W5L1 Substance Disorders II

Question 1

Neurobiological Etiology of Substance Disorders

Answer 1

nearly all drugs stimulate dopamine systems in brain
people take drugs to avoid withdrawal
dopamine/endogenous opioids are central for acute reward and initiation of addiction
neuroplasticity reduces capacity of prefrontal cortex to initiate behaviors in response to biological rewards and exercise executive control over drug seeking

Question 2

Allostatic Model of Addiction

Answer 2

highlights that drug addiction has characteristics of both impulse-control disorders and compulsive disorders
shift from positive to negative reinforcement
3 stages of addiction:
1. Preoccupation/Anticipation
2. Binge/Intoxication
3. Withdrawal/Negative Affect

Question 3

Treatment of Substance Disorders

Answer 3

4 million in 2006 received treatment; alcohol dependence 24% with lifetime AD received treatment
drug dependence treatment very infrequent: 8.1% for abuse, 37.9% for dependence
treatment more likely for those with comorbid psychopathology

Question 4

Treatment of Alcohol Use Disorders

Answer 4

inpatient hospital treatment detoxification
AA: largest self help group for problem drinkers, regular meetings provide support, understanding, acceptance; promotes complete abstinence

Question 5

Cognitive and Behavioral Treatments

Answer 5

contingency management therapy: patient and family reinforce behaviors inconsistent with drinking, teach problem drinker how to deal with uncomfortable situation, reward people for not using
relapse prevention: helping people to stay abstinent
brief motivational interventions: someone meets with people after they have an incident, even at the ER; screening, brief intervention, referral to treatment
controlled drinking: consuming alcohol in moderation, guided self change (does NOT work with drugs, only alcohol)

Question 6

Medications to Treat Alcohol Use Disorder

Answer 6

antabuse: produces nausea and vomiting if alcohol is consumed
naltrexone, acamprosate: most effective when combined with CBT

Question 7

Treatment of Illegal Drug Abuse and Dependence

Answer 7

detoxification is essential
CBT, AA attendance
drug replacement treatments/medication
heroin replacements (synthetic narcotics) used to wean heroin users from dependence; most effective if combined with psychological support and treatment