PSY 161 Chapters 1-3

Withdrawal

the physiological and psychological rxns w/n person reduces usage of the drug. Each drug has its own physiological consequence w/n a person starts to lessen their cxn to the substance.

Gene polymorphisms

are passed down f/ parents to children through specific patterns of inheritance. Drug abuse & addiction involves multiple genes and is susceptible to environmental influences. Researchers in the genetics of addiction and substance abuse are thought to follow a gene-environment interaction (GxE) model.

Three primary models of addiction

the moral model, the disease model, & the family systems model

Behavioral addiction

Over the last couple decades, we've started using the term "addiction" to describe non-substance related bhrs in which one seems to have a compulsion to engage (i.e. gambling, sex, eating).

Genetic Vulnerability to Addiction

Pedigree studies on addiction provide overwhelming evidence that addiction to alcohol and other psychoactive drugs have strong heritability estimates. For instance: First degree relatives of those who use opiates are significantly more likely to have drug or alcohol addiction. There's a family-linked association between alcoholism, opiate use, and depression—suggesting a common genetic link between these conditions. Compared to the general pop, the potential for alcoholism is increased in people who are biologically related to someone w/ alcoholism. BUT it's difficult to pinpoint the inheritance for one drug in particular, since many drug users also use other common drugs and the availability of any particular drug may increase & decrease over the yrs while other drugs become more readily available.

Polydrug use

consuming more than one type of psychoactive chemical. The neurological effects of mixing drugs can be... Synergistic Potentiating Additive Research shows overwhelmingly that compulsive users use more than one drug. Heroin users commonly use in conjunction with other drugs, especially cocaine and alcohol. Alcohol is frequently used to moderate the effects of cocaine.

psychotropic drugs

Reiter defines as drugs prescribed by med professionals, usually for the purpose of treating mental disorders.

Substance Dependence

when you're chemically dependent, you experience withdrawal symptoms when you don't use the substance. Dependence may occur w/n a person needs an increased amount of the drug to feel the effects of that drug Craving = an intense or heightened desire for a substance, which becomes a primary motivating factor to obtain that substance.

Receptors: Mechanisms of Drug Action in the Brain

All psychoactive drugs affect brain fxn by directly or indirectly influencing the activity of specific sites on neurons called receptors (proteins that span the membrane of a cell and can bind to a molecule like a neurotransmitter or a drug). Once activated by a particular drug molecule, neuron receptors can alter brain fxn through changing the voltage of a neuron, activating chemical cascades, or changing gene transcription. Remember that neurotransmitters are the naturally occurring, endogenous chemicals in the brain that activate their specific receptors. The effect of any neurotransmitter depends on the fxn of the receptor to which it binds The same neurotransmitter can have diff effects in different regions of the brain die to the properties of the receptors in those regions. Naturally occurring neurotransmitter systems are able to be appropriated and influenced by psychoactive drugs. The two main classification systems for psychoactive drugs influencing receptor bhr: antagonist and agonistic

Genes and the environment

Although GWAS and animal models offer objective evidence for the heritability of addiction, it's also commonly accepted that addiction sensitivity "runs in families." BUT, the extent to which these traits are expressed also depends largely on the environment. It's VERY DIFFICULT to untangle the distinct contribution of genes f/ the distinct contribution of the environment to bhr. Researchers have tried to better pinpoint the genetic contribution to nhr through adoption studies to compare "genetic" siblings w/ "environmental" sibling. Twin studies are also used to quantify bhr in twins who are separated v. kept together. Genetic contribution to addiction is very high compared to other bhrs: 40-50% of a person's susceptibility to drug addiction can be linked to genetic factors. The effect of home environment on addictive bhrs shows that parents have much less of an influence on drug use and abuse than do peers and same-sex siblings. During adolescence, the heritability of drug abuse is thought to be 40%, but this likelihood of addiction increases w/n there's an association w/ delinquent peers or same sex siblings who use addictive drugs. THUS, someone whose genes may predispose a predilection for drug abuse may not become addicted if they're around people who don't use (or only use occasionally), although another person whose genes do not predispose a predilection for drug abuse may become addicted if they spend a lot of time w/ their friends who are using! But, like all bhrs, genes and the environment combine to influence drug use & the chances of addiction. In particular, several environmental factors have been identified which appear to decrease heritability estimates of drug use and addiction. These include factors that indicate a less "permissive" environment like: Late-age of first drug use Being married Being raised in a religious household Being raised in a family that's strict or cohesive Having non-deviant peer-groups Combined, these findings underscore the idea that heritability of drug use and abuse isn't static, but rather is moved by the environment.

Susceptibility vs. Inevitability

DNA = basic unit of heredity Like other bhrs, the genetic vulnerability to addiction is complex. Having genetic susceptibility for addiction doesn't determine someone's fate—it only affects the way the body responds to drugs. It's important for therapists to appreciate that some indvs can be biologically predisposed to drug sensitivity. Bio differences in how the body processes and responds to drugs can help explain why addiction is much harder to control in some indvs compared to others. In other words, two people can "try" just as hard and be equally motivated to overcome addiction, but a bio predisposition can make it physiologically more difficult for one of them to get better.

Psychopharmacology

Examines how psychoactive drugs affect the central nervous system (CNS). The biology of drug use has important treatment and policy implications.

Routes of administration and entry into the CNS

For a drug to influence bhr, it has to reach the CNS; the most common routes are through inhalation, oral administration, and injection. Drug enters the bloodstream in one of 3 ways- and the route affects how fast the substance will enter the brain and elicit a psychoactive response These routes offer a trade-off between safety and efficacy. IV injection Inhalation Oral route Regardless of the speed of administration, all psychoactive drugs eventually reach the CNS through crossing the blood-brain barrier un order to affect thoughts and behavior. Since psychoactive drugs are very fat-soluble, they're able to cross the barrier; the rate of entry depends on the drug's particular lipid solubility. BUT stress can potentiate the effect of drugs b/c stress makes the blood-brain barrier more porous.

genogram

In family therapy, the primary way to begin making a pictorial depiction of the family is through the use of this One of the main purposes of creating one w/ the family is to start to explore potential patterns that've been occurring within the family. In clinical work, you can also use genograms as a summary for yourself or others on the status of the case. W/n doing one, there tends to be info that is sought that may not be explored in-depth w/n conducting a typical intake assessment. can be expanded to include not only the nuclear and extended family, bt also the larger systems the family comes into contact w/. McGoldrick, Gerson, & Petry (2008) refer to this as within community context. Other therapists create a picture called a family ecomap. One of the benefits of using is that it's model neutral and can be adjusted—where the therapist brings forth some info more than others depending on their approach. Although it has roots in intergenerational approaches, it has also been used w/ Narrative family therapy, Solution-focused therapy, Reality therapy counseling, and in training family therapists. joining w/ whoever is providing the info, as it's usually constructed during the first meeting w/ the client(s). provide many varied layers of a family's fxning. The first layer is who is in the family. A second layer is demographics. A third, and perhaps the most important, layer is distinguishing the relational dynamics between people. seems to be a current snapshot, it's actually a longitudinal view of the family. The family therapist can explore major family transitions like moves, deaths, financial hardships, and the impact of one or more members' substance abuse.

Drug Use and Pregnancy

It may be a combination of factors, pharmacological and lifestyle, which produce the problems associated with newborns of drug users. Heroin Cocaine Tobacco Alcohol "Women who take illegal drugs while pregnant cannot be charged with child endangerment crimes for doing so...the Kentucky Supreme Court...held that such prosecutions are unlawful under the state's Maternal Health Act of 1992, which expressly forbids charging women with a crime if they drink or do drugs during pregnancy." Since alcohol use has been shown to be detrimental to the health of a fetus, should we make alcohol use by pregnant women a crime? Since tobacco use has been shown to be detrimental to the health of a fetus, should we make tobacco use by pregnant women a crime?

Disease (or Medical) Model

It's the best-known of all models, having been popularized through media and 12-step programs. was first proposed by E.M. Jellinek (1952, 1960, 1983) Though it's been used to understand various types of drug and behavioral addictions, it was originally developed to explain alcoholism. It holds that the drug is the main problem & should be its own focus of tx. Focuses specifically on the addiction. Whereas the moral model views the addict as being at fault, the this views them of being at risk—since they initially had a choice whether to use the drug or not, but once they did use it to whatever extent, it overwhelmed their ability to choose. Through this lens, the therapist sees the disease as... impacting many people in very similar ways primary following a predictable course, which is progressive permanent fatal treatable This model emphasizes the involuntary nature of drug use - used based on a craving - that has found support in laboratory experiments with animals. The body of a drug dependent person is malfunctioning with respect to the production of crucial neurotransmitters, making drug use self-medicating. Some psychoactive chemicals alter the central nervous system, creating what appears to be a compulsion to use the drug to restore a sense of well-being. The theory has treatment implications compared to legal implications.

nature v. nurture, it's nature via nurture

Life events and environmental factors work w/ genetic predispositions to shape the likelihood of drug abuse and addiction. But not all environmental effects have the same impact on addiction This ides—that gene polymorphisms and environmental factors each have small indv effects, but can combine to have profound effects on the likelihood of addiction is the next stage of addiction research. Researchers have started looking at genetic risk scores (GRS) for improvements in therapy

Family Systems Model

Reiter stresses that we should study the family and view an issue like addiction through the lends of the family. views addiction as a symptom that signifies a larger issue w/in the user's family & relational world. Could be a local issue or a multi-generational process in how family members are able to cope w/ the anxiety & stressors of being an indv while also being part of a social group. The drug abuser is considered the Identified Patient (IP); they're the focal pt of the family dysfunction, yet they are not isolated in the problem. Since people are interdependent beings, the IP is the manifestation of many factors at work w/in the relational web of the family. This goes along w/ one of the primary precepts of a systems view in that change in part of the system leads to change in the whole system. This widening of focus f/ the indv to the family (f/ part to whole) is one of the aspects that separates the family systems model f/ the other models of addiction. "The whole is greater than the sum of its parts." If we only look at each indv in the family, we won't understand the dynamic interaction that occurs w/n members come together; we wind up knowing less about the indv if we only observe them. This model is a aggregate of many ideas, and thus is difficult to specify, as there are various models of family functioning. Reiter explores the model in terms of concentric circles...

Biological Theories of Drug use and Abuse

Testing biological theories of drug abuse is limited to working with lab animals and current users. A great deal is not known about how psychoactive drugs actually affect the nervous system of a specific person. There is evidence that the same substance can have a different impact on different people. One person's euphoria could be another's dysphoria.

Delta Alcoholism

The delta alcoholic is similar to their gamma counterpart, but they don't lose control and are thus able to fxn well in their personal, business, & social lives. This type occurs in countries like France or Italy, where drinking is legal and ritualistic and forms a primary role in social life.

Wilibanks (1989)

There's no way to determine whether the compulsion to use the drug is uncontrollable or uncontrolled. Not everyone that engages in the bhr, becomes addicted. encourages a shift f/ viewing the addict as a helpless victim to one that is not actively trying to control the drug use. The disease model holds addiction to be a medical illness.

Dopamine

a brain chemical that serves as a neurotransmitter is released into the synapse, and binds to the receptors of another neuron. To maintain balance, some neurons release an inhibitory neurotransmitter that works to prevent the receptor from being overstimulated. Natural release = is the key to pleasure! . Psychoactive drugs trigger the release of this in regions of the brain that, among other important functions, produce the sensation associated with such pleasures as eating and sex. Continued drug use may diminish the supply of neurotransmitters thus reducing the ability of the drug to impact the brain's reward system to which the user may respond by increasing dosage

substance-related disorders (SRDs)

a category which encompasses 10 classes of drugs: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids sedatives, hypnotics, anxiolytics stimulants, tobacco, & other (or unknown) substances. W/in this, the DSM-V distinguishes between substance use disorders (SUDs) & substance-induced disorders (SIDs)...

Substance-use disorders (SUD)

a group of cognitive, behavioral, & psychological symptoms which impact a person's fxning, even after problems develop. Once drug use starts to impair the person's fxning in a variety of ways, they continue to use. Criteria = impaired control, social impairment, risky use, & pharmacological criteria (including tolerance & withdrawal)

Homeostasis

a state of equilibrium achieved through the self-adjusting characteristics of the body When tolerance develops, the failure to ingest enough of a drug on a timely basis will disrupt homeostasis and cause the onset of withdrawal symptoms. The toxicity of a drug is affected by tolerance. Alocoholics may be able to ingest quantities of alcohol that would be potentially fatal for an occasional user. Some psychoactive drugs do not produce tolerance (marijuana), while other may produce various degrees of tolerance, from hardly perceptible to severe.

Dual Diagnostic

a term used w/n a person has more than one recognized diagnosis. It usually refers to having a psychological diagnosis in conjunction w/ a substance abuse diagnosis. Other used terms for this condition are "co-occurring disorders" or "co-morbid disorders."

Relapse

a worsening of the problem after some time of improvement. The drug use doesn't have to return to w/n it was at its worse to be considered a relapse, but it's usually a movement back into problematic actions & patterns. Might be a one-time occurrence or can last many years

Craving

an intense or heightened desire for a substance, which becomes a primary motivating factor to obtain that substance.

Substance-induced disorders (SID)

are secondary disorders that occur f/ the use of the drugs These symptoms are reversible & coincide w/ a reduction or abstinence f/ the specific drug being used. A key component is that the symptoms cannot be associated w/ a medical condition or other mental disorder.

Jellinek (1983)

delineated four species of alcoholism, which designate the many levels of severity & fxning of someone considered an alcoholic. also delineated a four-phase progression of alcoholism Pre-alcoholic phase Prodromal phase Crucial phase Chronic phase

antagonist

drug antagonizes the receptor by decreasing its activity. It can do this by: 1) decreasing the the amount of the neurotransmitter that naturally binds to a receptor or 2) binding to and blocking the receptor to which the neurotransmitter binds. It blocks opioids by attaching to the opioid receptors without activating them. cause no opioid effect and block full agonist opioids (e.g. naltrexone and naloxone. Naloxone is sometimes used to reverse a heroin overdose).

Reiter's definition of addiction

follows the 2014 American Society of Addiction Medicine's definition of addiction: "a primary, chronic disease of brain reward, motivation, memory & related circuitry" (ASAM, 2014) Mind that the ASAM definition provides a medical perspective to addiction where the action occurs within the indv but also has external consequences

Alpha Alcoholism

has a psychological, not physiological, dependence and is still most likely in control of their drinking. If they decide to quit, may not have many withdrawal symptoms, but they continue to drink as a way to mute the psychological & emotional pain This condition isn't a progressive process, but there's a possibility such indv may shift into a different species of alcoholism.

Gamma Alcoholism

has both a physiological and psychological dependence. This is the most predominating type of alcoholism in Western culture.

Beta Alcoholism

has many of the physiological effects of alcoholism (e.g. cirrhosis of the liver), but w/out the psychological or physical dependence. Thus, they have the opportunity to stop their heavy drinking, which they do quite often (maybe even every day) Those who fall into this category are labeled "social drinkers," as they drink w/n they have the opportunity but don't feel the need to have a drink.

Genotyping

is a new technique of identifying an indv's genetic code (genotype). Family based Genome-Wide Association Studies (GWAS) on addiction and drug use bhr usually look at the entire genome (all of the DNA) in a group of people w/ drug addiction & compare their genome to a group of people who don't have drug addiction. Results f/ these studies have found various genetic markers associated w/ substance use and abuse. Once a gene is identified as playing a role in the vulnerability to SUDs, animal models are widely used to test the fxn of the gene at the level of analysis that's not possible in humans.

Tolerance

is a progressive increase in the ability of the body to adapt to the effects of a drug that is used at regular and frequent intervals. Manifested two ways: Progressively larger doses needed to produce same effects Eventually as much as 10x the original dose can be safely taken

neuron

is the basic working unit of the CNS for sending information to and from the brain, to other neurons, and to muscle or gland cells. communicate by sending electrical signals that are transported to receptors across a small gap called the synapse. communicate through alternating chemical and electronic activity via neurotransmitters. When activated by electrical charges, neurotransmitters cross over the synaptic gap where they bind to receptors on the surface of an adjoining neuron. separated by two types of synapses: Excitatory Inhibitory

agonist

is the opposite of an antagonistic drug—it works to increase the activity of a receptor by 1) increasing the amount of the neurotransmitter that naturally binds to a receptor or 2) by binding to and activating the receptor to which the neurotransmitter binds. It activates certain receptors in the brain. activate the opioid receptors in the brain fully resulting in the full opioid effect (e.g. heroin, oxycodone, methadone, hydrocodone, morphine, opium). Most drugs of addiction work as this to a neurotransmitter system (caffeine is the exception).

Polymorphism

is the presence of genetic variation w/in a population, upon which natural selection can operate.

Heritability

is the proportion of the total variation of a certain trait in a population that is due to genetic variation. estimates are sometimes misinterpreted as estimates of genetic contribution to a particular trait in an indv, but they don't refer to indvs, but rather the variation w/in groups of people. Let's consider pedigree analysis - the study of an inherited trait in a group of related indvs to determine the pattern and characteristics of the trait. This includes the trait's mode of inheritance, age of onset, and phenotypic variability. Phenotype

model

means the theoretical orientation of the therapist. In the field of substance abuse, it refers to how & why people become addicted.

Cold Turkey

stopping total use rather than engaging in a controlled reduction of use.

Substance Abuse

occurs w/n a person uses a drug beyond its normal purpose or w/n they develop a pattern of use that necessitates further use and/or difficulties in various areas of their life. DSM defines as "a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances." Abadinsky makes it clear that "drug abuse" implies the misuse of certain substances - it is a moral, not a scientific term.

Bronfenbrenner (1979)

proposed the notion of an ecological systems theory, aka bioecological systems theory, which helps to describe how an indv is impacted by othrs in their relational field as well as larger systems. There are 4 ecological systems in this model: the microsystem: the inner-most system, where the indv is connected to those closest to him. the mesosystem: outer subsystem—includes systems that directly impact the indvs in the microsystem the exosystem: various aspects of the structure of indv/family fxning occur here, such as finances or socioeconomic status. the macrosystem: the social and cultural milieu in which the indv is housed.

Slip

similar to a relapse, but not as severe; a brief use of the substance after a period of reduction or abstinence f/ the drug. There's usually a quick return to a more fxnal state. Main difference between a slip and a relaose is that a slip is just use of the substance while relapse involves a return to neg patterns of bhr.

Epigenetics

the (study of) changes in heritability factors due to the environment devoid modifications to the DNA sequence Epigenetic modifications play a crucial role in drug abuse and addiction bhrs.. B/c epigenetic changes can affect long-term and heritable changes in gene expression, it serves as an attractive mechanism for the heritable & persistent factors that characterize drug addiction. Research shows that stress during childhood & adolescence increases the risk of addiction, independent of one's genotype. Behavioral changes in drug abuse are also thought to be a product of epigenetic changes

Abstinence

the complete disuse of a substance.

tolerance

the diminishing physiological impact of a substance upon repeated usage.

Recovery

the process of reducing or abstaining f/ a drug one's dependent on. Usually more connected w/ the notion of abstinence, where the recovery process is focused on the person not using the substance. can also refer to a moderated management of use. E.g. instead of getting drunk, which was normal pattern of bhr in the past, the person is able to drink only one or two drinks and not get drunk. When it comes to models of and theories on addiction, "being in recovery" and "being recovered" are not just mutually exclusive concepts, they're also contradictory.

Addiction

the process through which a drug changes the brain's natural reward circuitry. After receiving and processing information, the brain sends commands to muscles and glands. Not all drugs that result in dependency are biologically addictive. The changes that occur with addiction require continued use of the drug in order for an indv to feel "normal." But, all psychoactive substances (for med purposes or abuse) are used for their ability to alter thoughts and behavior.

Diagnostic and Statistical Manual (DSM)

the ultimate source for criteria of mental disorders DOES NOT provide a definition of addiction; rather it provides criteria for which various types of substance issues can be categorized. addiction related issues fall under substance-related disorders (SRDs

Drugs

usually considered to be a substance besides food that impacts the physiology of the body. substances that aren't necessary for the survival of human kind.

Substance Use

w/n a person comes into contact w/ a substance that's deemed a drug, regardless of the drug's legality

Moral Model

was the 1st and most prominent model in the early part of 20th century Since then, it has become less popular and is now the least supported of the three models of addiction b/c it's rooted in religion, not empirical evidence. In this model, people abuse substances not because of physiological reasons (as in the disease model), but b/c they lack the willpower to choose otherwise. Thus, addiction is a faulty choice making. The indv is most likely not choosing to become an addict, but their choices lead them into a particular lifestyle & destructive bhral patterns. This model proposes that people can easily choose to be abstinent if they are psychologically strong enough. Proponents of this model believe users should be punished, not provided w/ the chance of rehabilitation. This model still makes sense for the general public, esp. in Western societies, where personal responsibility is emphasized. The scientific community, however, has moved away from this model, as issues like genetics, neurobiology, & environmental factors gain widespread empirical support. Remember that law is not often based on research....and we can see this model used by the US gov't in the "War on Drugs"