PSYC 117: Drugs & Behavior - Drug Dependence

What is Drug Dependence (Addiction)?

As a consequence of previous use, the individual must continue to use the drug to avoid adverse consequences

• There are two types of Dependence: Physical Dependence  and Psychological Dependence

What is Physical Dependence?

When the person has used the drug long enough, that when they try to stop using they experience Abstinence Syndrome (Physical Withdrawal Symptoms).

• Physical Withdrawal Symptoms:

  • Crankiness

  • Seizures
    

  • Delusions

  • Hypothermia → Caused by Narcotics

  • Presence of Abstinence Syndrome

    
    

• Physical Symptoms are relieved by drug administration → If drug is taken the Physical Symptoms go away

What is the Homeostatic Model of Drug Withdrawal?

Homeostasis - When systems of the body keep the internal environment in an optimal state (Systems keep the body at normal levels)

• Example: Body Temperature

• Drugs interfere with normal homeostasis (drugs interfere with the internal state of the body)

  • Over time, the body adjusts to the presence of the drug and homeostasis is restored

  • When the drug is removed, Homeostasis is disrupted again because Adjustment to the drug is still there

• Tolerance - The body adjusts to the effects of the drug
  

  • Therefore in order to get the same effects of the drug a person needs a higher dosage

  • Tolerance and Withdrawal are closely related

• Physical dependence = Physical Withdrawal Symptoms 

• Psychological Dependence = Using the drug to cope

• Withdrawal symptoms is when the drug is taken away, and the response to the drug on the body is still there

• Eventually the body goes back to the way it was before the drug and physical dependence is gone

What is Psychological Dependence?

Compulsions/desires to use the drug for reasons other than to eliminate withdrawal 

• Drug use satisfies some “Psychological need” of the individual

• Physical and Psychological Dependence often occur Simultaneously → In most cases a person is both Physical and Psychological dependent on a drug
  

• Marijuana/Cannabis are drugs that don’t produce much Withdrawal

What is Drug Addiction?

What is the Ventral Tegmental Area (VTA)?

 Makes Dopamine & Sends Dopamine to various parts of the brain

• Ventral Tegmental Area (VTA) is located in the Midbrain, at the top of the brain stem

• One of the most Primitive Part of the Brain

• The neurons of the Ventral Tegmental Area (VTA) Synthesize (Create) Dopamine, which their axons then send to the Nucleus Accumbens

  • Nucleus Accumbens - Is a Natural Reward Center in the brain & is activated by Dopamine

• The Ventral Tegmental Area (VTA) is also influenced by Endorphins whose receptors are targeted by Opiate drugs such as Heroin and Morphine

• Dopamine is a Neurotransmitter that is important for the Reward Center and Addiction

• Addictive drugs seem to substitute that reward stimulation in the Nucleus Accumbens

  • Addictive drugs affect Dopamine transmission in the Nucleus Accumbens 
    

• Lesions of the Nucleus Accumbens eliminate drug self-administration of stimulants

What is the Nucleus Accumbens?

A natural reward center in the brain & is activated by Dopamine

• Dopamine is a neurotransmitter that is important for the Reward Center and Addiction

• Addictive drugs seem to substitute that reward stimulation in the Nucleus Accumbens

• Addictive drugs affect Dopamine transmission in the Nucleus Accumbens

• Lesions of Nucleus Accumbens eliminate drug self-administration of stimulants 

What is the Physical Dependence Model?

Drug is used to avoid Withdrawal Symptoms → Sometimes Called the Medical model (This model has been around the longest).

• Physical Dependence - Drugs are used for a long time so they suffer withdrawal symptoms if they stop using the drug. So individuals keep using the drug so they don’t experience the painful withdrawal symptoms 

• Addictive behavior occurs in order to avoid Withdrawal symptoms
  

• Face Validity → Not all addictive drugs seem to support Withdrawal

• Examples:

  • Marijuana & Cannabis → Most users don’t experience intense physical withdrawal, at least not to the extent to avoid experience of negative consequences
    

  • Cocaine & Amphetamine → Other drugs where users don’t experience intense Physical Withdrawal symptoms

• Is the individual cured once withdrawal has been terminated?
  

  • Most people when they stop trying to use a substance can be successful for days, weeks, etc.

  • 90% of the time individuals no longer experience withdrawal symptoms by the time they relapse 

• Nowadays the Physical Dependence Model is not really used to explain People’s Addiction

What is the Positive Reinforcement Model?

 Addiction occurs because the drug stimulates “Reward Centers” of the brain 

• Positive Reinforcement - A behavior followed by a pleasure outcome will make that behavior more common
  

• Drugs produce pleasure and positive effects, if we engage in behavior and we get positive effects then that behavior is more likely to occur again in the future

• If good things happen after we engage in a certain behavior that behavior will become more common in the future

• Positive outcomes: Pleasure, these drugs will activate areas in the brain that stimulates “Reward Centers” in the brain

What Evidence Supports the Positive Reinforcement Model?

Drug Addictiveness seems to follow the rules of Effective reinforcers:

• Saliency and Immediacy:

  Saliency - How Salient the reinforcer is (Something that stands out, something that is noticeable) → Unit of measure for Psychoactive drugs, that produce Euphoria

  • The Bigger the reward the more effective the reinforcer will be 
    

  • Drugs that produce more amount of pleasure will be more addictive, different forms will result in more or less pleasure
    

• Example:

  • Cocaine can be administered in different ways, you can it it, smoke it, inject it → The different forms change the addictiveness of the drug

  Immediacy - Instant reinforcement, instant delivery of the reward or punishment will be much more effective in changing behavior 

  • The sooner the outcome occurs, the more effective the reinforcer will be

  • Same with Psychoactive drugs in terms of routes of administration (smoking or injecting the drug) versus slower routes (taking a drug orally)
    

  • Taking a drug through a faster route will always be more addictive → Immediacy

• What about negative consequences?

  • The highs outweigh the lows

  • Negative consequences are delayed

What is the DSM-5?

Diagnostic and Statistical Manual 5th edition (DSM-5) - Is a catalog that lists all the different Psychiatric conditions people can be diagnosed with

What is the Diagnosis of Substance Use Disorder (Moderate & Severe)?

Dependent on how many signs or symptoms appear

• If a person meets 2-3 Symptoms they should be diagnosed with Moderate Substance Use Disorder

• If a person meets 4 symptoms or more they should be diagnosed with Severe Substance Use Disorder
  

• Psychiatric conditions can be much more variable compared to Physical conditions 

• Psychiatric conditions can be seen differently in people so it is important that professionals come together and decide what it looks like so we can treat these different disorders

• Diagnosis: Based on Maladaptive Pattern of Use that leads to clinically significant impairment or distress as manifested by at least 3 symptoms of the following in the last 12 months:

  • Tolerance - People use more of a drug than they use to use because they need more of a drug to get the same effect

  • Withdrawal - The person experiences Physical Symptoms when they stop using the drug (Abstinence Syndrome)
    

  • Recurrent failure to meet major obligations → Substance use affects a person to do their major life obligations 

    • Examples:

      • Going to work

      • Forgetting to pick up their children at school

  • Using a Substance in dangerous situations

  • Craving or Strong desire to use the Specific Substance

  • Recurrent problems associated with Substance use (Health problems, School problems, etc)
    

  • Substance is taken longer than intended 
    

    • Examples:

      • Person tends to have more alcohol than intended

      • A person drinks wine then goes to a bar until closing

  • Desire to quit or unable to quit a substance

  • Not finding pleasure in things they use to do, and their primary focus is on using the substance

  • Substance use reduces other important activities
    

    • Disrupting of life in some way →Impairing their functioning, so they aren’t able to function as well with this condition
      

• Has to have Maladaptive element in order to be Diagnosed
  

• Just having Tolerance and Withdrawal by itself isn’t enough to be diagnosed with Addiction

• Addiction is more Psychological (It’s Maladaptive behavior because it is harming yourself willingly)

• Addiction - Engaging in Maladaptive behavior regardless of the negative consequence

• It has to be Maladaptive (It has to prevent you from performing normally in order to be considered an Addiction)

Stages of Treatment for Substance Abuse: What is Detoxification?

Stage 1: Detoxification - Eliminating the drug from the body 

• Caused by: Overdose, major crisis from using a substance)

  • Elimination of drug from the body
    

  • Management of Physical Withdraw

    
    

• Physical Withdraw is more intense when leaving the body

• Medical treatment might be necessary

• A very Physical Withdrawal can be very dangerous and can require to go to the hospital

Stages of Treatment for Substance Abuse: What is Active Treatment?

Stage 2: Treatment Setting (Two different settings): Residential Versus Outpatient

• Residential setting - Patient lives at the facility for a period of time
  

  • Often staying for months at a time

  • counselors are present

  • round the clock treatment

  • individual treatment group
    

• Residential may be more effective → If a person has resources and means Residential treatment may be the way to go
  

• Disadvantage of Residential Treatment:
  

  • Patient’s life is uprooted, they have to leave their family, work, etc.

  • Expensive

• Outpatient Setting - Patient still lives at home, but attends treatment at a facility, but is still able to go home.

  • Tapers off as individual progresses
    

  • Advantage: Their Life isn’t completely changed with Outpatient treatment like it is with Residential treatment

  • They don’t leave their family, have to miss work as much, or use as many resources

  • Less expensive

Stages of Treatment for Substance Abuse: What is Aftercare?

Stage 3: Long- Term support against Relapse

• Most view Dependence abuse as a Life-Long Problem

• Most common option of Aftercare is Self-help Groups
  

  • Example: AA meetings, etc

What is the Goal of Abstience?

• The goal for most Substance Abuse programs in general in the United States is Abstinence

• Abstinence Based Programs - Disease based programs and they have to completely stop using the substance because they have this disease (Views drug abuse as a Disease).

• No one approach works for everyone (It is not a one size fits all solution), you have to  look at each individual client and see what works best for them
  

• Doesn’t matter what program is used, most likely will have the same outcome either way

What is Controlled Use?

Tend to be more Behavior Therapy, aimed toward reducing or eliminating the Abusive behavior that is associated with the substance.

• Example: Alcohol abuse → Educating the client about the overuse of alcohol, set up a designated driver, don’t put yourself in those negative consequences, try to identify those negative things associated with using the substance that makes it harmful

• Controlled Use Treatment Goal: To teach the client, and have the client learn how to not engage in the harmful behavior associated with that particular substance

• Controlled Use programs have a bad rep in the U.S.
  

• Women tend to participate in more Controlled Use programs than Men

What is Social Therapy?

Social Therapy → May be particularly effective

• Self-Help Groups - Most common form of Social Therapy, especially in terms of Alcohol Abuse; Alcoholics Anonymous (AA programs), where individuals are given support to go through the 12 steps 
  

  • Alcoholics Anonymous is run by the Clients themselves

  • It is a very widely available program and is immensely successful

• Structured Group Therapy - Where a licensed Practitioner/ Clinician runs the program

• Advantages for Structured Group Therapy:

  • Economical → The Clinician is working with several clients at a time 

• Social Therapies provide:

  • Interaction with people at different stages of Addiction

  • Peer Feedback 

  • Positive Peer Pressure

  • A safe practice environment
    

  • A drug free social network

What is Behavioral Therapy?

• Behavioral Modification - Setting up contingencies that don’t reinforce the drug taking behavior
  

• Antabuse - Is a drug that interferes with the enzyme Aldehyde Dehydrogenase
  

  • Disulfiram (Antabuse) -  is a drug that is given to individuals with problems with Alcohol abuse, when they are given this drug acetaldehyde builds up so when they drink alcohol they won’t experience the positive effects and instead it will produce a toxic effect such as making them sick

  • By taking the positive effects out of the substance and actually punishing the individual it will make that behavior less likely

• Behaviors are a result of Learning

• Cognitive Behavior Therapy (CBT) - The Most Common Therapy used in treating Substance Abuse. CBT looks at the behavior of the individual and the cognitive processes that is associated with that behavior

  • What is the person thinking when they use the substance

  • Identify the Antecedents (Factors that may cause Substance Abuse)

  • Look at the thought patterns of the individual that leads to Addictive behavior

What is Pharmacotherapy?

Drugs used to treat addiction, by itself is not effective, but combine the drugs to treat addiction with other forms of therapy and it is effective

• Pharmacotherapy reduces the impact of Withdrawal

• Pharmacotherapy  reduces the likelihood of Relapse

• Drug + Other form of Therapy = Pharmacotherapy 

• Substitution therapy - Not as devastating as using narcotics that are used to treat drug abuse. 
  

  • Give patient a drug that doesn’t have as many negative effects to wean them off the dangerous drug

Does substance abuse treatment work?

• About ⅓ to ⅔ of Clients have Positive outcomes after Substance Abuse Treatment

• Improvement rates of Untreated clients are about half as high

• 25-30% of clients are better off with Substance Abuse Treatment 

• With Substance Abuse Treatment there is a general trend of increase in Abstinence rates over time

• Comparing the data of treated to untreated: There is a statistical difference.
  

• Optimistics will look at drug abuse as a complex problem → Many factors play a part in Substance Abuse such as: Social, Biological, Personal, and Environmental Factors