16 Addiction – substances

Question 1

What is a drug/substance?

Answer 1

Anything that exerts an effect on body or mind –be it prescription, legal or illicit.

Question 2

What four kinds of effects might a substance have?

Answer 2

1. Neurophysiological –e.g. neurotransmitter dysregulation
2. Behavioural –aggression, disinhibition
3. Emotional – excitement, elation
4. Cognitive – disorientation, focus

Question 3

What is addiction?

Answer 3

Behaviours characterised by compulsion, loss of control and continued patterns of abuse despite perceived or objective negative consequences.

Question 4

How is habit distinguished from addiction in the field of substance use disorders?

Answer 4

Habit –a free choice to do something habitually

Addiction –no choice, as self-control is impaired by the substance

Question 5

Describe the choice theory of addiction (West, 2006)

Answer 5

The user balances up perceived benefits and costs, and makes decision.

Question 6

What evidence is there for the choice theory of addiction?

Answer 6

That addicts can stop cold turkey in certain circumstances. E.g. when pregnant.

Question 7

What’s the difference between addiction and dependence?

Answer 7

There’s no consensus –they’re often used interchangeably.

Question 8

What are the features of physiological dependence?

Answer 8

Physical symptoms of tolerance and withdrawal. The substance is needed to restore homeostasis.

Question 9

What are the features of psychological dependence?

Answer 9

Cravings lead to repetitive use. Drug used as coping mechanism.

Question 10

The symptoms of the A criterion for a substance-related disorder are split into 4 categories. What are they?

Answer 10

1. Impaired control
2. Social impairment
3. Risky use
4. Pharmacological

Question 11

What are the 4 symptoms in the Impaired Control category of criterion A of substance-related disorder?

2. Social impairment
3. Risky use
4. Pharmacological

Answer 11

Impaired control

1. Use of greater amounts or for longer periods than intended.
2. Repeated unsuccessful attempts to cut back/cease.
3. Excessive time obtaining the drug or recovering from its use.
4. Craving.

Question 12

What are the 3 symptoms in the Social Impairment category of criterion A of substance-related disorder?

Answer 12

Social impairment

1. Failure to meet obligations: home, work, school
2. Social and interpersonal problems
3. Social, occupational or recreational activities reduced

Question 13

What are the 2 symptoms in the Risky Use category of criterion A of substance-related disorder?

Answer 13

Risky use

1. Use in physically hazardous situations (e.g. driving)
2. Persistence despite awareness of physical or psychological problems exacerbated by use.

Question 14

What are the 2 symptoms in the Pharmacological category of criterion A of substance-related disorder?

Answer 14

1. Tolerance

2. Withdrawal

Question 15

What percentage of substance users have a comorbid psychiatric disorder?

Answer 15

60%

Question 16

What is the goal, when drinking, of 94% of males and 78% of females under the age of 19?

Answer 16

To get intoxicated. Duh.

Question 17

Why is substance abuse so prevalent in the young?

Answer 17

1. Younger individuals are more exposed to peer-related alcohol and drug use.
2. Heavy substance users are less likely to survive into later life.

Question 18

What evidence is there for a genetic basis for substance disorder?

Answer 18

Higher concordance rate in MZ twins than DZ twins.

Question 19

Is the genetic basis for substance disorder specific to certain substances?

Answer 19

No, looks like it’s non-specific. More of an addictive personality kind of thing.

Question 20

What neural systems are usurped by drugs in the process of neuradaptation (sensitization)?

Answer 20

Addictive drugs usurp neural circuitry normally involved in pleasure, incentive motivation and learning. They not only engage these reward systems, but change them.

Question 21

What two systems do drugs of dependence operate on?

Answer 21

1. The dopaminergic system

2. The endogenous opioid system

Question 22

What 2 dopaminergic brain circuits experience functional and structural changes from substance use?

Answer 22

1. Mesolimbic (amygdala, nucleus accumbens, hippocampus)
   - Acute reinforcing effects
   - Memory & conditioning linked to craving
   - Emotional & motivational changes during withdrawal
2. Mesocortical (prefrontal cortex, orbito-frontal cortex & anterior cingulate)
   - Conscious experience of intoxication
   - Salience
   - Expectations
   - Cravings
   - Inhibitory control/decision-making

Question 23

What is ‘compulsive use’ of a substance?

Answer 23

Continued use when the substance is no longer perceived as pleasurable.

Question 24

Describe the opponent process theory of addiction.

Answer 24

The drug activated a euphoric ‘a-process’ in brain reward circuits, which in turn activates an opponent ‘b-process’ –which serves to restore homeostasis. Subjectively, you feel the pleasant ‘a-state’, followed by the ‘b-state’, when you swing too far in the opposite direction.

Question 25

According to the opponent process theory of addiction, how are the a and b processes realised in addicts.

Answer 25

Once the b process is strengthened, the a process is less powerful. So you get less pleasure and worse withdrawals.

Question 26

What are the shortcomings of the opponent process theory of addiction?

Answer 26

An induced withdrawal state is LESS LIKELY to reinstate drug-seeking behaviour than re-exposure to positive drug effects. Relative to positive incentive processes caused directly by drugs...withdrawal much less powerful at motivating drug-taking than previously thought. And can't explain why addicts often relapse even after they are free from withdrawal.

Question 27

What single treatment is the best for substance use disorder?

Answer 27

There isn't one. Multiple treatments are more appropriate, because of the multiple factors that lead to substance use.

Question 28

How should dual-diagnosed clients be treated?

Answer 28

In an integrated fashion. If drugs are used to reduce anxiety, treating the addiction alone won't solve the problem.

Question 29

Does substance use treatment have to be voluntary to be effective?

Answer 29

No. Even when coerced – after being given a bit of MI – substance abusers may make positive changes.

Question 30

What three learning-based approaches are used in CBT for addiction?

Answer 30

1. Adjusting maladaptive behaviour patterns 2. Breaking down motivational & cognitive barriers to change (e.g. I can handle it, I can control use) 3. Skills deficits – poor coping strategies, distress tolerance, bad at dealing with stressors.

Question 31

How could cues for substance use be targeted to reduce substance use?

Answer 31

Identify cues for drug use – people, places, internal cues – and reduce likelihood of their occurrence. Rehearse non-drug alternatives to cues.

Question 32

What kind of cognitive distortions are typical of substance abuse?

Answer 32

Minimising – "one drink won't hurt me" | Hopelessness – "why bother trying, I'll always be an addict"

Question 33

How can artificial rewards encourage drug reduction?

Answer 33

Before naturally-occurring rewards are available (e.g., greater employment, relationship, and social success) artificial rewards may be used (monetary prizes, vouchers for goods, or treatment “privileges” e.g., take-home doses of methadone).

Question 34

What is motivational toxicity?

Answer 34

Motivational toxicity refers to the powerful drug-obsessed drive that takes control of a drug addict’s thoughts and behaviours at the expense of all other things. The toxic motivation of chronic, long-term drug abuse steals behavioural control away from the brain’s natural reward system and commandeers the associated cognitions into the endless pursuit for drug use (Esch & Stefano, 2004). Motivational toxicity is the combination of the over-valuing of the abused drug, reduced sensitivity to natural rewards, impaired inhibitory control and disrupted cognitive functioning (Volkow et al., 2004).