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Flashcards in Addictive Disorders Deck (25):
1

What is a drug and how are they classified?

Any substance that exerts an effect on body or mind
(prescription, legal & illicit) Effect may be neurophysiological, behavioural, emotional or cognitive

Classified according to effect type:
- Depressant (downers): Alcohol, benzodiazepines, sedatives
- Stimulants (uppers): Cocaine, amphetamines, caffeine, nicotine, MDA (ecstasy)
- Hallucinogen: mescaline, LSD, psilocybin
- Opioid/narcotics: Morphine, heroin, codeine
- Cannabinoids: Marijuana, hash, ganja
- Tobacco, steroids, volatile solvents, prescription drugs

2

How is addiction defined?

Behaviours characterized by compulsion, loss of control & continued patterns of abuse despite perceived or objective negative consequences

DSM:
- Impaired control (cravings, difficulty cutting back or limiting consumption)
- Social Impairment (failure to meet obligations, interpersonal problems, reduced activities)
- Risky use (in dangerous locations, times, health)
- pharmacological (tolerance and withdrawal)

3

What is Choice Theory of addiction?

Habit (choice) versus addiction (impaired control):

Choice theory describes addiction as a relationship between opportunity, perceived benefits and costs, self control and urges.

4

What is the difference between physiological and psychological dependence?

Physiological dependence: Associated with physical
symptoms of tolerance & withdrawal on cessation

Psychological addiction/dependence: Cravings/desire leading to repetitive (compulsive) use

5

What are the commorbidities of substance abuse disorders?

60% substance users have a co-morbid psychiatric disorder

Highest overlap is with mood/anxiety disorders (twice as likely as general population)

reasons for comorbidity: Overlapping genetic vulnerabilities, environmental triggers, involvement of similar brain regions. Interactive effect: Drug/other disorders can increase vulnerability to the other

6

What are the developmental trajectories of drug use?

Drug use (of many types) tends to peak in the mid 20s, men tend to consume higher levels than women

Alcohol addiction trends: begin drinking young (12-14 first drink, 14-18 intoxication) dependence onset around 23-30

7

What are the risk factors for addiction?

biological: genetic vulnerability, high neural sensitisation (due to hormones, stress, trauma, etc)

psychological: mood/anxiety disorders twice as likely

8

How does addiction affect the brain?

Addictive drugs usurp neural circuitry normally involved in pleasure, incentive motivation, learning (not only
engaging these reward systems, but changing them --> Neuro-adaptation)

Drugs of dependence operate on the brains’ reward systems:
1) The dopaminergic system
2) The endogenous opioid system

9

What is I-RISA?

Impaired Response Inhibition and Salience Attribution
- Hypothesised dopamine involvement in drugs addiction mediated by functional & structural changes in circuits modulated by dopamine

Four clusters of behaviours involved:
• Intoxication/excitement;
• Craving: ‘wanting’ or ‘needing’ rather than ‘liking’ :
• Compulsive use:
• Withdrawal:

10

What are the key areas of the brain involved in the dopamine reward system?

- Hippocampus: Remembers experience & context
- Prefrontal cortex: Focus attention
- Nucleus accumbens: “Pleasure center,” stimulated
- Reward system: Reactivated with each use

11

What is the Learning theory of addiction?

Psychological theory of addiction that attributes addiction to classical and operant conditioning.

Two phases:
- aquisitional: casual use, and initial reinforcement
- motivational: use of drugs compulsively (motivated to take them)

Reinforcement types
- negative reinforcement: tension reduction, avoidance of negative states,
- positive reinforcement: 'high'

12

What is the Opponent Process theory of addiction?

Drug activates euphoric ‘a-process’ in brain reward
circuits which in turn activates a opponent ‘b-process’ (which serves to restore homeostasis)

With repeated use, the a-process diminishes (tolerance) and the b-process sensitises (withdrawal)

13

What are the principles that guide effective management of addiction?

There are 6 key principles for effective management:
1. No single treatment is appropriate
2. Treatment needs to be readily available & accessible
3. Effective treatment involves & attends to multiple
psychological, medical & social interventions & needs
(CBT, naloxone, antabuse, methadone, peer support)
4. Dual diagnosed clients should have both disorders
treated in an integrated fashion
5. Treatment does not need to be voluntary to effect
change
6. Recovery from drug addiction can be a long term
process & frequently requires multiple episodes of
treatment

14

What is the CBT treatment for addiction?

- Identify high risk situations & events
- Reduce likelihood that these events are encountered
(providing alternative activities)
- Rehearsing non-drug alternatives to cues
- Enhance motivation for alternative activities
- Target cognitions that enhance likelihood of drug use (rationalisation, giving up)
- emotional regulation skills

aim to increase reinforcing consequences for drug avoidance (long term social, health etc, short term prizes/rewards can be necessary)

15

What are the most common barriers to treatment of addiction?

-Psychiatric comorbidity,
-Acute or chronic cognitive deficits
-Medical problems
-Social stressors
-Lack of social resources

16

What is the definition of gambling and disordered gambling?

Gambling: Risking item of value on outcome of events
determined by chance

Problem Gambling: Personal or social harm resulting fromexcessive gambling behaviour

Pathological Gambling/Gambling Disorder: Meeting DSM criteria

17

What is the prevalence and distribution of gambling disorders?

Prevalence of gambling: 60-85% of general population
In USA, Australia & Europe: 0.4 - 1.1% pathological gamblers, 1 - 2% problem gamblers

Age: Average age of onset = 12 – 15 yrs. (90% begin before age 20)

Gender: Males more risk taking, Females bimodal distribution: youth & > 45 yrs.

18

What are the commorbidities of PG?

5.5x more likely to have substance abuse (30-40% alcohol abuse/dependence in PG)
3.7 x more likely to be depressed
3.1 x more likely to have anxiety

19

What are the main stages of PG?

Early Winning Phase:
- 2/3 of pathological gamblers experience large wins prior to developing problems
- Facilitative cognitions, increased frequency & intensity

Losing Phase
- Heightened preoccupation with gambling
- Growing losses & attempts to recoup (‘chasing losses’)
- Increased stress, irritability, withdrawal

Desperation phase:
- Efforts to survive financially & psychologically become
increasingly extreme
- 60% have committed an offence to finance gambling

20

What are the learning mechanisms present in PG?

Operant conditioning: Reinforcement schedules are intermittent & variable. Random ratio reinforcement schedule is highly resistant to extinction

Classical conditioning: Neutral stimuli (e.g., sights, sounds, time of the day, people) become
associated with physiological arousal & subjective excitement

21

What is the Pathways model of PG?

based on the premise that Pathological gamblers are not a homogenous population
Three subtypes exist;
• Common phenomenology
• Differ in aetiological factors
• Differ in treatment requirements

22

What are the characteristics of Pathway 1 in the pathways model of PG?

Pathway One: Symptoms are causal outcomes of gambling-related problems: Motivation to generate excitement, winning, less dissociation & more absorption

demographics: Absence of psychopathology, comorbidities occurred after onset of PG

treatment: Amenable to psycho-education, brief interventions & brief CBT

23

What are the characteristics of Pathway 2 in the pathways model of PG?

Pathway Two: Affective disturbances, poor coping skills, & substance use contribute to gambling (dissociation & escape), gambling with money, not for money: prolong sessions to allow continued emotional escape

demographics: vulnerability factors, premorbid mood/anxiety pathology,

treatment: treat premorbid/underlying conditions

24

What are the characteristics of Pathway 3 in the pathways model of PG?

Pathway Three: Deficits in reward pathways (dopaminergic) & impulsive, often coincides with substance abuse and criminal behaviours

demographic: early onset PG, early history of family instability, history of impulsive and anti-social behaviour

treatment: Psychopharmacology & intensive interventions

25

What are the main cognitive biases associated with gambling?

1. Gamblers Fallacy: A series of losses must be followed by a win
2. Illusion of Control: Overmagnification of skill/ability
3. Biased evaluation: success = skill, fail = chance
4. Selective Recall: recalling wins, forgetting loss
5. Cognitive Regret: fear of missing out on potential win
6. Superstitious belief: Lucky items, rituals
7. Luck as a personal quality: 'I am lucky'
8. Illusory correlations:
9. Gambling for income: belief that money can be made long term