Task 3

Question 1

Treatment of substance use in pregnancy

Answer 1

— Primarily involve behavioral counselling
— E.g., brief intervention that utilize motivational interviewing

Question 2

Motivational interviewing (MI)

Answer 2

A patient-centered, collaborative and highly empathic counselling style for eliciting behavior change by helping clients to explore and resolve ambivalence
— It draws from the trans theoretical model of change in order to improve treatment readiness and retention
— in person or telephone-based
— can moderate prenatal drinking and smoking

Question 3

Cognitive behavioral Therapy (CBT

Answer 3

psychotherapeutic treatment, uses easy-to-learn set of strategies to help patient understand the situations that leas them to undesired thoughts, feelings, or behavior to then prevent those situations when possible or deal with them more effectively
— goal of the strategy is to break old patterns of responding and replace them with new ones

Question 4

Contingency management (CM)

Answer 4

Contingency management (CM) – Based on the principle of positive reinforcement as a means of operant conditioning to influence behavior change
— The premise behind CM is to systematically use reinforcement techniques, usually monetary vouchers, to modify behavior in a positive and supportive manner

— Most successful intervention for prenatal smoking cessation
— Some success in reducing marijuana use in women
— Assoc. with longer duration of cocaine abstinence
— Important addition to methadone or buprenorphine treatment

Question 5

Therapy for opiod use

Answer 5

Methadone maintenance – medically controlled, steady opiate dosing
— Standard care for pregnant women with opiate use disorders
— Decreases maternal and neonatal morbidity
— Greater relapse prevention

Buprenorphine maintenance – another potential therapy for opioid use in pregnancy
— Less treatment for NAS
— Lower retention rates

Question 6

therapy for cocaine use

Answer 6

Micronized progesterone – intervention for postpartum cocaine use

Question 7

Why is breastfeeding a treatment for SU

Answer 7

ctation (Breastfeeding) – potentially be useful tool for substance use in postpartum period

— Breastfeeding is the only available intervention shown to reduce NAS severity in opioid-exposed newborns
— Reduce NAS severity in opioid exposed newborns
— Protective for postpartum relapse

— Reduces HPA response to physical stress
— Behavior that reduces stress promotes relaxation and reduces stress would be helpful to women with substance use disorder  since psychosocial stress increases cravings

— (Drug) Craving causes stress  hormones released during lactation, Oxytocin, may mediate stress reduction
— positively associated with cognitive and motor development in the infant

Question 8

Sequeglia & Gray (2016) – Alcohol and Drug use and the Developing Brain

Main finding

Answer 8

Findings suggest that pre-existing neural features that relate to increased substance use during adolescence include poorer neuropsychological functioning on tests of inhibition and working memory, smaller gray and white matter volume, changes in white matter integrity, and altered brain activation during inhibition, working memory, reward, and resting state.

Question 9

Gray matter

Answer 9

Gray matter – neural cell bodies, dendrites, glial cells, synapses, and capillaries
— Decrease in gray matter during adolescence, probably due to synaptic pruning
— Changes in the extracellular matrix

Question 10

White matter

Answer 10

White matter – myelinated axons tracts that connect gray matter regions
— Increase in white matter, probably due to increased myelination of axons
—  allows more efficient communication between brain regions

Question 11

Inhibition (impulse control)

Answer 11

Inhibition (impulse control) – type of executive functioning that refers to the ability to withhold a pre-potent repose in order to select a more appropriate, goal directed response

— Study: compromised inhibitory functioning during early adolescence, prior to the onset of substance use, was related to greater subsequent alcohol and marijuana use by age 18

— Poorer inhibition functioning - predisposition to initiate substance use during adolescence
— Neuropsychological data could be used in preventative interventions to identify teens at risk

Question 12

Functional Brain Precursors

Answer 12

— Study: Used fMRI to investigate brain activity in adolescence with substance use
— Shown that neural circuity underlying inhibitory control undergoes significant neurodevelopment during adolescence

— Brain activation during reward processing has also been found to predict future adolescent substance use engagement
— Study: Heavy marijuana-using young adults exhibit higher brain activation during reward processing than controls

findings suggest that aberrations in brain activation during tasks of inhibition, working memory, and reward processing may be useful in predicting which youth will initiate alcohol and marijuana use during adolescence
Ú possible that prevention and intervention techniques targeting these cognitive domains could be helpful in staving off early adolescent substance use

Question 13

Structural Brain Precursors

Answer 13

— Less volume in brain regions involved in impulsivity, reward sensitivity, and decision-making and altered white matter appear to influence initiation

— Smaller frontal gray matter volume and less cerebellar white matter volume predict initiation of drinking by late adolescence
— Reward-related subcortical structures involved in initiation
— Smaller left nucleus accumbens predicts greater substance use

— Markers of vulnerability to initiation:
— Alterations in neurocognitive performance and neural response patterns during inhibitions, working memory, and reward processing

Question 14

Heavy substance use could have lasting effects into adulthood E.g

Answer 14

., worse performance on complex attention, memory, processing speed, and visuospatial functioning

Question 15

consequences of adolescent SU

Answer 15

— Heavy drinkers:
— accelerated decreases in gray matter over time (premature cortical gray matter decline similar to volume declines related to accelerated aging)

— Marijuana-related changes in white matter microstructure may confer risk for co-occurring psychological disorders like schizophrenia

— Binge drinking may affect the emotional component of reward processing
— Neural differences both predate and precede heavy drinking

Question 16

Adolescence

Answer 16

Adolescence – developmental period between the onset of puberty and the assumption of adult roles and responsibilities, spanning from 12 years to 25 years of age

— risk taking is crucial to adolescence successful maturation and movement towards independence

Question 17

Neurodevelopmental Models

Answer 17

— Suggest that risk taking is because of rapid changes in how the brain processes affective and social information, biasing the adolescent decision making toward short-term rewarding outcomes
— Because of the nature of their developing brain, adolescence are less able to anticipate or perceive long term negative outcomes
— Therefore, can make choices that have lasting negative health consequences

Question 18

What makes the adolescent brain resilient?

Answer 18

— Social attunement – form of social environment, which adolescent have to adapt to and harmonize with
— Unique capacity of adolescents to learn from an adapt to their constant evolving social environment
— Thought to be supported by enhanced socioaffective processing and brain plasticity

— Most substance use during adolescence naturally resolves by early adulthood, without any treatment or intervention
— Little is known about the neurocognitive mechanism underlying adolescent resilience to substance use disorder

Question 19

Best predictor in the decision to engage in substance use

Answer 19

has been found to be the proportion of substance-using friends

— Additionally, adolescence perception of peer substance use, in real world and on social media, has been directly linked to both youth current substance use and their substance use progressions

— Rise in substance use
— Results from features in the adolescent environment that creates opportunities for experimentation

Question 20

Binge drinking

Answer 20

Binge drinking – defined as more than 5 drinks per drinking occasion

Question 21

Winick (1960s)

Answer 21

Winick (1960s) reported natural decline in heavy use that coincided with their social community movement into increasingly responsible roles  maturing out of addiction
— Patterns of natural reduction in substance use from adolescence to emerging adulthood has been consistently observed

Question 22

Behavioral changes in adolsesnts

Answer 22

— Onset of puberty occurs with surges in emotional arousal and reward sensitivity, which causes adolescence to make choices in favor of short-term outcomes

— Social cognitive development
— Surge in social attunement to peer behaviors
— mere presence of peers substantially shifts the nature of adolescent’s decision making

Question 23

MAin brain aspect of adolesencen

Answer 23

— developmentally normative imbalance between social or emotional responsiveness and prefrontal cortex-mediated behavioral control and social cognition might also contribute to unique cognitive assets of adolescence
— including cognitive flexibility, social awareness and adaptation, acquisition of new experiences and enhanced capacity to learn from these experiences  modify behavior

Question 24

change in Brain structures during adolesence

Answer 24

— Frontal brain regions involved in social cognition and control mature later than do regions of the front limbic salience network and more posterior temporal and parietal areas
— Region-specific decrease in grey matter volume
— white matter increase (myelination), which subsequentially enhances functional connectivity between distant brain regions that results in more efficient communication within and between brain networks
— increased sensitivity of front limbic brain areas to social, emotional, and reward information

— executive control functioning is sensitive to social and affective context
— supports adaptive behavioral flexibility and social attunement to changing social environments
— neural sensitivity might drive adolescence risky choices, including substance use

Question 25

The role of brain plasticity

Answer 25

— Adolescence represent a crucial period of enhanced brain plasticity, specifically in areas associated with experience-dependent associative learning
— Shift in plasticity during adolescence towards brain areas involved in learning and complex cognitive functions  enhanced cortical plasticity
— Increased hippocampal plasticity  because of facilitated associative learning and reinforcement learning

— Positive memory bias because of better reinforcement learning of positive events in adolescence
— Suggested that the positivity, adaptive nature of reward sensitivity and learning in adolescent, and the inherent capacity adolescents show for neural and behavior resilience

Question 26

Implications of adolescent brain development in the context of substance use

Answer 26

— Course of substance use towards substance use disorder
— Transition from goal directed, voluntary use to choiceless, compulsive use, even in the face of negative consequences
— Salience network become increasingly attentive and responsive to substance use and cues that have previously been paired with it
— Resulting in the motivation to use, along with the automatic and often unconscious tendency to be drawn towards and respond to substance use-related cues

— Poor behavioral control over these motivations
— resulting from decreased functioning of the frontoparietal executive network
— is believed to support further escalation of substance use into substance use disorder

Question 27

Adolescent resilience to addiction: a social plasticity hypothesis

Answer 27

Hypothesis – the same neurosocial mechanisms that place adolescence at initial risk of introduction to and escalation of substance use underline protective factors driving the natural desistance from substance use during emerging adulthood

Model implies that adolescence resilience to substance use disorder results from social devaluation of substance use due to high social attunement, integrated with the optimization of behavioral control, during period when brain plasticity is still high

Question 28

Clinical implications of social plasticity hypothesis

Answer 28

Group Interventions
Field of e-health
Shifting social sphere