Problem 9

Question 1

Name the 4 substance-related conditions that appear in the DSM-4.

Answer 1

1. Substance intoxication
2. Substance withdrawal
3. Substance abuse
4. Substance dependence

Question 2

Name the 4 groups of substances that most often lead to substance disorders.

Answer 2

1. CNS depressants (Psycho-leptics)
   - -> alcohol, inhalants, benzodiazepines
2. CNS stimulants (Psycho-analeptics)
   - -> cocaine, nicotine, caffeine
3. Opioids (Psycho-leptics)
   - -> heroin, morphine
4. Hallucinogens (Psycho-disleptics)
   - -> Cannabis

=> withdrawal, abuse + dependence may occur with most of them

Question 3

Substance intoxication

Answer 3

Refers to a set of behavioral + psychological changes that occur as a result of the physiological changes of the CNS

–> that is due to the substance

Question 4

What are the symptoms of intoxication ?

Answer 4

The specific symptoms depend on what substance is taken

–> decline as the amount of substance in the blood declines, may last for hours

AND: users

a) expectation of the symptoms
b) environment

may influence them

Question 5

Substance withdrawal

Answer 5

Refers to a set of physiological + behavioral symptoms that occur when people who have been heavily using a substance for a long time stop/reduce their use

Question 6

What is required for a person to be diagnosed with substance withdrawal ?

Answer 6

Significant distress or impairment in a persons everyday functioning

–> e.g.: caffeine withdrawal is not significant

Question 7

Substance abuse

Answer 7

Is diagnosed when a persons recurrent use of a substance results in significant harmful consequences

Question 8

What is required for a person to be diagnosed with substance abuse ?

Answer 8

The occurrence of at least one of the following 4 categories of harmful consequences

1. Failing to fulfill important obligations
2. Repeatedly using the substance in situations in which it is physically dangerous/dumb
3. Repeatedly having legal problems as a result
4. Continuing to use the substance despite repeated social or legal problems

=> have to occur within 1 year period

Question 9

Substance dependence

Answer 9

Refers to a maladaptive patterns of substance abuse, thus showing tolerance or withdrawal from it

–> closest to drug addiction definition

Question 10

Tolerance

Answer 10

Experiencing less effects from the same dose of a substance

–> needing more to achieve intoxication

Question 11

What is required for a person to be diagnosed with substance dependence ?

Answer 11

Compulsively (not able to stop at own will) using the substance

–> despite

a) social
b) psychological
c) medical problems

BUT:

a) physiological dependence is not required for diagnose
b) cannot be diagnosed with SA and SD simultaneously

Question 12

Which substance will most likely lead to substance abuse or dependence ?

Answer 12

Substances that

1. can be absorbed rapidly + efficiently
   - -> injection, smoking, snorting
2. Act more rapidly on the CNS, thus faster intoxication
3. whose effects wear off quickly

Question 13

Substance-use disorder

Answer 13

Refers to the combined diagnosis of substance abuse + dependence

–> includes the criteria “craving”, removes “legal problems”

=> proposed by the DSM 5

Question 14

Depressants

Answer 14

Are substances that

1. slow the CNS
2. relax
3. reduce concentration
4. impair motor skills + thinking

–> alcohol, benzodiazepines, inhalants

Question 15

Alcohols effects on the brain occur in 2 distinct phases.

Name them.

Answer 15

1. Low doses
   - -> self-confidence, relaxed, euphoric
2. High doses
   - -> depression, fatigue, motor impairment

=> DEPRESSANT

Question 16

Alcohol-use disorder

Answer 16

Refers to the combination of alcohol abuse + alcohol dependence (alcoholism), that requires at least 2 symptoms to be diagnosed

–> proposed in DSM-5

Question 17

The withdrawal symptoms of alcohol manifest in 3 stages.

Name them.

Answer 17

1. Tremulousness (shaking), weakness, anxiety, vomiting
2. Convulsive seizures
   - -> after 12h
3. Delirium tremens (DTs)
   - -> auditory, visual, tactile hallucinations, fatal in 10%

Question 18

Alcohol-induced persisting amnesic disorder

Answer 18

Refers to a permanent cognitive disorder cause by damage to the CNS, consists of 2 syndromes

1. Wernickes encephalopathy
   - -> mental confusion, sometimes coma
2. Korsakoffs syndrome
   - -> memory loss for recent events + difficulty recalling distant ones

Question 19

Gender differences in substance abuse ?

Answer 19

In general more men than women

–> women are less likely to have personality traits associated with substance-use disorder + more sensitive to its risks

Question 20

Name 3 other groups of depressants (than alcohol).

Answer 20

1. Benzodiazepines + Barbiturates

–> decrease blood pressure + respiratory rate, sold by prescription usually used for treatment in anxiety or insomnia

2. Inhalants

• -> produce chemical vapors which are inhaled
  e. g.: gazoline, spray paints, laughing gas

BUT: both of these groups can cause serious permanent damage

Question 21

Stimulants

Answer 21

Activate the CNS, to cause feelings of

1. energy
2. happiness
3. power
4. decreased desire for sleep
5. diminished appetite

–> cocaine, amphetamines, caffeine, nicotine

Question 22

Why is cocaine so highly addictive ?

Answer 22

Because its effects wear off quickly, so a frequent intake is required to maintain the high

–> tolerance can also develop and be the cause

Question 23

Amphetamines

Stimulants

Answer 23

Refer to stimulants prescribed for the treatment of

a) attention problems
b) narcolepsy
c) chronic fatigue

–> can be taken as pill, snorted or smoked

e.g.: “speed”, “meth”, “chalk”

Question 24

How do the CNS stimulants produce their effects ? Which brain mechanisms does it activate ?

Answer 24

By activating the brain areas involved in pleasure + reward

1. release neurotransmitters involved (dopamine, norepinephrine, serotonin)
2. block the re-uptake of these NTs into the transmitting neurons which causes them to accumulate in the synapse to maintain the pleasurable feeling

BUT: a) may produce perceptual distortions
b) nicotine works on both CNS + PNS

Question 25

Can heavy coffee drinks be called "caffeine addicts" ?

Answer 25

No, because the dependence on the drug doesn't seem to cause significant social + occupational problems

Question 26

Opioids

Answer 26

Relieve pain, starting by sense of warmth until passing out into a state of drowsiness + slurred speech --> also naturally produced by our bodies, can be snorted smoked or injected e.g.: morphine, heroin, codeine

Question 27

Hallucinogens

Answer 27

Refer to a mixed group of substances including LSD --> results in sensory distortions + hallucinations

Question 28

Ecstasy

Answer 28

Has the stimulant effects of amphetamine + occasional hallucinogenic properties --> short-term use can have long-term negative effects on health + cognition

Question 29

How do Opioids produce their effects ? Which brain mechanisms do they activate ?

Answer 29

1. Inhibit GABA 2. GABA stops inhibiting dopamine 3. Dopamine is available to reward center => indirect

Question 30

Which brain areas are included in the Control network of substance use ?

Answer 30

1. Orbitofrontal cortex 2. DLPFC 3. inferior frontal gyrus --> if the reward network overpowers this one, one will be more likely to abuse substances

Question 31

Biological theory of substance use

Answer 31

Genetic variation in the dopamine transporter gene + receptor gene will influence how the brain processes dopamine --> affects individual reward sensitivity, thus genetics play substantial role

Question 32

Social learning theory

Answer 32

Suggests that children + adolescents may learn substance-use behaviors from the modeling of their parents --> usually bad male role models

Question 33

Behavioral under control

Answer 33

Refers to the tendency to be impulsive and prone to antisocial behavior --> are more likely to be diagnosed with substance abuse or dependence

Question 34

Sociocultural theory of substance abuse

Answer 34

People who are 1. chronically stressed 2. poor 3. female in abusive relationships 4. constantly witnessing fights are more prone to engage in substance abuse as this may be a way of fleeing

Question 35

Methadone maintenance program | Controversial

Answer 35

Involves the use of the opioid methadone with which gradual withdrawal from heroin can be achieved, as it has less long-lasting effects than heroin --> reduces extreme negative heroin symptoms BUT: although goal is to eventually withdraw patients from methadone, some take is for years under physicians care

Question 36

Aversive classical conditioning | Behavioral treatment

Answer 36

Involves developing conditioned responses to the substance e.g.: vomiting in alcohol abuse --> usually in combination with biological or other psychosocial therapies

Question 37

Cognitive treatment of substance abuse

Answer 37

Involve challenging the patients expectations of the substance by reviewing its negative effects on the patients behaviors

Question 38

Motivational interviewing

Answer 38

Designed to elicit + solidify the clients motivation + commitment to changing their substance use --> because w/o motivation no treatment will be effective

Question 39

What was the aim of Alcohol induced place conditioning ?

Answer 39

Finding out whether 1. non-dependent drinkers show a place preference for a location paired with alcohol 2. the fact that they spent time at this place is related to the subjective alcohol effects

Question 40

What was the result of the alcohol induced place conditioning test ?

Answer 40

Non-dependant consumers develop a preference for locations paired with alcohol consumption 1. More so for those with sedative effects from alcohol - -> sedation might be considered rewarding in terms of relaxation 2. Conditioning happened without explicit knowledge of the drug cue contingencies - -> behavior is influenced by the drug before we are even aware of it

Question 41

Disease model

Answer 41

1. Binge + intoxication - -> a) repeated experience of reward becomes associated with environmental stimuli that precede them b) dopamine cells stop firing in response to reward itself and start firing in an anticipatory response 2. Withdrawal + negative affect - -> drug consumption triggers much a) smaller increases in dopamine levels, less sensitive to + non-drug related give less rewards b) adaption in the circuit of the extended amygdala which results in increased reactivity to stress emergence of negative emotions Push: Escape distress Pull: want to feel euphoria 3. Preoccupation + anticipation - -> prefrontal region changes, thus impaired executive functioning, which leads to weakened ability to resist strong urges + follow through on decision to stop taking the drug CONCLUSION: Addiction is a brain disease

Question 42

Dual process model alcohol dependence

Answer 42

Suggests that alcohol dependence results from the imbalance of 2 system 1. Reflective system - -> cognitive evaluation (PFC), impaired 2. Affective system - -> emotional evaluation (Limbic system), over activated

Question 43

Continuum hypothesis of binge drinking

Answer 43

Assumes that there are similar deficits across different alcohol related disorders --> binge drinkers would show qualitatively similar but quantitatively less impairments than alcohol-dependent people

Question 44

Do binge drinkers show impairments in the affective or reflective system ?

Answer 44

Reflective system, due to reduced cortical thickness + executive impairments

Question 45

How does the dual process model explain substance abuse?

Answer 45

The affective system overrules the reflective system due to an over-activation of it

Question 46

The choice model | Heymann

Answer 46

Suggests that addiction is a choice as one bargains between immediate taking + not taking it a) immediate present (locally) b) anticipated future (globally) c) something in between --> immediate reward self is stronger than anticipated future

Question 47

Louis comment on choice model + brain disease model

Answer 47

It is a choice but not as easy as suggested --> should still take into account brain differences