Symposium on the Biopsychosocial Model

Question 1

How would you use the biopsychosocial model when the signs are slightly worse than average

Describe the balance between the biological, psychological and social aspects

Answer 1

Psychology
-behavior changes with strategies

Sociology
-create environments which are conducive to preventative health

Biology
-interventions rarely used unless the psychosocial elements don’t work

Psychosocial elements are dominant here

Question 2

How would you use the biopsychosocial model when major disability is caused by illness

Describe the balance between the biological, psychological and social aspects

Answer 2

Psychology

• sustain behavior changes
• adherence to treatment
• support mental health

Sociology
-create environments which are conducive to improving health

Biology

• pharmacological intervention
• prevent/manage complications

All aspects are equal

Question 3

Describe the dopaminergic/mesocorticolimbic reward pathway

How does alcohol affect this pathway

Answer 3

Substantia nigra (basal ganglia) => striatum (BG)

Ventral tegmental areas (MB) => nucleus accumbens (mesolimbic BG) and prefrontal cortex (mesocortical)

Involved in decision making and rewards

Alcohol enhances dopamine release by inhibiting neurones that inhibit dopamine secretion

Question 4

Describe the heritability of alcoholism

Answer 4

25% of children of alcoholics become alcoholic

MZ generally have higher concordance for alcoholism than DZ

Question 5

Describe how variants of the D2 receptor gene affects alcoholism

Answer 5

D2 has 1 phenotypes (A1 and A2), associated with dopamine receptor density

A1 => decreased no of dopamine binding sites
-increased chance of developing substance abuse

A2 => increased no of dopamine binding sites
-decreased chance of developing substance abuse

Question 6

How would you exploit the differences in D2 receptor phenotypes in reducing alcohol cravings

Answer 6

Bromocriptine

-dopamine agonist => activation of nucleus accumbens

Question 7

How can the RASGRF-2 gene affect the chances of developing alcoholism

Answer 7

Variant causes a stronger sense of reward when drinking => more likely to be a heavy drinker

Question 8

How can protective signalling pathways reduce your chance of developing alcoholism

What 2 molecules are involved in this

Answer 8

Homeostatic pathways activated by alcohol => protected against adverse effects

As a result, won’t drink at excessive, harmful levels

• Brain Derived Neurotrophic factor
• Glial Cell line Derived Neurotrophic Factor

Question 9

How can orexins affect your chances of developing alcoholism

• describe the effects of orexin receptor blockers
• what is the link between orexin and epigenetics
• what can trigger orexin release

Answer 9

Orexin is a neuropeptide synthesied in the hypothalamus => modulates reward seeking

Orexin blockers can make rats stop drinking freely available alcohol

Orexin receptors involved in the rewarding and motivational properties of alcohol

Orexin may be involved in withdrawal symptoms due to epigenetics

Cues associated with alcohol availability can trigger orexins

Question 10

What is the link between epigenetics and alcoholism

• in adolescents
• how could you treat the changes caused by alcoholism

Answer 10

Alcohol exposed in adolescent rats => tighter DNA coiling due to epigenetic changes => anxiety like behavior

Epigenetic changes can be passed on

When cancer drug given associated with tightly coiled gene (needed for synapse formation) => uncoiling of gene => reduction in anxiety and alcohol intake

Question 11

How can alcohol affect neuroimmune processes

• how do gut derived microbial products impact biological function
• how is crosstalk in the brain impacted

Answer 11

Alcohol thought to increase neuroimmune related gene and protein expression

gut derived microbial products activate innate immune system => systemic induction of inflammatory cytokines which are transported from blood => brain

Crosstalk in brain => induction of inflammatory and neuromodulatory properties of immune cells

Question 12

Capability to change behavior

What 3 factors must be considered and addresses to reduce the intention to drink and increase the capability of the person to change their behaviour

Answer 12

Attitude to drinking

Subjective norms
-what do other people think of your drinking

Perceived behaviour control
-are you confident that you are able to stop being dependent on alcohol

By addressing these factors, you can reduce the intention to drink

Question 13

Opportunities that result in excessive drinking

How can glass size influence the volume consumed
How can you use this knowledge to change drinking behaviors

Answer 13

May influence judgements on amount of wine consumed

Larger glasses, => increased consumption of units

By using smaller glasses, can start to control your drinking environment

Question 14

How can operant conditioning lead to excess alcohol consumption
How can you use this conditioning to stop being dependent on alcohol

Answer 14

Stimulus, response, reward pathway reinforced in alcohol consumption
This process becomes automatic

If conscious of cues, can use if when planning to decrease consumption

Question 15

What 3 factors influence motivation

Answer 15

Conscious voluntary processes
-capability, perceptions

Unconscious involuntary processes
-drinking cues and habits

Emotions
-depressive symptoms => increased consumption

Question 16

Describe the current social patterning of binge drinking in the UK

Answer 16

Increased no of teetotalers
-higher percentage in London, more ethically diverse so less likely to drink

Decreased no of people who have reported binging in the last week

Frequent consumption decreased in young adults

Increase in alcohol related admissions

Question 17

How does gender affect your chances of binging

Why

Answer 17

V small differences in the proportion of men and women regarding alcoholism
-gender roles are less prominent

Question 18

How does your occupation affect your chances of binging

Answer 18

Routine/manual workers more likely to abstain and less likely to binge
If they do drink. more likely to binge than professionals/managers

Question 19

How does deprivation affect your chances of binging

-case study in Glasgow

Answer 19

Men in more deprived areas

• 3x more likely to be admitted to hospital with alcohol related problems
• 6x more likely to die than men in less deprived areas

Question 20

How does the availability of cheaper alcohol affect your chances of binging

Answer 20

Proximity and density of off licences associated with frequent/high levels of drinking

Question 21

How can your social network affect your drinking habits

Answer 21

We tend to pick up drinking habits from significant peers

We tend to hang out with friends with similar drinking patterns

Question 22

What cultural factors are linked to alcohol

Answer 22

Tied very heavily to socialising

• sharing success
• celebrations

Question 23

Describe the Responsibility deal in the UK
What are the effects of the deal on alcoholism

What else could be done under this deal

Answer 23

Partnership between industry and government to improve public health

• labelling alcohol with units => unlikely to change behaviour
• industry funded campaigns => encourages drinking

Stop marketting outside schools => prevent underage drinking
Policy changes (taxing alcohol)

Question 24

How could you address problem drinking in a culture that drinks
What doesnt work

Answer 24

Information alone is ineffective
Controversial to have campaigns funded by alcohol companies
-May decrease no of bingers but increase the total no of drinkers