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Flashcards in Addiction II Deck (13)
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1

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

2

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

3

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

4

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

5

describe acceptable drinking limits in men and women

6

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)

7

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)

8

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)

9

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

10

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)

11

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

12

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

13

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