Substance Use Disorder- Week 9

Question 1

Why do many diagnostic manuals no longer use the word “addiction”?

Answer 1

The word “addiction” has connotations of character weakness and moral failure, so is not longer an official diagnostic term, so has therefore been replaced with “dependence”- which has more implied emphasis on the biological factors, such as tolerance and withdrawal

Question 2

How has the DSM V developed the DSM IV’s definition of substance use disorder?

Answer 2

In the DSM IV, there was a distinction between substance abuse and substance dependence, but in the DSM V, abuse and dependence have been combined into the diagnosis of “Substance Use Disorder”

Question 3

What are the 11 diagnostic criteria in the DSM V for substance use disorder? (these are for Alcohol use Disorder, but are applicable for other substances)

Answer 3

Alcohol taken in larger amounts or for longer periods than intended
Persistent desire for Alcohol and failure to cut down
Large amounts of time spent trying to obtain or use alcohol or recover
Craving
Affects ability to fulfil major role obligations
Continuing use despite it creating social issues
Sacrificing social, occupational or recreational activities in favour of drinking
Recurrent use in hazardous situations
Continuation despite knowledge of damage to health
Tolerance (increased amount or diminished effects of the same dose) and withdrawal

Question 4

How many of the criteria for SUD do you have to meet for diagnosis?

(include a “however”)

Answer 4

2/11

However, there is a continuum of severity:
2-3 criteria met = mild, 4-5 met = moderate, 6 or more = severe

Question 5

Describe the issue of non-specificity in the diagnostic criteria for SUD in the DSM V

Answer 5

. The criteria is very broad and the threshold for diagnosis is very low. In reality, symptoms tend to cluster together, but two people with moderate SUD could have no shared symptoms.

Question 6

What is the consensus definition of addiction?

Answer 6

addictions is when someone continues to use drugs despite a sincere intention to do otherwise.

Question 7

Is Alcohol Substance Use Disorder more prevalent in men or women?

Answer 7

men

Question 8

For men, where is alcohol use disorder most prevalent?

Answer 8

The UK, Russia, China, South America

Question 9

Is Tobacco use more common in men or women?

Answer 9

Men

Question 10

How have levels of alcohol and tobacco use changed in recent years?

Answer 10

Over time, alcohol abuse in young people has reduced, especially recently.
There has also been a reduction in smoking in recent years and an increase in people who have quit

Question 11

What are the most common disorder type for SUD to be comorbid with?

Answer 11

Mood disorders (i.e. Bipolar or MDD)

Question 12

What are the 6 most common comorbidities with SUD?

Answer 12

Bipolar
Major Depression
GAD
Social Anxiety Disorder
PTSD
Psychosis

Question 13

What are the heritability rates (estimates) for SUD?

Answer 13

Between 30 and 70% (discovered via twin and family studies by Agrawal and Lynskey et al)

Question 14

How can trauma- especially complex trauma-link to increased risk of SUD?

Answer 14

The way that trauma can link to a lack of emotion regulation therefore can have an implication that many cases of addiction can be primarily a disorder of emotion regulation.

Question 15

What type of behaviour is using?

Answer 15

Operant behaviour- not a voluntary behaviour. It is then followed by a positive reinforcement, so we continue.

Question 16

What are the different effects of specific drugs (getting high, increased alertness, social factors, etc)

Answer 16

Getting high- heroin, cocaine, MDMA, alcohol
Increase alertness and reduce fatigue- Nicotine and Caffeine
Social Facilitation- alcohol, MDMA, Cocaine
Alleviate Distress- Alcohol, Heroin, Nicotine

Question 17

What does motivational interviewing do?

Answer 17

Motivational interviewing is intended to resolve ambivalence and increase motivation to change

Question 18

What are the different process that go on in the brain in each phase of developing addiction?

How does this support the “disease model”

Answer 18

First stage of addiction- begin bingeing drugs, creates neuroadaptations that result in a shift from feeling euphoric to dysphoric.
We then begin tolerance and withdrawals, with focus on the limbic system and amygdala
The frontal cortex and ACC then create intense cravings.

These are some neural adaptations which suggest that the brain changes so that your behaviour is no longer voluntary.

Question 19

What is the disease model to explaining SUD?

Answer 19

These are some neural adaptations which suggest that the brain changes so that your behaviour is no longer voluntary.

Question 20

What neurological evidence is there for and against the “disease model”?

Answer 20

The changes in structure and function after chronic drug use do emulate the effects of brain damage. However, the factor of neuroplasticity allows some to question whether this is “brain change” or “ brain damage”

Question 21

How does recovery frequency contest the “disease model”?

Answer 21

The evidence for widespread recovery, often without any treatment, is evidence against the disease model.

Question 22

What is the model for habit formation (the changing of a normal behaviour to a habitual behaviour)

Bear in mind, this is debatably only applicable to animals, as it was mainly researched via animal studies.

Answer 22

Normal Behaviour
Stimulus (Cigarette)— Anticipated Outcome (effects of smoking)—– Response (smoking)
But, if this behaviour becomes habitual with repetition:
Stimulus—- Response (the Anticipated Outcome is no longer focused on and considered, hence why they still use despite the negative outcome)

Question 23

what are the two types of process involved in the dual process model of explaining SUD?

Answer 23

Controlled and automatic processes

Question 24

How can using either be assigned to automatic or controlled processes?

Consider how the different stages of addiction can affect this

Answer 24

If it is a controlled process, we have expectations of the outcomes and intentions to use, and therefore use. This is what we believe is the case for novice substance users. If substance using is an automatic process, using is a spontaneous reaction to memory associations, could be due to a lack of attentional biases, and is caused by cues in the environment. This occurs when someone is addicted, as the damage caused to the brain has inhibited controlled processes. Therefore, some have developed treatments to reverse the cognitive processing biases that can convert substance use from an automatic to a controlled process in addicted individuals.

Question 25

How is likely of recovery affected by age?

Answer 25

As people get older, the levels of individuals in remission drastically increases, until an individual is eventually more likely to be in remission than not in remission.

Question 26

How does likelihood of recovery vary between SUD sufferers and people with other psychiatric disorders?

Answer 26

There is even (controversial) data to suggest that substance use disorders are more likely to end in remission than the average psychiatric disorder.

Question 27

How can CBT be used to treat SUD?

Answer 27

CBT- uses behavioural homework and cognitive tasks to try and develop coping skills for CBT, which will hopefully then help us identify the distorted thoughts that are affecting our behaviours. It challenges the individuals belief that they can’t control their drug use and what the outcomes of their drug use are

Question 28

What are the two most common talking therapies used for SUD?

Answer 28

Motivational interviewing and CBT

Question 29

What are the main features of self help groups (such as Alcoholics Anonymous) and their treatment of SUD?

Answer 29

Involves pairing with a sponsor (someone in remission) and helps people to maintain and achieve abstinence. They are believed to be effective because they increase self -efficacy and brings about changes in social networks (more supportive environment and new role models who ALL don’t use).

Question 30

How is residential rehabilitation related to the techniques of self help groups?

Answer 30

Residential Rehabilitation (which is usually private and expensive) will often adopt the 12 step principles of self help groups such as AA.

Question 31

Is there a pharmacological cure for SUD?

Answer 31

No

Question 32

How effective are nicotine replacements in aiding people to quit smoking?

Answer 32

Very, they double peoples’ likelihood of quitting

Question 33

How do pharmacological treatments aid the recovery of SUD?

Answer 33

They either reduce the motivation to use the drug, increase the motivation to abstain from the drug or provide people with the resources needed to change their behaviour.

Question 34

What is contingency management?

Answer 34

it is a system that will award those involved monetary payment when a urine-based drug test proves you have not used. If you provide a sample and it comes back negative, you receive a small reward. Lasts about 12 weeks.

Question 35

What evidence is there that contingency management treatments are effective beyond the duration?

Answer 35

After the user stops receiving payment, people are more likely to remain abstinent than those who did not receive the contingency.

Question 36

What two processes are involved in the Dual Process Theory of SUD?

Answer 36

Automatic and Controlled Processes