clinical psych > Lecture 4 > Flashcards

Lecture 4 Flashcards

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1
Q

what are class A drugs

A

crack cocaine, ecstasy, heroin, LSD, magic mushrooms, meth etc

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2
Q

what are class B drugs

A

amphetamines, cannabis, codeine, ketamine

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3
Q

what are class C drugs

A

anabolic steroids, benzodiazepines (diazepam)

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4
Q

what are temporary class drugs

A

??

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5
Q

transition from dsm four to five relative to addiction

A

substance use disorder used to be two separate diagnoses (substance abuse and substance dependence) but in DSM 5 its now just substance use disorder

patients now need two or more symptoms for diagnosis rather than one for substance abuse in DSM 4

eliminated “legal problems” as a criteria from DSM 4 and added “craving” now

DSM 5 eliminated the physiological sub-type and diagnosis of polysubstance dependence now is with substance use disorder diagnosis instead of separate

added gambling

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6
Q

what are the 10 classes of drugs

A
  1. alcohol
    caffeine (must be 250mg and more)
    cannabis
    hallucinogens
    inhalants
    opioids
    sedatives
    hypnotics
    anxiolytics

ALSO INCLUDES gambling and other behavioural addictions (shopping addiction? exercise addiction? etc)

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7
Q

how are substance sections in dsm 5 divided

A

substance use disorders: CRITERION A: impaired control, social impairment, risky use, pharmacological criteria

substance-induced disorders: intoxication, withdrawal (usually associated with substance use disorder), other substance/medication induced mental disorders

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8
Q

what is an alcohol use disorder

A

problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following in 12 month period:

alcohol in large amounts, persistent desire to cut down/control, cravings to use alcohol

also social impairment symptoms: recurrent alcohol use resulting in a failure to fulfil major role obligations at work/school/home, continued alcohol use despite persistent/recurrent social/interpersonal problems caused or exacerbated by the effects of alcohol, important activities are given up/reduced because of use

recurrent alcohol use in situations where its physically hazardous, alcohol use is continued despite knowledge of having problems caused by it

tolerance built up lots, withdrawal

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9
Q

what is early remission for alcohol use

A

after full criteria has been met, for 3-12 months no criteria has been met except cravings

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10
Q

what is sustained remission for alcohol use

A

early remission for 12 months or longer

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11
Q

how to determine severity of alcohol addiction

A

mild = 2-3 symptoms
moderate = 4-5 symptoms
severe = 6 or more

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12
Q

what is alcohol intoxication

A

clinically significant problematic behaviour

contributes to suicidal behaviour

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13
Q

how to diagnose someone with alcohol withdrawal

A

two or more symptoms which cause distress/impairment in functioning after stopping use:

autonomic hyperactivity
increased hand tremor
insomnia
nausea
transient visual, tactile, auditory hallucinations
psychomotor agitation
generalised tonic-clonic seizures

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14
Q

what is ICD 11 criteria for substance use disorders

A

under mental, behavioural, neurodevelopmental disorders:

disorders due to substance use or addictive behaviours

THEN SUBCATEGORY OF THAT IS disorders due to use of alcohol, disorders due to substance use, disorders due to addictive behaviours

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15
Q

what are some diagnostic categories for alcohol

A

episode of harmful use of alcohol

harmful pattern of use of alcohol

alcohol dependence

alcohol intoxication

alcohol withdrawal

alcohol-induced delirium

alcohol-induced mood disorder

alcohol-induced anxiety disorder

unspecified

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16
Q

how do you need to diagnose alcohol dependence in ISM 11

A

must have two or more symptoms:

impaired control

increasing precedence of alcohol over other aspects

physiological features indicative of neuroadaptation to the substance (tolerance to effects of alcohol or withdrawal symptoms etc)

must be over 12 months long but diagnosis can be made if use is continuous (daily) for at least 3 months

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17
Q

which substance withdrawal is most deadly

A

alcohol!! by far!! deadly to withdraw may die

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18
Q

what is the ICD-11 gaming disorder diagnosis necessities

A

persistent pattern of repetitive behaviour which the individual exhibits impaired control over the behaviour

continuous or episodic over 12 months

increasing priority to behaviour over other life activities

significant distress or impairments

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19
Q

can you describe a case study for gambling addiction

A

gwen from 28 days (2000)

mom was alcoholic and died when Gwen was young

drinks and uses opioid pills

drunk at sisters wedding and crashes car into house

sentenced to 28 days in recovery centre

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20
Q

what are the theories/models of addiction

A

moral model

psychological models (cognitive/learning/personality)

disease model

biological/medical model

biopsychosocial model

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21
Q

what is the moral model of addiction

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A

something morally wrong with people who are addicted

“much of addictive behaviour is voluntary”? (Satel, 1999, para 5)

22
Q

what is the psychological (cognitive) model for addiction

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A

developed a cognitive vulnerability to drug abuse

specific beliefs activate ie “i cannot socialise without getting high”

TYPES OF DYSFUNCTIONAL BELIEFS:
1. anticipatory = expectation of drug use, “i feel amazing when i use”

  1. relief-oriented beliefs = will remove an uncomfortable state
  2. facilitative or permissive beliefs = drug use considered acceptable despite potential consequences ie “i deserve it im a hard worker”
23
Q

evidence for the cognitive model for addiction

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A

Franken, 2003 = excessive attention on drug-related cues, found by Event Related Potentials (ERPs) and self-report measures after neutral and heroin related pictures were shown to 19 abstinent heroin dependents, 14 male health controls AND it took ex addicts longer to process heroin related images and followed up by post experiment cues = attention bias

Lusher et al (2004) = attentional bias on alcohol stimuli, 128 ppts (64 in alcohol group, 64 in control), alcoholics respond slower to alcohol-related than neutral words when compared to controls

24
Q

what is learning theory for addiction

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A

classical conditioning

operant conditioning
MORE positive reinforcement than negative

25
evaluation of learning model of addiction
well-rehearsed activity may not be compulsive ie we do tons of things a day that aren't compulsive like tying shoelaces addicts don't follow set pattern of actions to obtain drugs BUT it may explain rituals associated with drug consumption (ie tapping joint before lighting up) BUT evidence for positive reinforcement (rats self administer drugs Stewart et al 1984) AND dopamine antagonists block rewarding effect, BUT positive effects of drugs often decrease as addiction progresses BUT evidence for negative reinforcement (neg life events more associated with smoking and drinking Wills et al 2002), (drug taking more likely in adverse environments as rats in a 'rat park' didn't self administer morphine Alexander et al 1978), (priming effect = small amount of drugs leads to more drug taking), (alcohol and nicotine use increases tension when no other distractions present)
26
what is the social learning model for addiction
addiction is learned through observation and/or direct experience
27
how does learning theory suggest we overcome addiction
to weaken behaviour, apply a negative consequence or remove a positive consequence
28
what is the cause of an addictive personality
Nakken (2009) = impact of addiction creates an addictive personality BUT mak et al 2001 = individuals with outlying personality traits could be prone to addiction due to emotional dysregulation
29
what does amodeo 2015 assert about the addictive personality
no evidence personality characteristics ascribed to addictive personality result from the addiction, not beforehand addicted ppl who use other drugs during/after treatment just have an inappropriate or incomplete treatment
30
what is the history of the disease model of addiction
1800s rush = habitual drunkenness should be seen as a disease 1800s trotter = biological defect 1935 Alcoholics Anonymous founded who talk about a physiological susceptibility 1940s and 50s = Jellenick - biological illness with a predictable course people said brain structures (mesolimbic pathway) are involved
31
what is the biological/medical model of addiction
brain structures in fMRI studies activated (Four Fs - feeding, fighting, fleeing, fucking) all come down to mesolimbic dopamine system (dopamine projections from ventral tegmental area (VTA) and nucleus accumbens (NAcc) to prefrontal cortex and striatum most addictive drugs activate this pathway 'hijacking' the motivational circuitry pleasure centre Hall et al 2015
32
what is evidence for the pleasure centre
rats press a lever for electrical stimulation of nucleus accumbens but not for other parts Olds and Milner found they do this rather than eat Hoebel et al 1983 self-administer amphetamine into the nucleus accumbens Wise and Bozarth 1987 = if dopamine levels are strongly depleted using a neurotoxin called 6-hydroxydopamine, rats no longer self-administer amphetamine and cocaine
33
what did griffiths say about the biopsychosocial model of addiction
components model: salience mood modification tolerance withdrawal symptoms conflict relapse
34
what did Hall et al 2015 emphasise about the biological model of addiction
published in the Lancet needs to take a broader look at how it all links
35
evaluation of psychological models
provides understanding empirically testable BUT reduces complexity, some models not useful from treatment perspective, cannot account for whole issue, does not consider biological or social
36
evaluation of biological/medical model of addiction
biological empirically testable BUT reduces complexity, treatment only accounts for one aspects ie withdrawal, doesn't account for broader issues
37
what are general psychological interventions and evaluate them
aims to: engage person in change change behaviour prevent relapse may address co-existing problems ie anxiety too National Institute of Clinical and Health Excellence (NICE) = no evidence of one treatment over another high relapse rates in all treatments
38
what is the cycle of change
1. precontemplation - 2. contemplation - then preparation leads us onto - 3. action - 4. relapse (which leads to maintenance) Prochaska and DiClemente
39
what does miller and rollnick 2012 say in their book Motivational Interviewing
change is hard clinician must increase intrinsic motivation to change NOT produce change (links to self-determination theory) counselling style is to create 'cognitive dissonance' and develop commitment to change
40
how is CBT applied to addiction
beliefs about change beliefs about self/others/world behavioural work with cravings/triggers emotion regulation skills disorder-specific treatments (look at McGill and Ray 2009 meta analysis)
41
what is SMART recovery
self-help group 4-point programme: 1. building and maintaining motivation 2. dealing with urges 3. managing thoughts, feelings, behaviours 4. cultivating a lifestyle balance of short/long term rewards to prevent relapse
42
evaluation of SMART recovery
Zenmore et al 2018 found SMART was just as good as AA
43
how to address negative emotional states
antidepressants, based on assumption drug use is to reduce neg emotions (zyban - bupropion - is effective for smokers and SSRI is helpful for some family therapy = facilitate more adaptive interactions within family
44
treatment to reduce positive reinforcement
naltrexone (opiate antagonist) acamprosate (glutamate antagonist) - reduces craving sometimes used in combination ^^ poor client adherence to treatment OR aversion therapy but not very effective at stopping behaviour, only reducing craving ie rapid smoking, antabuse for alcoholism
45
treatments to reduce neg reinforcement
nicotine replacement therapy (doubles amount of smokers abstinent at 6 weeks, relative to placebo) methadone maintenance for opiate users (reduces heroin use, but rarely eliminates) not successful rates
46
what are operant programmes for addiction
contingency management: token systems that give rewards for abstinence, therapy attendance, completing goal-related activities etc - can be exchanged for recreational activities or goods NORMALLY in conjunction with something else McDonnel et al 2013 = CM large reductions in drug use it also increases retention of patients BUT there's a financial cost to run it
47
what is relapse prevention
maintain gains rather than cessation straight away set goals recognise and anticipate precipitants of relapse explore events that trigger a lapse
48
what is psilocybin for alcohol addiction
NEW RESEARCH Bogenschutz et al 2022 double-blind randomised clinical trials, 93 ppts, 12 weeks of manualised psychotherapy and either got psilocybin or diphenhydramine in 2 day medication sessions at weeks 4 and 8 heavy drinking days during 32 weeks of follow-up were lower in psilocybin
49
how did addiction trends change in COVID
reduced gambling behaviour in UK 28% decline in addiction treatment initiations people with substance use disorders (SUDs) had higher COVID risk and mortality risk nicotine prevents COVID but tobacco worsens prognosis
50
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