Addiction

Question 1

Effects of drugs can be:

Answer 1

Neurophysiological
Behavioural
Emotional
Cognitive

Question 2

The most rapid route of drug administration is, then..?

Answer 2

Inhalation, intravenous, oral

Question 3

DSM-5 marks the first presence of the word

Answer 3

Addiction

Question 4

What are the key features of an addiction?

Answer 4

1. Chronic disease of brain reward, motivation, memory & related circuitry
2. excessive pursuit of reward (either positive rft and/or negative rft)
3. Diminished control
   - repeated unsuccessful efforts to reduce or control use
   - persistent use despite harmful consequences
4. Compulsion and craving
5. Salience: rewarding qualities of the substance becomes predominant over other interests
6. Increased tolerance and withdrawal syndrome on discontinuation
7. cycles of relapse and remission common

Question 5

the Choice Theory of addiction is in contrast to the

Answer 5

Impaired control model

Question 6

Addiction and _______ often used interchangeably

Answer 6

dependence

Question 7

What is the difference between physiological dependence and psychological dependence?

Answer 7

Physiological dependence is associated with physical symptoms of tolerance withdrawal

Psychological dependence is associated with cravings/desire leading to repeated (compulsive) use

Question 8

What is the average age of onset for alcohol dependence?

Answer 8

23-33

Question 9

What is the average of alcoholics entering treatment?

Answer 9

40

Question 10

___ of substance users have a comorbid psychiatric disorder?

Answer 10

60%

Question 11

Patients with mood/anxiety disorder _____ as likely to develop substance disorder, and vice versa

Answer 11

twice

Question 12

likely that the genetic basis for substance dependence is largely ________, rather than unique to particular substances

Answer 12

non-specific

Question 13

once sensitised, individuals often show…

Answer 13

cross-sensitisation

Question 14

Majority of drugs are association with…

Answer 14

the dopaminergic reward system

Question 15

What is the kitchen sink analogy?

Answer 15

Drugs act like a rubber stopper - stopping the reuptake of dopamine in the neurons
This causes an excess of dopamine in the synapse, this ‘overflow’ causes pleasure and euphoria

Question 16

The mesolimbic system of the amygdala, nucleus accumbens and hippocampus is associated with…

Answer 16

acute reinforcing effects, memory and conditioning linked to craving, emotional and motivational changes during withdrawal
Arousal and euphoria

Question 17

The mesocortical system of the PFC, obito-frontal cortex and anterior cingulate is associated with…

Answer 17

conscious experience of intoxication, salience, expectations, craving, inhibitory control/decision-making
Increased inhibition, bad decision-making

Question 18

Ventricle tegmental area sends dopamine —> __________ —> regulates emotions; _________ —> controls motor functions —> __________, memories formed —-> __________, decision-making and attention

Answer 18

amygdala
nucleus accumbens
hippocampus
prefrontal cortex

eg eating a piece of cake
amygdala: this is delicious, making me happy
nucleus accumbens: pleasure centre activated, making u want to take another bite
hippocampus: remembers experience and context
prefrontal cortex: focus attention on cake, making the decision to take another bite
reward system = reactivated with each bite

Question 19

Drugs of dependence operate on three areas:

1. basal ganglia
2. extended amygdala
3. prefrontal cortex

Answer 19

1 = reward and formation of habitual use
2 = irritability, anxiety and withdrawal 
3 = decision making/control

Question 20

The four stage cycle of addiction involves

Answer 20

1. binge/intoxication
2. withdrawal/negative affect
3. preoccupation/anticipation
   - –>
4. craving/compulsive usage

Question 21

What is incentive salience via conditioning?

Answer 21

With repeated use, there is increased salience for using that particular substance
- taking priority over other natural rewards, social activities

Question 22

What happens when you take the drug away?

Answer 22

A state of depletion in the dopamine system; an aversive state, experienced with physical symptoms of withdrawal —> motivates individuals to continue taking the drug

Question 23

Withdrawal —> ______ reinforcement

Answer 23

negative

Question 24

How do neurotransmitters change in addiction?

Answer 24

compensate for excess dopamine - dopamine dysregulation

Question 25

What is the violation effect?

Answer 25

person is abstinent for a long period of time, but then is exposed to stress (which they have in the past associated with usage) leading to relapse (negative reinforcement) - reward memory in hippocampus

Question 26

What are the different phases in learning theories of addiction?

Answer 26

Acquisition (experimental/circumstantial drug use ---> casual drug use) Motivational phase - compulsive drug use - motivation to use increases ---->Addiction

Question 27

Opponent-process theory A-process = B-process =

Answer 27

``` A = euphoria from drugs B = bring back to homeostasis ```

Question 28

With repeated usage, the ___-process becomes stronger, which results in _________ and requires ______

Answer 28

B tolerance increasing dosage of drug (A) to make it the same response as you previously had

Question 29

Prolonged abstinence can ________ b-process. Once b-process returns to normal, addiction _______.

Answer 29

decay | ceases

Question 30

How does antabuse work to treat alcohol addiction?

Answer 30

If you drink you become violently ill - lose positive association (counter-conditioning)

Question 31

What are the targets of CBT?

Answer 31

1. maladaptive behaviour patterns 2. motivational and cognitive barriers to change 3. skills deficits (eg improve capacity to say no thanks to alcohol) 4. identify high risk situations (eg people, places, internal cues) 5. reduce likelihood these situations are encountered 6. rehearsing non-drug alternatives to cues 7. enhance motivation for alternative activities 8. target cognitions that enhance likelihood of drug use 9. emotion regulation 10. non-drug alternatives to reducing negative affect (social support)

Question 32

What are the common barriers to effective treatment?

Answer 32

1. psychiatric comorbidity 2. acute or chronic cognitive deficits 3. medical problems 4. social stressors 5. lack of social resources

Question 33

90% of gambling disorder patients started gambling before the age of...

Answer 33

20

Question 34

In DSM-IV, gambling was classified as an

Answer 34

Impulse control disorder (ICD)

Question 35

Which sub-criterions in gambling disorder correlate with 1. psychological dependence 2. tolerance 3. withdrawal 4. negative reinforcement & motivation 5. erroneous and distorted cognitions 6. impaired control

Answer 35

1. preoccupation 2. increased amount gambled 3. irritability/restlessness after cessation 4. escape from stress 5. chasing losses 6. repeated failure to cease

Question 36

2/3 of pathological gamblers experience _______ prior to developing problems

Answer 36

large wins

Question 37

The cognitive model of gambling assumes __________ beliefs and misunderstanding concepts of __________ and mutual independence of chance events contributes to overinflated estimates of winning

Answer 37

erroneous | probability

Question 38

What is cognitive regret?

Answer 38

Gamblers persist to avoid the pain of missing a win | - like walking away from a bus stop

Question 39

What is the gambler's fallacy?

Answer 39

after a losing streak, a win is due - assume that there is memory involved in the machine - assume that law of averages applies to a small window

Question 40

The integrated bio-psycho-social model of gambling show multiple interactive vulnerability factors, that being

Answer 40

1. neurobiological / genetic 2. family history 3. belief schemas 4. peer group interactions 5. coping strategies 6. personality traits

Question 41

The random ratio reinforcement schedule is highly resistant to...

Answer 41

extinction

Question 42

Are the same brain regions activated in gambling and substance misuse?

Answer 42

yes

Question 43

Pathway one of gamblers: | Symptoms are causal outcomes of gambling-related problems: amenable to ____________, ___________ and _____________

Answer 43

psychoeducation, brief interventions and brief CBT

Question 44

Pathway two of gamblers: | ____________, ___________ and ____________ contribute to gambling (dissociation and escape)

Answer 44

affective disturbances poor coping skills substance misuse

Question 45

Pathway three of gamblers: | Deficits in ____________ and ________: treated with _________ and __________ interventions

Answer 45

``` reward pathways (dopaminergic), impulsive psychopharmacology, intensive ```

Question 46

Pathway 2 gamblers prolong their sessions in order to...

Answer 46

allow continued emotional escape

Question 47

Pathway 3 gamblers often show a history of..

Answer 47

family instability, abuse/neglect

Question 48

In the Inhibition Dysregulation Theory (2004), parts of the frontal region of the brain such as the _____ and _________ are thought to compromise the _________ system. Impairment of the ______ system results from compulsive drug-taking as well as other compulsive behaviours.

Answer 48

obito-frontal cortex anterior cingulate cortex inhibitory

Question 49

Medications for substance use disorders serve which three purposes?

Answer 49

1. antagonist drugs can be used to black the rewarding effects of the substance - --- eg naltrexone for alcohol 2. agonist medication can be used as a substitute for the abused substance in order to reduce the harms associated with substance misuse (eg methadone for heroin) 3. medication may be used to reduce severity of withdrawal symptoms - nicotine patches

Question 50

Females report gambling predominantly as a means to deal with _____, in contrast to males who report being motivated by factors related to ___.

Answer 50

negative emotional states | winning, excitement, chasing losses

Question 51

It has been proposed that the same _________ pathway underlying substance dependence is also relevant for behavioural addictions such as gambling.

Answer 51

neurobiological

Question 52

Decreased serotonergic activity has been consistently related to the personality traits of ________ and ____________.

Answer 52

impulsivity | sensation seeking

Question 53

Severity of gambling-related problems was significantly correlated to _________.

Answer 53

impulsivity

Question 54

The majority (80%-90%) of pathological gamblers have at least one..

Answer 54

personality disorder.

Question 55

m,≤The _____ and ________ schedules of reinforcement associated with gambling are known to produce behaviours that are highly resistant to ______.

Answer 55

intermittent, variable | extinction

Question 56

What is illusion of control?

Answer 56

Belief and over-magnification of one's skills and ability to influence or predict the outcome of an event.

Question 57

What is gambler's fallacy?

Answer 57

A series of losses must be followed by a win

Question 58

What is biased evaluation?

Answer 58

Successful outcomes are attributed to one's skill; losses are discounted as due to unforeseen external reasons.

Question 59

What is selective recall?

Answer 59

Selectively recalling wins and forgetting losses

Question 60

What is gambling as a source?

Answer 60

The belief that one can win at gambling - over the long term one can come out ahead

Question 61

What is illusory correlations?

Answer 61

misinterpretation of a correlation between mutually independent events

Question 62

Pathway 3 refers to 'biologically based problem gamblers' with ________ dysfunctions that result in high levels of _________ and differential responses to _______ and ___________.

Answer 62

neurochemical impulsivity reward punishment