Drugs and Behavior Chapter 5

cocaine cravings have been reported to be able to last _____ years?

7

_______ is a therapy for drug addicts with partners as an added support to individual and group therapy?

Behavioral couples therapy

_______ (BSFT) targets family interactions that are thought to maintain or exacerbate adolescent drug abuse and other co-occurring problem behaviors such as oppositional behavior, delinquency, associating with antisocial peers, aggressive and violent behavior, and risky sexual behavior? BSFT is based on a family systems approach to treatment, where family members' behaviors are assumed to be interdependent such that the symptoms of any one member (e.g., the drug-abusing adolescent) are indicative, at least in part, of what else is going on in the family system.

Brief Strategic Family Therapy

First published in 1952, the ________ (The Diagnostic and Statistical Manual of Mental Disorders) is currently in its fifth edition which was released in 2013. This is compiled by the American Psychiatric Association (APA) and provides criteria for diagnosing a myriad of psychiatric disorders?

DSM

One of the most articulate theorists of the disease model,________, wrote a book called The Disease Concept of Alcoholism. Thanks to this person, the idea of addiction as a disease became formalized? (He was the first to formulate a disease theory of addiction)

E. M. Jellinek

______ describes a drug's capacity to act as a positive reinforcer?

abuse liability

As a general estimate of severity, a ______ substance use disorder is suggested by the presence of two to three symptoms, ______ by four to five symptoms, and _______ by six or more symptoms. Changing severity across time is reflected by reductions or increases in the frequency or dose of the substance used by an individual.

mild; moderate; severe

The DSM-IV-TR included two diagnostic categories related to maladaptive substance use—substance dependence and substance abuse. The DSM-IV-TR criteria for ________ were considered more severe and problematic, and included: a failure to fulfill major obligations at one's job, at school, or to one's family; persistent social or interpersonal problems use of a substance in physically hazardous conditions; and recurrent substance-related legal problems (deleted from the DSM-5). The presence of any one of these criteria over a 12-month period was sufficient for a diagnosis of substance abuse? (substance dependence and substance abuse were merged into one in the DSM-5)

substance abuse

addiction is a disease? (true/false)

true

_______ such as those of Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous are some of the most well-known behavioral treatments for addiction? One of the goals of these self-help groups is to increase the likelihood of drug abstinence through affiliation and active engagement in a social community. Three key aspects predominate: acceptance, surrender, and active involvement.

12-step programs

alcoholism was declared a disease by the World Health Organization in ______ and the American Medical Association in ______?

1951; 1953

George Koob and Michel Le Moal proposed a theory of addiction as a ______stage cycle, the beginning of which involves substance intoxication and impulsive bingeing. Although acute drug use is positively reinforcing, activating brain reward and incentive salience neural circuitry, this stage 1 pattern of use does not constitute addiction. Instead, the progression toward drug addiction entails a compulsivity of substance use (that is, a loss of control) and the recruitment of negative reinforcement processes. These are the key elements of stage 2 of the addiction cycle, during which the user develops an aversive emotional state and motivational signs of withdrawal, including chronic irritability, physical and emotional pain, malaise, dysphoria, alexithymia (a dysfunction in emotional awareness), and a loss of motivation for natural rewards. In laboratory animals, this syndrome is marked by an increase in the reward threshold for brain stimulation, indicative of a loss of reward sensitivity, during withdrawal from all major drugs of abuse. Koob refers to this stage of the cycle as the "dark side" of addiction during which drug use alleviates a devastating negative emotional state, thereby acting as a negative reinforcer Finally, stage 3 is characterized by a preoccupation with, and an anticipation of, drug use. It is during this third stage that individuals experience craving and a relapse to compulsive drug taking, even long after the acute symptoms of withdrawal have disappeared These three stages of the addiction cycle are proposed to feed into one another, become more intense, and ultimately lead to the pathological state known as addiction?

3

Research indicates that most addicted individuals need at least _____ months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment?

3

An additional source of guidance for clinicians diagnosing addiction is the International Statistical Classification of Diseases and Related Health Problems (the _____), published by the World Health Organization (WHO)?

ICD

a number of brain regions form an integrated circuitry responsible for learning, motivation, and the control and direction of behavior—that is, a ____________? Stimuli that act as reinforcers interact with this motivation control system in complex ways, and the motivation control system handles a number of different functions.

Motivation control system

_____ is aimed at helping individuals resolve ambivalence about engaging in treatment. Motivational interviewing principles are used to strengthen motivation to stop drug use and build a plan for change.

Motivational Enhancement therapy

__________ (MDFT) for adolescents is an outpatient approach that views adolescent drug use in terms of a network of influences (individual, family, peer, and community).? Treatment includes individual and family sessions held in clinics, homes, or with family members at a family court, school, or other community location.

Multidimensional Family Therapy

______ (MST) addresses the factors associated with serious antisocial behavior of adolescents who abuse drugs.? These factors include characteristics of the adolescent (e.g., favorable attitudes toward drug use), the family (poor discipline, family conflict, and parental drug abuse), peers (positive attitudes toward drug use), school (alienation, dropout, and poor performance), and neighborhood (criminal subculture).

Multisystemic Therapy

_______ will be self-administered to a greater extent by humans if they know that they are about to experience a painful stimulus?

Opioids

The DSM-IV-TR included two diagnostic categories related to maladaptive substance use—substance dependence and substance abuse. _______ was characterized by a subset of the same features included in the DSM-5 diagnostic criteria for substance use disorder. These include symptoms of impaired control over substance use ,social impairment related to substance use, risky use, and physiological symptoms? A diagnosis of substance dependence required that three or more of these symptoms be present over a 12-month period.

Substance dependence

The feasibility of employing biologics as treatments for substance use disorders has increased in recent years. Approaches include using ________ that stimulate the immune system to produce drug antibodies? Vaccines are developed by chemically bonding a minute amount of drug to a protein against which the immune system builds antibodies. With multiple vaccinations, when the drug of abuse is ingested, antibodies latch on to the drug molecules forming a complex that is too large to pass through the blood-brain barrier. With enough antibodies, most drug molecules will be prevented from reaching their sites of action and the individual will not experience drug effects.

Vaccines

The discovery that dopamine mediates general arousal, physical effort, and motor activity formed the basis of the ______ hypotheses of dopamine function, for which there is a wealth of empirical support? In fact, the output of the nucleus accumbens normally provides continuous inhibition of the motor system. When dopamine is released in the nucleus accumbens, it actually inhibits the inhibitory output to the motor system, and this has the same effect as stimulating the motor system.

activation-sensorimotor

The ability of a drug to cause physical dependence (and, consequently, withdrawal) became accepted as the universal indication of an ________ drug, and the presence of physical dependence became the defining feature of an addict and an addiction? In other words, physical dependence is both the cause and consequence of addiction.

addicting

Toward the end of the nineteenth century, the temperance and antiopium social movements began using the term ________ to refer exclusively to the excessive use of drugs and to replace such terms as intemperance and inebriety. The medical profession also adopted this term and started using it as a diagnosis of, and an explanation for, excessive drug use, thereby giving it the character of a disease?

addiction

_______ can refer to a condition or state in which a person lives, or to a progressive process that leads from recreational to compulsive and habitual drug use, and for that reason the term is somewhat ambiguous?

addiction

_______ refers to situations where the set point is not constant but changes in response to changes in the individual's environment? It is succinctly defined as "stability through change" and involves a feedforward mechanism that entails continuous reevaluation of need and ongoing readjustment of systems toward new set points?

allostasis

Koob and Le Moal conceptualize this spiraling cycle of reward/antireward system dysregulation that drives addiction as an ________ process? Allostasis is a relatively new concept in stress physiology and medicine and stands in contrast to homeostasis.

allostatic

_______ creates an aversive effect in the user if the drug of abuse (for instance, alcohol) is consumed?

antabuse

_________ is a metabolite of opium that stayed in the body well after the drug was gone? This was claimed to have effects opposite to opium which, in the absence of the drug, made the person very sick. The theory of an autotoxin was later disproved, but the sickness experienced after a drug leaves the body is real and became known as withdrawal or ________?

autotoxin; abstinence syndrome

________ are designed to engage people in treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviors related to drug use, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and relapse?

behavioral therapies

________ was originally developed as a relapse prevention strategy and is based on the theory that learning processes play a critical role in the development of maladaptive behavioral patterns. Individuals learn to identify and correct problematic behaviors through techniques intended to enhance self-control by exploring the positive and negative consequences of continued use, self-monitoring to recognize drug cravings early on and to identify high-risk situations for use, and developing strategies for coping with and avoiding high-risk situations and the desire to use. A central element of this treatment is anticipating likely problems and helping patients develop effective coping strategies. The skills individuals learn through CBT approaches remain after the completion of treatment?

cognitive behavioral therapy

a built-in protective mechanism, called _____ causes rejection of any taste that is followed by sickness or an alteration in nervous system functioning?

conditioned taste aversion

If drug-related stimuli cause a compensatory response, they will reduce the effect of the drug when they are presented along with the drug. This is called _________?

conditioned tolerance

_______ are based on operant conditioning principles of reinforcing drug-free urine samples with low-cost incentives such as prizes or vouchers exchangeable for food items, movie passes, and other personal goods. Incentive-based interventions are highly effective in increasing treatment retention and promoting abstinence from drugs?

contingency management interventions

The dependence model, however, has a serious flaw: the ________ between dependence and addiction is less than perfect. That is, it is possible to have an addiction in the absence of dependence and to have dependence without addiction? Another problem lies in using physical dependence to explain the development of addiction; what comes after cannot be used to explain what comes before

correlation

Assessing the presence of ______ presents the same problems as that of self-control. Strong desire or persistent urge to use a drug is a subjective state and ultimately depends on self-report of the user?

craving

______ entails intense preoccupation, strong desire, or an overwhelming urge to use a substance?

craving

Brain imaging studies provide intriguing insight into addiction as a brain disease. Cortical dysfunction and deficits in higher-order processing may also shed light on why so many substance users _____ the presence or severity of their addiction? Researchers suggest that this denial may actually be the product of dysfunctional cortical circuits that mediate insight and self-awareness.

deny

________ meant both (a) the state in which a drug produces physical dependence (withdrawal symptoms occur when the drug is stopped) and (b) the compulsive self-administration of a drug (addiction). This model of drug abuse, which we shall call the dependence model, is still widely supported?

dependence

________ is defined as a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and that typically includes a strong desire to take the drug (i.e., craving), difficulty controlling drug use, persistent use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state

dependence syndrome

A _________ is often caused by a pathogen—bacteria causing tuberculosis or a virus causing the measles—or some genetic malfunction, such as in Lou Gehrig's disease?

disease

The _____ model suggests that casual use is a result of the initial stages of the disease. The ______ model implies a rapidly forming physical or psychological dependence that results from occasional drug use motivated by curiosity, experimentation, peer pressure, and other factors?

disease; dependence

a _______ can include disabling outcomes resulting from a disease or an injury?

disorder

mental disorder does not necessarily imply that the condition meets all definitions of mental disease and may not be relevant to legal or moral issues such as whether a person is competent or responsible for his or her actions. Thus, the term _______ does not necessarily absolve the disordered individual from criminal or moral sanction as hoped by the early social reformers?

disorder

The DSM (does/does not) pathologize the casual or recreational use of a drug (or, for that matter, any behavior considered to be within the realm of normalcy), but does include a list of problematic consequences that could result from the compulsive and habitual use of a substance, or what we might think of as a drug addiction?

does not

the greatest subjective drug high comes from drug classes and routes of administration that result in the fastest and highest peaks in _____ activity? Remember, though, that the fast, high surges in dopamine that correspond with drug taking are not what cause the feelings of euphoria—correlation, however strong, does not imply causation. Instead, these surges ensure that any stimulus that elicits extreme pleasure also gains incentive salience and is emblazoned in the motivational system. Increases in the activity of other neurotransmitter systems, such as opioids and endocannabinoids, which are highly implicated in liking, may in fact be causing the pleasure. The heightened surge in dopamine related to these highly pleasurable stimuli ensures that users are motivated to seek and use them again.

dopamine

_________ is conceptualized as a disorder that develops when behavior initially maintained by positive reinforcement (intoxication) progresses to being motivated by negative reinforcement—that is, drug-taking as a means of alleviating the unpleasant emotional state experienced during withdrawal?

drug addiction

______ drug use follows the positive reinforcement model subsequent longer term functions under a negative reinforcement model?

early

_______ suggest that addiction is a disease that is caused by repeated exposure to the drug?

exposure theories

Addiction appears as a diagnostic term in the DSM-5? (true/false)

false

The greatest conceptual shift presented in the DSM-5 chapter on addictive disorders is the inclusion of a non-substance-related disorder, or what we might call a behavioral addiction— ________?

gambling disorder

Mice are not likely to self administer ______ because they do not have the cortex to produce the mind altering effects that the drug produces in humans?

hallucinogens

_______ is similar to the DSM-IV-TR concept of substance abuse, marked by a pattern of substance use that is damaging to one's physical or mental health.

harmful use

the ______ hypothesis of dopamine function was highly influential. Proponents explained the concept of reinforcement by saying that food, for example, stimulates the mesolimbic dopamine system, and this means that the organism experiences the sensation of pleasure. The pleasure reinforces the behavior of seeking food, and this behavior is, therefore, repeated?

hedonia

_____ proposes a mechanism of drug-addiction development that aligns with the opponent process theory of motivation proposed by Solomon and Corbit? The A process is driven by brain reward systems, the neurocircuitry involved in the positively reinforcing effects of drug use and that controls happiness and pleasure; the A process is primarily experienced during the first (binge/intoxication) stage of addiction. The B process is driven by brain antireward systems, the neurocircuitry involved in negative hedonic balance and that opposes and limits the sensation of reward through evocation of dysphoria and a stress response; the B process dominates the second (withdrawal/negative affect) stage of addiction. Such opponent processes are hypothesized to begin early in drug taking. Indeed, elevations in reward threshold can appear within a single session of drug self-administration. During the third (preoccupation/anticipation) stage of addiction, the dysregulations that comprise the "dark side" of addiction persist, even during protracted abstinence, and set the tone for vulnerability to craving by activating reorganized, hypersensitive drug-, cue-, and stress-induced reinstatement neurocircuits

hedonic dysregulation theory

_______ postulates that addictive behavior arises in part from avoidance of drug withdrawal symptoms?

hedonic dysregulation theory

__________ is the term used to describe the lowering of the mood set point?

hedonic dysregulation,

Berridge and colleagues have pinpointed tiny __________ in the nucleus accumbens and ventral portion of the pallidum that mediate pleasure. Increases in "liking" reactions result from the activation of these hotspots, whereas damage to these hotspots corresponds with "disliking" reactions, even to sweet tastes ?

hedonic hotspots

We are attracted to specific targets: the taste of sugar or the experience of a drug high. This attraction to a specific stimulus is called ______?

incentive

When a need state occurs (e.g., hunger), the mesolimbic system is activated. This causes an increase in general activity. In the absence of any previous learning or presence of relevant salient stimuli, this activity ensures that the organism moves around its environment and may find food accidentally. For illustrative purposes, think of an animal living in the woods. This animal normally eats flying insects, but they have all flown away and the animal is hungry. Hunger activates the animal and it rummages around its environment. Finally, the animal finds grubs after turning over a rock in a streambed. This outcome (the accidental discovery of food) causes the release of mesolimbic dopamine, and neurons in the nucleus accumbens become active. Information associated with the discovery is stored in the hippocampus and the cortex. As a consequence, grubs and the streambed acquire _________. The salience part means that these stimuli will be able to grab the animal's attention in the future. The incentive part means that the animal will be attracted to them. In the future, when the animal gets hungry and the nucleus accumbens is stimulated by the ventral tegmental area, general activity will increase. But now the stones in the streambed will draw the animal's attention, it will be attracted to them, and consequently it is likely to find food. The stones, the streambed, and the act of turning over the stones then acquire more incentive salience.

incentive salience

Intrinsically neutral cues associated with drug use also gain incentive salience; they too become more noticeable, attractive, and desirable. Their representation in the brain is transformed into more than a simple perception or memory; they become motivational magnets. In other words, there is a sensitization of incentive motivation. The ________ theory uses this change in motivational sensitivity to explain addictive behavior?

incentive sensitization

The _______ was designed to explain the phenomenon of drug craving, which the researchers define as: "pathologically intense feelings of wanting, which can be produced when incentive salience (or core [unconscious] 'wanting') is translated into conscious awareness"?

incentive sensitization

Jellinek proposed that alcoholism is not caused by alcohol. It is a disease that is _________; people are born with it?

inherited

An ______ entails inflicting damage or harm, such as breaking one's leg?

injury

direct injection of tiny amounts of drug through a cannula into specific parts of the brain?

intracranial

direct injection through a cannula into the stomach?

intragastric

injection through a cannula into the ventricles in the brain?

intraventricular

______ animals that lack certain genes that code for specific neurotransmitter receptor subtypes, enzymes, or chemical precursors vital to neurotransmitter function?

knock-out mice

In addition to receiving information about the internal state of the organism, the motivation control system also receives sensory information about the environment. This information is processed by the thalamus and cortex and then sent to the amygdala and the hippocampus, which are part of a _________ system?

learning and memory

Rather than rely on self-report measures of pleasure related to reinforcement, Kent Berridge and colleagues from the University of Michigan have developed objective measures of "liking" and "disliking" that can be used with laboratory animals. ______ of sweet tastes elicits cross-species patterns of facial reactions, such as rhythmic tongue protrusions, whereas ________ of bitter tastes elicits reactions such as gaping?

liking; disliking

You will find various definitions of addiction contained in other sources. Most definitions, like those of the DSM-5 and ICD-10, have several elements in common. They usually state that (a) the addicted individual demonstrates a ________, as indicated by an escalation in dose and sustained use of a drug, and that (b) the drug use has ______ consequences?

loss of control; harmful

Detoxification is the process by which the body clears itself of drugs and is often accompanied by unpleasant and sometimes even fatal side effects. Medications are available to lessen the potentially dangerous physiological effects of withdrawal; therefore, it is referred to as ________?

medically managed withdrawal

The APA defines a _______ as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is typically associated with either a painful symptom (distress) or impairment in one or more important areas of functioning (disability). In addition, there is an inference that there is a behavioral, psychological, or biological dysfunction, and that the disturbance is not only in the relationship between the individual and society". In the 1987 revision to the DSM-III that yielded the DSM-III-R, the APA added that the syndrome of mental disorder is associated with: "...a significantly increased risk of suffering death, pain, disability, or an important loss of freedom"?

mental disorder

On a neurobiological level, increasing evidence supports impairments in the_______ reward circuitry of problem gamblers, similar to those seen in substance addict?

mesolimbic

the _________ system has two roles in motivating behavior. The first role is general activation. This can be thought of as a pushing behavior without any general direction. When we do not eat for a while, we get hungry—we get up and do something. What we do, however, is controlled by the second function. The second function of the mesolimbic dopamine system is to direct behavior toward a particular goal. This is done by the process of incentive salience; that is, various stimuli in the environment have or acquire special motivational properties that cause us to notice them, be attracted to them, and do something to them?

mesolimbic dopamine

In the midst of the social reform movement and its zeal to help inebriates, the medical profession was involved in the distribution of other drugs of abuse: morphine and opium. _______, the principal active ingredient in opium, was usually injected.

morphine

In addition to behavioral sensitization, there is also sensitization of _______ circuitry—the animal or individual develops an attentional bias toward, and a compulsive wanting or craving for, the drug?

motivation

Pleasure arises from the drug activating other neurotransmitters and brain regions. Repeated drug use sensitizes only the neural circuitry of the ______ system, not that of a system mediating the pleasurable effects or "liking" of drugs. In fact, pleasure tends to show tolerance, rather than sensitization, with repeated drug use. This explains the dissociation between "wanting" and "liking" in substance users—people often crave drugs even though they report that, at the same time, they are miserable and get little or no pleasure from the drug?

motivational

The nucleus accumbens also sends axons to the basal ganglia which, together with parts of the cortex, belong to the ______?

motor loop

Even though they are not natural reinforcers, drugs control behavior by using the same brain mechanisms as other _______ positive reinforcers. Reinforcing drugs activate the mesolimbic dopamine system, either directly via stimulation of the nucleus accumbens or indirectly via facilitation of excitatory input or blocking of inhibitory input to motivation circuitry natural reinforcers have a satiation mechanism that terminates their reinforcing effect. Most drugs, on the other hand, do not appear to have any natural limits to their reinforcing ability.

natural

One __________ associated with long-term drug use is a decrease in dopamine function? This manifests as both a downregulation of D2-like receptors in the ventral striatum that persists even after months of abstinence and a reduction in ventral tegmental area dopamine neuron activity and transmitter release in the ventral striatum. Volkow and colleagues suggest that this hypodopaminergic state might explain the lack of interest in social or recreational activities (natural rewards) that substance users previously enjoyed. Further, it might prompt additional drug use as a way to temporarily alleviate the deficit in dopamine activity so that the individual can feel normal.

neuroadaptation

the _______ phenomenon proposes that addiction is caused by exposure to the drug alone? ( the process starts off as casual or recreational use of a substance that, in vulnerable individuals, eventually escalates to the uncontrollable and self-destructive use we call addiction)

oops

In the midst of the social reform movement and its zeal to help inebriates, the medical profession was involved in the distribution of other drugs of abuse: morphine and opium. _______, the raw extract of the opium poppy, was usually consumed in the form of laudanum, a mixture of opium and alcohol?

opium

extreme self-injurious behavior must be _______ because no person or animal who has control of their behavior would deliberately injure themselves?

out of control

early ideas of addiction focused on _______?

physical dependency

The ________ assumes that drugs are self-administered, at least initially, because they act as positive reinforcers and that the principles that govern behavior controlled by other positive reinforcers apply to drug self-administration?

positive reinforcement model

A ______ is any stimulus that increases the frequency of a behavior it is contingent upon?

positive reinforcer

_______ say that people are either born with the disease or acquire it at some time before they begin abusing the drug. The disease predisposes certain people to become addicts whenever they start using the drug?

predisposition theories

________ proposes that drugs such as cannabis cause subjective withdrawal symptoms that sustain a psychological or psychic dependence. In other words, the concept of psychological dependence focused on mental, as opposed to physical, withdrawal symptoms (e.g., irritability, negative affect, dysphoria, or craving) that were so distressing that people were highly motivated to avoid them?

psychological dependence

Koob and Le Moal's theory is an example of a modern dependence theory of addiction. It proposes that one of the withdrawal symptoms of all drugs of abuse is dysphoria (depression or unhappiness). Because this takes place in the brain and is normally only evident to the drug user, this dysphoria can be thought of as a _______ syndrome that can be alleviated only by taking more drug, in larger quantities? This makes it a mechanism of psychological dependence

psychological withdrawal

The priming effect, also called _________, refers to the reestablishment of operant responding for a reinforcer, following a period during which responding had been extinguished, by a noncontingent presentation of that reinforcer?

reinstatement

A final concept often included in most definitions of addiction is that it is a chronic, _____ disorder. This means that an addict may be free of his or her symptoms of addiction and remain free for extended periods, but the symptoms can and often do reappear at any time? (once diagnosed with an addictive disorder, the person is never "cured," but rather in remission of symptoms which could reappear at any time.)

relapsing

Learning and memory circuitry provides the basis for the ________ hypotheses of dopamine function, which implicate dopamine in the acquisition of operantly conditioned response-reward actions, classically conditioned stimulus-reward associations, and the coding of predictions about reward availability based on the presence of conditioned stimuli, that is, the guidance system?

reward learning

When a drug is administered, it is preceded or accompanied by a distinctive stimulus, such as a light. Eventually, the animal will learn to emit a response (such as bar press) just to make the light come on; that is, the light acquires reinforcing properties because of its association with the drug. These reinforcing properties can be demonstrated using a ___________. The light is presented on a schedule of reinforcement such as an FR 10. The FR 10 itself is considered to be a single response in another schedule that is reinforced by a drug infusion—perhaps an FR 20. Thus, the light comes on after every 10 responses, and after 20 of these FR 10s are completed, the light and the drug are presented together. Thus, the animal gets the drug after making 200 responses.

second-order schedule

________ is the gold standard of understanding human drug abuse?

self-administration

hallucinogenics and psychadelics work through the ______ system?

serotonergic

_______ residential programs provide intensive but relatively brief treatment based on a modified 12-step approach? The original residential treatment model consisted of a 3- to 6-week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in an aftercare self-help group, such as Alcoholics Anonymous, which helps to reduce the risk of relapse once a patient leaves the residential setting.

short-term

the neurophysiological mechanisms that appear to be involved in stress-induced increases in drug intake do not involve relief from _____, per se. Rather, stress directly activates and sensitizes brain mechanisms responsible for the reinforcing value of a drug? (It is also likely that the effect of previous exposure to the same or a similar drug is mediated by a general sensitization to the reinforcing effects of drugs).

stress

Drugs of abuse alter the brain's _______, resulting in changes that persist long after drug use has ceased? This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.

structure and function

_______ are characterized by a cluster of cognitive, behavioral, and physiological symptoms that manifest with compulsive drug-taking. These symptoms range in severity, sometimes resulting in a mild form of substance use disorder while, at other times, characterizing a severe state of chronically relapsing, problematic drug use?

substance use disorders

In its chapter entitled Substance-Related and Addictive Disorders, the DSM-5 includes diagnostic criteria for ____ and ______, not substance addictions?

substance use disorders; substance-induced disorders

________ include drug-specific physiological and behavioral symptoms of intoxication, withdrawal, and other possible mental disorders resulting from the use of a drug (such as substance-induced psychotic disorder or substance-induced depressive disorder)?

substance-induced disorders

_______ or replacement therapies are quite common? For example, nicotine patches or gums are used as a substitute for cigarettes; methadone is used to treat heroin addiction; and benzodiazepines are administered to combat the potentially fatal symptoms of alcohol withdrawal. These therapies prevent or lessen the discomfort of detoxification, making withdrawal more tolerable. But, of course, addiction is not cured in this way.

substitution

The best-known long-term residential treatment model is the _________ (TC), which provides 24-hour a day care with planned lengths of stay between 6 and 12 months. TCs focus on the resocialization of the individual?

therapeutic community

when there is an imbalance or deficiency in some internal system, such as when an organism is hungry, this input stimulates the ______ area in the midbrain?

ventral tegmental

Because drugs activate the mesolimbic system, they are also _____? With repeated use, a drug will acquire greater incentive value (and be a stronger reinforcer) because of sensitization.

wanted

Thus, the mesolimbic dopamine system, and the nucleus accumbens in particular, constitutes a ________ system rather than a pleasure system. In other words, this system is there to make you repeat certain actions, not to make you feel good; it is a do-it-again system, not a pleasure system?

wanting

Thus, through neuroadaptations of learning and motivational circuitry and sensitization of the mesolimbic dopamine system, attraction toward drug-associated stimuli is increased. According to incentive sensitization theory, the subjective consequence of activation of this system is ______, and the subjective experience of a sensitized system is intense wanting or ______?

wanting; craving