Guided learning: Addiction Flashcards
Define Addiction
- Addiction is classed as a relapsing and remitting disorder comprising behaviours that are performed in a complusive manner despite the potential for self harm
Why is addiction particularly difficult to treat?
- Difficult to treat as it is a relapsing remitting disorder that cycles through behavioural stages of anticipation, intoxication and withdrawal.
- Both psychological and physiological components underpin the behaviours making it very hard to treat.
What is the difference between addiction and dependence?
What is dependence syndrome?
- Addiction refers to the compulsive need for the substance
- Dependence is characterised by a state of withdrawal when the substance of abuse (drugs/ gambling) is removed.
- ICD 10 definition of dependence syndrome includes both elements of addiction and dependence
- Note addiction has been removed from ICD 10/ DMS 5 as it is considered stigmatising.
What are the most common substances/ behaviours that lead to dependence?
- analgesics and opiods
- alcohol
- tobacco
- stimulants –> caffiene
- sedatives/hypnotics –> solvents
- psychoactive substances
- gambling –> habit and impulse disorders
What is the main pathway associated with addiction?
The main pathway associated with addiction is the Reward pathway:
From the ventral tegmental area to the nucleus accumbens in the basal forebrain.
From here DA neurons project to the limbic system, (mesolimbic pathway) and the cortex (mesocortical pathway).
In the mesocortical pathway they project particularly to the prefrontal cortex where they are involved in higher cognitive function and personality.
The reward pathway is only part of a complex neural circuit involved in addictive behaviours. What are the three behaviours involved in addiction and dependence?
- drug seeking/ craving behaviours : anticipation of obtaining or taking the drug prior to its use
- Binging /Intoxication: taking the substance, the “highs”, tolerance and dependence
- Withdrawal: negative effects of removal of the drug
What two main categories can dependence be divided into?
- Psychological dependence – the need to keep performing compulsive behaviours, emotional distress on stopping these behaviours
- Physical dependence –> the need for the functional effect of the drug on the body itself, characterised by physical symptoms on withdrawal of the drug.
What are some of the physiological signs of withdrawal from prescription drugs?
What are some of psychological signs of dependence on prescription drugs?
- Legs throbbing –> muscles aches and cramps
- emesis –> throwing up
- hypothermia –> freezing all the time
Pyschological signs:
- behavioural change
- personality changes
- postive reinforcement
What is dependence syndrome?
What is the ICD 10 definition?
What is this classified as in DSM V?
- Dependence syndrome describes a group of behavioural, cognitive, and physiological phenomena that develop after repeated substance abuse. Typically includes:
- strong desire to take drug
- difficulty controlling its use
- persisting in its use despite harmful effects
- increased priority to drug use than other activities
- tolerance
- physical withdrawal
- DSMV classes all these behaviours as substance abuse disorders.
What is tolerance?
How might a patient experiencing tolerance present?
Tolerance describes the requirement for increasing amount of the drug/ behaviour to elicit the same level of positive reinforcement “high” as experienced during previous exposures to the substance/ behaviour.
Presents with: request for higher dose, complaint drugs arent working as well as they used to, may attend multple sites to obtain additional substance
What occurs when a person is experiencing tolerance?
- During tolerance the positve effects of the drug use is decreased with each use, whilst the negative effects are increased during the wear off.
What are the three types of tolerance?
- Acute tolerance –> repeated use of the drug in a short time frame, e.g. cocaine use in 1 night, each high will be less than before
- Chronic tolerance –> constant exposure to the drug over a longer period of time, e.g. opiod abuse
- Learned –> frequent exposure to the substance that is integrated into normal behavioural routine, e.g. alcohol abuse and “high functioning”, individual learns to compensate for the effects of alcohol.
Does exhibiting tolerance mean a person has an addiction/ dependence?
What is the physiological basis for tolerance?
- Exhibiting tolerance does not mean an individual has an addiction/ is dependent.
- Tolerance simply means decreased sensitivity or increased resistance to a drug that can result from long term exposure to many substances.
- May lead to alteration in receptor density/ conformation or circuitry affected.
What is withdrawal and how does it differ from the immediate crash that occurs after wear off of the drug/ behaviour?
- Withdrawal describes the effects of the removal of the substance
- It is often prolonged and painful, also termed detoxification.
- “Crash” is the rebound dip in mood or behaviour occuring immediately after wear off of the drug/ behaviour.
- Crash actually occurs before plasma levels of the drug wear off, due to a change in regional neuronal activation.
- High in striatum/ thalamus/ nucleus accumbens/ cortex subsides other areas take over such as striatum/ amydala, negative aspects become more dominant.
Complete this table with the physical and psychological effects of withdrawal
- Psychological: HIDe Away Feel Crap
- headache
- irritability
- dysphoria–> unease and dissatisfaction with life
- anxiety, anhedonia
- fatigue
- confusion
- Physical: SWEATTTY
- Tachycardia
- Tachypnoea
- Tremor
- hyperhidrosis
- lacrimation
- rhinorrhea
- confusion
Why are some of the psychological symptoms of withdrawal also classed as physiological?
- Withdrawal leads to physiological changes
- physiological changes affect neuronal cell function
- leads to psycholigcal changes occuring
- e.g. confusion due to altered neuronal metabolism
What is the difference between acute withdrawal and PAWS?
- Acute withdrawal: matter of weeks
- tremors and seizures
- intense cravings
- autonomic hyperreactivity
- PAWS: Post acute withdrawal syndrome:
- months after initial withdrawal
- psychological changes: insomnia, mood swings, anxiety, anhedonia
Label the following diagram showing the brain regions involved in the three stages of dependence:
1) druk seeking behaviour
2) binging behaviour
3) withdrawal behaviour
Green circuit –> Orbitofrontal cortex, mPFC (Medial prefrontal cortex), hippocampus
Red circuit —> Amydala, BNST (Bed nucleus of stria terminalis), which is the centre of integration for the limbic system, and ventral striatum
Blue circuit –> dorsal striatum, globus pallidus
What behaviours are the circuits shown involved in?
Green circuit –> Drug seeking behaviour: preoccupation, anticipation, craving, conditioned cues
Blue circuit –> Binge behaviour: euphoria, binge, reward, intoxication and habit
Red circuit –> negative emotions, dysphoria (unease general dissatisfaction), malaise, withdrawal
Fill out the picture
Salience = want/ desire
How does the route of administration infuence the likelihood of dependence forming?
Rate the speed of administration and the concentration peak in the CNS
- Route of administration determines the speed at which the drug hits the CNS, and therefore has an effect on the likelihood of the drug and positive effects forming.
- Inhalation, fast, large peak
- injection similar to inhalation, fast large peaks of conc in CNS
- Snorting, slower peak
- ingestion, slowest onset of peak conc in brain
What is the transtheoretical model for behaviour change?
- Its is a behavioural model for the stages through which an individual must go to alter a health related behaviour. Many rehabiliation clinics base their programmes around this model.
- The stages are:
- precontemplation
- contemplation
- preparation
- action
- maintenance
- can also replapse –> expected individuals will have to go through the cycle a few times before the behaviour will stick, reflect why relapse occurred and put systems in place to prevent it.
What is fetal alcohol syndrome?
How would an infant present?
How would a child or adolescent present?
- Fetal alcohol syndrome describes a developmental disorder caused by alcohol consumption during pregnancy, mainly occurs during 1-3 months pregnancy. Associated with growth and cognitive retardation.
- As alcohol rapidly diffuses across all membranes there is no safe amount that can be consumed during pregancy
- Alcohol associated with miscarriage and amenorrhoea
- Neonate presents with thip upper lip, absent philtrum, flat mid face, small nose, low nasal bridge, ear abnormalities, epicanthal fold (skin fold of upper eyelid covering inner corner of eye).
- Child presents with irritability, slow development and hyperactivity
- teens present with learning difficulties, poor impulse control and coordination, heart defects.
