Substance Use and Addictions Pt.1

Question 1

outline the general course of addiction

Answer 1

experimental/recreational use > increasingly regular use > addiction

Question 2

list six diagnostic criteria for dependence syndrome

Answer 2

strong desire /sense of compulsion to take substance, difficulty controlling substance taking behaviour (onset, termination, or levels), withdrawal state when use stopped / reduced, evidence of tolerance, progressive neglect of alternative interests, persisting use despite evidence of harmful consequences

Question 3

define addiction

Answer 3

compulsive drug use despite harmful consequences, characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, (depending on the drug) tolerance and withdrawal

Question 4

define dependence

Answer 4

refers to a physical adaptation to a substance

Tolerance/withdrawal eg opioid, benzodiazepine, alcohol, so can be dependent and not addicted

Question 5

list behavioural addictions

Answer 5

gambling disorder

internet gaming disorder

Question 6

substance use issues can be classified as?

Answer 6

hazardous use
harmful use
addiction
dependence

Question 7

faster onset of a drug is related to?

Answer 7

speed of reaching the brain crossing the blood-brain barrier lipophylic

Question 8

list heroin types from slower to faster brain entry

Answer 8

opium > morphine > heroin > snorted heroin > i.v./smoked heroin

Question 9

list cocaine types from slower to faster brain entry

Answer 9

coca leaves > coca paste > cocaine > crack

Question 10

list tobacco types from slower to faster brain entry

Answer 10

chewing tobacco > snuff > cigarettes/vaping

Question 11

what elements are involved in alcohol/drug use and addiction?

Answer 11

social
environmental
drug
personal
genetic

Question 12

the brain: from use to addiction

Answer 12

pre existing vulnerability, family hx, age > drug exposure, compensatory neuroadaptations to maintain brain fx, resilience > sustained recovery or cycles of remission and relapse

Question 13

the brain: from alcohol use to addiction

Answer 13

pre existing vulnerability, family hx, age > drug exposure, compensatory neuroadaptations to maintain brain fx > tolerance, withdrawal

Question 14

alcohol alters the balance between what systems in the brain?

Answer 14

excitatory > glutamate (NDMA receptor)

inhibitory > GABA-benzodiazepine (GABA-A receptor)

Question 15

acute alcohol exposure has what effect on excitatory systems?

Answer 15

Blocks excitatory system

- Impaired memory (alcoholic blackouts)

Question 16

acute alcohol exposure has what effect on inhibitory systems?

Answer 16

Boosts inhibitory system
Anxiolysis
Sedation

Question 17

Chronic alcohol exposure results in what neuroadaptations in the presence of alcohol?

Answer 17

GABA & glutamate remain in balance: upregulation of excitatory, reduced fx in inhibtory > GABA-A receptor: switch in subunits to make less sensitive to alcohol

Question 18

Chronic alcohol exposure results in what neuroadaptations in the absence of alcohol?

Answer 18

GABA & glutamate are no longer in balance – withdrawal state
NMDA receptor: increase in Ca2+
- toxic leading to hyperexcitability (seizures) and cell death (atrophy)

Question 19

how to treat alcohol withdrawals

Answer 19

treat with benzodiazepines

Question 20

name a medication used to help people remain abstinent from alcohol

Answer 20

acamprosate > reduces NMDA function

Question 21

models of addiction

Answer 21

reward deficiency (+ve reinforcement)
overcoming adverse state (-ve reinforcement)
impulsivity/compulsivity

Question 22

list key modulators in addiction

Answer 22

mu opioid, GABA B cannabinoids, glutamate

Question 23

action of amphetamine?

Answer 23

enhances the release of dopamine

Question 24

action of cocaine on neurotransmitters

Answer 24

blocks reuptake of dopamine

Question 25

action of alcohol, opiates, nicotine on neurotransmitters

Answer 25

increase dopamine neuron firing in VTA

Question 26

hypothesised that levels of _________ predisposes subjects to drugs

Answer 26

brain dopamine D2 receptor levels

Question 27

how to assess function in the reward pathway with fMRI?

Answer 27

Monetary Incentive delay task - anticipation of winning money

Question 28

blunted brain activation is seen where?

Answer 28

years prior to development problematic drug use in adolescents
in abstinent addicts

Question 29

in abstinent addicts, those with blunted response in the brain to ‘anticipation of reward’ are more or less likely to relapse?

Answer 29

more likely

Question 30

what regions of the brain are involved in binge/intoxication?

Answer 30

thalamus
dorsal striatum
ventral tegmental area

Question 31

what regions of the brain are involved in withdrawal/negative affect?

Answer 31

amygdala

brainstem

Question 32

what regions of the brain are involved in anticipation ‘craving’?

Answer 32

insula
hippocampus
prefrontal cortex

Question 33

how does motivation for substance use change are addiction/dependence develops?

Answer 33

Change from positive to negative reinforcement

Question 34

Assessing amygdalar function with fMRI

Answer 34

Emotional processing of aversive images

Question 35

amygdalar function in abstinent polydrug addicts and alcoholics

Answer 35

Heightened brain response in left amygdala in abstinent polydrug addicts to aversive images but not in alcoholism

Question 36

Change from voluntary drug use to more habitual and compulsive drug use involves transition from?

Answer 36

prefrontal to striatal control over drug taking

ventral (limbic or emotional) to dorsal (habit) striatum

Question 37

Assessing neurocircuitry involved in inhibitory control with fMRI: go-nogo task

Answer 37

Greater response in frontal pole/inferior frontal gyrus during inhibiting response in abstinent alcoholics:
greater response associated with longer abstinence