Task 9 - Drug Use Disorders

Question 1

What is a drug?

Answer 1

A substance that has a physiological effect when ingested or otherwise introduced into the body

Question 2

What is an addiction?

Answer 2

Drug use to the point where the body’s normal state is the drugged state (the body requires the drug to feel normal)

Question 3

What does Psychological Dependence mean?

Answer 3

The user’s tendency to alter their life because of the drug, and to center their activities around the drug

Question 4

What is tolerance?

Answer 4

A need for greater amounts of the drug or substance to achieve intoxication or a markedly use of the same amount of the drug or substance

Question 5

What is withdrawal?

Answer 5

A maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance or drug decline in an individual who has previously maintained prolonged heavy use of the substance or drug

Question 6

What is the DSM-5 criteria for Substance Use Disorder (SUD) ?

Answer 6

1. Impaired control
2. Social impairment
3. Risky use
4. Pharmacological criteria

Question 7

What is the prevalence for SUD?

Answer 7

Lifetime prevalence of SUD in the US at between 2,6 and 5,1%;
–> only 8,1% sought help or treatment

Question 8

The SUD is highly comorbid with a range of other psychological disorders.
Which disorders are have the strongest connection with SUD?

Answer 8

There is strong association of lifetime mood (bipolar 60.7%) and anxiety disorders

Question 9

There are 3 stages to addiction: Experimentation, Regular use, and Abuse and dependence. Explain each of them.

Answer 9

Experimentation: A period when an individual may try out different drugs. In some cases, this period of experimentation may lead to regular drug use

Regular use: Stimulants like cocaine and amphetamines affect reward pathways in the brain causing feelings of euphoria, energy and confidence

Abuse and dependence: Regular use of a substance is not sufficient to give rise to a substance use disorder:

Question 10

There are several treatment for SUD. Mention them.

Answer 10

• Community-based programes
• Behavioral therapy
• Cognitive behavioral therapies
• Family and couple therapy
• Biological treatments

Question 11

What are a couple examples of community-based programes?

Answer 11

• Alcoholics anonymous
• Peer-pressure resistance training: A strategy used by drug prevention schemes where students learn assertive refusal skills when confronted with drugs
• Rehabilitation centres

Question 12

What 2 types of behavioral therapy are there?

Answer 12

• Aversion therapy: Clients giving their drug followed by another drug causing nausea and sickness. Attacks the conditioned part of the addiction
• Contingency management therapy: Behavioural therapy which aims to help the individual identify environmental stimuli and situations that have come to control symptoms such as substance use

Question 13

What is Motivational-enhacement intervention (MET)?

Answer 13

It’s a cognitive behavioral therapy for substance abuse and dependency involving communication training, work-and-school-related skills, problem-solving skills, peer refusal skills, negative mood management, social support and general relapse prevention

Question 14

What is methadone maintenance programmes? (biological treatment)

Answer 14

A detoxification programme where users take a less virulent opiate in order to wean themselves off heroin

Question 15

What is Naloxone (Narcan)? Biological treatment

Answer 15

One of a set drugs used to treat substance use disorders which influence brain neurotransmitter receptor sites and prevent the neuropsychological effects of stimulants, opiates and hallucinogens

Question 16

What is drug replacement treatment?

Answer 16

Involves treating severe cases of substance abuse and dependency by substituting a drug that has lesser damaging effects

Question 17

Explain the different types of drugs

Answer 17

1. Stimulants - Substances that increase central nervous system activity and increase blood pressure and heart rate
2. Sedatives - slow the activity of the body, reduce its responsiveness, and reduce pain tension and anxiety.
3. Hallucinogens - may either sharpen the individual’s sensory abilities or create sensory illusions

Question 18

What is the definition of Alcohol Use Disorder?

Answer 18

Problematic patterns of alcohol use leading to clinically significant impairment or distress

Question 19

What is Alcohol Myopia?

Answer 19

The situation where an alcohol-intoxicated individual has less cognitive capacity available to process all ongoing information, and so alcohol acts to narrow attention and means that the drinker processes fewer cues less well

Question 20

What are the long-term physical effects of heavy alcohol consumption?

Answer 20

Delirium tremens: A severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes

Korsakoff’s syndrome: A syndrome involving dementia and memory disorders

Fetal alcohol syndrome: Physiological risk associated with heavy drinking in women, in which heavy drinking by a mother during pregnancy can cause physical and psychological abnormalities in the child.

Question 21

Prevalence of AUD

Answer 21

Alcohol dependence are at around 12,5%,, and 17,8% for alcohol abuse.
Alcohol abuse is more prevalent among men (12.4%) than women (4.9%)

–> Heavy alcohol abuse is often part of polydrug abuse and over 80% if alcohol abusers are smokers

Question 22

What are other drug use disorders?

Answer 22

• Tobacco Use Disorder
• Cannabis Use Disorder
• Stimulant Use Disorder
• Sedative Use Disorder
• Hallucinogent-Related Disorders

Question 23

What is Condition Place Preference CPP?

Answer 23

Association between a drug effects and place/cues drug was taken, established via Pavlovian conditioning processes

Question 24

What did Childs and Wit find out about CPP?

Answer 24

Experimental paired group (received alcohol ) in first room, did not receive alcohol in second room) spent significantly more time in context that was paired with alcohol;

Moreover, subjective responses to alcohol (sedative effects) predicted preference for the alcohol-paired room; Possibly, the relaxing effects/relieving stress effects of alcohol could be the reward component that contributes to CPP

Question 25

What does the Dual Process Model suggest about binge drinking?

Answer 25

Suggests that alcohol is not only associated with impaired executive control, but rather with a simultaneous reduction of executive control and in increased impact of automatic and emotional processes

Question 26

What are the 2 systems playing a role in DPM?

Answer 26

1. Reflective system - Involved in cognitive evaluation of the stimuli by means of memory and executive functions, responsible for controlled-deliberate responses 2. Affective system - Involved in the emotional evaluation of the stimuli, initiating automatic-appetitive responses

Question 27

What is the process proposed for the 2 systems in alcohol dependence?

Answer 27

An impairment of the two systems, leading to imbalance o Affective-automatic system AAC is overactivated by emotional or alcohol-related stimuli, leading to impulsive prepotent behaviours o Reflective system RS is impaired leading to an inability to voluntarily inhibit the consumption

Question 28

What are the impairments related to RS in binge drinking?

Answer 28

After 1 year of binge drinling impairments have been identified in perceptive-motor and attentional abilities as well as altered higher-level functions, notably working and episodic memory

Question 29

What are the brain areas involved in RS?

Answer 29

Reduced cortical thickness among male binge drinkers and reduced activations in prefrontal areas during memory and executive tasks were observed

Question 30

What are the brain areas involved in AAS?

Answer 30

Reduced activation in the voice processing are (superior temporal gyrus), but showed increased activation in another area usually not involved in emotional processing

Question 31

What are the limitation of DPM?

Answer 31

* The interactions between reflective and affective-automatic systems are unknown * No study directly compared the systems deficits in binge drinking and alcohol-dependence

Question 32

Explain the Heyman's choice model.

Answer 32

Addiction viewed as extreme from of choosing what is most rewarding in the moment at expense of long-term goals. Heyman (2009) argues repeatedly choosing immediate rewards --> sets both immediate and long term rewards to lower and lower values, e.g. heroin becomes less and less attractive, destroys person financially and socially --> more difficult to ignore immediate rewards

Question 33

What is then the solution proposed by Heyman?

Answer 33

Heyman argues the “solution” is to acquire strategies to evaluate overall sum of rewards over time and learn to ignore immediate attractions

Question 34

What is the process behind Icentive behavior/cue-triggered wanting?

Answer 34

Drug intake --> release of dopamine in ventral tegmental area (VTA) --> increase of dopamine in nucleus accumbens and ventral pallidum (ventral striatum; involved in reward seeking), increased activity in amygdala (emotional conditioning) and orbitofrontal cortex (encoding of expectancies) Over time salient cues become associated with drug effects --> cues can signal/motivate reward through Pavlovian conditioning and drive behaviour

Question 35

The author of the article (Lewis) argues the fact that addiction changes the brain does not necessarily mean it is a disease, instead it is a biological and psychological condition based on hedonic experience (i.e. feelings) and neural restructuring. Explain these brain changes in further detail.

Answer 35

Drugs lead to changes in regions associated with goal seeking: alterations in responsiveness of VTA: dopamine release is enhanced in relation to drug and its cues but is decreased in relation to other stimuli Moreover, reduction in acetylcholine (involved in normal alertness, attention), leaving dopamine to dominate behaviour, thus behaviour shifts from exploration and alertness into single-minded desperate pursuit

Question 36

What is, once again, the brain processes during the stage of binge and intoxication?

Answer 36

Repeated experiences become associated with environmental stimuli (cues) that precede/predict the rewards, thus dopamine cells fire in response to the cues that “predict” the reward is about to come --> urge/craving for the drug

Question 37

What are the brain processes in the stage of withdrawal and negative affect?

Answer 37

Reward system becomes less sensitive to stimulation for both drug-related and drug-unrelated rewards, i.e. person can no longer experience same euphoria from drugs, also become less motivated by relationships and favourable activities that were previously motivating and rewarding

Question 38

What is the Anti-reward system?

Answer 38

It states that a drug previously taken to get euphoria now (i.e. after repeated exposures) is taken to obtain a relief from dysphoria

Question 39

What are the processes underlying the stage of anticipation and preocupation?

Answer 39

Changes in prefrontal cortex (PFC): impairments in executive processes, self-regulation, decision making, attribution of salience and monitoring of error --> Impairments occur in glutamatergic and dopamine signalling --> weaker ability to resist strong urges or follow through on decisions to stop on taking the drug

Question 40

In the USA the legal drinking/tobacco use is at the age of 21. Why is that?

Answer 40

Adolescents are particularly sensitive to drug effects which contributes to their greatest vulnerability. This is because they have enhanced neuroplasticity during which judgment regions (PFC) cannot yet properly regulate emotion.