Final Exam Flashcards
(118 cards)
1
Q
Substance addiction (define)
A
repetitive, pathological intake of a drug or food.
- May involve exogenous ligand
2
Q
Behavioral addiction (define)
A
repetitive, pathological engagement in
behaviors which do not involve ingestion.
- May alter endogenous ligand function
3
Q
Defining an Addiction: Specifics
A
1.“Rush” effect, appetitive effect
– Not a consistent, slower deliberate tempo
– May involve any number of behaviors (not just drugs)
– Changes arousal levels, affect, or cognition; different experience of self in the moment
– Interferes with reflective processing
2.Time-intensive repetition to achieve satiation
– Temporary period where things are fine
– Engagement may or may not be context-appropriate (studying for finals buzz)
3.Intense behavioral or cognitive preoccupation (“I need my XXX!”)
– Often not step-by-step, deliberate processing
4.Loss of control
– Given demands of a context (pushes and pulls)
* Pushes—stress; pulls–seductions
5.Negative consequences (e.g., social complaints)
– Ignoring longer-term gains decisions
– Tendency to try to minimize negative consequences
4
Q
Sussman/Ames (2001, 2008, 2017) behavioral
scheme (8 categories):
A
Depressants
PCP
Inhalants
Stimulants
Opiates
Hallucinogens
Cannabis
Other drugs
5
Q
Depressants
A
DXM [dextromethorphan-for coughs]
6
Q
Inhalants
A
4 types
7
Q
Stimulants
A
MDMA (3,4-methylenedioxymethamphetamine)
8
Q
Opiates
A
fentanyl
9
Q
Hallucinogens
A
- LSD, mescaline, belladonna
10
Q
Other drugs
A
-GHB [Gamma-hydroxybutyrate]
-Ketamine
11
Q
DA
A
novelty impact
12
Q
Single Addiction
A
43% of population in a 12- month period
13
Q
Concurrent Addictions (E.g., “Speed ball” (cocaine with heroin/morphine), smoking with drinking, drinking with eating or gambling, love with sex)
A
23% of those addicted
14
Q
Substitute (Replacement) Addictions
A
Quit alcohol, then smoke; quit heroin, then use marijuana
15
Q
World prevalence of addictions!
- Tobacco, Alcohol, or Other Drug Use (controlling for overlap)
A
30%
16
Q
World prevalence of addictions!
- Tobacco as sole drug-of-choice (DOC):
A
15%
17
Q
World prevalence of addictions!
- Alcohol
A
10%
18
Q
World prevalence of addictions!
- Marijuana
A
2.5%
19
Q
World prevalence of addictions!
-Stimulants:
A
0.5%
20
Q
World prevalence of addictions!
- Opiods/cocaine
A
0.3% [0.5% when legal]
21
Q
World prevalence of addictions!
-other drugs
A
1.7%
22
Q
World prevalence of addictions!
-Add on over eaters, gambling, sex, love, internet, shopping, workaholism, exercise):
BLANK% of the U.S. adult population has a serious problem with one of 11 addictions in a 12-month period
A
46%
23
Q
Drug Misuse and the Harm-Dysfunction (HD) Perspective!
A
MAYBE WE SHOULD GIVE DRUG MISUSE A MORE STRICT-RESTRICTIVE DEFINITION
24
Q
Drug Misuse and the Harm-Dysfunction (HD) Perspective!
Harm (define):
A
damage to self or others (social, legal, danger, role)
25
Drug Misuse and the Harm-Dysfunction (HD) Perspective!
Dysfunction (Define):
Inability to function normally without drug (physiological), with craving (psychological)
26
Drug Misuse and the Harm-Dysfunction (HD) Perspective!
-Using HD criteria lowers alcoholism prevalence from BLANK% to BLANK% of U.S. adult population
May control for “emerging adults” who grow out of it
10% to 5%
27
Drug Misuse
Definition involves NOT using a drug as:
– appropriate (e.g., alcohol binge),
– directed (e.g., over-the-counter meds (OTC)
– or prescribed (e.g., Oxy fun)
28
ER visits due to alcohol plus other drugs misuse:
25-40%
29
Fatal Car Accidents and relapse
48%/50% fatally impaired drivers-alcohol
30
Relapse rate for a single attempt at abstinence from ATOD misuse:
65% to 80%
31
Costs of drug abuse
Only about BLANK-BLANK% of costs are adjudication- related
20-25%
32
Costs of drug abuse
Violence:
35- 50% drug-related
33
Costs of drug abuse
accidents:
40-50% drug-related
34
Universal Negative “Consequences” of
Substance and Behavioral Addictions!
(name 2)
- Unusual Thinking (e.g., psychotic reactions with drugs)
-Withdrawal-like (craving,irritability,concentration)
35
DSM-IV (1994-2013): Drug use-to-dependence continuum
Substance Abuse:
a DSM-IV disorder involving recurrent drug use over a 12-month period and involving 1 or more of 4 criteria:
* Failure to fulfill role obligations
* Hazardous use (physical danger)
* Legal problems (dropped in DSM-V)
* Social problems
36
DSM-IV (1994-2013): Drug use-to-dependence continuum
Substance dependence:
a more “severe” DSM-IV disorder involving 3 or more of 7 criteria:
* 1. Tolerance
* 2. Withdrawal
* 3. Use more than intended
* 4. Desire, but inability, to quit or cut down
* 5. Consumes life (takes up a lot of time)
* 6. Other activities are neglected or given up
* 7. Use results in negative consequences, but still use
– Physical addiction in red
37
DSM-V:
created one disorder with 11 criteria; deleted legal consequences as a
criterion; added cravings as a criterion
38
DSM-V Substance Use Disorders-2013
Legal consequences is out, craving is in SAD and SDD are combined
39
To understand these terms, know the context of their use
street drugs
40
Arguments for Marijuana to be Illegal:
lung lining damage (smoked)
41
How many types of Assesment are there?
6
42
Name two of the 6 main types of assessments
Mental Status Exam
Structured Clinical Interview for the Diagnostic
Statistical Manual V (SCID-V)-decision trees, clinical exploration (formal diagnosis)
43
Predictors of drug use, misuse, abuse,
and dependence (2)
1. Intrapersonal predictors
- neurobiological
-cognition
2. Extrapersonal predictors
-social groups
-large social and physical environment
44
Chicken and the Egg:
Does a variable lead to later drug use or addictive behavior (it is a predictor), or does it stem from drug use or addictive behavior (outcome)
* A (antecdents) -> B (behavior) -> C (consequences
45
Neurobiologically relevant etiology
1. Genes
2. BRAIN STRUCTURES
3. BRAIN “JUICES”: Neurotransmitters and neuropeptides
4. EARLY CHILDHOOD ENVIRONMENT AND PERSONALITY PHENOTYPES
46
Neurobiologically relevant etiology
GENES (define)
Genetic variations, genetic polymorphisms, and allele associations lead to differences in metabolic processes, which may lead to addiction.
47
Neurobiologically relevant etiology
BRAIN STRUCTURES:
Brain variation or structure/pathway communication may lead to addiction.
48
Neurobiologically relevant etiology
BRAIN “JUICES”: Neurotransmitters and neuropeptides
are chemical substances which act as mediators for the transmission of impulses from neuron to neuron through the synapse. Dysregulation of neurotransmitter, neuropeptide, and hormonal systems may lead to addiction.
49
Neurotransmitters associated with appetitive-motivated behaviors
- Dopamine (novelty)
- Serotonin (please)
- all recreational drugs appear to increase DA turnover
50
Neurotransmitter relevant theories of Addiction
-Reward deficiency syndrome
Insufficient D2 dopamine, serotonin, or norepinephrine production, receptors,
pattern of firing; self-medication maybe
51
Neurotransmitter relevant theories of Addiction
Incentive-sensitization theory
Dissociation of “liking” [ mu opioid hotspots] with "wanting" [mesolimbic DA ]
52
Neurotransmitter relevant theories of Addiction
1. Reward deficiency syndrome
3. Incentive-sensitization theory
4. Allostasis
53
Cognitive etiological variables of drug abuse!
Cognitive-information errors:
may affect one’s likelihood of becoming a drug abuser:
Implicit associative processes: spreading activation in memory; cues-behaviors-outcomes
54
Cognitive etiological variables of drug abuse
Limits in rational cognitive processing
may affect one’s likelihood of becoming a drug abuser:
- Expecting what have been taught or past experiences; can
form a semantic network of associations in memory
-Implicit/relatively automatic processes can take over control
55
Friends and peer group affiliation inhibit or promote drug use (Peer social influence)
Informational:
-covert/observational/modeling
-social influence may operate
- OTHER PEOPLE DO THIS SO I WILL DO THIS
56
Friends and peer group affiliation inhibit or promote drug use (Peer social influence)
Normative:
-overt/adherence/acceptance
-social influence may operate
-YOU WANT TO BE LIKES, YOU DO IT
57
Majority of cocaine is manufactured in...
Colombia (about 80%)
58
Majority of opium comes from...
Afghanistan (85%)
Myanmar (~10%)
59
opioid use disorder treatment cases:
- 70% of cases in Asia countries, Russian
Poppy cultivation has also
Federation, and high in Western Europe
-20% in “America” (but tied for highest
illicit drug)
60
M are (BLANK) times more likely to report a substance use disorder than FM
2-to-4
61
M>FM self-disclosure of addiction (T/F)
True
62
FM>M: custody issues, more likely to lack insurance, victimization
- If a heavy drinker-deaths: FMs 50-100% > M (T/F)
True
63
Does sex role expectations and differential stigma affects drug use prevalence or disclosure?
Yes
64
Gender roles:
androgynous least likely to misuse substances
65
Biopsychosocial models
drug misuse and behavioral addictions are biopsychosocial [BPS] phenomenons
66
Currently Very Popular Model
Risk and Protective Factors Considered within a
Ecological Model (SEM)
-Look at diagram for content!!
67
The ABCs of Health Behavior Research
A (Antecedents) = (e.g., intra-personal, interpersonal, environmental variables)
l
Prevention-of problem behavior
l
v
B (Behavior) = (e.g., smoking, unsafe driving, drug use)
l
Cessation- recovery of function/minimize Cs
l
v
C (Consequences) = (e.g., heart disease, cancer, accidents)
68
Types of prevention: (Chronology definition)
A.Primary prevention:
Implemented on a population before the problem behavior starts
69
Types of prevention: (Chronology definition)
B.Secondary prevention:
Targeting the population after the problem behavior starts but before the disease sets in
70
Types of prevention: (Chronology definition)
C. Tertiary prevention:
Aimed to improve conditions for diseased individuals before death is likely
71
Types of prevention: (Target population definition)
A. Universal prevention:
Designed to affect the general population
72
Types of prevention: (Target population definition)
B. Selective prevention
Designed to affect subgroups at elevated risk for developing a problem, based on social, psychological, or other factors (e.g., children of alcoholics)
73
Types of prevention: (Target population definition)
C. Indicated prevention:
Designed to affect high-risk subgroups already identified as having some signs or symptoms of a developing problem (e.g., experimental drug users)
74
History of drug abuse prevention
Always religion, law enforcement, and family
- emphasis on moral education
75
6 Types of Neurobiologically Relevant Prevention Programming
1. Genetics
2. Neurotransmission
3. Delay (harm delay)
4. Emotional learning and cooperation learning
5. Sensation seeking (SS) alternatives programming
6. Self-control/self-regulation skills
76
Instruct in: The 3 parts to assertive communication
"Let's say your friend borrowed a CD and now you’d like it back.":
A. Other-statement
- "Im glad you enjoyed the CD"
B. Self-statement
- "...but I would like to listen to it today."
C. Action statement
- "How about if I pick it up from you after school?"
77
Types of cognitive processes-related prevention
1. Cognitive-informational errors counteraction EX: Drug revalence overestimates - point out discrepancies between perceived and actual prevalence of drug use among peers or engage in “overestimates reduction” activity. (also can be considered a social group- level activity)
EX: Error- related myth formation
2. Cognitive processing limits counteraction
EX: decision making practice (options, pros and cons of each, selection, action, re-evaluate
78
78
Comprehensive social influences programming
(a) Enhance social skills (e.g., listening and communication, assertiveness, social decision making, and activism) and
(b) correct social misperceptions (e.g., of drug use prevalence overestimates, normative restructuring, and
78
Types of social interaction and social group-
related prevention
1. Comprehensive social influences programming
5. Family-based prevention programming
79
How many elements of comprehensive social influences programming?
Most important one?
a) Eleven
b) Refusal assertion emphasis: To refuse drug offers assertively but not aggressively or passively. (other-self-action statements; must link to normative correction material or can be iatrogenic)
80
Family-based prevention programming
( know that there is are variety of family-based features; strength in families (just recognize it)
- Strengthen family dynamics
-Skills training
-Resource acquisition instruction-e.g., remedial education, transportation
- Family therapy
- Parent training
- Contingency management
- Stimulus control
- Expressed emotion modification-critical comments, hostility, overinvolvement
- Paradoxical intention
- Social support training.
- Examples include Strengthening Families, Family Matters, Functional Family Therapy,
Multisystemic Therapy, and Multidimensional Treatment Foster Care (pages 190 S&A, 2008)
- Teach parents to be good parents, children to be good children, and teach parents and
children to communicate better
*Rule setting, monitoring, spend time together, education encouragement, authoritative,
communication
81
3 types of large social and physical environmental prevention
1.Media-based programming:
can reach a large audience and hard-to-find individuals.
2. Social and physical environmental resources: Access to prosocial (e.g., drug free recreation alternatives, jobs) and physical environmental resources
3. Regulatory scheme:
(setting conditions of use [minimum age, zoning], information about use, taxation, sanctions]
82
Tobacco Use Prevention Modalities
“Modalities” of tobacco use prevention programming have been referred to as
“types” of programming, program “components”, types of “policies”, “approaches”, or “strategies”, or “settings of delivery”
Several modalities of tobacco use prevention programming have been implemented. The major ones include:
Mass media programming
83
Name a Community-based Programming Example
Coalitions work best if well-units together including researchers, practitioners, and organized, and focused on bringing community units, and on restricting environmental access
- not good as the deliveries of specific program contents
84
Models of Motivation (to Quit)
INITIATING AND SUSTAINING MOTIVATION TO QUIT AND STAY STOPPED ARE KEY
-Direction-energy model (goals and work)
-Intrinsic extrinsic model (for self or others, contingent on behavior key in this model)
-Self-regulationmodel-(a)idealstate,(b)currentstate,(c) behavior, (d) feedback
-Transtheoretical model stages: 5 stages!!
85
Alcohol: (blank)% get and stay sober on their own
33%
86
Only BLANK% of alcoholics get sober through AA (BLANK% reach AA and BLANK% of them get and stay sober
Only 5% of alcoholics get sober through AA (10% reach AA and 50% of them get and stay sober
87
Harm reduction (Cessation)
is another treatment option (protect from consequences, and gradually ease away from harmful use in steps) - e.g., needle exchange, methadone
Remember that 75+% of addicts relapse on a first attempt.. It is not just acute withdrawal...
the addiction “worked” for awhile.. They are “experts” on their addiction... neurobiology can
take a of couple years to get back towards a neurobiological baseline...
88
Three Stages of Recovery Models
1. Mueller & Ketcham: 3 steps
2. Johnson: 4 steps
3. Gorski & Miller: 6 steps
89
Medications According to Uses (Alcohol & opiod)
Alcohol: Librium= Eases withdrawal
Opioid: Methadone (every day) & Buprenorphine
(every 3 days)
90
Neurobiological
Post-acute Withdrawal Symptoms (PAWS)!
Physical coordination problems
– Gorski: operates up to 18 months after following acute withdrawal
91
Gorski and Miller (1984, 1986) Relapse Warning Signs
(11 in total)
-Denial
-Defensiveness
-Crisis building
-feel trapped
-loss of control
-Option reduction
92
A Cognitive-Level Treatment
CBT (S-O-r-R Model)
LOOK AT SLIDE FOR MORE INFO
93
Type of Cognitive Processes-related Cessation
Cue exposure treatment paradigms
(Protocols involve extinguishing conditioned responses through unreinforced exposure to conditioned stimuli.)
94
Rational Recovery
cant do both with AA!!!
- Quit altogether, not one day at a time (the Big Plan)
-The Addictive Voice is the cause of the addiction and part of equivocation, excessive appetite, the “Beast”
95
Alternatives to AA:
SOS, RATIONAL RECOVERY, SMART RECOVERY, LifeRing Secular Recovery
96
LifeRing Secular Recovery
strengthen the Sober Self (S) and weaken the Addict Self (A)
97
Explicit cognitive strategies: (Relapse Prevention)
directly challenge beliefs and irrational thinking (e.g., alcohol expectancy challenge
(EC)
LAPSE VERSUS RELAPSE (SLIP VERSUS FULL BLOWN BACK TO BASELINE USE
-indivdual responsibility for change (not based on a disease model)
98
Implicit cognitive strategies: (Relapse Prevention)
a) attentional retaining (use of visual probes)
b) elaborative processing of new associations
c) formulating implementation intentions (vigilance)
99
Social level: Motivational Intervention
1. Inquiry (of need)
2. Assessment (of family)
3. Preparation (scripts, rehearsal)
4. Intervention
5. Follow-up/case management
100
A.A./N.A.
- interpreted as a disease model)
12-steps (individual internal process of change)—self-help
Steps 1 to 3: turning it over to G-d (cosmic, good orderly direction)
- Compliance, surrender
Steps 4 to 6: Clarity and readiness to clean up one’s act
- Willingness to change
Steps 7 to 9: Making amends, “cleaning one’s house”
Steps 10 to 12:Maintenance (daily self
-, self-to-G-d, self-to-other checks)
101
(BLANK)-step program of recovery
12
102
Criticisms of 12-step programming
* Often non-professionals as leaders
* May be lots of gossip
* May encourage dependence on program
* May discourage skepticism of program
* Members may suggest that 12-step programs are for everyone or that nothing else works
* May over-attribute problems to “the disease”
* Some monopolizing over treatments available out there
* Personal stories may get repetitive
* There can be deviancy training among members
* Works better for people who fit well in groups
* Meta-religious tone
* Not direct self-empowerment
* Abstinence focused
* Gender-incorrect language
103
Motivational Interviewing
LOOK AT SLIDE
104
Other Social/Community-Level Treatments:
Outpatient treatment.
Okay if and only if environmental support systems and clinical indicators do not impact negatively on treatment process/reduce
likelihood of success.
105
Other Social/Community- Level Treatments:
Student assistance programs
training in drug education (e.g., signs and symptoms of drug misuse), training in intervention techniques and referral skills; resource library; peer support
106
Other Social/Community- Level Treatments:
Employee assistance programs
education and counseling
** Work: if ATOD problem
40% absenteeism
40% tardy
30% mistakes
25% problems with boss
25% on completing work
10% on-the-job injuries
107
Prison treatment
***66% of arrestees placed in prisons tested positive for at least one drug at the
time of arrest
63% previous drug treatment
25% had committed crimes to get
money for drugs
60% in jail for drug-
related crimes
108
Residential treatment
Just remeber class example
20-50% of nursing home residents have alcohol-related problems
109
Responsible Gambling Information Centers (RGICs)
only about 1/3 of casino employees had
spoken with the RGIC staff
110
Addiction Cessation (4 levels)
1. Neurobiological Level
(ex: Keeping optimally busy, Keeping physically active, structured time)
2. Cognitive Level
(ex: Pausing to reflect on stream of inner speech; sit still and hurt)
3. Micro-social Level
(ex: Being in the company of normalcy, Taking care of others (conscientiousness)
4. Large Social and Physical Environment
(ex: Avoiding too much curiosity to “explore” – Keeping one’s ears open and mouth quiet – Provide safe locations to go to)
111
Motives of Addictions
Dominance
Avoidance/submissive
Pleasure/hedonist
Nurturance
112
Five Phases of CTC for Drug Abuse Prevention
1. Get Started
2. Get Organized
3. Develop a Community Profile
4. Create a Community Action Plan
5. Implement & Evaluate
113
Special populations: Example of Alcohol Use Prevention
Ethnic identification and pride are protective mediators
- surface changes (e.g names, folk stories
-deep changes (e.g. relationship structure, basic prevention activities)
114
Transdiscliplinary Teams/Translation
Multidisciplinary- draws on various knowledge bases but stays within borders
Interdisciplinary- synthesizes links between disciplines into a coherent whole
Transdisciplinary- approach-problem-focused approach that blurs boundaries between research disciplines (common language develops)
-e.g. neurology+behavioral science=neuroscience
115
Common Global Adaptations of Project EX
language, tobacco product, Names, currency, policy facts, no incentive
CHECK SLIDE FOR INFO
116
Several country-level variables might be considered when entertaining translation of existing programming to a new country context. These include:
patriotism, degree of governmental involvement in the healthcare system, festivals, popular stories, level of disparities, main causes of premature death
