28. Introduction to Addictions Flashcards Preview

M2 Psychiatry > 28. Introduction to Addictions > Flashcards

Flashcards in 28. Introduction to Addictions Deck (37)
1

Is physiological tolerance and withdrawal enough to describe someone as addicted?

NO, tolerance/withdrawal are not enough to diagnose an addiction. Addiction requires other criteria such as: loss of control, substance use despite adverse health/social/financial effects, use under dangerous conditions, failing to live up to obligations, etc

2

what is classical conditioning?

involves a previously irrelevant stimulus (ie, bell with Pavlov's dog) that becomes meaningful by association with a reward (dog food). Plays a huge role in drug use and relapse.

3

what is operant conditioning?

involves both positive and negative reinforcement.

4

what is positive reinforcement?

INCREASES the frequency of behavior because the behavior makes a good feeling start.

5

what is negative reinforcement?

INCREASES the frequency of behavior because the behavior makes a BAD feeling END.
note different from punishment which will DECR the frequency of behavior

6

very generally, how do addictive drugs activate the reward pathway?

Reward Circuit: Dopaminergic neurons in ventral tegmentum; these project up to the nucleus accumbens and from there, access the higher brain centers.

7

generally, what is the cycle of addiction?

Drug euphoria --> neuro-adaptation --> drug craving --> brain reward --> back to euphoria and adaptation

8

what are the adaptations (2 main ones) that the brain uses in response to drug use?

neuro-adaptations:
1. tolerance
2. upregulate the anti-reward system
unfortunately, the net result is that, after taking drugs, something that should be naturally rewarding (food, sex, exercise) now is much less rewarding.

9

What is the anti-reward system, and why do we need it?

Turns off the reward, so that we will do the behavior again to prompt another reward. Basically a decay of the reward signal.

10

in order of speed of delivery/effect, what are the various routes of drug administration?

oral (slow due to first pass effect)
intranasal
IV
intrapulmonary (bypasses the venous system)

11

Why can addiction be considered a disease? (3 reasons)

1. addiction has identifiable symptoms
2. has a predictable course
3. has treatment that is as successful as that for other diseases (diabetes, asthma)

12

3 different causes of relapse, in general terms?

cue-induced
stress-induced
drug-induced

13

what would be an example (in mouse model) of a cue induced relapse?

train mouse to self-administer drugs in a cage with a checkered floor. then un-addict the mouse.
mouse will try again to administer the drug when placed on a checkered floor.

14

human analog to cue-induced relapse?

people, places, things

15

what would be an example (in mouse model) of a stress induced relapse?

train mouse to self-administer drugs. then un-addict the mouse.
Stress mouse (foot shock): mouse will attempt to self-administer again.

16

human analog to stress-induced relapse?

kinda obvious: stress
HALT = hungry, angry, lonely tired

17

what would be an example (in mouse model) of a drug induced relapse?

train mouse to self-administer drugs. then un-addict the mouse.
Give mouse drug again unexpectedly. mouse will attempt to self-administer again.

18

human analog to drug-induced relapse?

having one drink and relapsing completely

19

define a full agonist

bind/activate the receptor in a dose-dependent way. linear response until max is achieved.

20

most abused opioids are what kind of agonist?

full agonist

21

define a partial agonist

bind/activate the receptor, but increased dose is less effective than with a full agonist.
max point is lower than a full agonist --> diminishing returns

22

what kind of agonist is methadone?

full. think Porsche

23

what kind of agonist is buprenorphine?

partial. think Penske moving truck

24

what kind of agonist is naloxone?

antagonist!! think gum in a lock. blocks agonists

25

how does positive reinforcement work to perpetuate drug use?

direct: you use drug, you get euphoria

26

how does negative reinforcement work to perpetuate drug use?

kind of indirect: you use drug, you avoid the misery of withdrawal

27

methadone works on what kind of receptors?

mu opioid receptors.

28

methodone: how used to stop negative reinforcement?

it has a long half-life, so pts can take it once/day and not have withdrawal. extinguishes the effect of negative reinforcement.

29

methodone: how used to stop positive reinforcement?

give people same dose as heroin, then rachet up dose to way past the heroin dose they used. now they can't afford to get high with heroin. stops positive reinforcement (can't afford heroin high)

30

methodone: we use it to get people off what drug?

heroin (and other opiates? unsure)

31

Buprenorphine: works on what receptors?

mu opioid receptors

32

Buprenorphine: how does it stop positive reinforcement?

binds really tightly to mu opioid receptor. nothing else (no other drug) will displace it. even if you take heroin, won't get high.

33

Buprenorphine: how does it stop negative reinforcement?

it has a long half-life, so pts can avoid withdrawal. extinguishes the effect of negative reinforcement.

34

why can addiction be considered a BRAIN disease?

1. all addictive substances act on one area of brain (ventral tegmental tract or reward system)
2. prolonged use causes changes in brain function that persist after end of drug-taking
3. addicted brain is different from non-addicted brain.

35

(handout) define social use of a substance

use without meeting criteria for either abuse or dependence

36

(handout) define substance abuse

maladaptive pattern of use leading to impairment/distress defined as one of these within 12 months:
-failure to fulfill major obligations
-use even when physically hazardous
-use-related legal problems
-use despite recurrent social/interpersonal problems that it is causing

37

(handout) define substance dependence

(essentially this is addiction: more severe than substance abuse)
three or more items from a long list within 12 months. List includes tolerance, withdrawal, interference with life activities, loss of control of use.