Week 3

Question 1

What is the social influence approach?

Answer 1

The main emphasis of this approach is to make students aware of the various social pressures to use substances in order to be psychologically prepared to resist these influences.

Question 2

For early and middle adolescents the social influence approach does not appear to work that well. Why is that?

Answer 2

Instructing students not to conform to their peers while conformity peaks in this developmental stage might be less advisable.

Question 3

The social influence approach does work for late adolescents. How can this be explained?

Answer 3

As late adolescents are less oriented on the needs, expectations and opinions of their peers, it makes sense that programmes applying a social influence approach and programmes teaching refusal skills are effective in this specific developmental period.

Question 4

What are some individual or person-related factors discussed by Kleinjan & Engels considering substance use?

Answer 4

Knowledge, attitude, intention, motivation, coping, social skills, psychological problems, identity, education, genetics

Question 5

What are some environmental factors discussed by Kleinjan & Engels considering substance use?

Answer 5

Parents, norms, friends, availability

Question 6

What are the three types of preventions? (Three-tiered preventive intervention classification system)

Answer 6

1. Universal prevention like governmental policy measures and public education;
   2 Selective prevention;
2. Indicated prevention

Question 7

In the area of alcohol, … prevention and … prevention seem to work best. Smoking however benefits most from … prevention.

Answer 7

selective, indicated, universal

Question 8

What are the two key messages about prevention mentioned in the 5th lecture by Marloes Kleinjan?

Answer 8

1. Prevention works! (It saves 16.000 lives a year)
2. But improvement is possible! (5.000 more could be saved)

Question 9

On maps we see that northern countries drink …, while southern countries drink ….

Answer 9

less often but more, more often but less

Question 10

Are we in The Netherlands more worried about the how much people drink or about how often people drink?

Answer 10

How much people drink (the quantity)

Question 11

Which health issues of alcohol consumption are mentioned in the 5th lecture by Marloes Kleinjan?

Answer 11

• (temporary) damage to some neural brain systems
• higher risk of school-problems, traffic accidents, aggression, suicide, and violent crimes.
• later in life also, debt problems, ruined careers, divorces, and birth defects
• According to the WHO, there is a causal relationship between the total amount of alcohol consumption and more than 60 types of disease and injury

Question 12

What are some effects of cannabis use?

Answer 12

• increase in heart rate,
• decreased blood pressure
• decreased cognitive and motor function.
• cannabis use has been found to be associated with psychological problems and psychosis

Question 13

What are the two key strategies for the prevention of substance use?

Answer 13

• Reduce risk factors associated with negative outcomes
• Increase protective factors that diminish risk

Question 14

What is universal prevention? Name an example.

Answer 14

Prevention aimed at an entire population when they are not in a condition of known need or distress. Directed towards general behavioral and lifestyle changes. Goal is to lower new occurrences of a disorder. (Clear at School)

Question 15

What is selective prevention? Name an example.

Answer 15

Approaches targeted to individuals considered “at risk” for development of bad outcomes. This requires detection of individuals at high risk. Goal is to lower new occurrences of a disorder within a high risk population. (Preventure)

Question 16

What is indicated prevention? Name an example.

Answer 16

Individuals who exhibit early signs of problem behaviours. Goal: reduce intensity & duration, thereby preventing future escalation or re-occurrence. (What Do You Drink?)

Question 17

What do responsible prevention efforts include? There are 5 factors.

Answer 17

• Incorporating science-based knowledge (and use Intervention Mapping Approach!)
• Not only focusing on the individual but also the environment
• Thinking about at-risk AND general population
• Adjusting the material to the developmental level of the recipient
• Testing for program effectiveness PRIOR to widespread implementation

Question 18

Which nine points about effective prevention methods are discussed?

Answer 18

1. Comprehensive, time-intensive
2. Aiming for earliest possible intervention
3. Developmentally appropriate
4. Highly structured
5. Involving adults (f.e. parents, teachers)
6. Active and skills-oriented
7. Targeting multiple systems (individual, parents, schools, neighbourhood)
8. Theory-based

Question 19

Marloes Kleinjan discussed many prevention strategies that she tested for secondary schoolers. But only one of them showed positive results. Which one was this?

Answer 19

Preventure, many universal prevention methods did not show any effects. Preventure focuses on coping strategies.

Question 20

Universal prevention techniques are not recommended for early adolescents. What is?

Answer 20

It is better to focus on strengthening general competences and supporting parents of at-risk youth.

Question 21

What are the three stages of addiction described by Volkow et al.?

Answer 21

Binge and intoxication,
withdrawal and negative affect,
and preoccupation and anticipation (or craving)

Question 22

Persons with addiction no longer experience the same degree of … from a drug as they did when they first started using it.

Answer 22

euphoria

Question 23

In the addicted brain, the … system becomes overactive, giving rise to the highly dysphoric phase of drug addiction that ensues when the direct effects of the drug wear off

Answer 23

anti-reward

Question 24

What is meant with ‘clean’ is not ‘cured’?

Answer 24

Substance addiction results from changes in brain function. These changes are long-lasting, so ‘clean’ is not ‘cured’. Long lasting brain changes are the substrate of relapse.

Question 25

What is craving?

Answer 25

An overwhelming desire for the substance. Craving persists after discontinuation of use, outlasts withdrawal symptoms.

Question 26

Craving is provoked by which three things?

Answer 26

• Substance itself
• Substance-associated cues (paraphernalia, ‘scene’)
• Stress
  -> often a combination

Question 27

In pictures of the brain we see significant differences between control and addiction when we look at … and …. Both are less effective in people with addiction.

Answer 27

dopamine D2 receptors, glucose metabolism

Question 28

What is a progressive ratio schedule of reinforcement?

Answer 28

Incremental number of responses are required for every subsequent reward.

Question 29

Rats and mice showed change after prolonged substance use. What changed?

Answer 29

They got less sensitive to a bitter taste or external inferences

Question 30

What can animal studies study?

Answer 30

• rewarding and motivational properties of substances
• role of substance-associated cues in addictive behaviour
• relapse to substance use
• loss of control over substance use

Question 31

What is the positive reinforcement theory and what are its shortcomings?

Answer 31

Addiction is maintained because of the euphoria substances induce. Substances act as positive reinforcers because they produce pleasure and are therefore addictive. Role for ventral striatum, amygdala. Shortcomings: No clear relationship euphorigenic and addictive potential of substances. Negative consequences of addiction are enormous relative to pleasure. Substance taking can be maintained in absence of subjective pleasure.

Question 32

What is the negative reinforcement theory and what are its shortcomings?

Answer 32

Addiction is maintained because the aversion of withdrawal is alleviated by the substance. Substances used to ‘self-medicate’, relieving preexistent symptoms such as pain, anxiety or depression. Role for ventral striatum, amygdala, stress system. Shortcomings: Substances are used in the absence of withdrawal symptoms. Relief of withdrawal minimally effective in treating addiction. High tendency to relapse after withdrawal has subsided.

Question 33

What is the incentive sensitization theory and what are its shortcomings?

Answer 33

Incentive Sensitization Theory: Substances cause hypersensivity of brain substrate of motivation
(=nucleus accumbens dopamine) to substances and substance cues ‘Wanting’ (=motivation), not ‘liking’ (=pleasure) is enhanced → craving. Role for ventral striatum. Shortcomings: Behavioural sensitization can be evoked by a single substance exposure. Sensitization also results in enhanced motivation for natural reinforcers.

Question 34

What is the cognitive processing (‘habit’) theory?

Answer 34

During early stages of use, substance drug taking is voluntary and goal-directed. After prolonged use, substance taking gains automatic, habitual quality; driven by cues, but no longer voluntary or goal-directed. Role for dorsal striatum, prefrontal cortex. Automatic drug use with abundant availability. Narrowing of behavioural repertoire by substance cues.

Question 35

What is the disinhibition/impulsivity theory?

Answer 35

Prefrontal cortex involved in executive functions: attention, planning, decision making, working memory. Chronic substance use compromises frontal functions: impaired control of behaviour. Substance-directed behaviour difficult to inhibit. Role for prefrontal cortex.

Question 36

Addiction-related brain changes are in part reversible. What methods are mentioned?

Answer 36

Combination psychotherapy and pharmacotherapy:

• abstinence
• craving and relapse
• replacement therapy
• counteracting substance effects
• normalization of brain function