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NEUR3310 Neuroscience > WEEK 6: LECTURE 12 ADDICTION AND WITHDRAWAL > Flashcards

WEEK 6: LECTURE 12 ADDICTION AND WITHDRAWAL Flashcards

1
Q

What are the 2 Main Dopamine pathways?

A
  1. mesocorticolimbic
  2. Nigrostriatal
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2
Q

DA encodes?

A

DA encodes REWARD AND APPROACH OF REWARD TO SHAPE BEHAVIOUR

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3
Q

Mechanisms of Cocaine and Methamphetamine

A

Mechanisms of Cocaine and
Methamphetamine (‘INCREASE IN DA’)

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4
Q

Define Addiction - SUBSTANCE-USE DISORDERS (SUDs)

A

‘compulsive engagement in rewarding stimuli despite adverse consequences.’

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5
Q

Addiction – Substance-Use Disorders (SUDs)

*DSM 5 – 11 criteria, broadly organised into 4 categories = 4

list and explain them

A
  1. IMPAIRED CONTROL = a ‘craving’ or strong urge to use the substance; desire or failed attempts to cut down or control substance use.
  2. SOCIAL PROBLEMS = Substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are ‘given up or cut back’ because of substance use
  3. RISKY USE = SUBSTANCE IS USED IN RISKY SETTINGS - continued to use despite known problems
  4. DRUG EFFECTS: TOLERANCE (need for larger amounts to get the same effect); WITHDRAWAL symptoms (different for each substance)
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6
Q

OTHER ADDICTIVE BEHAVIOURS = 4

A
  1. BEHAVIOURAL
  2. GAMBLING
  3. SIMILAR BUT DIFFERENT - ‘COMPULSIVE:’
  4. EATING DISORDERS - BINGE EATING DISORDER, ANOREXIA NERVOSA etc
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7
Q

Using drugs does not lead to addiction but …PEOPLE WHOP AE VULNERABLE TO ADDICTION HAVE…

A

USING DRUGS DOES NOT = ADDICTION

  1. Vulnerabilities
    - 3. GENE-ENVIRONMENT INTERPLAY
    - 4. PAST TRAUMA/STRESSORS
    - 5. DEVELOPMENT
    - 6. SOCIETAL/CULTURAL FACTORS
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8
Q

List addiction phases = 5

A
  1. Non-problematic or recreational use
  2. escalation of drug use
  3. Compulsive and/or problematic use
  4. abstinence (withdrawal)
  5. relapse

it is cyclical

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9
Q

Stages of Addiction:
‘Neurocircuitry Perspective’

= 3 and where and what

A
  1. preoccupation/anticipation
    - in PREFRONTAL CORTEX
    - Executive function deficits
  2. Binge/intoxication
    - in BASAL GANGLIA
    - Incentive salience
  3. WITHDRAWAL/NEGATIVE IMPACT
    - in ‘EXTENDED AMYGDALA’
    - Reward deficit and stress surfeit

IT IS A FEEDBACK LOOP

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10
Q

Understanding ‘BINGE’ and INTOXICATION = 6

A
  1. occurs in MESOLIMBIC SYSTEM - NAc (nucleus accumbens) is the REWARD.\/MOTIVATION HUB
  2. All drugs pof abuse ACTIVATE THE MESOLIMBIC SYSTEM
    - 3. ‘STIMULANT DRUGS’ = fast and steep DA release in the NAc - acute rewarding effects
    -4. ‘OTHER DRUGS’ = NAc activity not necessary for Rewarding effects, but they indirectly activate nac which still reinforces behaviour
  3. BUT NEED REPEATED EXPOSURE –> ADDICTION
  4. REPEATED ACTIVATION of NAc REINFORCES DRUG-TAKING BEHAVIOUR
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11
Q

What is Chronic drug use? 3

A
  1. drug-related cues become conditioned stimuli after repeated use
  2. whenever cues appear INCREASE STRIATAL DOPAMINE —> INCREASED MOTIVATION
  3. ONE ASPECT UNDERLYING CRAVINGS
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12
Q

CHRONIC DRUG USE - EXPLAIN THE PROESS = 9

A
  1. REPEATED EXPOSURE –> ‘MALADAPTIVE SENSITISATION’
  2. Enhanced Dopamine neurotransmission in response in response to drug challenge
    —3. increased DA release
    —4. inhibition of D2 autoreceptors
    —5. D1 receptors more sensitive in NAc
  3. HYPERACTIVATION of the MOTIVATION/DRIVE CIRCUIT —> greater ‘wanting’ to drug and its cues and contexts
  4. Increase in ‘wanting’ for the drug and its cues without a change in ‘liking’
  5. Strong drug-taking urges –> ‘Compulsive use’
  6. eventually repeated use –> HABIT FORMATION
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13
Q

What is HABIT FORMATION? = 5

A
  1. No longer ‘goal directed’
  2. action no longer dependent of the outcome value
  3. automatic/compulsive
  4. continued use despite punishment or aversive effects
  5. shift from ventral to dorsal striatum activity
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14
Q

understanding habit formation - cell activity = 8

A
  1. VENTRAL STRIATUM. NUCLEUS ACCUMBENS

2 ‘outcome/value dependent behaviour’

  1. DORSOMEDIAL STRIATUM
  2. ‘outcome/value dependent behaviour’
  3. DORSOMEDIAL STRIATUM
  4. ‘stimulus/cue dependent outcome independent behaviour’
  5. DORSOLATERAL STRIATUM
  6. stimulus/cue dependent outcome independent behaviour’
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15
Q

Chronic Drug Use – Withdrawal/negative affect

Understanding what NEUROADAPTATION IS…4 and explain

A
  1. REPEATED HYPERDOPAMINERGIC SIGNALLING –> compensatory hypodopaminergic state
  2. REDUCED LEVELS OF D2 RECEPTORS and in the amount of DA released by DA cells
  3. Less BASAL DOPAMINE SIGNALLING –> Decreased sensitivity to natural rewards —>ANHEDONIA
  4. WITHDRAWAL with NEGATIVE AFFECT 9irritable, stress malasie), improved temporarily with Drug use
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16
Q

Preoccupation and Anticipation… NEUROADAPTATION = 4

A
  1. NEUROADAPTATION —> reduced D2 receptors
  2. Reduced D2 receptors impact PFC functioning —> ‘impaired cognitive control’
  3. Weakened executive control network
  4. Inability to ‘inhibit’ drug seeking behaviours contributes to impulsivity and compulsive drug seeking
17
Q

What is Craving?

A
  1. Drug related cues result in DA increase – increase LIKELIHOOD OF RELAPSE
  2. CRAVING INCUBATION - PROGRESSIVE INCREASE IN CUE-INDUCED CRAVING FOR THE DRUG FOLLOWING WITHDRAWAL
18
Q

(Some) Mechanisms Underlying Craving Incubation = 3

A
  1. CENTRAL AMYGDALA EXTRACELLULAR SIGNAL-REGULATED KINASE (ERK) ACTIVITY
  2. D3R ACTIVITY IN NUCLEUS ACCUMBENS 9NAc) CORE OR SHELL, or CENTRAL AMYGDALA
  3. ACCUMULATION OF ‘CA+2’ permeable GluA2-lacking AMPA receptors in NAc
19
Q

How to break out of the FEEDBACK LOPP OF ADDICTION? =

A
  1. Detoxification
  2. inpatient rehab – shelter from cues, drug seeking behaviour
  3. therapy to give coping strategies’ craving executive dysfunction, emotional processing
  4. Medication
20
Q

DE-ADDICTION… PHARMACOLOGICAL METHODS…5

A
  1. usually USED IN COMBINATION WITH NON-PHARM AND PSYCHOSOCIAL INTERVENTIONS
  2. REPLACEMENT with safer option
  3. reduce cravings and withdrawal effects
  4. deter via increased negative effects
  5. NO FDA- approved treatment for stimulant abuse yet
21
Q

HOW TO Replacement with safer option WITH EXAMPLES…5

A
  1. REPLACEMENT with LESS ADDICTIVE, SAFER OPTION ‘AGONIST’
  2. SMOKING: Nicotine replacement therapy
  3. OPIODS
  4. — METHADONE AND BUPRENORPHINE
  5. — ‘Methamphetamine’ : MODAFINIL
22
Q

EXPLAIN WHAT ‘METHADONE’ IS: =

A
  1. no ‘HIGH’
  2. REDUCE CRAVING and PREVENT WITHDRAWAL
  3. lasts longer - so can administer once per day
  4. Occupies OPIOID RECEPTOR BINDING SITES – less effect on another opioid, if taken
  5. LONG-TERM MANAGEMENT: months to years
  6. CONTROLLED ADMINISTRATION - lower risk of overdose, reduce IV drug use
23
Q

REDUCE CRAVINGS AND WITHDRAWAL SYMPTOMS FOR ALCOHOL, SMOKING AND OPIODS - MEDS = 6

A

ALCOHOL
1. NALTREXONE - opioid receptor antagonist - reduce craving and rewarding effect of alcohol/opioid use

  1. ACAMPROSATE - modulate GABA And GLUTAMATE RECEPTORS to RESTORE BALANCE

3 - inhibit NMDA glutamate receptor activity which are hyperexcitable and associated with physical symptoms of withdrawal and craving

SMOKING
4. BUPROPION - anti-depressant, inhibit DAT and NET. Increase DA for anti- craving and anti-withdrawal –combat hypodopaminergic state

5 - can also be used in combination with NALTREXONE for ALCOHOL TREATMENT

OPIOIDS
6 - NALTREXONE

24
Q

DE-ADDICTION — INCREASE NEGATIVE EFFECTS …6

A
  1. DISULFIRAM
  2. inhibits metabolism of alcohol - in hibits acetaldehyde dehydrogenase
  3. build up of acetaldehyde –> unpleasant side effects

4.* E.g. flushing, headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, marked uneasiness, weakness, vertigo, blurred vision, and confusion

  1. NOT A FIRST LINE TREATMENT, POOR ADHERENCE
  2. LOOK AT CHEMICAL EQUATION.. SLIDE 21 FOR ETHANOL —> DISULFIRAM (ANTABUSE)–> ACETATE
25
Q

DE-ADDICTION …NEW TARGETS AND METHODS…9

A
  1. COMBAT ‘ALTERED PLASTICITY’ during Addiction
  2. BRAIN STIMULATION —> activity-induced plasticity changes
  3. E.g. repetitive transcranial magnetic stimulation (rTMS)
  4. REDUCE CRAVING BY:
    1. COMBAT HYPODOPAMINERGIC STATE:
      —- 6. INCREASE SYNAPTIC DA
      —- 7. UPREGULATE D2 RECEPTOR ACCUMULATION
    1. STRENGTHEN PFC GLUTAMATE SYNAPSES
      —-9. improve executive deficits
26
Q
  • Neurological changes with chronic drug use = 6
A
  1. Cue-induced craving
    • Maladaptive sensitisation to the drug
    • Reduced basal dopamine signalling (neuroadaptation)
    • Weakened executive functions
    • Habit formation
    • Craving incubation
27
Q
  • Pharmacological approaches to deaddiction = 4
A

1 * Replacement with safer alternative

2 * Reduce craving and withdrawal symptoms

3 * Increase negative effects

4 * Alter plasticity

NEUR3310 Neuroscience (18 decks)

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