Substance Abuse and Addiction

Question 1

Be familiar with Table 11.1 on the DSM-V criteria for an Alcohol Use Disorder.

Answer 1

• Problematic pattern of alcohol use that leads to impairment or distress
• Must be present for 12 months and requires the specification of a severity level
• Requires 2/11 symptoms, the general themes of which are: loss of control, failure to fulfill obligations, continued use despite problems, tolerance or withdrawal symptoms, cravings, and desire (or failed attempts) to quit

Question 2

According to the text, what were the two most notable changes between the DSM-IV and V? With respect to what was added, in general what did the research evidence suggest as to why this was a critical symptom to include?

Answer 2

1 - Removal of “legal problems”
2- Addition of “drug craving” in an effort to increase consistency between the DSM and the International Classification of Diseases + acknowledge the role that craving has in the perpetuation of the disorder

Question 3

Based on what rationale does the DSM-V differentiate between early and sustained remission?

Answer 3

Early = no criteria met for at least 3 months, but less than 12
Sustained = no criteria for 12 months or longer
(Both of these exclude the craving criteria)

Question 4

What is a controlled environment specifier?

Answer 4

Indicates that the individual is in an environment where access to alcohol is limited

Question 5

What is the general trend with respect to the difference in rates of Alcohol Use Disorder amongst men and women?

Answer 5

Alcohol dependence is generally more prevalent in men than women, with more men reporting episodes of heavy drinking

Question 6

What is the immigrant paradox and what makes it a surprising phenomenon?

Answer 6

Those that are born outside the US and then immigrate have a lower risk for alcohol use disorder than those born in the US
This is surprising, as immigrants typically face more risk factors for developing alcohol use disorder than those born in the US face

Question 7

What do we know about the prevalence of alcohol use on U.S. college campuses? Why is early onset of alcohol use so concerning?

Answer 7

Those who begin alcohol consumption before age 15 are at a higher risk for developing alcohol dependence

There is a high prevalence of alcohol use and binge drinking on college campuses, with about 20% of students meeting the criteria for alcohol use disorder

Question 8

What is the central idea behind the expectancy theory of alcohol use disorder?

Answer 8

The biological and cognitive effects of previous experiences create a memory template (about the reinforcement or incentive value of drinking) that can guide future behavior

Question 9

What is the central idea behind the tension-reduction theory of alcohol use disorder?

Answer 9

Individuals drink alcohol because it reduces tension

Question 10

What did Greeley and Oei (1999) conclude about the empirical status of the tension-reduction theory?

Answer 10

Alcohol may reduce some signs of tension or dampen the stress response in some individuals under specific contextual conditions (it differs across people and situations)

Question 11

What is the central idea behind the personality theory of alcohol use disorder?

Answer 11

Certain personality traits make one more likely to develop alcohol use disorder

Question 12

What personality factor seems most relevant to developing an alcohol use disorder? What aspect of this broad personality dimension seems the most predictive of alcohol problems?

Answer 12

Impulsivity or disinhibition appear to be the more relevant, as they might lead to impulsive decision making
(Other traits such as high neuroticism and extraversion have also been examined)

Question 13

What is the central idea behind the social learning theory of alcohol use disorder?

Answer 13

Learning from social environments and cognitions are important determinants of behavior, especially situational factors (triggers), coping skills, self-efficacy (belief in one’s ability to obtain a desired outcome), and outcome expectancies (beliefs about the consequences of alcohol use)

Question 14

What is the basic idea behind Marlatt & Gordon’s (1985) conceptualization of the relapse process?

Answer 14

Lack of coping skills for high-risk situations = low levels of self-efficacy (believe they’re unable to cope with stress) + expectancies that alcohol use will help them cope effectively = relapse

Question 15

What is addictive behavior?

Answer 15

A compulsive habit in which the individual seeks immediate gratification despite long-term costs
Begins as a pleasure-seeking behavior, but eventually becomes avoidance (attempt to relieve tension and cravings)

Question 16

What is likely being inherited with respect to predispositions to addictive behavior?

Answer 16

Predispositions to finding the effects of psychoactive substances reinforcing
OR
Predisposition for behavioral control problems and impulsivity such as: greater orientation for immediate pleasure-seeking, ignoring potential risks, and foreshortened orientation for the future

Question 17

What is temporal discounting and how might it relate to addiction?

Answer 17

The relative “value” of a reward gets discounted as time increases
Individuals with addictive behaviors tend to discount rewards at a higher rate (it takes less time for them to decide that a reward isn’t worth it)
So, they’re more likely to choose the short-term gratification of substance use over the long-term benefits of sobriety

Question 18

What is the role of operant and classical conditioning in substance use disorders?

Answer 18

Operant: the rewarding effects following behavior will increase the chance that the behavior will occur again. In addiction, social, environmental, and biological factors will produce rewards

Classical: drug-induced euphoria becomes associated with environmental stimuli present during that state, such as the location, people, behaviors, and paraphernalia

Question 19

What is the Opponent-Processing Theory of addiction?

Answer 19

Any effects of a substance on the CNS are automatically opposed by CNS mechanisms that reduce the intensity of said effects (in order to return the body to homeostasis)

Process A = the effects of the substance
Process B = the opponent biological mechanism that brings you to baseline

Question 20

What are the differences between process A and process B in addiction?

Answer 20

Latency to Response: B kicks in a little later than A
Augmentation Time: B takes a while to start working effectively, but A has a really quick and intense response
Decay Function: A’s effects cut out pretty quickly, but B sticks around, leading to a “dip” in which only the effects of B can be felt

Question 21

How do the A and B processes of addiction relate to withdrawal?

Answer 21

B lasts longer than A and its effects are considered aversive
Reinitiation of A removes the aversive effects of B
Over time, the negative reinforcement of B is what maintains addiction

Question 22

How do the A and B processes of addiction relate to tolerance?

Answer 22

Process B is strengthened through use and weakened through disuse
Over time, more of the substance will be required to produce the desired effect of process A

Question 23

How do the A and B processes of addiction relate to cravings?

Answer 23

Through classical conditioning, the body learns environmental cues related to substance intake
When these cues are present, process B will start even before the substance intake occurs, producing cravings
The user then initiates process A to reduce the cravings caused by process B

Question 24

What is the Expectancy Theory of alcohol addiction?

Answer 24

People’s expectations about the effects of alcohol (as either positive or negative) will influence how inclined they are to consume it as well as the outcomes that occur when they do consume it

Expectations develop over time through peer influences (non-personal experiences) and direct chemical effects of drinking (which may be influenced by genetic factors)

Question 25

What is the Tension-Reduction Theory of alcohol addiction?

Answer 25

Cultural influences often lead people to believe that alcohol use will decrease tension On a biological level, though, this isn't entirely true. Only some people in some conditions have reduced tension, while most others have increased tension This means that just the belief that alcohol reduces tension will encourage intake, even if doesn't actually do that

Question 26

What is the Social Learning Theory of alcohol addiction?

Answer 26

Includes situational factors and expectancies about alcohol, but in uniquely emphasizes coping skills and abstinence self-efficacy in the realm of relapse prevention

Question 27

What are coping skills and abstinence self-efficacy and how do they impact relapse prevention?

Answer 27

C.S. = the ability to deal with stressful events without reverting to alcohol use Stress is a big trigger, so we must be mindful of situational factors and develop a plan to deal with them beforehand A.S.E. = personal beliefs about one's ability to refrain from drinking Patients have to believe in their ability to maintain sobriety

Question 28

Michael Patterson, the man in our case study for alcohol use disorder, did not initially want to seek therapy. So, who wanted him to consider treatment?

Answer 28

His wife, Grace, was concerned about his heavy drinking and asked a psychologist for help Michael said he would consider treatment, but not total abstinence

Question 29

What problems was Michael experiencing because of his alcohol use?

Answer 29

- Loss of control - High blood pressure, forgetfulness, hypersomnia - Loss of friendships + marital problems - Anger and aggression - Continued use despite negative physical and social effects - Drinking while driving (putting others in potential harm) - Failed attempts to cut back

Question 30

When/where did Michael's drinking start?

Answer 30

In high school to reduce social anxiety around girls, which continued into college and grew in severity

Question 31

Why did Michael's drinking get even worse (after his graduation, marriage, etc.)?

Answer 31

He applied to be head of the history department at the high school he teaches, but was rejected His devastation led to heavier drinking and attempts to conceal said drinking from Grace

Question 32

What did Michael's initial treatment involve?

Answer 32

A month of abstinence, discussing pros and cons, distractions to fill time, muscle relaxation techniques Abstinence followed by reintroducing alcohol with strict guidelines Encouraged to go to group sessions, but he did not

Question 33

What happened 3 years after Michael's initial treatment? What was done about it?

Answer 33

He began heavily drinking again after being denied another promotion Treatment this time involved: challenging cognitions + feelings of worthlessness, reestablishing moderate drinking, again encouraging to go to group sessions

Question 34

What happened after Michael's big relapse?

Answer 34

He began to cancel appointments or not show up 2 years later: heavy drinking returns, Grace files for divorce, Michael dies of a heart attack, and Grace begins therapy to address her grief and guilt

Question 35

What is the Dual-System Theory of video game addiction?

Answer 35

Behavioral excess results from an imbalance between the reward system (hyperactive) and inhibition system (hypoactive = impaired decision making)

Question 36

What are some predispositions to video game addiction?

Answer 36

Personality traits like neuroticism, impulsivity, anxiety, and aggression Gender (men)

Question 37

How does social media addiction manifest? What are the predispositions to it?

Answer 37

Manifestation: mood disturbance, interpersonal problems, poor mental health, lowered academic performance Predispositions: insecure attachment, impulsivity, self-esteem, social anxiety, age, negative attentional biases, gender (women)

Question 38

What is the Hyper-Personal Model of social media addiction?

Answer 38

Exposure to glorified self-presentations online leads to the belief that others are more successful and happier than oneself, leading to lower self-esteem

Question 39

What new clinical phenomena are we observing because of social media?

Answer 39

FOMO: apprehension that others are having rewarding experiences from which one is absent Doom/Aimless Scrolling: scrolling through social media in search of negative information (doom) or for sensation-seeking regardless of content (aimless) Increased prevalence of tic disorders and DID

Question 40

Why might prevalence of tic disorders and DID be increasing because of social media?

Answer 40

These behaviors are potentially glorified for being "unique" Taking on a neurodivergent persona may be an attempt to gain positive social reinforcement from online communities We don't yet know if these symptoms are genuine or malingering

Question 41

What are the effects of social media use?

Answer 41

Decreased responsivity, increased depressive symptoms, and addictive symptoms such as tolerance, difficulty inhibiting use, cue reactivity, and cravings

Question 42

What does big data tell us about the addictive nature of social media?

Answer 42

Filtering presents you with content that the algorithm thinks you'll like, creating echo chambers Hyper Nudging produces targeted recommendations in an attempt to influence behavior/decision-making Microtargeting aims to deliver highly personalized ads and content Side effects: highly addictive, political polarization, misinformation, ideological extremes, and political inequality