substance use and addictive disorders. ch 5 pg 118-131 Flashcards
definitions of drug addiction usually state 2 facts:
- the addicted individual has impaired control over the use of the drug
- the drug use has harmful consequences
what is one problem with the control aspect of the def. of addiction
–> what is the real questions that needs to be asked
there is no way to tell the difference between behaviour that is controlled or not controlled
–> can the person stop if he or she wanted to
craving and control are subjective states that ultimately depend on the?
self -report of the user
is a person ever cured fro addiction?
no they are just in remission of symptoms. (addiction is a chronic disorder)
hedonia means?
pleasure
can stimuli act as reinforcers without the sensation of pleasure
yes
activation of the mesolimbic dopamine system occurs in response to the stimuli that precede or anticipate a stimulus as opposed to?
the actual stimulus itself.
where are hedonic hotspots
nucleus accumbens and ventral portion of the pallidum
increases of “liking” reactions results from activation of?
the hedonic hotspots by opioids
are the hedonic hotspots and “liking” dependent on dopamine
no
what are the nucleus accumbens and mesolimbic dopamine systems role in reinforcement
wanting
- -> general activation (pushing) ex, hungry
- -> directing the behaviour towards the goal
directing a behaviour towards a goal is done by ?
incentive salience
various stimuli in the environment have or acquire special motivational properties that cause us to notice
incentive salience
what brain structure is responsible for incentive salience and what is a crucial element in the process
nucleus accumbens, dopamine
the nucleus accumbens turns a neutral stimulus into?
a stimulus that we WANT
if dopamine is taken away what happens?
you still “like” the stimulus but your drive to obtain it (want) it lessons
what is the “do it again” system
“wanting” system
what is one of the most important differences between natural and drug related reinforcers?
under normal conditions, natural reinforcers have a satiation mechanism that terminates their reinforcing effect. (ex, after we eat and are full food loses its reinforcing effect)
what reinforcement is more immediate and why?
drug reinforcement (over natural) because drugs are able to get the brain immediately
the fast, high surges in dopamine that correspond with drug taking are not what cause the feelings of euphoria
–> could be what?
- could be opioids and endocannabinoids (liking)
the heightened surge in dopamine ensures?
we are motivated to seek them again
Stress can increase the strength of a reinforcing stimulus. this is due to increased levels of?
glucocorticoid hormones causing the release of dopamine
repeated exposure to a stressful stimuli will do what?
cause sensitization to that stimulus
in addiction there is sensitization to both the sensation of the drug as well as the motivation circuitry. the incentive becomes a?
- in other words there is a sensitization of?
motivational magnet
- incentive motivation
the ? uses the change in motivational sensitivity to explain addictive behaviours
- incentive sensitization theory
a strong de- sire or urge to use a specific substance
craving
The incentive motivational effects of drugs and their cues become stronger (sensitized) with repeated exposure due to increased activity of the
meso- limbic dopamine system and neuroadaptations of brain circuits that mediate classical conditioning of incentive motivational processes
2 characteristics of incentive salience
- The stimulus is easily noticed and attended to by the organism
- the stimulus motivates behavior that is directed toward it
what happens when a recovering alcoholic see a picture of alcohol
it induces a craving and increased activity in the pre frontal and anterior cingulate cortices and the mesolimbic dopamine system becomes active
the dysfunction of dopamine in the ventral striatum my lead alcoholics to?
attribute increased amounts of attention to alcohol related cues
can internal memories induce cravings?
yes
According to incentive sensitization theory, the subjective consequence of activation of this system (craving) is ?, and the subjective experience of a sensitized system is intense wanting or ?
- wanting
- craving
the more a drug is used the more it gains control over?
the motivational circuitry and the more it can control a large amount of your behaviour
–> addiction
people often crave drugs even though they report that, at the same time, they are miserable and get little or no pleasure from the drug–> this explains the difference b/w ?
liking and wanting
hedonic, neurobiological/psychological dependence model of addiction based on a continually shifting balance between the activity of?
the reward system and the anti-reward system
with repeated use of a drug the REWARD system become? and the ANTI-REWARD system become?
–what kind of process is this?
- dysfunctional/dysregulated - don return to normal level
- increasingly recruited and level of activity increases
- allostatic process
a contrast to homeostasis
allostasis
situations where the set point is not constant but changes in response to changes in the animal’s environment
allostasis
what does allostasis mean in regards to dosage
new allostatic set point means that a person must take larger and larger doses of the drug to achieve the same degree of euphoria or pleasure as he or she did from the first dose.but at the same time the person does not get the same feelings when on the drug and gets worse and worse depression when not on it
changes take place in the neurocircuitry and neurochemistry that drive the stress response
between system
eventually sensitization is overcome by the processes of? the term they use to describe the lowering of the mood set point.
hedonic dysregulation,
dysphoria
depression or unhappiness
dysphoria can be thought of as? that can only be alleviated by taking more drugs
psychological withdrawal syndrome
drug addiction involves a dysfunction in information processing and integration among multiple brain regions that comprise four interrelated circuits. these circuits are?
- reward saliency
- motivation/drive
- memory/ conditioning
- inhibitory control/ executive function
all circuits receive direct input from?
dopamine
dysfunction of brain areas (orbitofrontal cortex, anterior cingulate gyrus, dorsolateral prefrontal cortex, and insular cortex) involved in motivation and attentional control, LEADS TO
compulsion and impulsivity
long term dug use leads to dysfunctional prefrontal cortex so it cannot properly regulate dopamine which means the ? and ? are left uninhibited, resulting in?
the motivational drive and memory conditioning circuits
- compulsive drug intake
researchers think denial may be due to?
dysfunctional cortical circuits that mediate insight and self-awareness
the most affective treatments for drug addiction are those that focus on?
all aspects of functioning that have been disrupted by drug use
process by which the body clears itself of drugs and is often ac- companied by unpleasant and sometimes even fatal side effects.
detoxification
medically managed with drawal.
medications that help lesson the effects of withdrawal
provide intensive but relatively brief treatment based on a modified 12-step approach
short term residential treatment
often is more suitable for people with jobs or extensive social supports
out patient treatment program
provides 24-hour a day care with planned lengths of stay between 6 and 12 months
therapeutic community (type of long term residential treatment)
focus on the resocialization of the individual
therapeutic community
designed to engage people in treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviors related to drug use, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and relapse.
behavioural treatments
individuals learn to identify and correct problematic behaviors through techniques intended to enhance self-control by exploring the positive and negative consequences of continued use, self-monitoring to recognize drug cravings early on and to identify high- risk situations for use
cognitive behavioural theory
based on operant conditioning principles of reinforcing drug-free urine samples with low-cost incentives such as prizes or vouchers exchange- able for food items, movie passes, and other personal goods
contingency management interventions
aimed at helping individuals resolve ambivalence about engaging in treatment
motivational enhancement theory
Alcoholics Anonymous and Narcotics Anonymous, are some of the most well-known behavioral treatments for addiction
- these are an example of?
12 step facilitation therapy
3 key aspects of 12 step facilitation therapy
- acceptance
- surrender
- active involvement
for drug addicts with partners as an add-on to individual and group therapy
behavioural couples therapy
what is a very important part of therapy for youth/adolecense
family involvement
outpatient approach that views adolescent drug use in terms of a network of influences
Multidimensional Family Therapy (MDFT
targets family interactions that are thought to maintain or exacerbate adolescent drug abuse and other co-occurring problem behaviors such as oppositional behavior, delinquency, associating with antisocial peers, aggressive and violent behavior, and risky sexual behavior.
Brief Strategic Family Therapy (BSFT
addresses the factors associated with serious antisocial behavior of adolescents who abuse drugs
multi systemic therapy
substitution or replacement therapies
drug of abuse could be replaced with a gradually decreasing dose of a pharmacologically similar, longer-acting medication until the individual was drug free.
(ex, nicotine patch)
