Substance Use Flashcards
1
Q
What is the definition of addiction?
A
- The tendency to persist with an appetitive or rewarding behaviour that produces pleasure states and desire, despite mounting negative consequences that outweigh these more positive effects.
- The person feels caught in this appetitive behaviour, and does not want to or cannot seem to moderate or stop it.
2
Q
What are the negative consequences of addiction?
A
Negative consequences include preoccupation and compulsive engagement with the behaviour, impairment of behavioural control, persistence with or relapse to the behaviour, and craving and irritability in the absence of the behaviour
3
Q
What type of SUD has the highest lifetime prevalence?
A
Alcohol abuse or dependence (21.6%). The second highest is cannabis use or dependence (18.1%)
4
Q
What is the concept behind behavioural addictions?
A
- What causes a person to lose control is not the substance (e.g., cocaine)
- It is the underlying neural circuitry that fires when presented with the reward the substance provides
- In substance addiction, seeing a drug stimulus (e.g., the dealer or syringe) can activate the brain reward system and thus become reinforcing
- In gambling and gaming, related stimuli (e.g., sounds, visuals) also activate the brain reward systems and become reinforcing
5
Q
What is the spectrum or dimensional view of addiction?
A
- Starts with experimental/ recreational use
- Casual or situational
- Intensive
- Compulsive
- then addiction
6
Q
How is addiction classified in the DSM-5?
A
- DSM-V: Substance-related and addictive disorders (non substance behavioural addictions)
- Substance use disorder (SUD). Each specific substance is addressed as a separate use disorder (e.g., alcohol use disorder, stimulant use disorder, etc.).
- Nearly all substances are diagnosed based on the same overarching criteria
7
Q
Do SUD’s and addictive disorders have a familial/genetic influence?
A
Substance use disorders and addictive behaviours are influenced by genetics.
8
Q
What are the neurobiological effects of substance use?
A
Abused substance affects the internal reward system of the brain.
9
Q
What did study with rats tell us about the neurobiology of reward?
A
- The reward centre in the brain
- Studied effects of electrical stimulation on rat brains
- When certain areas were stimulated with small amounts of electricity, rats behaved as if they received something very pleasant (e.g. food)
- Exact location in human brain is still subject to debate, but believed to involve the dopaminergic system and its opioid releasing neuron
10
Q
How does cocaine effec the brain/ reward system?
A
- When you consume cocaine, it blocks the reuptake of dopamine by the post synaptic cell. so dopamine floods the synapse creating an immense high
11
Q
What is amphetamine?
A
- Amphetamines are similar in structure to dopamine
- Can move from outside the neuron into the cell via dopamine transporters or directly by diffusing through the neural membrane
- Once inside, amphetamines force dopamine out of their storage vesicles and expel them into the synapse
12
Q
How is dopamine related to addiction?
A
- Addiction is thought to be the result of repeated stimulation of the mesolimbic system, which triggers reorganization in the brain’s neurocircuitry
- These changes in the brain may mediate positive reinforcement, motivation, craving and relapse for the drug
- As people become more driven to use the drug, the drive can also progress to a state of negative reinforcement (i.e., to alleviate negative symptoms associated with withdrawal)
13
Q
What are the neural mechanisms underlying vulnerability to addiction?
A
- neuroplasticity and neuroadaptation
14
Q
What is neuroplasticity?
A
- The brain’s ability to reorganize itself by forming new neural connections throughout life
- Allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment
- Important for learning and memory
15
Q
Does dopamine theory apply to other substances?
A
- Given existing data, DA release seems to apply better to stimulants (e.g., cocaine)
- Mixed results from non-stimulants should have given the field pause for thought
- Research has largely focused on DA in the striatum, but decision making for the most part takes place in the cortex
16
Q
What is neuroadaptation?
A
- The process whereby the body compensates for the presence of a chemical in the body so that it can continue to function normally
- For people who abuse substances (e.g., cocaine), neuroadaptation leads to tolerance and dependence on a substance
- Sensitization (i.e., reverse tolerance) occurs when repeated administration of a drug elicits escalating effects at a given dose
17
Q
When does sensitization occur?
A
- Can be seen in early phases in addiction, using cocaine in small amounts infrequently is seen as a form of sensitization. Until you build a tolerance.
- Can also be in the throws/later stages of addiction too, for example a person with alcohol addiction no longer has the enzyme that breaks down alcohol in their liver anymore
18
Q
What is the insula?
A
- The insula is involved in a network of brain regions that represent bodily states associated with emotions and decision making
19
Q
How is the insula involved in craving and addiction?
A
- Cue-induced craving can be conceptualized as an emotion
- Drug seeking cues activate the insula, and activity in the insula is linked with self reported craving
- Greater activation in the insula is associated with greater likelihood of slips (Evidence is not very strong for this theory)
20
Q
How is the insula involved in the automatic drug seeking mode?
A
- Divorced from the value of drug takin
- no subjective craving
- unaffected by Insula lesions
21
Q
How is the insula involved in goal directed drug seeking mode?
A
- tied to value of drug taking
- subjective craving
- abolished by insula lesions
22
Q
What are the psychological perspectives of the etiology of addiction?
A
- Affect and motivation
- Cognition and beliefs (Expectancies about taking substance or performing the
behavior) - Positive and negative reinforcement (Substance increases positive affect (e.g., excitement) and Substance alleviates negative affect (e.g., anxiety)
- Personality and other predispositions. Neuroticism (proneness to experience negative affect) and Attachment styles (how we relate to significant others)
23
Q
What are the 4 major personality traits that predict substance use disorders?
A
- Impulsivity (disinhibited traits)
- Sensation seeking (disinhibited traits)
- people with disinhibited traits like these 2, are more likely to use stimulants
- Hopelessness (drug/alcohol misuse)
- Anxiety sensitivity (sedatives)
24
Q
Why do people consume alcohol?
A
- Positive reinforcement (enhancement, because it is exciting, to get a high)
- Negative reinforcement (depression, to forget painful memories, to stop from feeling hopeless about the future)
- Negative reinforcement (anxiety, to reduce anxiety and to forget worries)
- Social (as a way to celebrate, to be sociable)
- Conformity (so I won’t feel left out, because my friends pressure me to use)
25
What was the method of the study about personality factors, drinking motives and alcohol use disorder severity?
- Study involving university and high school students (N = 550)
- Big Five Personality traits
- Five drinking motives
- AUDIT
26
What were the results of the study about personality factors, drinking motives and alcohol use disorder severity?
- Greater conscientiousness was associated with less severe alcohol use via lower enhancement and lower coping depression motives
- Greater agreeableness was associated with less severe alcohol use via lower enhancement, social, and coping depression motives
- Greater extraversion was associated with more severe alcohol use via greater social and conformity motives
- Greater neuroticism was associated with more severe alcohol use via coping depression motives
- Openness to new experiences was not related to severity of alcohol use via drinking motives
27
What were the limitations of the study about personality factors, drinking motives and alcohol use disorder severity?
- Cross-sectional research design
- Did not statistically control for shared variance between the personality traits.
- Did not examine interactive effects of personality on drinking motives and severity of alcohol use
- Did not examine interactive effects of drinking motives on severity of alcohol use
28
What are the social perspectives for the etiology of addiction?
- The immediate interpersonal environment of a person who develops an addictive disorder (Social support, friendships, family)
- Broader socio-structural properties of the environment (Social disadvantage due to race, poverty, culture)
- Community health and “the globalization of addiction” (Bruce Alexander)
29
What is the dislocation view of addiction (Bruce Alexander)?
- It identifies addiction as an adaptive response to broader societal problems that dislocate the individual from a sense of meaning, purpose, and value, driving them towards addictive behaviors.
- Dislocation is identified psychologically as a “lack of attachment, belonging, identity, meaning, [and] purpose. Social and economic forces beyond the control of the individual – among them free-market capitalism, ecological devastation, consumerism and more – work to alienate and dislocate the individual from structures of meaning.
- Our modern social arrangement, Alexander argues, means that we have to sacrifice “family, friends, meaning, and values” in order to be more “efficient” and “competitive” in the rat race. In this framework, addictive behaviors are adaptive responses meant to fill that void of meaning and purpose. Using substances can provide a temporary sense of community (with other users), purpose (to acquire the substance), and meaning (feelings of euphoria or calm from using the substance). Substance abuse and addiction help to fill the gaps in meaning and purpose left by modern society.
- Globalization of free markets --> Dislocation --> Mass addiction
30
What are ACE's?
- Adverse childhood experiences
- Abuse (sexual, emotional, physical)
- Neglect (physical or emotional)
- Household dysfunction (mental illness, incarcerated relative, mother treated violently, substance abuse, divorce)
31
What is the multiple risk and protective factors model?
- A person's risk status increases exponentially the more of them you have, the effects are additive
- however, protective factors can moderate the relationship between risk factors and drug use
- Posits that Addiction cannot be fully accounted for by any one or even a few etiological factors
- Addiction increase as numbers of vulnerability conditions to which a person is exposed and with which they must cope increase
- Buffering effects
32
What are the items on the protective factor index?
- High GPA
- Low depression
- Having supportive relationships at home
- Perceiving many sanctions for drug use
- High religiosity
- High self-acceptance
- High law abidance
33
What are the items on the risk factor index?
- Low educational aspirations
- High perceived adult drug use
- High perceived peer drug use
- Many deviant behaviors
- High perceptions of community support for drug use,
- Easy availability of drugs
- Low perceived opportunity
34
What did Newcomb & Felix-Ortiz (1992) find about how risk/protective factors predict concurrent drug use?
- Risk Factor Index by Protective Factor Index interaction was not predictive of all outcomes.
- Only for hard drug frequency (both sexes)
- Cocaine and cigarette use (women only)
- Buffering effect
- - High risk and low protection linked to high drug use
- - Low risk and high protection linked to low drug use
35
What did Newcomb & Felix-Ortiz (1992) find about how risk/protective factors predict prospective drug use 4 and 8 years later?
- Risk Factor Index by 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
36
What is the most helpful perspective for conceptualizing the complex and varied pathways to addiction?
- the biopsychosocial perspective
- Biological (genes, nutrition e.g., higher sensitivity to brain's reward center)
- Psychological (emotions, behaviour e.g., anxiety or depression)
- Social (stress, trauma, environment e.g., learning vicariously at a young age that substance use is an efficient tool for coping)
37
What are the different biological treatment approaches?
- Agonist substitution - replacing one drug with a similar one (Methadone for heroin);
- Antagonist substitution - block one drug’s effects with another drug (Naltrexone for opiates and alcohol);
- Aversive treatments - make taking the drug very unpleasant;
- Drugs to help recovering person deal with withdrawal symptoms (Clonidine for opiate withdrawal, or sedatives for alcohol)
38
What is the "all or nothing" service delivery approach?
- Require abstinence prior to receiving treatment
- Rooted in belief that change is motivated by the experience of negative consequences from substance use
- Continued substance use is a sign that that the person is unmotivated to change
- Providing service to persons who have not abstained would delay their commitment to abstinence and thus change
39
What are the limitations of the "all or nothing" approaches?
- Deprives people who are not interested in cessation, but want to remain healthy
- Deprives people who have problems controlling one addictive behavior, but not other addictive behaviors
- Limits the right to self-determination
- Harm reduction policies, programs, and approaches deal with these limitations (e.g., safe injection sites and needle exchange programs)
40
What is the relapsing nature of addictive behaviours?
- Although changing an addictive behavior is difficult, maintaining change is even more challenging
- Relapse means failure to maintain behavioral change
- Relapse is common in the recovery process for addictive behaviors (during treatment and post treatment)
- Addiction has been conceptualized as a chronic relapsing disorder or chronic disease
41
What is the stages of change model?
- Enter: precontemplation
- contemplation
- determination
- action
- relapse
- maintenance
- Exit and re-enter at any stage
42
What are the five principles of motivational interviewing?
1) Express empathy for the client
2) Develop discrepancy between the client’s goals and values and their current behavior (i.e., behavioral addiction)
3) Avoid argumentation and direct confrontation
4) Roll with client resistance, instead of fighting it
5) Support the client’s self-efficacy, or their belief that they can change
43
What are 12-step mutual help organizations and what do they do?
- Alcoholics Anonymous (AA) supports recovery through helping members cultivate spirituality and related practices as a new way of living
- AA facilitates helpful social network changes (e.g., by helping people drop heavy drinkers from their social networks and adopt abstainers and recovering people into their social network)
- AA boosts people’s confidence in their ability to remain sober when faced with high risk social situations or when feeling down or angry.
- AA Reduces craving and impulsivity. In other words, for many individuals, AA provides a number of pro-recovery benefits
44
What is the social identity theory?
- Social Identity theory - Part of people’s self-concept is derived from their membership in social groups
- The nature of MHOs like AA fits well with the major themes of the social identity approach to behavior change
- Being a member of a group of people in recovery can have important benefits (e.g., social support from similar others, knowledge-base of coping resources)
- People who used MHOs indicate that they valued the identification and belongingness they developed with others and feelings of hope
45
What is the preventure program?
- Examined how children’s temperament drives their risk for drug use, indicating different pathways to addiction
- Since most teenagers who try addictive substances (e.g., alcohol, opioids or methamphetamine) do not become addicted, the program focuses on what’s different about the minority who do.
- Personality testing can help identify most of the highest risk children before their risky traits cause problems
46
How does the preventure program work?
1. An intensive two- to three-day training is given for teachers— a crash course in therapy techniques proven to fight psychological problems.
2. When the school year starts, middle schoolers take a personality test to identify the outliers. Months later, two 90- minute workshops—framed as a way to channel students’personalities toward success—are offered to the whole school, with only a limited number of slots.
3. The workshops teach students cognitive behavioral techniques to address specific emotional and behavioral problems
47
How are the interventions conducted?
- The interventions are conducted using manuals that incorporate components of:
- - psycho-educational
- - motivational enhancement therapy (MET)
- - cognitive–behavioral therapy (CBT)
- and include real-life ‘scenarios’ shared by local youth with similar personality profiles.
48
Is the preventure program effective?
The evidence is promising:
- Two RCTs show reduced alcohol consumption and initiation and problem drinking among at-risk adolescents
- One RCT showed reduced cannabis consumption and initiation amongst at-risk adolescents who score high on sensation seeking (SS) only
- - Maybe b/c there was more cannabis use among SS youths
- - Maybe other personality factors play a role in cannabis use during later development
- - Perhaps other personality-targeted interventions do not target motives relevant to Cannabis use in youths (e.g., thrill seeking, enjoyment, seeking altered perceptions)
49
What is the goal of thee preventurre program?
- Goal is to provide participants with the tools to moderate the cognitive and behavioral tendencies stemming from their personality that contribute to their difficulties in life
