Addiction

Question 1

What two areas of the brain are mainly involved in addiction?

Answer 1

Reward pathway (VTA to nucleus accumbens) and the Judgment area (prefrontal cortex)

Question 2

What is the reward deficiency syndrome and what are the effects?

Answer 2

It is an inherited trait in which a person has less D2 receptors. The results include:

inability to feel joy
low motivation
insecure
overwhelmed
SAD
Difficulty achieving orgasm

Question 3

What is the significance of the adolescent brain and addiciton? What are the results?

Answer 3

• More vulnerable.
• Brakes (frontal lobes) are still maturing.
• Prone to impulsivity.
• Weakened by peer pressure.

The earlier someone begins to use an abusive substance, the more likely they are to become dependent on it. The frontal lobe isn’t entirely mature until about 25.

Question 4

What is the difference between the addicted individual and the non-addicted individual? What are some traits of each?

Answer 4

• Poor insight
• Manipulative
• Selfish
• Dishonest
• Inconsiderate
• Entitled
• Good insight
• Generous
• Honest
• Considerate
• Non-demanding

Question 5

What is the best predictor of sustained recovery (8+ years) of substance dependence? Give examples.

Answer 5

Extended Abstinence is Predictive of Sustained Recovery

After one year of abstinence, more than half are likely to remain abstinent. During the 3-5 year period, 86% will achieve sustained recovery.

Question 6

What role does long term potentiation play in addiction? What do dopamine receptors have to do with that?

Answer 6

The individual will always remember how good that first high felt. Even after years of sobriety, their brain will still remember that. As periods of dependence continue, dopamine receptors will be downregulated, meaning the same high can’t be achieved. However, people will remember that first high and thus continually seek it out, taking more and more and more but never achieving it.

Question 7

What are some opiod seeking behaviors?

Answer 7

• Manipulative and demanding behaviors
• Only possible solution
• Insists on addictive drugs at first visit
• Non-addictive drugs “don’t work” or “allergic”
• High tolerance
• Lost prescriptions and early refills
• Pitting one physician against another
• Praising the physician
• Non-pharmacologic options quickly dismissed
• “Write rather than fight”

Question 8

What are 5 questions to ask prior to starting opiod therapy?

Answer 8

• 5 questions to ask prior to starting opioid

therapy: – Family History of Substance Abuse

– Personal History of Substance Abuse

– Age between 16 and 45

– History of preadolescent sexual abuse

– Psychiatric disorders: ADHD, OCD,MDD, Bipolar

disorder, schizophrenia

• Aberrant (drug-seeking) behaviors

– Low Risk: 6%

– Medium Risk: 28%

– High Risk: 91%

Question 9

What are some good things to keep in mind concerning opiods?

Answer 9

• Between 10% and 30% of our patients who are

prescribed opioids are abusing them.

• Random urine drug screens are very helpful.
• Use a non-judgemental, empathic but firm

approach with drug abusers.

• Good treatment options are available and life-
saving.

• Consider supporting Missouri’s PDMP.

80% of opiod use occurs in the united states