Addictive Disorders Flashcards
1
Q
Give the two groups of substance related disorders.
A
Substance use and substance-induced.
2
Q
What do substance induced disorders include?
A
Specific mental health problems induced as a result of substance use, like stimulant induced psychosis and alcohol induced depression.
3
Q
Explain the placement of substance use disorders on a continuum from mild to severe.
A
Mild disorders show 2 or 3 of the 11 symptoms, moderate 4 to five, and 6+ is severe.
4
Q
Give the listed substances or classes of substances. (9)
A
Alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives (hynoptics or anxiolytics), stimulants, tobacco, and unknown substances.
5
Q
How could caffeine be classed as a substance?
A
It results in intoxication and subsequent withdrawal symptoms.
6
Q
Define physiological dependence.
A
Tolerance and withdrawal.
7
Q
Give Edwards and Gross’ precise description of alcohol dependence syndrome. (6)
A
Behaviours like priority given to drinking over other activities, a subjective awareness of a compulsion to drink, increased tolerance to alcohol, repeated alcohol withdrawal symptoms, consuming alcohol to avoid withdrawal symptoms and a rapid reinstatement of dependence even after a period of abstinence.
8
Q
Give the eleven diagnostic criteria for substance use disorder.
A
Larger amounts of the substance are consumed than intended; a persistent desire, or unsuccessful attempts, to reduce substance use; a large amount of time is spent, obtaining, using or recovering from the effects of the substance; craving for the substance; failure to fulfil major role expectations; continued substance use even when it interferes with social or interpersonal activities; reduction or ceasing of social or occupational activities; substance abuse occurs in physically hazardous situations; continued use of the substance even when the individual is aware of the problems it causes, and tolerance and withdrawal are present.
9
Q
An individual must have at least __ of the following symptoms within a __ month period, which have resulted in ____ ____ ____ or ____ to be diagnosed with a substance use disorder.
A
2, 12, clinically significant distress or impairment.
10
Q
Describe tolerance, as defined by the DSM-5. (2)
A
A need to increased amounts of the substance in order to achieve the same effect, or a markedly diminished effect for the same amount of the substance.
11
Q
Describe withdrawal, as defined by the DSM-5. (2)
A
A range of characteristic physical and psychological symptoms that emerge after cessation or reduction in substance use, or taking the substance (or a related substance) in order to alleviate these symptoms.
12
Q
What does withdrawal refer to?
A
The development of a set of symptoms that occur upon cessation of using the substance, especially after prolonged or heavy use.
13
Q
Which substance withdrawal state is life-threatening?
A
Alcohol withdrawal.
14
Q
Give some symptoms of alcohol withdrawal within 12 to 24 hours. (8)
A
Autonomic hyperactivity, nausea or vomiting, shakiness (increased hand tremor), insomnia, psychomotor agitation, increased anxiety, hallucinations, and grand mal seizures.
15
Q
When is the risk of death from severe withdrawal highest from alcohol withdrawal?
A
When the individual has a history of very heavy continuous drinking followed by an abrupt cessation in use.
16
Q
Name three opioids.
A
Morphine, heroin, and methadone.
17
Q
Give the symptoms of opioid withdrawal. (7)
A
Nausea and vomiting, diarrhoea, running nose and eyes, yawning and insomnia, muscle aches, piloerection and negative mood.
18
Q
How long can the symptoms of opioid withdrawal last?
A
5-7 days.
19
Q
Give the symptoms of stimulant withdrawal. (5)
A
Fatigue, vivid and unpleasant dreams, sleep disturbances, increased appetite and psychomotor agitation or retardation.
20
Q
Give the symptoms of cannabis withdrawal. (8)
A
Depressed mood, irritability, restlessness, sleep difficulty, increased anger and aggression, decreased appetite, nervousness/anxiety, and headache.
21
Q
Give the ICD-10’s definition of harmful use.
A
A pattern of psychoactive substance use that is responsible for clear physical or psychological harm, which may lead to disability or adverse outcomes for relationships.
22
Q
Give the ICD-10’s definition of substance dependence.
A
Three of more symptoms occurring over the previous month or repeatedly over the previous 12 months.
23
Q
Name all 6 of the symptoms for substance dependence.
A
A strong desire of compulsion to use, impaired control over use, physiological withdrawal symptoms, evidence of tolerance, preoccupation with substance use, and persistent use despite clear evidence of harm.
24
Q
What does ICD stand for?
A
International Classification of Diseases.
25
What is the most commonly used drug in Australia?
Alcohol.
26
ICD categories of harmful use and dependence occur in how many people, regarding alcohol?
1 in 20.
27
One of the reasons that substance use and substance use disorders predominate in the young relates to:
Birth cohort effects. Younger generations have been exposed to the easier availability of alcohol and drugs.
28
What does earlier first use of a drug increase the chance of?
Developing that substance use disorder in later life.
29
For each year that first use of alcohol is delayed, the risk of developing alcohol use disorder decreases by what percent?
5-9%.
30
Psychosis is how many times more common among regular amphetamine users?
11.
31
Describe methamphetamine powder, or speed.
The lowest purity of methamphetamine since it is easiest to cut with adulterants, with a median purity of 10%.
32
Describe damp/oily methamphetamine, or base.
More potent that speed, and less likely to be cut with adulterants, with a median purity of 21%.
33
Describe crystal methamphetamine, or crystal meth/ice.
The purest form, with a median purity of 80%, but there is an adultered form with a median purity of 19%.
34
What percentage of people with a drug use disorder have a comorbid mental disorder?
53%
35
What percentage of people with a alcohol use disorder have a comorbid mental disorder?
37%
36
Those with comorbid conditions typically have worse outcomes than those with single disorders on a range of measures including: (7)
Physical health, social and occupational functioning, self-harm and suicide, violence, homelessness and relationship problems.
37
Explain why substance use disorders have a high frequency of comorbidity with other psychological disorders. (3)
Individuals become dependent on a substance to escape negative feelings caused by mental health, or substances may cause mental health problems, or a third factor, like childhood trauma, may cause both substance abuse and mental illness.
38
How many times more likely are opioid users to self-harm or commit suicide?
6 times more likely to self-harm and 14 to commit suicide.
39
What percentage of suicide attempts involve the use of alcohol?
30-40%.
40
How does older age interact with substance abuse, and what effects foes it cause?
Higher blood concentration from alcohol use, higher use of prescription medication with can interact with alcohol, mortality from falls, motor vehicle accidents and suicide.
41
What has been linked to dementia?
Smoking and higher levels of alcohol use.
42
The misuse of what is likely to increase in the elderly?
Prescription medications.
43
What does the prevalence of substance use disorders decline with age?
Death from excessive use of substances reduces the number of people with these disorders who reach older age.
44
Those with a substance use disorder have a life expectancy of about __ years less than the general population.
14.
45
How does heavy alcohol use in the early 20s increase mortality?
Death from accidents, violence, and suicide.
46
How does heavy alcohol use increase mortality in later life?
The medical complications of excessive alcohol consumption, like liver cirrhosis and certain cancers.
47
Give four causes of death from illicit drug use.
Trauma, suicide, overdose, and infectious diseases like HIV or hepatitis related complications.
48
Explain the concept of DALYs, or disability adjusted life years.
The amount of time lost to both fatal and non-fatal events, or years of life lost due to premature death, coupled with years of healthy life lost due to disability.
49
In Australia, alcohol use accounts for what percent of the total burden of disease?
3.2%.
50
In Australia, illicit drug use accounts for what percent of the total burden of disease?
2%
51
In Australia, tobacco use accounts for what percent of the total burden of disease?
7.8%
52
How many Australian adults have been affected in some way by the drinking of others.
3/4.
53
What percentage of Australians reported serious harm like being threatened, physical assaulted or property damage, as a result of the drinking of strangers.
43%
54
What is the disease model of addiction?
The view than substance abuse is an incurable physical disease, such that only total abstinence can control it.
55
What is central to the disease model of addiction?
Loss of control.
56
Explain Skog's choice theory.
The apparent loss of control seen in those with a substance use disorder as a consequence of individuals changing their minds.
57
First-degree relatives of individuals with a substance use disorder are _ times more likely to suffer from such a disorder themselves.
8.
58
Give some supporting evidence for a genetic component to substance use.
Monozygotic twins have a higher concordance rate fro substance use disorders, and adoptees have a higher chance of developing substance use disorders if their biological parent had the disorder.
59
What are the brain's two major reward systems?
Dopaminergic reward system and the endogenous opioid system.
60
What is the endogenous opioid system?
The system within the body that produces and responds to both internally produced opioids (endorphins) and ingested opioids or opiates.
61
Levels of what increase following the administration of most drugs of dependence, like alcohol, nicotine, cannabis, opioids, cocaine and amphetamines.
Dopamine.
62
After administration of drugs, where does dopamine activity increase?
The nucleus accumbens.
63
Where does the nucleus accumbens receive information from?
The ventral tegmental area in the midbrain.
64
What is the pathway between the nucleus accumbens and the ventral tegmental area in the midbrain called?
The mesolimbic dopamine pathway.
65
Where are messages from the nucleus accumbens sent?
The prefrontal cortex where they are encoded as experiences.
66
What is the reward pathway from the nucleus accumbens to the ventral tegmental area in the midbrain implicated in?
A range of pleasurable activities, like eating and sex.
67
What kind of effect do substances have on the reward pathway?
A much greater effect than other activities.
68
Who proposed Inhibition Dysregulation Theory? (3)
Lubman, Yucel and Pantelis.
69
Describe Inhibition Dysregulation Theory.
Explains addiction as being underpinned by impairment of the neural system that is responsible for inhibiting rewarding behaviour.
70
What brain areas are implicated in Inhibition Dysregulation Theory? (2)
Orbitofrontal cortex and the anterior cingulate cortex.
71
Explain classical conditioning.
A form of learning in which a neutral stimulus, through its repeated association with a stimulus that naturally elicits a certain response, acquires the ability to produce the same response.
72
Explain the instrumental or operant learning model.
A model with posits than substance use problems develop as a result of conditioning based on instrumental learning principles.
73
What can classical conditioning be use to explain in substance use disorders? (3)
Tolerance, withdrawal and craving.
74
What conditioned response has been proposed as the reason why tolerance develops?
Unrelated stimuli that becomes associated with drug use elicits a response that prepares the body for administration of the drug, meaning that the body begins to compensate for the effects of the drug and reduces the effects of it.
75
What is neuroadaptation?
The brain adapts to the presence of a drug, and is unbalanced when it isn't present, leading to unpleasant symptoms of withdrawal.
76
When does negative reinforcement occur?
When a drug alleviates an unpleasant state.
77
Explain the opponent-process theory of addiction.
Brain processes act automatically once the balance or affective equilibrium of the brain has been disrupted; a drug will activate one process (the 'a' process) which then triggers an opponent process (the 'b' process) to bring the brain back to a state of affective equilibrium.
78
When does the individual experience a pleasant feeling in opponent-process theory of addiction?
When the 'a' process in greater than the 'b' process.
79
When does the individual experience an unpleasant feeling in opponent-process theory of addiction?
When the 'b' process is greater than the 'a' process.
80
What accounts for the process of tolerance in opponent-process theory?
The opponent process increases in strength and duration with each administration of the drug.
81
What accounts for the process of withdrawal in opponent-process theory?
The opponent process will be triggered fully by even a small reduction in the dose of the drug.
82
Explain the incentive-sensitisation theory of addiction.
Drugs of addiction change the areas of the brain that are responsible for the incentive to use drugs, causing the brain to become sensitised to the rewarding effects of the drugs and the stimuli associated with drugs via classical conditioning.
83
Define the incentive-sensitisation theory of addiction's pathological wanting.
A term for how much the individual wants the drug, because the incentive has been increased.
84
What sets incentive-sensitisation theory of addiction apart from other theories of drug-addiction?
Pathological wanting can be experienced consciously or unconsciously.
85
The incentive-sensitisation theory of addiction proposes that the pleasure associated with drugs becomes less important as physical dependence develops: dependent individuals ___ rather than ___ the drug over time.
Want, like.
86
Explain Cloninger's Tri-Dimensional Personality Theory.
A general personality theory which suggests that the interaction between three dimensions of personality influences vulnerability to developing a substance use disorder.
87
Give Cloninger's three traits.
Novelty-seeking, harm avoidance, and reward-dependence.
88
What are the characteristics of novelty-seeking?
Risk taking and impulsivity.
89
What are the characteristics of harm avoidance?
Caution and inhibition.
90
What are the characteristics of reward dependence?
Sensitivity to social cues and emotional dependence.
91
Describe Cloninger's individuals with type II alcohol use disorder.
Earlier onset, male, and have more problems.
92
Individuals with type II alcohol use disorder have been found to have:
High novelty-seeking, low harm avoidance and low reward dependence.
93
What is outcome expectancy theory?
A cognitive approach to substance use, where an individual's expectations of positive consequences from substance use increase their propensity to use the substance.
94
What was outcome expectancy theory originally developed to explain?
Heavy alcohol use.
95
What evidence supports outcome expectancy theory?
Positive expectations about alcohol (increased confidence and reduced tension) predict drinking to excess.
96
Describe Beck's cognitive theory of substance use.
Those who develop a substance use disorder have a network of dysfunctional beliefs.
97
How did Beck explain relapse after an extended period of abstinence?
External stimuli (being in a former substance-using environment) and internal stimuli (stress) activate the individual's substance-related beliefs.
98
Explain relapse-prevention theory.
A cognitive-behavioural theory of substance use and disorders, which argues that individuals in high-risk situations will use the substance if they do not have the appropriate coping strategies, have positive expectations of the substance, and have a low degree of self efficacy.
99
What does PRIME theory stand for?
Plans, responses, impulses, motives, and evaluations.
100
What is a plan, according to PRIME theory?
A mental map of what the individual intends to do in the future.
101
What are motives, according to PRIME theory?
The degree of attraction or repulsion to achieve the plan.
102
What are evaluations, according to PRIME theory?
A set of beliefs about a situation that may contain contradictory elements.
103
What is an impulse, according to PRIME theory?
The desire to take the substance.
104
What is a response, according to PRIME theory?
Whether or not the individual follows the plan.
105
What is the second theme of PRIME theory?
A focus on the movement, meaning that while people may intend to change their behaviour, their actions depend on moment-to-moment processes and events.
106
What is the third theme of PRIME theory?
Neural plasticity, where exposure to substances affects the motivation system (sensitisation or habituation).
107
What is the fourth theme of PRIME theory?
Addressing issues of identity and self-awareness, where beliefs the person has about themselves become a major source of motivation.
108
What is the fifth theme of PRIME theory?
Unstable mind, where motivation is inherently unstable and trivial events have the capacity to trigger behaviour.
109
Give two areas where familial influences have affected substance use.
Family functioning and parental modelling of substance use.
110
Give some types of family functioning that can result in substance use.
Ineffective parenting, negative communication patterns, and poor family relationships.
111
What is substance use the result of according to peer socialisation?
Influence from those in the individual's social network in the form of modelling, encouragement, and pressure.
112
What is substance use the result of according to peer selection?
The substance use behaviour occurs prior to the friendship, and the individual chooses to associate with others who have substance use behaviours similar to their own.
113
Why is inpatient treatment still important for drug use disorders? (2)
Detoxification, and patients with minimal social support to discontinue substance abuse often require different housing to minimise their drug use.
114
What occurs after detoxification in the treatment of substance use disorders?
Treatment as an outpatient or non-residential basis where the individual attends sessions with a health professional once or twice a week.
115
Give the three phases of detoxification.
Initial evaluation, a period of stabilisation including medical support for withdrawal, and linkage with treatment services.
116
What is detoxification?
A period of abstinence from a substance while providing support to manage the physiological and psychological symptoms of withdrawal.
117
Why is detoxification not a sufficient treatment approach for severe entrenched substance use disorders.
It produces high relapse rates.
118
Explain how vaccines for cocaine and nicotine work.
They stimulate production of antibodies so that when the drug is ingested, antibodies attach to the drug, making the molecule too large to cross the blood-brain barrier, which reduces the reinforcing properties of the drug.
119
What do antagonist drugs do?
Block the rewarding effects of the substance.
120
What does naltrexone do?
Reduce the rewarding effects of alcohol, craving for alcohol and consumption of alcohol.
121
What are agonist drugs?
Medications that can be used as a substitute to avoid the harm of substance use.
122
Give the use for the third kind of medication used in the treatment of substance use.
Reducing withdrawal symptoms.
123
What is motivational interviewing?
An approach that is valuable for individuals experiencing low motivation to change, exploring the client's ambivalence about their drug use and using a non-confrontational stance.
124
What does motivational interviewing increase?
The value of changing their substance use (weighing the positives and negatives) and their confidence that they can successfully change.
125
What type of intervention is appropriate when the substance use disorder is not yet severe?
Brief interventions.
126
What generally occurs in a brief intervention?
Limited contact with a health professional, usually involving assessment and feedback regarding the effect's of the individual's substance use on their health, normative feedback, educational material about the negative effects of substance use and strategies to overcome it.
127
What is normative feedback?
The amount that other people drink or use substances.
128
What is an ideal complete package for treatment of substance use disorder?
Screening, brief intervention, and referral for treatment.
129
With respect to substance use disorder, CBT typically focuses on: (3)
Helping the client to recognise situations where they are most likely to use drugs, help them avoid these situations, and help them cope with the problems and problematic behaviour arising from their drug use.
130
What kind of training has been shown as effective for alcohol use? (6)
Communicating effectively with others, problem-solving, assertiveness skills, drink/drug refusal skills, challenging dysfunctional beliefs, and relaxation and stress management.
131
Substance use disorders are often referred to as:
Chronic relapsing conditions.
132
With respect to substance use, give one definition of recovery.
Voluntarily sustained control over substance use, which maximises health and wellbeing and participation in the rights, roles, and responsibilities of society.
133
Define gambling.
An agreement between two or more parties to risk an item of value on the outcome of a chance event in order to obtain a larger return.
134
What percent of Australian adults gamble regularly?
15%.
135
How many adults play gambling machines weekly or more often?
5%.
136
What percent of adults have gambled at some point?
70-90%.
137
What are social, recreational, or non-problem gamblers?
People who gamble within affordable limits.
138
What is problem gambling?
The presence of harm irrespective of the chronicity, severity or impact of that harm.
139
Give the South Australian Centre for Economic Studies Report's definition of problem gambling.
Problem gambling is characterised by difficulties limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or within the community.
140
What is disordered gambling?
The severe end of the problem gambling spectrum, with impaired control manifested by repeated, failed attempts to cease or reduce gambling despite the development of significant negative personal, familial, financial, occupational and legal difficulties.
141
How does the DSM-5 defined gambling disorder?
A persistent and recurring problematic gambling behaviour leading to clinically significant impairment or distress as indicted by at least four of the diagnostic criteria in a one-year period.
142
Give the diagnostic criteria for gambling disorder. (9)
Need to gamble with increasing amounts of money in order to achieve the desired excitement, restlessness or irritability when attempting to cut down or stop gambling, repeated unsuccessful attempts to control, cut back, or stop gambling, preoccupation with gambling, frequent gambling when distressed, after losing money returning to get even, lying to conceal gambling, jeopardising or losing a relationship, job, education or career opportunity, relying on others to provide money.
143
What suggests a common neurobiological process underlying both gambling and substance use?
Similarities in genetic abnormalities and neurobiological activities involving reward pathways.
144
What percent of gamblers have comorbid alcohol abuse?
40%.
145
What percent of substance abusers are pathological gamblers?
30%.
146
Give some differences between problem gambling and substance dependence.
Symptoms following cessation of gambling are mild and psychological, in contrast to withdrawal symptoms from substance use, and substances act directly on reward pathways to the brain.
147
Why do women gamble?
To cope with negative emotional states.
148
Why do men gamble? (3)
Winning, excitement, and chasing losses.
149
Give some factors that contribute to the higher incidence of gambling in Indigenous communities. (7)
Cultural and traditional beliefs, isolation, poor integration in urban areas, lack of social cohesion/dislocation, racism, socioeconomic disadvantage, and family dysfunctions are higher than in the average community.
150
Name Custer's three phases of problem gambling.
The winning phase, the losing phase, and the desperation phase.
151
Explain Custer's winning phase.
People are motivated to continue gambling because of the excitement associated with occasional wins.
152
What event changes the affective salience of gambling?
A large win.
153
What is the affective salience of gambling?
Gambling-induced mood changes attain a position of dominance over those produced by other activities.
154
How does a large win increase gambling frequency?
A large win changes the affective salience of gambling and results in dysfunctional beliefs, which then lead to an increase in the frequency and intensity of gambling.
155
What triggers entry to Custer's losing phase?
Preoccupation with gambling, coupled with accumulating losses.
156
What occurs in Custer's losing phase?
Gambling escalates as the individual attempts to regain losses
157
What occurs in Custer's desperation phase?
Changes in personality emerge as the individual becomes stressed, irritable, and withdrawn and individuals may engage in illegal acts (stealing) for financial and psychological survival.
158
What percentage of problem gamblers in treatment have major depression?
75%.
159
What percentage of problem gamblers in treatment have substance use problems?
30-40%.
160
What percentage of problem gamblers report committing an offence to finance gambling.
60%.
161
When is suicide risk greatest for problem gamblers?
Immediately prior to the disclosure of debts, criminal offence, or marital disintegration.
162
Name the factors that have a role in the development of gambling disorder. (8)
Neurobiological/genetic, personality traits, family history, coping and problem-solving strategies, cognitive factors, peer-group interactions, media-based learning, and classical and operant conditioning.
163
Disturbance of which neurotransmitter systems may play a role in gambling disorder? (3)
Serotonin, dopamine and norepinephrine.
164
How do neurotransmitter systems affect gambling disorder? (3)
They affect behavioural inhibitory control, reward mechanisms and arousal in impulsive and addictive disorders.
165
Which pathway is central to neurobiological explanations of gambling disorder?
The dopaminergic pathway.
166
What does the dopaminergic pathway do?
Activates dopaminegic-enriched cells in the ventral tegmental area and in the nucleus accumbens.
167
What is serotonin?
A neurotransmitter involved in the regulation of mood, appetite and impulse control.
168
Which personality traits is decreased serotonergic activity related to?
Impulsivity and sensation seeking.
169
What are low levels of serotonin related to? (4)
Poor impulse control, like suicide, violent impulsive behaviour, alcoholism and arson.
170
Give some evidence for the connection between low serotonin activity and pathological gambling?
SSRIs reduce gambling behaviour.
171
Which gene (related to dopamine) is associated with impulsive/addictive disorders?
The dopamine recpetor D2 gene (DRD2).2
172
50.9% of those with pathological gambling carry the ____ allele.
D2A1.
173
Dopaminergic neurons are distributed through which brain structures? (5)
Mesolimbic, mesocortical and orbital frontal brain structures, including the ventral tegmental area, the nucleus accumbens, orbitofrontal cortex, amygdala and hippocampus.
174
What are the mesolimbic, mesocortical and orbital frontal brain structures associated with? (6)
Reward sensitivity, associative learning, memory, expectancies, cravings, and the emotional and motivation changes during withdrawal.
175
What is norepinephrine involved in?
Arousal, excitement, impulsive behaviour and sensation seeking.
176
What breakdown product of norepinephrine do pathological gamblers have more of in their systems, confirming a causal role of norepinephrine in gambling disorder?
3-methoxy-4-hydroxyphenolglycol (MHPG).
177
What kind of behaviour results for impulsivity?
Spontaneous behaviour carried out without regard to its consequences and an inability to delay gratification.
178
Define sensation seeking.
The desire for novel and stimulating experiences.
179
How does sensation seeking play a role in gambling disorder?
Higher sensation seeking is found in adolescent and adult gamblers and is associated with larger bets and gambling in casinos.
180
What is a personality disorder?
A chronic pattern of maladaptive cognition, emotion and behaviour that begins in adolescence or early adulthood and continues into later adulthood.
181
What do the majority of pathological gamblers have?
At least one personality disorder.
182
What kind of personality disorders are most commonly found in pathological gamblers?
The cluster B personality disorders, like narcissistic, antisocial and borderline personality disorder.
183
How is gambling a positive reinforcer?
It produces subjective arousal (elevated mood states like excitement or euphoria) and physiological arousal (increases in heart rate).
184
How is gambling a negative reinforcer?
The excitement helps the individual to escape negative mood states or emotional distress.
185
Which schedules of reinforcement produce behaviours highly resistant to extinction?
Intermittent/occasional and variable (unpredictable).
186
What schedules of reinforcement does gambling exhibit and how does that affect it?
Intermittent and variable, as the wins occur occasionally and at unpredictable times, leading to gamblers playing long after a win.
187
How is classical conditioning represented in the context of gambling?
Gambling-related environmental cues may be repeatedly paired with physiological arousal and subjective excitement associated with a win, resulting in later exposure to those environmental cues triggering a craving to gamble.
188
What do cognitive models of gambling emphasise?
The importance or irrational beliefs about randomness and probabilities causing individuals to overestimate their chance of winning.
189
Give the nine cognitive errors that result in problem gambling.
Illusion of control, gambler's fallacy, biased evaluation, selective recall, cognitive regret, superstitious beliefs and luck, luck as a personal quality, gambling as a source, and illusory correlations.
190
Explain illusion of control.
Belief and over-magnification of one's skills and ability to influence or predict an outcome.
191
Explain gambler's fallacy.
A series of losses must be followed by a win, when the chances of winning/losing remain the same on each play.
192
Explain biased evaluation.
Successful outcomes are attributed to one's skill, and losses are discounted for external reasons.
193
Explain selective recall.
Selective recalling wins and forgetting losses.
194
Explain cognitive regret.
Having invested considerable time and money in a session, a sense of regret at missing out on the next, potentially winning, gamble.
195
Explain superstitious beliefs and luck.
Use of lucky charms, prayers, objects, or rituals to improve the chances of winning.
196
Explain luck as a personal quality.
Believing one has a lucky quality, and can be related to cultural associations to ancestor's looking out for the individual.
197
Explain gambling as a source.
The belief that one can win at gambling over the long term.
198
Explain illusory correlations.
Misinterpretation of a correlation between mutually independent events.
199
Give the classifications for common thinking errors among gamblers. (3)
Illusions of control, superstitious rituals and beliefs and the gambler's fallacy.
200
Explain gambler's fallacy.
Selective recall and erroneous perceptions regarding randomness and the independence of chance events.
201
What are the most common cognitive errors?
Superstitious beliefs and illusion of control.
202
How many times more likely are adolescents who's parents have gambling problems to develop gambling problems themselves?
3.
203
Give a familial environmental influence for gambling problems.
Parental modelling of positive attitudes towards gambling.
204
Explain how early negative childhood experiences contribute to the development of problem gambling. (3)
Adolescent pathological gamblers more often come from dysfunctional families, have low self-esteem and report using gambling for excitement and to alleviate depression.
205
Explain Jacob's general theory of addictions.
Childhood social and developmental experiences lead to feelings of inadequacy, worthlessness, low self-esteem, and rejection predispose individuals to engaging in addictive behaviours.
206
According to Jacob's general theory of addictions, what does addiction allow individuals to do?
Escape emotionally painful realities and experience self-esteem enhancing fantasies of importance and success.
207
What is the basis of the exposure model of gambling.
As gambling opportunities increase within a community and shifts in attitudes occur, there will be greater participation in gambling.
208
Explain the social adaption model.
Populations eventually learn to adapt to environmental changes and challenges.
209
Why may pathological gambling be decreasing, according to the social adaptation model? (2)
Protective factors like the promotion of responsible gambling, familiarity, and loss of novelty.
210
What support is there for the exposure model of gambling?
Early prevalence studies, as increased rates of pathological gambling have been reported over the last 30 years as gambling has become more available.
211
Who proposed the integrated pathways model? (2)
Blaszczynski and Nower.
212
What factors does the integrated pathways model of gambling combine? (6)
Biological, personality, learning, cognitive, social and cultural factors.
213
What is a pathway 1 gambler, as described by the integrated pathways model?
Behavioural conditioned problem gamblers.
214
What are behavioural conditioned problem gamblers characterised by?
Excessive gambling in the absence of any psychological disturbances that predated their gambling problem.
215
What kind of gambling do behavioural conditioned problem gamblers exhibit and why?
Regular-heavy problem gambling as a result of classical or operant conditioning and distorted cognitions overestimating the chance of winning.
216
What motivates behavioural conditioned problem gamblers to chase losses?
Accumulating financial losses.
217
What do the stresses of accumulating financial losses cause in behavioural conditioned problem gamblers? (2)
Depression and substance use.
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What kind of treatment is recommended for behavioural conditioned problem gamblers?
Brief interventions as motivation for treatment is high.
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What is a pathway 2 gambler, as described by the integrated pathways model?
Emotionally vulnerable problem gamblers.
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What are emotionally vulnerable problem gamblers influenced by? (3)
Conditioning, cognitive and social processes.
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What factors put emotionally vulnerable problem gamblers at greater risk? (3)
Mood disturbance, poor coping and problem-solving skills, and dysfunctional families.
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Why do emotionally vulnerable problem gamblers gamble?
To escape from emotional stresses.
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What is a pathway 3 gambler, as described by the integrated pathways model?
Biologically based problem gamblers.
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What causes gambling in biologically based problem gamblers?
Neurochemical malfunctions that result in high impulsivity and varying responses to reward and punishment.
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What do biologically based problem gamblers have a history of? (8)
Impulsivity and risk taking, substance abuse, poor interpersonal relationships, suicidality, irritability, low tolerance for boredom and engagement in criminal activities.
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When does gambling begin and how does it develop in biologically based problem gamblers?
It starts at an early age and rapidly escalates in intensity and severity.
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What kind of treatments do biologically based problem gamblers benefit from?
Psychological treatments and additional medications directed at decreasing impulsivity.
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What did Freud believe was the basis of gambling disorder?
A masturbation addiction.
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What did Freud define a masturbation addiction as?
A primal addiction for which all later addictions are substitutes.
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What kind of approach to treating gambling does Gamblers Anonymous take?
12-step recovery process and abstinence treatment similar to Alcoholics Anonymous, and shared common experiences provided by mutually supportive peers in a group setting.
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What does Gamblers Anonymous believe compulsive gambling is?
A progressive incurable disease.
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What is the basis of behavioural interventions for gambling?
It is a learned maladaptive behaviour that can be unlearned through techniques based on the principles of learning.
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How did Skinner view the development of gambling?
It follows operant conditioning principles with monetary reward delivered on intermittent variable ratio schedules acting as the primary reinforcement.
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What does Anderson and Brown's two factor model of gambling emphasise?
The role of classical conditioning whereby environmental cues for gambling come to elicit arousal/excitement, and the negative reinforcement associated with a reduction in negative emotional states produced by the narrowing of attention and hence distraction from awareness of life problems.
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Give an example of how aversion therapy is used to treat gambling disorder.
Operant or classical conditioning techniques used to counter-condition the arousal/excitement associated with gambling.
236
Give an example of how exposure therapy is used to treat gambling disorder.
Operant or classical conditioning techniques used to produce extinction of arousal through a process of repeated exposure to gambling cues.
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Explain covert sensitisation.
A type of aversion therapy where the aversive stimuli are presented in the form of negative imagery.
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How is cognitive therapy used to treat gambling disorder?
It identifies common cognitive errors and correct them by providing accurate information on the nature, operation and probabilities of winning associated with specific forms of gambling.
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What core belief does cognitive therapy target in gambling disorder?
Gambling represents a source of income and losses can be won back.
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What three classes of medications are effective in treating pathological gambling?
SSRIs, opioid antagonists, and mood stabilisers.
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When are SSRIs recommended, with reference to pathological gambling?
When comorbid depression is present.
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When are mood stabilisers recommended, with reference to pathological gambling?
Evidence of cyclothymic or bipolar mood disturbances is present.
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When is naltrexone recommended, with reference to pathological gambling?
Comorbid alcohol abuse.
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What is the public health model?
A model of gambling that focuses on external social causes of gambling.
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What does the public health model argue the risk of problem gambling is related to? (2)
The duration of exposure to gambling, and the addictive quality of the type of the available gambling.
