Philosophy and addiction, whats the choice model vs the disease model
Q: Why is addiction not explained by pure “choice” or pure “disease”?
A: Addiction exists between voluntarism and determinism; framing it solely as disease disempowers patients, while framing it as choice ignores trauma and neuroadaptation
: List key factors that predispose individuals to addiction.
Q: List key factors that predispose individuals to addiction.
A:
* Genetics (≈ 50% heritability)
* Epigenetic changes due to trauma or substance exposure
* Adverse childhood experiences (≈ 60% PTSD prevalence)
* Environment (availability, community use)
* ADHD
* No such thing as an “addictive personality”
whats the mostest common drug in UK
cannabis
and powder cocaine
drugs increasing in usage
magic ushrooms ketamine lsd
: Why is addiction not a moral failing?
A: Addiction represents a subconscious, maladaptive coping response to pain and trauma, reinforced by neurobiological changes
addiction presentation
Q: How does language affect addiction care?
A: Stigmatising terms (“junkie”, “weak”) worsen outcomes; person-centred, non-judgemental language improves engagement and recovery
IMSA-Style Clinical Vignette (Stigma)
Stem:
A junior doctor documents that a patient “refused treatment due to poor motivation.” The patient later disengages from care.
Question:
Which reframing best reflects evidence-based understanding of addiction?
A. The patient lacks willpower
B. The patient prioritises drugs over health
C. The patient is experiencing impaired executive control due to addiction
D. The patient is manipulative
E. The patient requires stricter boundaries
Correct answer: C
Why: Addiction impairs decision-making circuitry; moral framing undermines care
🔑 LEARNING OBJECTIVE 4
Appreciate that treatment is effective but requires time
Flashcards (LO-tethered)
Card 11 — Recovery timeline
Q: Why does addiction treatment require long-term engagement?
A: Neural pathways remodel slowly; relapse is part of recovery, not failure
🔑 LEARNING OBJECTIVE 2
Understand that multidisciplinary treatment is optimal and medications are adjuncts
Flashcards (LO-tethered)
Card 5 — Treatment aim
Q: What is the primary goal of addiction treatment?
A: To restore normal functioning — parenting, relationships, work, purpose — not merely abstinence
important Card 6 — What works
Q: Which treatment components are most effective in addiction care?
A:
* Psychological therapies (CBT, DBT, MI)
* Community (12-step, SMART recovery)
* Trauma-informed care
* Housing, purpose, meaningful activity
* Long-term engagement (time-dependent recovery)
Card 7 — Role of medication
Q: What is the role of medications in addiction treatment?
A: Medications are adjuncts, primarily for opiates and alcohol, used for harm reduction and stabilisation, not standalone cures
Card 8 — Examples
Q: Give examples of medical adjuncts used in addiction.
A:
* Methadone, buprenorphine (opioid substitution)
* Naloxone (overdose reversal)
* Acamprosate, naltrexone, disulfiram (alcohol)
Stem:
A 35-year-old woman with heroin dependence is stabilised on methadone but continues to relapse when discharged to temporary accommodation. She has PTSD and no daytime structure.
Question:
What intervention is most likely to improve long-term outcomes?
A. Increasing methadone dose
B. Switching opioid substitute
C. Trauma-focused psychotherapy and supported housing
D. Prison sentence
E. Detoxification alone
Correct answer: C
Why: Medications stabilise physiology; psychological and social interventions drive recover
IMSA-Style Clinical Vignette (Time + effectiveness)
Stem:
A patient relapses multiple times over three years but eventually achieves stable housing, reconnects with family, and remains abstinent.
Question:
What does this best illustrate?
A. Ineffectiveness of treatment
B. Need for stricter punishment
C. Chronic relapsing nature requiring sustained care
D. Failure of substitution therapy
E. Poor patient compliance
Correct answer: C
Why: Addiction recovery is longitudinal, not linea
important
Drugs cause changes in the brain which make ongoing addiction more likely
Brain imaging shows changes in the brain which are critical for judgement , decision - making , learning , memory and behaviour control
Take a drug ⬆️ dopamine
Striatum is repeatedly activated
Synaptic pruning as in deep learning - experts is using drugs
Less and less connection to prefrontal cortex and striatum
Appeal of drug is always greater than delayed gratification
The frontal cortex enables us to control our behaviour , the planning and organisation of what we do .
Striatum . Nucleus accumbes , enables self control - the reward centre
Midbrain Mediates learning reward and pleasure where dopamine the pleasure chemical is produced
how can we help
acronym always
what was the portugal model and how can we be better
How can we becum better in uk
Decriminalisation ?
More funding
Reverse austerity
Psychological treatments
Move from medical model
Housing
Attitudes
Invest in child services , child protection and child and family support
what are the opiate receptors present in our brains
and ___ agonists are very effective in opiate addiction
Mu agonists
what r the med treatments only ok for alcohol and opiates
Prescribed replacement opioids ( harm reduction)
Methadone
Buprenorphine
Buvidal
Alcohol Detoxification
Naltrexone / Acamprosate/ disulfiram
lashcard 11 — Dopamine vs GABA
Q: Contrast dopamine and GABA roles in addiction.
A:
* Dopamine: reward, reinforcement, craving, habit learning
* GABA: inhibition, anxiety reduction, withdrawal physiology
* Addiction = dopamine overstimulation + GABA dysregulation
addiction presentation 25
.
Flashcard 7 — Drugs acting on GABA
Q: Which substances commonly act on GABA pathways in addiction?
A: Benzodiazepines, alcohol, pregabalin, gabapentin, and some sedative
