Task 9 drug use disorder

Question 1

DSM-5

Answer 1

o Impaired centre control:
 The substance is taken in increasingly larger amounts or over a longer period of time than originally intended.
 The substance user craves the use of the substance
 The substance user feels an ongoing desire to cut down or control substance abuse
 Much time is spent in obtaining, using, or recovering from the substance
o Social impairment:
 The ongoing use of the substance often results in an inability to meet responsibilities at home, work, or school
 Important social, work-related, or recreational activities are abandoned or cut back because of substance use
 Ongoing substance use despite recurring social or relationship difficulties caused or made worse by the effects of the substance
o Risky use:
 Ongoing substance use in physically dangerous situations such as driving a car or operating machinery
 Substance use continues despite the awareness of ongoing physical or psychological problems that have likely arisen or been made worse by the substance
o Pharmacological criteria:
 Changes in the substances user’s tolerance of the substance is indicated by the need for increased amounts of the substance to achieve the desired effect or by a diminished experience of intoxication over time with the same amount of the substance.
 Withdrawal is demonstrated by the characteristic withdrawal syndrome of the substance and/or taking the same or similar substance to relieve withdrawal symptoms

Question 2

Severity of DUD

Answer 2

• Mild: 2-3
• Moderate: 4-5
• Severe: 6+
o for over a year

Question 3

Prevalence (general)

Answer 3

2,5-5% (USA)

Question 4

Synaesthesia

Answer 4

overflow from one sensory modality to another, mood shifts, can produce psychosis

Question 5

Drug treatments for druf use disorder LOL

Answer 5

o Benzodiazepines: used to decrease withdraw symptoms of alcohol
o Antidepressants: decrease depressive symptoms but not relay proved efficiency
o Antagonistic drugs: block or change effects of drug, thereby reducing desire
 Can cause extreme withdraw symptoms in some people
 Disulfarm: makes people sick when they drink
 Replacement for nicotine: plasters etc.
o Methadone maintenance programs:
 Achieves gradual withdraw
 Block receptors and withdraw

Question 6

Behavioural therapies

Answer 6

 With disulfarm negative conditioned response to alcohol is created
• Then learn to avoid through operant conditioning

Question 7

Covert sensitization therapies

Answer 7

uses imagery to create associations between thoughts of alcohol use and thoughts of highly unpleasant consequences

Question 8

Contingency management programs

Answer 8

provide reinforcers such as vouchers (controlled with urine test)

Question 9

Cognitive treatments

Answer 9

o Helps identifying situations in which drinking occurs most likely, as well as maladaptive expectations

Question 10

Motivational Interviewing

Answer 10

o Elicits and solidifies clients motivation and commitment to changing their substance use.
 Taking the side of the participants and support his will to stop

Question 11

Relapse prevention

Answer 11

o Teaches people to see slips as temporary and situational caused
 By e.g. avoiding risky situations or develop coping situations for them
Counteracting abstinence violation effect

Question 12

Abstinence violation effect

Answer 12

 Sense of guilt when breaking abstinence and continuous drinking to supress conflict

Question 13

Prevention programmes

Answer 13

o Target younger people as onset predominantly during adolescent risk period (brain still developing, esp. prefrontal cortical regions that cannot yet regulate emotions properly)
o Focus education on immediate risk of excess & payoffs of moderation
o Harm reduction model – drink safe like you drive safe
 Learn to be aware of drinking habits & thought to calculate alcohol blood level .

Question 14

Biological factors

Answer 14

o Individuals whose reward network overpowers their control network may be more like to use substances
o After continuous usage of drugs brain decreases dopamine production which creates craving when no drug is used
o Stress and conditioned stimuli trigger craving
o Repeated exposure to drugs impairs impulse control
o Heredity: 0,5
o Genes controlling GABA and Dopamine systems mediate the experienced pleasure
s

Question 15

Social learning theory

Answer 15

suggest that children may learn substance use behaviours from the modelling of their parents and others
 Because children prefer similarity it might run through male family members

Question 16

Cognitive theories

Answer 16

focused on people’s expectation of alcohols effects and their beliefs about the appropriateness of using it to cope with stress
 No other coping mechanisms facilitate that

Question 17

Behavioural undercontrol

Answer 17

take drugs at an earlier age, ingest more, higher likelihood of diagnoses
 Might be influenced by genes

Question 18

Sociocultural factors

Answer 18

People living in stressful environment use drugs as relief and think they have little to lose.

Question 19

Cultures

Answer 19

Attitude about drugs mediates prevalence

Religion-> big factor

Question 20

Gender differences in risk

Answer 20

 In the past drinking was less accepted
 Carry less risk factors than men (personality)
 Suffer alcohol related illness at lower levels of exposure than men
 May notice intoxication sooner
 More likely to be drawn into addiction by family or lovers

Question 21

Alcohol-induced place conditioning in moderate social drinkers (childs article)

Answer 21

• Conditioned place preference: rewarding drugs become associated with context by the mean of classical conditioning
• Method:
o Paired group: always receives alc in one room but not in the other
oUnpaired group: receives alc and non alc in both rooms
• Results:
o Participants styed longer in the alcohol conditioned room
o Subjective responses to alcohol predicted preferences for the alcohol-paired room
o Participants who reported the greatest sedative effects from alcohol exhibited the strongest place preference
o Conditioning is mediated by sedative-like component of alcohol experiences rather than the exciting effects
o Behaviour may be influenced by drug cues before individuals are aware of drug: cue contingencies

Question 22

Choice model

Answer 22

rejects disease model because possibility of voluntary stopping violates disease criteria
o Immediate rewards take precedence over long-term gains
 Repeatedly choosing immediate rewards sets both immediate and long-term rewards to lower and lower values
o Ignore brain
o Cues are driving part of drug addiction

Question 23

Criticism on choice model (Lewis)

Answer 23

o Motivation and emotion influence behaviour by narrowing appraisals and urging actions that address them
o Choosing to not take a drug is extremely difficult, increases with time

Question 24

Dopamine

Answer 24

o Responsible for wanting rather than liking
o Role in addiction: the motivation and urge results from excessive dopamine release that is highly enormously exciting or pleasurable
o Activating the power of cues
o Shuts down intertemporal flexibility

Question 25

Craving and the power of now

Answer 25

o Self-reports of craving and their striatal and orbitofrontal activity both peaked just before the moment of drug administration and declined immediately after
o Craving and its foundation in “now”, may be the byproduct of a brain designed to be maximally responsive to immediate rewards

Question 26

Utility theory

Answer 26

Describes the idea that delayed reward discounts with increasing intervals

Question 27

Incentive-sensitization hypothesis

Answer 27

increased activity in VTA to drugs and decreased activity to other stimuli

Question 28

Decrease of acethylcholine as a result of exposure

Answer 28

leaving dopamine to dominate effortful behaviour

o Causes shift from exploration, alertness and volition to single minded desperate pursuit

Question 29

Orbitofrontal cortex and ACC

Answer 29

become dysfunctional both during addiction and withdrawal
o OFC: assigning value
o ACC: judging option and selecting among them

Question 30

Dual process model

Answer 30

decision making abilities result from interactions between two systems
o Reflective system: involved in cognitive evaluation of the stimuli by means of memory and executive functions, responsible for controlled-deliberate responses
 Impaired prefrontal network (could be cause or effect for binge drinking)
 Inhibited, leading to an inability to voluntarily inhibit the consumption
o Affective automatic system: involved in the emotional evaluation of the stimuli, initiating automatic-appetitive responses
 Limbic network
 Over activated by emotional or alcohol related stimuli leading to impulsive behaviour
o Cycle continuous

Question 31

Continuum hypothesis

Answer 31

binge drinkers would display qualitatively similar but quantitatively less marked impairments than alcohol dependent individuals

Question 32

Binge and intoxication

Answer 32

o Increases in dopamine release elicit a reward signal that triggers associative learning or conditioning (Ventral striatum and nucleus acumbens)
 Preceding environmental stimuli are conditioned
 In response dopamine starts firing when reward is absence and give anticipatory responses to the conditioned stimuli in a sense that predict the delivery of reward
 Leads to binge of drug

Question 33

Withdraw and negative affect

Answer 33

o Former natural rewards loose their power
 But also drug induced power decreases after time
o Most drugs lead to adaptions in extended amygdala
 Results in increase in a persons reactivity to stress and lead to the emergence of negative symptoms
 Increases desire
 Change from getting high to relief from dysphoria

Question 34

Preoccupation and anticipation

Answer 34

Changes in PF cortices involved in executive processes
 Neuroplastic changes in glutamatergic and dopaminergic signalling
• Weakens ability to resist strong urges or to follow through on decisions to stop taking the drug

Question 35

Prevalence of specific drug use disorder

Answer 35

•	Tabaco: 13%
•	Alcohol: 
o	12-17:  4.6%
o	18 and older: 8.5%
o	18-29: 16.2%
•	Cannabis: 1.5%
•	Cocaine/Heroin: 0.3%