The Clinical Relevance of Health Compromising Behaviours

Question 1

What are health compromising behaviours

Answer 1

behaviours that undermine or harm current or future health. Habitual in nature leading to addiction in certain cases. Substantial contributors to global burden of disease

Question 2

What are the characteristics of health-compromising behaviours

Answer 2

Produce pleasurable effects: sensory pleasure – alliesthesia (external stimulus perceived as pleasant if maintains or improves internal homeostasis, perceived as unpleasant if threatens internal homeostasis), thrill-seeking behaviour – positive reinforcement. Stress reduction, coping mechanisms: avoidance – negative reinforcement. Acquired gradually over time: degree of engagement & experimentation

Question 3

Why are adolescents particularly vulnerable

Answer 3

Developmental state seen as window of vulnerability, risk-taking behaviour

Question 4

Which factors predict substance abuse of all kinds

Answer 4

Neuroticism, Genetic risk factors, Low SES, Family conflict, Deviance-tolerant attitudes

Question 5

Explain substance use to substance abuse

Answer 5

Crossing the line not always clear: quantify degree of substance abuse and/or dependence, identify possible risk factors, assess associated consequences (social, psychological, and/or physiological functioning

Question 6

What is the leading cause of death in men aged 16-54

Answer 6

Alcohol

Question 7

Describe the effect alcohol has on the GI tract

Answer 7

Site of alcohol absorption. Direct contact with mucosa can induce metabolic & functional changes. Functional changes & mucosal damage disturbs assimilation of nutrients. Alcohol-induced mucosal injuries can have deleterious effects on liver and other organs. Increased risk of major gastric & duodenal bleeding in non-predisposed individuals

Question 8

What are the risk factors for peptic ulcer disease

Answer 8

Age, alcohol abuse, prolonged NSAID use, socioeconomic status

Question 9

Describe dependence, tolerance and withdrawal

Answer 9

Body adjusted to substance, incorporated use into normal functioning of body’s tissues- removal of drug evokes unpleasant symptoms, psychological dependence: compulsion to use drug  anxiety if withheld. Increasing adaption to substance, larger doses required to reach same effects
Unpleasant symptoms (physical & psychological) when administration discontinued- Abstinence Syndrome

Question 10

Describe abstinence syndrome

Answer 10

Following sudden reduction or cessation, chronic alcoholism withdrawal can lead to delirium tremens, craving: Conditioning process whereby environmental cues trigger strong desire

Question 11

When should a diagnosis of dependence be made

Answer 11

Three or more of the criteria have been present at some time in the last year

Question 12

What criteria are used to assess dependence

Answer 12

a) a strong desire or sense of compulsion to take the substance
b) difficulties in controlling substance-taking behaviour
c) a physiological withdrawal state when substance use has ceased or been reduced
d) evidence of tolerance, such that increased doses of the psychoactive substances are required in order to achieve effects originally produced by lower doses
e) progressive neglect of alternative pleasures or interests because of psychoactive substance use
f) persisting with substance use despite clear evidence of harmful consequences (physical & mental)

Question 13

What is addiction

Answer 13

Chronic, relapsing disorder where compulsive drug-seeking & drug-taking behaviour persist despite harmful consequences- can occur in absence of physiological or chemical dependence

Question 14

Describe the stages of addiction

Answer 14

Exposure, compulsion, loss of control

Question 15

Describe learning perspectives of addiction

Answer 15

Operant conditioning: stimulus -> behaviour -> consequence -> likelihood of future behaviour increases/ decreases. Continuous vs. intermittent schedules of reinforcement. Shape behaviour via consequences of operant responses. Reinforcement important in addiction (learning process gone wrong

Question 16

What is starting drinking again in order to relieve unpleasant symptoms an example of

Answer 16

Negative reinforcement (reinforcement as giving something (punishment is taking something away), -ve as taking away a bad feeling (+ve would be giving a good feeling))

Question 17

Describe operant conditioning associated with addiction

Answer 17

Learning that taking a substance can produce reinforcing effects or outcomes can exert profound effects on future behaviour

Question 18

Describe positive reinforcement

Answer 18

Euphoria, feelings when intoxicated, enhanced social life etc

Question 19

Describe negative reinforcement

Answer 19

Stress-reduction, coping mechanism, temporary relief from unpleasant sensations/ experiences

Question 20

Outline the positive reinforcement reward pathway

Answer 20

Same circuits activated that are involved in behaviours such as eating, bonding, and sex. Dopamine increase in response to natural rewards, brain remembers pleasurable experiences and wants to repeat. Dopamine release enhanced when drugs are taken (e.g. alcohol, nicotine). Repeated use leads to structural, functional, biochemical changes -> loss of control over voluntary act

Question 21

What are the structures of the reward (dopaminergic) pathway

Answer 21

Core structures located in the limbic system. Primary circuits relevant to addiction involved dopaminergic mesolimbic pathways. Medial forebrain bundle connect core structures of the reward pathway, nerve fibres also connect core structures with other structures

Question 22

Explain what occurs beyond the reward pathway

Answer 22

Serotonin affected by substances such as cocaine, amphetamines, LSD, alcohol. Important functions include temperature regulation, mood, sleep, appetite, pain. Role in acquisition & maintenance of drug-use behaviour, might overlap with genetic risk factors for addiction. Role in mediating stress, trigger reward memory & enhance neuroadaptation

Question 23

Outline negative reinforcement in the reduction of stress and negative emotion

Answer 23

Alcohol reduces activity in regions associated with stress and negative emotion. Alcohol & stress can induce release of CRF, stress response to addiction. Prolonged stress conditions affect dopamine uptake levels  altered behaviours

Question 24

Describe substance dependence and reinforcement

Answer 24

Early use motivated by positive reinforcement. Later use driven by negative reinforcement. Maintenance of behaviour over time as a result of negative reinforcement (avoidance behaviour)

Question 25

Describe the transition from reinforcement to the addicted brain

Answer 25

Progression from ‘user’ to ‘abuser’ to ‘addict’ involved shift from positive reinforcement initially to maintenance via negative reinforcement. Leads to structural and functional changes -> long-lasting drug-induced neuroplastic changes. Craving can also result from learning process whereby conditioned stimuli activate reward circuits

Question 26

Describe craving according to classical conditioning and neuroadaption

Answer 26

Craving is a result of dependency and a learning process

Question 27

Outline the classical conditioning explanation of addiction

Answer 27

UCS (alcohol) -> UR (intoxication).
UCS paired with CS (environmental cue)
UCS + CS -> CR. (intoxication)
CS -> CR
CS (drug cues) consequently activate reward circuitry.

Question 28

Describe the neuroadaptive model of craving

Answer 28

Chronic use leads to altered cell function, alteration in neurotransmitters leads to development of reward pathway. Discomfort associated with abstinence activates reward memory -> craving

Question 29

A 34-year-old female presents to A&E after an episode of violent retching and vomiting blood. Upon further investigation you reveal that the oesophageal bleeding is due to a mucosal tear. The patient admits to binge drinking and that she has an alcohol dependence problem.
What most accurately describes the above presentation

Answer 29

Mallory-Weis Syndrome

Question 30

Describe problem drinking and alcoholism

Answer 30

Alcoholism -> physical addiction to alcohol (dependence)
∴ Alcohol dependence -> withdrawal symptoms when abstaining
high tolerance for alcohol
little ability to control drinking. Problem drinkers -> may not have above symptoms but have substantial medical, psychological, and/or social problems as a result -> harmful use

Question 31

Describe the physical and psychological dependence of alcohol

Answer 31

high tolerance for large amount of alcohol, stereotyped drinking patterns, drinking early in the day & middle of the night, craving. Can be defined by alcohol-specific behaviours: inability to cut-down on drinking, binge drinking, need for daily use. memory loss whilst intoxicated, drinking non-beverage alcohol (e.g. cough syrup, mouthwash, etc)

Question 32

What are the symptoms of alcohol abuse

Answer 32

Disturbance in occupational functioning- job performance. Disturbance in social functioning- inability to function well socially without alcohol. Impact on relationships- family & friends concerned, harm to yourself and/or others. Drink in risky situations -> legal problems (e.g. driving convictions). Keep drinking despite health problems

Question 33

What are the risk factors for alcoholism

Answer 33

Gender- men twice as likely to develop alcoholism. Age- typically develops in young adulthood (20 - 40 years). Family history of alcohol abuse. Impulse control problems, antisocial personality disorder. SES- low income, social isolation

Question 34

What are the origins of problem drinking and alcoholism

Answer 34

Genetic factors- concordance rates in MZ vs. DZ twins, specific gene variants (e.g. GABA genes) linked to alcoholism. Learning (environmental stimuli shaping behaviour)- classical conditioning, operant conditioning (reinforcement, punishment). Social learning- modelling of parental & peer drinking. Cognitive expectancies- health belief model -> expectations of drug effects

Question 35

Describe the chronic effects of alcohol use in terms of structural and functional brain changes

Answer 35

diminished function of regions mediating regulatory behaviour  compulsive use. Korsakoff’s syndrome- persisting amnesic disorder. Chronic alcoholism withdrawal produces Delirium Tremens- mental confusion; terrifying hallucinations (e.g. tactile); agitation, restlessness; anxiety, depression; profuse sweating, tachycardia; nausea, vomiting, loss of appetite; seizures (common up to 48 hours post last drink, past complications)

Question 36

Describe Korsakoff’s syndrome

Answer 36

Persisting amnesic disorder

Question 37

What causes Delirium Tremens

Answer 37

Chronic alcoholism withdrawal

Question 38

What is Delirium Tremens

Answer 38

Mental confusion; terrifying hallucinations (e.g. tactile); agitation, restlessness; anxiety, depression; profuse sweating, tachycardia; nausea, vomiting, loss of appetite; seizures (common up to 48 hours post last drink, past complications)

Question 39

Why do people smoke

Answer 39

Genetic factors- twin studies, more prominent in transition to nicotine dependence, may involve long-term changes in brain reward & stress systems. Age- initiated using during early adolescence, period of experimentation, not all make transition to nicotine dependence, ~ 10% of UK 15-year-olds smoke regularly. Environmental factors-learned behaviour, avoidance

Question 40

What are the synergistic effects of smoking

Answer 40

Enhances impact of other risk factors in compromising health- nicotine increases reactivity to stress, compromised immunity, less physically active. May cause depression, especially in youth. Related to increased anxiety. Public largely unaware of synergistic effects
Graph shows smoking exposure effect in teenagers

Question 41

Describe nicotine addiction

Answer 41

addiction, reported to be harder to stop than alcoholism. Exact mechanisms unclear- classical conditioning (cue-evoked cravings), operant conditioning (+ve & -ve reinforcement): +ve reinforcement -> pleasurable & desirable, airway sensory stimulation, direct central effects of nicotine; -ve reinforcement -> regulating affects & performance, can result in impaired concentration, increased tension, anxiety, moodiness, low weight. Early intervention to reduce smoking, and prevention, important- media campaigns, shift in social norms, interestingly, anti-smoking ads may elicit cue-induced craving

Question 42

What are chippers

Answer 42

smokers- consume only a few cig/day, don’t move on to heavy smoking. Several risk factors shared with heavy smokers- tolerate social deviance, positive smoking attitudes. Exhibit more protective factors- greater value placed on succeeding; little smoke among parents & friends, less drug use. Number increased in recent decades, despite addictive nature of smoking

Question 43

What drug was developed to reduce alcohol consumption by acting as an opioid receptor antagonist

Answer 43

Naltrexone

Question 44

What are pharmalogical interventions in the management of alcoholism

Answer 44

Naltrexone (opioid antagonist  decreases desire to drink). Disulfiram, aka Antabuse (increases concentration of acetaldehyde  discomfort when drinking). Psychedelics to treat alcoholism ? Risks vs. benefits

Question 45

Describe the use of CBT In addiction management

Answer 45

Behaviour modification, identifying triggers (coffee, etc.), breaking cycle where CS -> CR in craving

Question 46

Describe non-pharmacological interventions in management of addiction

Answer 46

Transdermal nicotine patches (no sensory reward) – e-cigs?, stress management, lifestyle change

Question 47

Explain maintenance and relapse

Answer 47

Abstinence violation effect- single lapse can reduce perception of self-efficacy, increases -ve mood, decreased belief that can successfully quit smoking. Stress-triggered lapses lead to quick relapse. Occasional relapse is normal, not a sign of failure. Prepare for management of withdrawal- increased appetite, urge to smoke, coughing, discharge of phlegm. Avoid situational triggers (cue-triggered relapse)