in extracellular dopamine in the Nac. High, brief bursts of Dopamine are needed for addiction.

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12
Q

Why are high brief bursts of dopamine so impactful in reducing alternative rewards?

A

DA surges resemble and surpass the physiological increases triggered by natural reinforcers

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13
Q

Is such fast dopamine increases sufficient for the development of addiction?

A

No, they are however necessary

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14
Q

What is the positive reinforcement in AUD reinforced by (neurotransmitters)

A

See slide:

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15
Q

What clinical evidence can be found for persistent changes in the brain, that are related to AUD?

A

Tolerance
Withdrawal
Persistence of craving over many years
Depression
Decreased response to natural rewards
Possibility of relapse, even many years later

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16
Q

Explain the study conducted on mu-opiate receptor availability, that was discussed in this lecture.

A

Result: In Patients with AUD craving correlated with opiate receptor availability

17
Q

What two systems are engaged in the Dual system Model of addiction? Wich of these systems is mainly addressed by psychotherapy?

A

Impulsive system (Automatic processes) - striatum,amygdala, vmPFC
&
Reflexive system (cognitive control); mainly addressed by psychotherapy - dlPFC, insula

18
Q

Explain the Harry-Frankfurt Freedom of will model in relation to AUD

A

See slide: