The origin and history of cocaine use
German chemist albert nieman was the first to isolate cocaine extracted from coca leaves in 185
Cocaine became popular in the 1880 in the medical community. Used as an anesthetic for cataract surgery
Freud was fascinated with cocaine and promoted it as a “magical substance”
Cocaine and coca cola (originally had cocaine in it
The american crack epidemic of the 1980’s
Increase of crack cocaine use in major cities across the united states between the early 1980s and the early 1990s
High with crack cocaine is much shorter and very intense, its very cheap
Increase in crime and violence in inner city neighbourhoods
Lead to “tough on crime” policies and the “war on drugs”
Past year of cocaine use internationally
~300,000- age 15-64. More prevalent in North America. A lot of Canadian youth are using cocaine relative to adults who are 25+ , as age progresses cocaine use decreases. Grade 7-12 have used it at least once in the past year. Alcohol is most used, cannabis second, hallucinogens third and cocaine/crack is 4th
What are the protective factors for drug use and abuse?
- High GPA
- Low depression
- Having supportive relationships at home
- Perceiving many sanctions for drug use
- High religiosity
- High self acceptance
- High law abidance
What are the risk factors for drug use and abuse?
- Low educational aspirations
- High perceived adult drug use
- High perceived peer drug use
- Many deviant behaviours
- High perceptions of community support for drug use
- Easy availability
- Low perceived opportunity
Describe the relationship between risk factors, drug use, and predictive factors
Risk factors lead to drug use and they are mediated by protective factors
How did this study predict concurrent drug use?
Risk factor index X protective factor index interaction was not predictive of all outcomes
Only for hard drug frequency (both sexes)
Cocaine and cigarette use for women only
Found a Buffering effect: High risk and low protection linked to high drug use/ Low risk and high protection linked to low drug use
How did this study predict prospective drug use 4 and 8 years later
Risk factor index X protective factor index interaction was not predictive of all outcomes.Predicted greater cocaine and cannabis use 4 years later. Predicted greater alcohol problems 8 years later
Final conclusions of this study
Drug use nor addiction cannot be fully accounted for by any one or even a few etiological factors. Drug use and addiction increase as numbers of vulnerability conditions to which a person is exposed and with which they must cope increase Buffering effects
MRI of the neurobiology of cocaine
Over time the receptors don’t seem to be restored, potentially neurological marker of impulsivity. The image shows low dopamine D2 receptors may contribute to the loss of control in cocaine users.
How Cocaine effects the brain
Cocaine goes to the ventral tegmental area/nucleus accumbens: the reward area of the brain. Cocaine reaches the synapses and elicits the release of dopamine but prohibits/blocks the reuptake of dopamine so it forces the postsynaptic cell to absorb it all, creating a flood of dopamine and an intense high.
What are the health consequences of cocaine?
Withdrawal (craving, deep sleep post binge, negative affect), Overdose (seizures, severe hypertension, rapid heartbeat, coma and death), Physiatric effects, delusions, paranoia, hallucinations, severe anxiety, Psychosis, suicidality. Symptoms can persist for months after abstaining
History of tobacco use
Tobacco use has a very long history. James bonsack invented the cigarette making machine in 1881. Bonsack’s cigarette machine could make 120,000 cigarettes a day. Cigarette smoking became widespread
Prevalence of tobacco smoking
Increasing in some countries but decreasing as a whole. In 2015, over 1.1 billion people smoked tobacco. More men than women smoked tobacco
Prevalence of tobacco use among youth aged 15-19
26.7% of youth were using tobacco in the 12 months prior to the survey. Tobacco smoking in youth is associated with more frequent use of alcohol, cannabis, and other illicit drugs relative to youth who do not smoke and to adults who do or do not smoke.
On days when alcohol was consumed…
Smokers (15-19) averaged 5 drinks
Non smokers averaged 2-3 drinks
What does the data indicate about smokers under the legal drinking age?
Smoking under the legal drinking age (15-17) drank as frequently as those at the legal drinking age (18-19). The data do not speak to whether tobacco smoking is a gateway for use of other substances. Data indicate that tobacco smoking in youth is a good indication that youth may be engaging in other risky behaviour.
Why are the results about underage drinkers concerning?
High rates of problematic drinking are as common in underage youth age as they are among those at the legal drinking age. Teenage smokers appear to have ready access to significant quantities of alcohol, despite being under the legal age for obtaining both tobacco and alcohol
What are some limitations of the study on tobacco and other substance use?
Limitations = recall bias and motivation to misrepresent actual use of substances (retrospective study)
How is nicotine dependence measured
The fagerstrom test for nicotine dependence Screening tool designed to provide an ordinal measure of nicotine dependence
Contains six items that seek information on the number of cigarettes smoked, compulsion to smoke, and dependence. Provides a severity rating that can be used to help plan treatment and assess the prognosis
What is the most common SUD?
Why is nicotine known as the chameleon drug
Acts as a sedative when the smoker is anxious and as a stimulant when the smoker is fatigued. Reaches the brain within seconds
What is the neurobiology of nicotine?
When you inhale nicotine it effects the CNS and binds to certain receptors in the brain. It is a dopaminergic releasing drug, binds to Ventral tegmental area which sends a message to the nucleus accumbens to release dopamine
What is Nicotine double effect on Dopamine Release?
Nicotine affects 2 neurons that modulate DA level in the NAcc: Nicotine stimulates the release of glutamate, which triggers additional DA release. Nicotine also blocks the release of GABA which sustains DA levels. Nicotine acts on these neurons to increase the ratio of glutamate to GABA in the VTA. This amplifies the rewarding process of nicotine
Health consequences of tobacco
Strokes (however can lead to quitting) Lung cancer, heart problems
what is nicotine withdrawal?
Characterized by fatigue, irritability, gastrointestinal upset and craving. Acute withdrawal resolves in ~5 days. But craving can last for many months
Relapse rates are high
What is a non-substance based behavioural addiction?
People engaging excessively in problematic behaviours like gambling, gaming, sex, shopping etc.
What is the difference between gambling and substance misuse?
Hidden addiction Can't overdose- no saturation point Huge financial problems Cant function at work Cant be tested (e.g., biometric test, urine test) Doesn’t require ingestion
What are the similarities between gambling and substance misuse
Preoccupation, Negative impact on major life areas, Tolerance, Immediate gratification, Loss of control
A broader concept of addiction
Addiction is about enacting or performing a behaviour: Behavioural aspect of substance addiction (e.g., drug taking), Enactment of a behaviour that is addictive (e.g.,gambling).Treatment involves stopping or reshaping the behaviour and replacing it with alternate activities
How are all addictions behavioural?
These behaviors are enjoyable when balanced with other activities. However, when a person becomes increasingly absorbed by and dependent on a behavior to the extent that it crowds out other involvements, a negative cycle can be initiated whereby other areas of life are neglected, and the person’s functioning and relationships come under pressure
What does gambling involve?
“Gambling involves risking something of (perceived) value in the hopes of obtaining something of greater (perceived) value”
How Did Freud view gambling?
Freud (1928) came to the conclusion that Dostoevsky’s irrational gambling was a substitute for masturbation, which was provoked by prima oedipal guilt.
What was Edmund Bergler’s view on gambling?
published The Psychology of Gambling in 1957. He viewed the gambler as neurotic and who had an unconscious desire to lose and be punished and felt they were omnipotent and could control outcomes that are largely determined by chance.
What happened in the 1950 in terms of gambling?
A medicalization of it, the disease model of gambling
When was gambling legalized?
in the 80’s and 90’s
What is gambling like today?
Gambling moves into the 21st century, online and app gambling. More access. Popular recreational activity
A lot of venues to gamble in and around Canada, the larger the province the more venues there are.
Which provinces have the most and least gambling venues?
Quebec and Ontario have the highest number of venues and newfoundland has the lowest
What are the 4 E’s of Gambling?
Entertainment: to have fun
Excitement: to get a rush from risk and uncertainty
Economic gain: to win money
Escape: to lose one’s self in play
Why do people gamble?
Dream of hitting the jackpot Intellectual challenge Chance of winning Social rewards Mood change
Gambling addicition in the DSM 3
In DSM 3 pathological gambling was listed
Gambling addiction in the DSM 4
DSM 4 pathological gambling must meet at least 5 of the criteria and they added “committing illegal acts to sustain addiction, such as stealing money to gamble with”. Gambling was grouped with other impulse control disorders
Gambling addiction in the DSM 5
In DSM 5 pathological gambling left the impulse control disorder and joined substance related and addictive disorder as a non-substance related disorder. The first formal recognition of a behavioural addictions. 9 vs 10 criteria (illegal activities dropped)
How is the severity of gambling disorder measured?
Gambling disorder severity rated (9 criteria)
2-3 criteria will be indicative of a mild disorder
4-5 criteria will be indicative of a moderate disorder
6 or more will be indicative of a severe disorder
Gambling disorder and psychiatric comorbidity
People living with GD have a high rate and wide range of comorbidities. More likely to have nicotine dependence (60.1%), substance use disorders (57.5%), mood disorders (37.9%), and anxiety disorders (37.4%). Gambling problems co-exist at a high rate with alcohol dependence and problematic substance use
What is the prevalence of gambling disorder?
1.4 % of population of manitoba were likely to be gamblers, the highest in Canada and Quebec/Ontario is the lowest
The epidemic curve
People believe gambling follows this same Epi. Curve
(starts with rapid infection increase among the most vulnerable, infection among the resistant, and population evidence for recovery)
What is the influence of consumption?
As exposure to a stimulus increases the most vulnerable are the first to be infected, we may see increases in gambling participation near epicenters of gambling, then there is a period of adaptation
A biopsychosocial perspective of gambling: psychological aspects
Learning: operant conditioning and classical conditioning
The variable ratio of positive (winning) and negative (losing) reinforcement in gambling.Erroneous beliefs about probability of winning and personal skill: Odds of winning at games of chance Irrational thought (believing in luck)
The odds of understanding odds
People fail to understand that most games involve sampling with replacement
The odds are fixed- they do not change even if you play again and again
Past wins or losses have no bearing on the outcome of the next gam
What is illusion of control?
Belief that chance outcomes can be controlled through personal skill, effort
What is double switch phenomenon?
The tendency for people to understand that the odds of winning aren’t in their favor before and after gambling, but a lack of understanding during gambling (once they start they abandon logical thought processes)
What is the homogeneity bias?
all games are not created equal. The skill-luck continuum. Non rational thought: luck is a random event or luck Is a trait aspect
Findings regarding personal luck and GD
Luck can be acquired and used to maximize outcomes. Ppl who believe in luck view gambling as a challenge. No need to stop if one has a skill (gamble, gamble, gamble)
What is risk sensitivity theory?
A general theory of decision-making under risk that involves evolutionary considerations. Situations of high need (i.e. when there is a discrepancy between one’s current state and a desired state) induce a shift toward preferences for riskier goal attainment strategies. When people in a state of high need (e.g. relative deprivation) believe that they will come up short by pursuing low-risk options, they will prefer high-risk options that have a small chance of completely eliminating the need deficiency
What are the biological aspects of involved gambling? The dopamine reward system
fMRI imaging has shown that chance monetary rewards (i.e., gambling) activate the brain’s dopamine reward system. As the reward is never predictable the gambler receives a burst of dopamine into the brain every time they play. reinforced by social environmental cues resulting in the development and maintenance of a strong response that is very resistant to extinction.
What is the relationship with gambling and dopamine
DA release in the brain reward circuitry is evoked by reward but also by prediction of reward. Could be one of the driving forces in the obsessive need to gamble.Slot machine gambling is a good context to study DA in gambling
What is the method of the study by Jousta et al. on DA and gambling?
12 GD and 12 non-GD
Underwent 3 Positron Emission Tomography Imaging) scans on the same day (3 hrs apart) under different conditions: High-reward, low-reward, and control tasks (counterbalanced)
What were the key results of the study by Jousta et al. on DA and gambling?
DA release was observed in the right striatum in all participants while gambling. High reward also activated DA release in the ventral striatum for all participants.The high-reward task induced gambling “high” in all participants. DA release was associated with gambling addiction severity in the high-reward, but not in the low-reward, task
Gambling addictions and genetics: twin studies
2,889 pairs of twins investigated the role of genetic and environmental factors in the development of gambling addiction.
Identical twins who were gamblerswere more likely to have a twin who was also a gambler than non-identical twins.
The researchers suggest that this association was more to do with agenetic link than environmental factors.
What 3 subtypes did the pathways model identify?
- Behaviorally conditioned
- Emotionally vulnerable
- Anti-social impulsivist
Describe the subtype behaviourally conditioned?
Do not have any etiological risk factors (e.g., premorbid psychopathology)
Develop gambling problems mainly in response to reinforcement contingencies of gambling. Cognitive distortions related to gambling (e.g., gambler’s fallacy, illusion of control, beliefs in luck)
Describe the subtype emotionally vulnerable?
Like behaviorally conditioned, but… Biological vulnerability (Family history of GD), Emotional vulnerability (Personality, Mood/Anxiety disorders, Life stress) ACEs
Describe the subtype anti social impulsivist
Like the other 2, but also have: Impulsivity traits, Anti-social personality traits, Engage in many maladaptive behaviors (e.g., Drug taking, criminal behavior)