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Flashcards in Addiction II Deck (13)
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describe the etiology of addiction

  1. drugs stimulate the brain's reward circuitry, either directly or indirectly, signaling the person to repeat the behavior
    • reward circuitry:
      • dopaminergic pathway
        • mesolimbic pathway
        • ventral tegmental area to the nucleus accumbens
  2. stimulation of the reward pathway affects functioning of the prefrontal cortex, altering self-control
  3. drug use may cause brain changes that result in physical withdrawal symptoms upon drug cessation
    • this discomfort may drive relapse
  4. repeated drug use decreases the availability of DA
    • this is associated with prolonged feelings of anhedonia aka "protracted abstinence syndrome"
  5. drug use has been paired with environmental/internal cues; these cues cause physiological changes that trigger drug seeking


describe vulnerability to addiction

  • genetics: genes account for 40-60% of the vulnerability to addiction
    • what is inherited is still unknown; possibly less DA availability
  • psychosocial factors (multiple)
    • age of first use
    • method of drug administration
    • presence of other mental illnesses


explain CAGE questions about alcohol

  • C: do you feel the need to CUT back on your drinking?
  • A: do you get ANNOYED with others for criticizing your drinking?
  • G: do you ever feel GUILTY about drinking?
  • E: do you ever need an EYE opener (morning drink)?

yes to ≥ 2 of these is highly suspicious of addiction


describe FOY questions in alcohol screening 

"Has concern about your drinking behaviors been expressed by your Family, Others, or Yourself?"

yes to this single question is suggestive of addiction


describe acceptable drinking limits in men and women


describe drug rehabilitation

  • in-patient setting
  • usually ≥ 90 days (after this time, anhedonia is improved and relapse is less likely)
  • recovery continues for a life time
  • early intervention is important
    • deterrents (e.g. denial, costs, stigma) often treatment by many years
    • successful treatment does occur (even if treatment was legally compelled)


describe what the acute phase of drug rehabilitation focuses on 

  • detoxification (getting person off drugs)
    • supervised drug tapering
    • pharmacological management of short-term withdrawal symptoms
  • treatment of associated medical problems (e.g. skin ulcers)
  • treatment of comorbid psychiatric problems (e.g. depression)


decribe the recovery phase of drug rehabilitation

  • recovery phase of treatment focsues on preventing relapse
  • challenges:
    • difficulty reversing habits (and enduring the protracted abstinence syndrome)
    • the Abstinence Violation Effect (AVE)
      • relapse causing shame and further non-sobriety
      • avoid AVE by:
        • preparing addict for relapse
        • not viewing relapse as sign of failure
        • immediate return to treatment (modified plan)


describe CBT in drug rehabilitation

  • CBT helps patients learn to recognize, avoid or cope with high-risk relapse situations
  • cognitive component:
    • emphasize importance of abstinence
    • learn to identify and correct self-defeating thoughts leading to relapse
    • have action plan ready to implement for high-risk situations


describe stimulus control, contingency management programs and aversion therapy in drug rehabilitation

  • stimulus control: i.e. remove/recondition cues that trigger drug-seeking behavior
  • contingency management programs
    • voucher system
    • reports to licensing body/employer after failing to achieve treatment goals
  • aversion therapy: emetic (associate cues with nausea) and faradic (associate cues with electric shock)


describe self-help groups (patient)

  • not formal treatment but therapeutic
  • includes inspirational testimony and moral support from others in recovery
  • provides a source of impulse control (via sponsors)
  • typically uses a 12-step framework
    • 1st step = admitting there is a problem
    • 12th step = helping others with their addictions


describe medication-assisted therapies

  • used as adjunctive treatment:
    • to act as substitute for a more harmful drug (replacement therapy)
    • to decrease craving or to block the effect of a drug of abuse
    • for aversion therapy


describe vaccinations for drug addiction

  • research on vaccines is in progress for cocaine and nicotine addiction
  • theory: following vaccination, when a substance of abuse is used, antibodies bind to the drug, making it too large to enter the CNS
    • thus, the durg does not have reinforcing effects