Abnormal Psychology 3018 Addictive Disorders: Substance Abuse

Addiction: ‘a primary, chronic disease of brain reward, motivation, memory & related circuitry, with potential for both relapse & recovery.

Because they adapt to the drugs, resulting in tolerance & withdrawal (with cravings and urges).
Can also be considered ‘neuro-adaption’.

Because the person must use the substance(s) over and over again, as opposed to the occasional use of a substance.

The circuitries become associated with behaviours that induce the need for survival or pleasure.

The desire for a substance because it fulfils some particular need within the individual.

Repeated drug use despite negative consequences.

The person repeatedly trying to stop but can’t.

‘When the drive to use overwhelms the desire to stop.’

1. Salience (person becomes preoccupied with the drug).

2. Mood modification.

3. Tolerance.

4. Withdrawal (and the craving for more drugs to stop withdrawal symptoms).

5. Conflict (‘will I take it?’ vs. ‘I shouldn’t take it.’)

6. Relapse.

The brain disease model vs. psychosocial factors.

It minimises the impact of social, environmental and psychological factors that play a role in the development of addiction.

And it deflects the responsibility over actions.

'I want something' vs. 'I need something.

Or:

Irresistible urge vs. compulsive drive.

Or impairment in either:

Desire centred vs. control centred.

The biopsychosocial framework.

Spirituality.

Because it involves a combination of signs and symptoms that stem from a multifactorial interaction between biopsychosocial factors.

Because there is no single cause, there are multiple pathways and multiple reasons why a person may develop an addiction.

It is an interplay between:

• Biological vulnerabilities, (i.e., high impulsivity, reward sensitivity).

• Psychological factors, (i.e., high anxiety, depression, low self esteem).

• Social factors, (poverty, lifestyle, trauma exposure).

Peer pressure.

They probably have a low sensitivity to punishment.

PTSD.

• Neurobiological factors.

• Psychosocial factors.

• Intrapsychic factors.

• Environmental factors.
  They lead to a vulnerability within an individual.

Exposure.

If a vulnerable person is exposed to drugs, it might lead to a subjective shift.

More exposure and repeated use.

Either positive reward (the rush) or negative reinforcement (the loss of something unpleasant like anxiety).

Health problems (cancer, liver cirrhosis).

Longterm social, psychological and biological effects (social drift, comorbid conditions & neuroanatomical changes).

Moving from one drug to another (e.g., marijuana to alcohol).

Distal antecedants (biopsychosocial factors) creating a vulnerability. The vulnerable person being exposed. The exposed person starting repeated use due to conditioning (premorbid addiction syndrome). Then developing health problems and long-term biopsychosocial problems.

• Medical/disease model: impaired control over urges/cravings.

• Rational choice model: voluntary behaviour that can be controlled.

• reduced stigma.

| - reduced personal responsibility (people are more prone to relapse if treated under this model).

• increased personal responsibility.

• increased sense of control.
  The majority of people characterised in this model will cease without treatment.

About 70%.

1. The dopaminergic system. | The endogenous opioid system.

Most drugs including alcohol, nicotine, cannabis, opioids, cocaine, amphetamines.

By blocking the re-uptake of dopamine receptors. The overflow of dopamine causes pleasure and euphoria.

The dopamine levels plummet to be much lower than normal.

No, even after 4 months the receptor levels may have increased a little but they still remain low.

There are two states: A state & B state.
The A state is the euphoria experienced after taking a drug.
The B state is the process attempting to bring the body back to homeostatis.
The higher the A state, or the more drugs needed to achieve an A state, the more intensely B process will work to pull the body back to homeostatis. In doing so, the body will come to dip way below homeostatis and withdrawal symptoms (or comedown) will become stronger.

The B-process (or opponent process) is trying to balance the A-process (or drug activation) by bringing the body to homeostatis. Over time, the B-process brings the body lower and lower in an 'allostatic level'. The A-state then requires more and more of the drug to achieve a high. It is a vicious cycle.

The 'wear and tear on the body' that accumulates as the individual is exposed to repeated or chronic stress. This is evident in chronic drug use.

Impaired Response Inhibition and Salience Attribution.

• Mesolimbic (amygdala, nucleus accumbens & hippocampus) related to the impairment of 'response inhibition'.
  Mesocortical (prefrontal cortex, orbito-frontal cortex & anterior cingulate) related to the impairment of 'salience attribution'.

1. Impaired - Response Inhibition: changes in motivation, bad decisions.

2. Impaired - Salience Attribution: enjoying the conscious experience of intoxication.

1. Intoxication/excitement: higher dopamine concentrations in limbic circuits and frontal lobe.

2. Craving: conditioning to the cues of pleasure, memory of pleasure consolidated in amygdala & hippocampus.

3. Compulsive Use: when the drug is continued even though it is no longer pleasurable.

4. Withdrawal: dysphoria, anhedonia & irritability which may contribute to a relapse. Involves the frontal cortical circuits.

The reasons that lead me to use the drug, ending in a binge or intoxication period.

• Amygdala: 'this is great… making me very happy right now'.

• Hippocampus: remembers the experience and the context.

• Prefrontal Cortex: focuses attention to the cake.

• Nucleus Accumbens: 'pleasure centre', stimulated causing you to want another bite.

• Reward System: reactivated with each bite.

If the action is repeated too often, addictive behaviours emerge.

Chronic substance abuse -->
Sensitisation (neuro-adaption, involving initial negative affect and the exposure to cues) -->
Changes in Neurotransmitters (e.g., dopamine dysregulation).

That can lead to Initial Abstinence OR Prolonged Abstinence.

Relapse occurs in:

• Initial Abstinence due to withdrawal symptoms, which lead to cravings and then relapse.

• Prolonged Abstinence due to reward memory, which leads to cravings and then relapse.

Often it is when memories come back, the experience of negative emotions or the exposure to old cues that may trigger the relapse.

'Compelled behaviour', (or a chosen behaviour).

No (generally not). But it is the initial choice to engage in the drug that can trigger a biological addiction.
So the person IS initially choosing to take the drug.

Rationality/utility is understanding how subjective short term benefits outweigh long term costs.

Perceived benefits: short-term benefits, associated with urges.
Perceived costs: long-term costs, associated with self-control.

Socioeconomic constraints on drug-taking.
Limiting access to and patterns of drug taking (sniffer dogs at parties).

Can't do anything about genetic predisposition or peer group pressure.

1. psychiatric comorbidities (feel depressed and don't want help/want to keep self-medicating).

2. acute or chronic cognitive deficits (can't make the decision to get better).

3. medical problems (unwell, want the drugs to feel better).

4. social stressors (living in poverty).

5. lack of social resources (not enough support).

6. stigma (don't want to admit they have a problem).

Identify high risk situations and events and steer people away from partaking in those events (reduce the likelihood they will encounter these events by providing different activities).
Find alternatives then taking a drug when experiencing a cue (change patterns of behaviour and rehearse non-drug alternatives).

1. No single treatment is sufficient.

2. Treatment must be readily available and accessible.

3. Address multiple psychological/medical/social interventions and needs.

4. Comormid conditions are treated in an integrated manner.

5. Mandated treatment can lead to produce initial change.

6. Recovery is a long term process and frequently requires multiple episodes of treatment for relapse.