The Clinical Relevance of Health Compromising Behaviours Flashcards
What are health compromising behaviours
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
What are the characteristics of health-compromising behaviours
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
Why are adolescents particularly vulnerable
Developmental state seen as window of vulnerability, risk-taking behaviour
Which factors predict substance abuse of all kinds
Neuroticism, Genetic risk factors, Low SES, Family conflict, Deviance-tolerant attitudes
Explain substance use to substance abuse
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
What is the leading cause of death in men aged 16-54
Alcohol
Describe the effect alcohol has on the GI tract
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
What are the risk factors for peptic ulcer disease
Age, alcohol abuse, prolonged NSAID use, socioeconomic status
Describe dependence, tolerance and withdrawal
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
Describe abstinence syndrome
Following sudden reduction or cessation, chronic alcoholism withdrawal can lead to delirium tremens, craving: Conditioning process whereby environmental cues trigger strong desire
When should a diagnosis of dependence be made
Three or more of the criteria have been present at some time in the last year
What criteria are used to assess dependence
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)
What is addiction
Chronic, relapsing disorder where compulsive drug-seeking & drug-taking behaviour persist despite harmful consequences- can occur in absence of physiological or chemical dependence
Describe the stages of addiction
Exposure, compulsion, loss of control
Describe learning perspectives of addiction
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
What is starting drinking again in order to relieve unpleasant symptoms an example of
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))
Describe operant conditioning associated with addiction
Learning that taking a substance can produce reinforcing effects or outcomes can exert profound effects on future behaviour
Describe positive reinforcement
Euphoria, feelings when intoxicated, enhanced social life etc
Describe negative reinforcement
Stress-reduction, coping mechanism, temporary relief from unpleasant sensations/ experiences
Outline the positive reinforcement reward pathway
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
What are the structures of the reward (dopaminergic) pathway
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
Explain what occurs beyond the reward pathway
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
Outline negative reinforcement in the reduction of stress and negative emotion
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
Describe substance dependence and reinforcement
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)
Describe the transition from reinforcement to the addicted brain
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
Describe craving according to classical conditioning and neuroadaption
Craving is a result of dependency and a learning process
Outline the classical conditioning explanation of addiction
UCS (alcohol) -> UR (intoxication).
UCS paired with CS (environmental cue)
UCS + CS -> CR. (intoxication)
CS -> CR
CS (drug cues) consequently activate reward circuitry.
Describe the neuroadaptive model of craving
Chronic use leads to altered cell function, alteration in neurotransmitters leads to development of reward pathway. Discomfort associated with abstinence activates reward memory -> craving
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
Mallory-Weis Syndrome
Describe problem drinking and alcoholism
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
Describe the physical and psychological dependence of alcohol
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)
What are the symptoms of alcohol abuse
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
What are the risk factors for alcoholism
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
What are the origins of problem drinking and alcoholism
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
Describe the chronic effects of alcohol use in terms of structural and functional brain changes
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)
Describe Korsakoff’s syndrome
Persisting amnesic disorder
What causes Delirium Tremens
Chronic alcoholism withdrawal
What is 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)
Why do people smoke
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
What are the synergistic effects of smoking
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
Describe nicotine addiction
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
What are chippers
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
What drug was developed to reduce alcohol consumption by acting as an opioid receptor antagonist
Naltrexone
What are pharmalogical interventions in the management of alcoholism
Naltrexone (opioid antagonist decreases desire to drink). Disulfiram, aka Antabuse (increases concentration of acetaldehyde discomfort when drinking). Psychedelics to treat alcoholism ? Risks vs. benefits
Describe the use of CBT In addiction management
Behaviour modification, identifying triggers (coffee, etc.), breaking cycle where CS -> CR in craving
Describe non-pharmacological interventions in management of addiction
Transdermal nicotine patches (no sensory reward) – e-cigs?, stress management, lifestyle change
Explain maintenance and relapse
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)
