CPch10 - Substance Use Disorder Flashcards

Question

how is alcohol concentration based on gender?

Answer 1

- women have higher blood alcohol concentrations (even after adjustment of weight) → bc of differences in: > body water content > the enzyme that breaks down alcohol (alcohol dehydrogenase)

Answer 2

through interaction with several neurotransmitters: - stimulates **GABA receptors** (for ability to reduce tension) - increased level of **dopamine** and **serotonin** (for ability to produce pleasurable effects) - inhibits **glutamate receptors** (cause cognitive effects of alcohol intoxication - e.g. memory loss and slowed thinking)

Answer 3

- low and high dose of alcohol administred to participants + simulation of driving = low dose→ small impairment in motor functioning = high dose→ significant motor impairment = any dose→ effects in ACC and orbitofrontal cortex (making decisions and monitoring mistakes)

Answer 4

- impairs digestion of food and absorption of vitamins - cirrhosis of the liver (if together with reduction of protein intake) > liver cells become engorged and prevent functioning

Answer 5

- heavy alcohol consumption during pregnancy - accounts for less than 20% of fetal alcohol spectrum disorders - leading known cause of intellectual disability among children - slowed growth of fetus + cranial, facial and limb anormalities * even moderate drinking can produce detrimental effects on fetus

Answer 6

- lower risk if coronary heart disease and diabetes (only for women in wealthier countries) - great alcohol consumption predicts less gray matter density (particularly hippocampus) - many associations with cancer, self-harm, accidents (across the world and no matter of wealth)

Answer 7

it declined about a third - 83% decline in people with college degreee - 39% decline in people with less than high school degree !! despite the decline, smoking remains the single most preventable cause of premature death

Answer 8

- emphysema - cancers of the larynx, esophagus, pancreas, bladder, cervix and stomach - complications during pregnancy - sudden infant death syndrome - periodontitis - cardiovascular disorders

Answer 9

- nicotine - carbon monoxide - tar (hydrocarbons→ carcinogens) ! study: people that smoke even just one cigarette a day are more likely to die from any cause than people who never smoked

Answer 10

- tobacco use among people 18-25 has declined between 2015-2018 - smoking is more prevalent among people in lower socioeconomic classes - difference in addiction across race and ethnicity

Answer 11

- men: 48.2 - women: 31.4

Answer 12

- native american or alaska native: 51.3 - white: 39.2 - black or african american: 29.4 - hispanic or latino: 28 - asian: 21.2

Answer 13

- they retain nicotine in their blood longer than European Americans do - they metabolize more slowly - they are more likely to smoke menthol cigarettes (due to advertising) → with menthol cigarettes, they inhale more deeply and hold in the smoke for longer time (more deleterious effects)

Answer 14

- smoke coming from the burning end of a cigarette - also called "envoronmental tobacco smoke" (ETS) - it contains higher concentrations of ammonia, carbon monoxide, nicotine and tar (than does the smoke inhaled by the smoker)

Answer 15

chinese americans metabolize less nicotine from cigarettes

Answer 16

- prolonged exposure to smoke can lead to lung cancer and cardiovascular disease - precancerous lung abnormalities and development of allergies - babies of nonsmoker women exposed to smoke are often born premature and with low birth weight and birth defects - children of smokers are more likely to have upper respiratory infections, asthma, bronchitis and inner-ear infections

Answer 17

- made with plastic or metal and filled with nicotine and toher chemicals (often with flavours) - battery-operated→ heats up the nicotine

Answer 18

- half the amount of people that smoke normal cigarettes smoke e-cigarettes - adolescents that use e-cigarettes are more likely to use alcohol and marijuana

Answer 19

- e-cigarettes are less toxic than traditional combustible cigarettes - e-cigarettes can be helpful tools to stop smoking (only for adults) - young people who use e-cigarettes are more likely to transition to smoking cigarettes - secondhand aerosols from e-cigarettes contain nicotine and other chemicals (ETS)

Answer 20

dried and crushed leaves of the plant cannabis sativa - in DSM-V under "cannabis use disorder"

Answer 21

- much stronger than marijuana - removing and drying the top of cannabis sativa

Answer 22

artificially created chemicals that are sprayed on plant (illegal)

Answer 23

- in 2018, 27.7 million people reported using marijuana in the past month - most common drug used across age groups - equivalent across ethnic groups - 7.6 million people have daily use (2012)

Answer 24

- cannabinoids are active chemicals in marijuana - THC is major cannabinoid - cannabidiol (CBD) -> second most common cannabinoid + also contains carcinogens

Answer 25

> intoxicating effects depend on the potency and size of dose - usually feel more relaxed and sociable - larger dose: rapid shifts in emotion, dull attention, fragment thoughts, impaire memory, time moving slowly - extremely large dose: hallucinations, panic - marijuana can interfere with cognitive functioning - when high, impaired complex psychomotor skills necessary for driving ("high" can last for 8 hours but not felt anymore-> dangerous for driving)

Answer 26

- longitudinal study assessed cognitive functioning at 13 and 38 y.o. = less IQ and poorer working memory and processing if used marijuana persistently

Answer 27

- bloodshot, itchy eyes, dry mouth and throat, increased appetite, reduced pressure within the eye, raised blood pressure - longterm use-> impair lung structure and function - tolerance and withdrawal symptoms (depression, anxiety, restlessness, tension, stomach pains, insomnia, ...)

Answer 28

- CB1 and CB2 cannabinoid receptors in the brain - cognitive problems are associated with effect of marijuana on CB1 receptors in hippocampus - regular users show different patterns of connectivity between amygdala and frontal cortex when trying to regulate emotions

Answer 29

- reduction in nausea and in loss of appetite that come with chemotherapy - alleviation of glaucoma, chronic pain, muscle spasms and discomfort for people with aids - can help symptoms of Tourette's syndrome, social anxiety, dementia, sleep disorders

Answer 30

- more adolescent users in states with legalized marijuana - difference in use was there before legalization - increase in recreational use in states with early legalization

Answer 31

- marijuana dangerous because it's first step of young people towards use of other drugs - not much evidence - cocaine and heroin users are likely to have started with marijuana

Answer 32

- opium, morphine, heroin and codeine - can relieve pain in moderate doses - in 2018 over 9 million people misused prescription pain medications - in DSM-V: "Opioid use disorder"

Answer 33

- hydrocodone (eg for vicodin) - oxycodone - fentanyl (causes the most deaths by misuse of opioids)

Answer 34

1. started in 1990s (prescription pain medications) 2. started in 2010 (heroin)

Answer 35

- more than 800.000 people over 12 y.o. in US in 2018 - more men than women - usually start after prescription meds - misuse of prescription meds more common in white americans - overdose deaths from syntetic opioids have risen deamatically since 2015

Answer 36

- euphoria, drowsiness, lack of coordination, increased self confidence - letdown and stupor (later on) !! these effects produced by stimulating neural receptors of body's own opioid system or by acting on nucleus accumbens - withdrawal symptoms are similar to influenza, + vomiting, no sleep, diarrhea, ...

Answer 37

- increase altertness and motor activity - amphetamines (synthetic), cocaine (natural, from coca leaf), caffeine

Answer 38

- caffeine can create tolerance and withdrawal symptoms - most common effects: metabolism, body temperature and blood pressure increase, sleepiness and appetite diminishes and hand tremors created - excess use can cause death - addiction start early on (caffeine also in hot cocoa, soft drinks, ...)

Answer 39

- release of norepinephrine and dopamine - block reuptake of these neurotransmitters

Answer 40

- heighten wakefulness, inhibit intestinal functions and suppress appetite (used in diets) - (less common) quicken heart rate and constrict blood vessels - person becomes euphoric, more self-confident, agitated, confused, ... - tolerance built only 6 days after repeated use

Answer 41

- derivative of amphetamines - most come from illecit sources - men more likely to misuse methamphetamines (less gender differences in amphetamines) - person becomes very agitated when drug wears off

Answer 42

- damage to dopamine and serotonin system - reduction in brain volume in temporal and frontal cortices - smaller volume of hippocampus (poorer performance on memory test) - areas impacted are associated with reward and decision-making (insula, striatum and frontal and temporal cortex) > unclear whether these areas were damaged before methamphitamine use or only after !! difficult to find participants that use only one drug (confounds)

Answer 43

- from leaves of coca shrub - "crack" is a form of cocaine (rock-crystal that is melted and smoked) - cocaine use is declining - men use cocaine and crack more often than women

Answer 44

- blocks reuptake of dopamine in mesolimbic areas - dopamine left in synapse facilitates neural transmission -> pleasurable state - vasoconstrictor (causes blood vessels to narrow) > prenatal exposure makes grey matter smaller in frontal cortex - increases risk for stroke, causes cognitive impairments

Answer 45

- include LSD, psilocybin, mescaline - main effect: hallucinations (recognized by user as caused by the drug) - in DSM-V: "hallucinogen persisting perception disorder" > experience of flaschbacks and perceptual symptoms felt during drug even when not under the effect

Answer 46

- increased use in past years - tolerance developed quickly - no signs of withdrawal ! alters a person's sense of time (slower) ! sharp mood swings and extended consciousness ! increases anxiety because you feel that you are going crazy, but reduces anxiety in people with life-threatening illnesses

Answer 47

- made from MDMA - in DSM-V: "other hallucinogen use disorder" - as a pill, but added to other substances - neurotoxic effects on serotonin system because it reduces availability of SERT transporter in brain ! enhances intimacy and insight, improves interpersonal relationships, elevates positive emotion and self-confidence, and promotes aesthetic awareness ! causes muscle tension, rapid eye movements, jaw clenching, nausea, faintness, chills or sweating, anxiety, depression, depersonalization, and confusion

Answer 48

- "angel dust" - in DSM-V: "phencyclidine use disorder" - more men than women - severe paranoia and violence, coma and death

Answer 49

- genetic - neurobiological - psychological - sociocultural ! differently related based on the different substance

Answer 50

- heritability: 0.4-0.6 - twin studies: genetic component in alcohol use disorder, smoking, heavy use of marijuana and general drug use disorders

Answer 51

- peers are particularly important environmental variable > higher heritability for alcohol problems among adolescents that have many drinking peers > higher heritability for alcohol and smoking among adolescents whose best friend smokes or drinks > higher heritability in schools where the "popular crowd" smokes or drinks

Answer 52

- asians have lower rate of alcohol problems because of physiological intolerance > inherited deficency in enzymes for alcohol metabolism (alcohol dehydrogenases - ADH) - mutations in ADH2 and ADH3 gene code proteins that make ADH enzyme, and these genes have been linked with alcohol use disorders = many asians lack ADH which metabolizes alcohol; they experience flushing (unpleasant sensation), which may protect them from becoming dependent on alcohol

Answer 53

- nicotine stimulates dopamine release and inhibits its reuptake - people who are more sensitive to this effect are more likely to become regular smokers

Answer 54

- link between smoking and SLC6A3 gene, which regulates reuptake of dopamine > people with this gene have lower likelihood of smoking & higher likelihood of quitting - gene CYP2A6 codes for enzymes that metabolize nicotine > faster metabolism of nicotine leads to smoking more > this gene is also associated with more lung cancer likelihood

Answer 55

four different genes have been associated with marijuana dependence, but not enough evidence

Answer 56

- vulnerability model > problems in dopamine system increase the vulnerability to becoming dependent to substances - toxic effect model > problems in the dopamine system are the consequences of taking substances ! people continue to take drugs to avoid negative symptoms of withdrawal

Answer 57

People with Alcohol use disorder that recently stopped drinking have larger physiological responses to unpredictable stress

Answer 58

Incentive-sensitization theory

Answer 59

- dopamine system (pleasure, liking) becomes super sensitive to direct effects of drug and to cues of such drug (e.g. spoons, needles) - sensitivity to cues induces craving (wanting) - liking decreases, but wanting remains very intense !! transition from liking to wanting maintains addiction (transition accomplished by pathways involving dopamine)

Answer 60

- cues can elicit similar responses to drug itself > e.g. changes in physiological arousal, increase in craving and "high feeling" in response to cue - cues activate reward and pleasure areas of the brain implicated in drug use > e.g. looking at a cigarette before stressful task lessened the physiological and perceived stress more than actually smoking the cigarette

Answer 61

- yes - more craving and liking of alcohol at baseline assessment the more A.U.D. symptoms they had 6 years later - more craving predicts use of cigarettes

Answer 62

- in go/no-go task, when refraining from pressing the no-go button, basal ganglia, inferofrontal gyrus and premotor areas are activated - people that show greater brain activation when refraining from pressing button were less likely to act on craving

Answer 63

- people with substance dependence often value immediate and impulsive pleasure and reward coming from taking a drug more - lab setting where people offered 1$ now or 10$ in the day > delay discounting: extent to which people opt for smaller immediate rewards > people with S.U.D. have more delay discounting

Answer 64

- valuing short-term rewards: amygdala and nucleus accumbens - valuing long-term rewards: prefrontal cortex ! these brain regions compete with one another when evaluating which reward to accept

Answer 65

- people who have low tolerance for ambiguous risk but not for known risk were more likely to relapse > predict relapse through computer game that assesses tolerance for known vs ambiguous financial risks - risky decision making associated with orbitofrontal cortex, parietal cortex and rostral parts of ACC - tolerance for ambiguity is associated with the dorsolateral prefrontal cortex, parietal cortex, and dorsal parts of the ACC

Answer 66

- emotion regulation - expectancies about alcohol and drug effects - personality traits

Answer 67

- people with S.U.D are less able to regulate negative emotions (cause or effect?) - alcohol reduces self-reported and physiological indicators of anxiety (particularly when uncertainty about negative event) - alcohol lessens positive emotions in response to anxiety-provoking situations

Answer 68

- as emotion regulation tool - it helps calm down thoughts of being rejected and focus instead on the pleasures of being around others

Answer 69

- some studies found that nicotine reduces negative emotions, others didn't - this is because it depends on stage of smoking (just started? tried to stop and failed?) - greater reduction in negative emotions when starting to smoke than when regularly smoking or when in relapse > (study) greater relief in negative emotions when smoking after not smoking for 12 hours

Answer 70

- suggested that it's act of smoking (e.g. inhaling) that reduces negative emotions (and not nicotine) - many studies have proved that negative emotions are relieved even if cigarettes did not contain nicotine

Answer 71

- distraction theory - alcohol impairs cognitive processing and narrows attention to most immediatly available cues = alcohol myopia -> intoxicated person has less cognitive capacity, so focuses on immediate situation, does not think about negative emotion, negative emotion decreases

Answer 72

- reduction in anxiety perceived when smoking during a distracting activity (not if no distraction) ! alcohol and nicotine might increase negative emotions when distraction is not present > e.g. if drinking alone, limited cognitive capacity is focused on negative emotions, and they become stronger - effects of alcohol are stronger than expectancy of alcohol

Answer 73

- people that expect alcohol to reduce anxiety and relieve stress are more frequent users - expectancies about alcohol and its effects begin at age four - expectancies become more positive throughout development and after first exposure - more aggressiveness even when you believe you're drinking alcohol - the higher expectancy of danger of the drug, the lower the rates of consumption

Answer 74

- neuroticism (negative emotionality) - persistent desire for arousal + increased positive affect - constraint (cautious behavior, harm avoidance, conservative moral standards) ! low constraint and high neuroticism predicted onset of alcohol, nicotine and drug use disorders + strong associations with low levels of agreeableness and conscientiousness

Answer 75

- alcohol is the most used substance in countries studied (differences in levels of use across cultures) - marijuana is next common substance (most countries) - higher rates of amphetamines, ecstasy and cocaine in countries with higher rates of marijuana ! other research documented other differences in substance use

Answer 76

- acceptable social norms of the community and culture - social setting also influences use (e.g. peer influences) - social networks influence use of substance, but also inclination to use substances makes person select networks where substance is used

Answer 77

- social influence model (media) - social selection model (networks)

Answer 78

- adolescents exposed to ads about e-cigarettes were more likely to try them - advertising about ill effects of smoking has opposite effect

Answer 79

- inpatient hospital treatment - alcoholics anonymous - couples therapy - motivational interventions - moderation in drinking - medications

Answer 80

- typically chronic and often relapse - first step: admitting that there is a problem > several treatment programs require addict to stop using before starting the program to show commitment - medication approved for alcohol, tobacco and opioids - only 1 out of 10 addicts receive treatment

Answer 81

- first step of treatment: detoxification - often happens in hospitals because of supervised setting - inpatient treatment is much more expensive

Answer 82

- more than 2 million people around the world - half of the people that receive treatment do so through AA (2018) - also narcotics anonymous, cocaine anonymous and marijuana anonymous - still "alcoholic" even if not had a drink in 15 years

Answer 83

- group provides understanding, emotional support, close counseling and social network - AAs principles outlined in 12 steps - most effective line of treatment - goal: complete abstinence (reached for at least 3 years) - often "attrition" (dropping out)

Answer 84

- reduction in problem drinking - improvement in couples' distress generally - effective for couples of all sexualities - individual cognitive skills + dealing with stress as a couple

Answer 85

- intervention in college 1. comprehensive assessment including TimeLine Follow Back (to assess drinking in the past three months) 2. brief motivational treatment > including individualized feedback about person's drinking in relation to community and national averages, education about effects of alcohol, tips for reducing harm and moderating drinking - TLFB works, but if add motivational intervention, longer lasting results

Answer 86

- "controlled drinking": goal of the treatment approach "guided self-change" - assumption: > people can exercise control over their drinking than they typically believe > more awareness of the negative effects of drinking too much can help and awareness of the benefits of drinking less - e.g. delay of 20 minutes before taking second drink can help - effective treatment!

Answer 87

- antabuse: induces violent vomiting after ingesting alcohol - very harsh, very high drop-out rates and not effective (study) - naltrexone (opiate antagonist) blocks activity of endorphins stimulated by alcohol -> reduces craving > proven to be effective if together with CBT - acamptosate reduces drinking and cravings by impacting glutamate system

Answer 88

- if people in the social network stop smoking, it is easier to stop - only half of people that go to a smoking cessation program stop smoking when the program ends - only small percentage keeps abstaining after one year > psychological treatments > nicotine replacement treatments and medications

Answer 89

- most widespread psychological treatment is physician telling person to stop smoking - ...because of lung disease, hypertension, heart disease, diabetes, ... - motivational interviewing only moderately effective - some smells quite down craving for five minutes (e.g. apple, lemon, chocolate, ...) - school interventions and cognitive behavioural approaches (on coping skills and problem solving) are effective * stopping all at once is too difficult

Answer 90

by 18 years old: - 2/3 of cigarette smokers regret starting - 1/2 have already tried stopping - 40% show interest in obtaining treatment to stop

Answer 91

- nicotine replacement therapy: different gradual delivery of nicotine to reduce cravings - e.g. gums, pathces, inhalers or e-cigarettes

Answer 92

- nicotine gum release nicotine more slowly but causes cardiovascular changes (e.g. increased blood pressure) - nicotine patches release nicotine through the skin and carried to the brain > only one a day and not remove before new one (advantage compared to gum) > treatment effective after 8 weeks of use, no longer than three months > dangerous levels of nicotine if smoking while wearing patch > effective for both genders - abstinence rates are less than 50% at 12-months follow-up - not effective for adolescents

Answer 93

- evidence is mixed - no statistical difference between results of gum, patches and e-cigarettes

Answer 94

- antidepressant burpropion (NRT more effective than burpropion alone; more effective than varenicline alone) - varenicline (effective alone or in combination with behavioural treatment or NRT)

Answer 95

- psychological treatment - medication

Answer 96

- CBT (effective) > learn to avoid high-risk situations > recognize lure of the drug > develop alternatives to using the drug > strategies to cope with craving and resisting the tendency to regard slip as catastrophe ! CBT on computer was even more effective than one in person + less dropout rate

Answer 97

- learn to reinforce behaviours inconsistent with drug use (eg taking medication in trigger situations) - learn to avoid situations associated with drug use in the past - vouchers given if "clean", to buy things person wants ! based on belief of importance of environmental contingencies ! effective (greater likelihood of abstinence and better quality of life)

Answer 98

- CBT + techniques to help person to generate solutions for themselves - effective

Answer 99

1. separation of people from previous social contacts > assumption that these relationships have been instrumental in maintaining use disorder 2. new environment without drugs and with support to transition to no drugs 3. presence of former drug addicts 4. direct and intense confrontation in group therapy (accept own responsability and change behaviour) 5. setting in which people are respected and not stigmatized

Answer 100

- obstacles in evaluating efficacy - high drop-out rate -> remaining people not representative of population (their motivation is stronger and it's possible cause of getting better)

Answer 101

- 90% of people needing treatment do not get it - many end up in prison and don't get treated - option to get treated instead of going to prison is less costly and 4/10 people succeed

Answer 102

- 16 CBT group sessions - 12 family education sessions - 4 individual therapy sessions - 4 social support group sessions

Answer 103

- more effective than TAU (treatment as usual) - no lower rates of relapse after 6 months than TAU

Answer 104

- "medication assisted treatment" (MAT) - opioid substitutes (agonists) > stimulates neurotransmitters > chemically similar to opioids and lower the cravings - opioid antagonists > dampens activity of neurotransmitters > prevent user from experiencing the high - often not provided because of stigma around it

Answer 105

- opioid substitutes: methadone and buprenorephine - also addictive (controversy) - weaker withdrawal symptoms - lower risk of overdose death

Answer 106

- methadone works best when together with psychological treatment - has to be taken in clinic in front of physician - does not produce "high": people return to heroin - methadone + contingency management - side effects: constipation, sweating, insomnia, diminished sexual functioning

Answer 107

- advantage: can be taken at home rather than a clinic - not as powerfully addicting - to combat potential of abuse of drug: drug created containing buprenorphine and naloxone (to fight against overdose effects)

Answer 108

- prevent feeling "high" if use opioids later - binds to opiod receptors without stimulating them - when surgically implanted, works best

Answer 109

- 1/2 of adult smokers started smoking before age 15, and almost all before age 19 - prevention is important from early age - same measures for smoking also work for drugs and alcohol > brief family interventions > state measures (smoke-free zones, tobacco control programs, taxes on cigarettes, restricting tobacco advertising, public education campaign, ...) - graphic warning labels on cigarettes packages

Answer 110

- 8 in 10 Dutch adults sometimes drink alcohol - many Dutch adults have used drugs in their life - prevalence depends on the country

Answer 111

- positive reinforcement > rewarding/mood-enhancing effects of the drug - negative reinforcement > drug use reduces negative affect (self-medication) > drug use prevents withdrawal symptoms

Answer 112

- 18% of suicides - 18% of interpersonal violence - 27% of traffic injuries - 13% of epilepsy - liver cirrhosis, mouth cancers, pancreatitis, tuberculosis, colorectal cancer, breast cancer, hypertensive heart disease, ...

Answer 113

- only a minority of people who use develops a full-blown substance abuse disorder - e.g. for every 250 people that use, 25 abuse

Answer 114

- 17% of people suffer from substance abuse at some point in their life - alcohol: 12.8% - drugs: 6.6%

Answer 115

- substance and alcohol abuse are prevalent - it has a destructive impact on individual's wellbeing and mental health, social relationships and professional functioning - society pays a price for substance abuse > healthcare resources, lost productivity, spread of diseases, crime and homelessness

Answer 116

1. positive attitude 2. experimentation (craving) 3. regular use (habit) 4. heavy use 5. substance abuse (compulsive drug seeking) 6. maintenance 7. (recovery and) relapse

Answer 117

problematic pattern of substance leading to clinically significant limitations or suffering (DSM-V)

Answer 118

- at least 2 of 11 features occurring within 1 year - 2-3 mild, 4-5 moderate, >6 severe 1. taking the substance in larger amounts or for longer than what you're meant to 2. wanting to cut down or stop using the substance but not managing to 3. spending a lot of time getting, using or recovering from use of the substance 4. **cravings and urges** to use the substance 5. not managing to do what you should at work, home or school because of substance

Answer 119

6. continuing to use, even when it causes problems in relationships 7. giving up important, social, occupational or recreational activities because of substance abuse 8. using substances again and again, even when it puts you in danger 9. continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance 10. needing more of the substance to get the effect you want (**tolerance**) 11. development of **withdrawal** symptoms, which can be relieved by taking more of the substance

Answer 120

- e.g. Gambling Disorder > in "substance-related and addictive disorders" - more research needed for Internet Gaming Disorder (might be related to other mental disorders) - neurological processes are similar to other addictions

Answer 121

- addictive effect on the brain > brain disease model

Answer 122

- 1850 Moral (re-education institutions) - 1920 Pharmacological (drug causes addiction-> prohibition) - 1940 Symptomatic (psychoanalysis; personality disorder) - 1950 Disease (genetic, biological and psychological premorbid differences between addicts and normal users; some people should not use) - 1975 Learning (maladaptive learnt behavior -> behavioral intervention) - late '70s Social - 1980 Biopsychosocial (multimodal intervention: housing, relocation, ...) - 1990 Brain Disease (not much different from Biopsychosocial model; neurobiological and genetic basis of addiction)

Answer 123

- "addiction might be better considered and treated as an acquired disease of the brain" - addiction: > complex, chronic, relapsing brain disease > genetic and neurobiological basis > compulsive drug seeking and use despite harmful consequences

Answer 124

(see picture)

Answer 125

- "people take drugs out of choice and can stop out of choice" - "addicts are not blameless vicitms of some terrible illness they have no control over"

Answer 126

- role of dopamine > abused substances increase dopamine much more than natural reinforcers > brain's natural reward system becomes highjacked

Answer 127

.. external stimuli (places, things, people) .. internal stimuli (stress, anxiety, depression) - through ***pavlovian learning*** (classical conditioning), stimuli become associated with substance = these stimuli in envoronment become potent triggers of craving

Answer 128

- incentive-sensitization theory 1. repeated use sensitizes the brain 2. drug and stimuli become more able to elevate dopamine activity 3. increased "wanting" and decreased "liking" (liking sometimes stays the same) = brain becomes desensitive to drug and sensitive to craving

Answer 129

- cravings - "chasing the first high" - unnatural disconnection between wanting and liking - (see graph)

Answer 130

- instrumental learning (operant conditioning) - stimuli-> behavior-> habit - it happens with natural rewards as well, but more with drugs because of dopamine system

Answer 131

- repeated performance in behavior in presence of certain stimuli-> stimulus-response (S-R) habits become stronger - rewards reinforce S-R learning - because of dopamine, stronger association between stimulus and habit - once formed, habits are automatically triggered by stimuli, independent of one's motivation for outcome

Answer 132

- from stimuli to craving: pavlovian (classical) conditioning > stimuli trigger craving - from stimuli to habit: instrumental (operant) conditioning > stimuli trigger behavior to get drug

Answer 133

- impaired response inhibition - steeper delay discounting - risky decision making ! these impairments can be both: > consequence of neurotoxic effects of substances (on prefrontal cortex particularly) > vulnerability factors for the development of an addiction

Answer 134

- bottom up processes (craving and habits) - top down processes (cognitive control functions) > disrupted reward system + impaired executive functions = compulsive drug seeking

Answer 135

- gender (men greater risk) - young age - living alone - being unemployed - very high degree of urbanization

Answer 136

- sensation-seeking (desire for increased arousal and positive affect) - low impulse control (cognitive control functions)

Answer 137

- drug availability - advertising and media (16% less consumption if ads portraying danger)

Answer 138

Family: - substance abuse by caregivers - marital discord, psychiatric or legal problems in the family - lack of parental monitoring - lack of emotional support by parents Peers: - social influences (become role models)

Answer 139

- depression (especially with alcohol abuse) - anxiety, PTSD, ADHD, bipolar disorder, borderline and anti-social personality disorder ! when dual diagnosis, there's greater risk of addiction, more severe development of S.U.D. and more resistance towards treatment

Answer 140

- self-medication hypothesis (mental disorder > substance use) - high-risk hypothesis (substance use > mental disorder)

Answer 141

- no single factor can predict whether a certain individual will develop substance abuse - interplay between genetic, environmental and developmental factors influences risk for addiction - the more risk factors, the greater the chance that alcohol/drug use spirals out of control - the more protective factors, the greater the resilience of an individual against developing addiction

Answer 142

- 45% alcohol - 14% opioids - 11% cocaine - 17% cannabis - ... ! stigma is the barrier (a lot of people don't seek out treatment)

Answer 143

- aim: breaking through pattern of problematic substance use (reducing or quitting) - protocolled treatment + workbook - CBT + motivational interview (most common, strong evidence) - potentially in combination with medication

Answer 144

1. enhance motivation for treatment 2. self-control measures and contingency management 3. functional analysis 4. dealing with craving 5. prevention of relapse 6. declining/refusing substances

Answer 145

1. Motivational Interviewing > helps people to believe in their ability to change (intrinsic motivation) > important because some people are still ambivalent when starting treatment (they don't believe they can change) > collaborative, goal-oriented conversation style with special focus to change language 2. Cost/Benefit Balance - disadvantages of use - benefits of decreasing/stopping use

Answer 146

- withdrawal symptoms (only at the beginning) - exposure to external or internal stimuli (!)

Answer 147

- table where you have to write down external situation, internal situation, behaviour and consequences - to learn how to identify and deal with triggers

Answer 148

- Stimulus Control > avoid risk situations/triggers - Stimulus-Response Prevention > link the risk situations/triggers with alternative behaviour (preferably one with same function; e.g. relaxation techniques)

Answer 149

- desirable behaviour is reinforced or rewarded (e.g. with vaucher) > abstinence > attendance (to meetings) > positive activities - not applied systematically at addiction treatment centers (it is effective, but there's problems with insurance)

Answer 150

- seek distraction or social support when experiencing craving - "urge surfing" (wait out urge) > trigger→rise→peak→fall

Answer 151

- a slip after a period of abstinence may cause person to feel guilt, shame and self-doubt - this may increase risk of complete relapse ! see slips as part of recovering process ! perform task that is effortful/unpleasant but that makes you feel better at the end (e.g. exercising)

Answer 152

- often strong social aspect to substance abuse - CBT treatment may involve role play with the therapist to practice declining substances

Answer 153

- aversion drugs > antabuse (disulfram): nausea and vomiting if alcohol is consumed - anti-craving drugs > naltrexone > acamprosate - detoxification and/or maintenance drugs > methadone

Answer 154

- largest self-help group - also Narcotics anonymous - goal: complete abstinence - 12-step program - regular meetings with other addicts - provides support, understanding and acceptance

Answer 155

- community, reinforcement and family training > protocolized, evidence-based treatment based on CBT principles - aims: > help close relatives to adjust their behaviour in order to motivate patient to recover from their addiction > improve quality of life of close relatives ! not reinforcing unwanted behavior, but positive reinforcement of desirable behaviour