Alcohol use disorders & substance use disorders

Public Attitudes and Support Models for AUD

Society has shifted toward harm reduction and handling heavy college binge drinking. Alcoholics Anonymous (AA) was founded in 1935 by Bill Wilson & Dr. Bob Smith as a spiritual 12-step model; Rational Recovery (RR) uses self-empowerment and the Addictive Voice Recognition Technique; SMART Recovery and Moderation Management are other paths.

Abstinence vs. Moderation in AUD

Bujarski (2013) showed that patients who aimed for total abstinence got better long-term results. Trying to moderate drinking only works for younger people with mild physical dependence and no family history of alcoholism.

DSM-5 AUD Criteria & Evolution

DSM-5 combined old categories of "abuse" and "dependence" into one single disorder called Alcohol Use Disorder (AUD), dropped legal problems from the list, and added craving. Requires meeting at least 2 out of 11 criteria within a 12-month window.

The 11 Criteria for AUD

1. Drinking more/longer than planned; 2. Wanting to cut down or failing to do so; 3. Spending a huge amount of time getting, using, or recovering; 4. Craving or strong urges; 5. Failing home/work duties; 6. Keeping up use despite social fights; 7. Quitting important hobbies; 8. Drinking in dangerous situations (like driving); 9. Drinking despite physical/mental health issues; 10. Tolerance (needing more alcohol to get the same buzz); 11. Withdrawal symptoms when stopping.

Severity levels of AUD

Mild (2-3 symptoms met), Moderate (4-5 symptoms met), Severe (6-11 symptoms met).

Alcohol Withdrawal criteria

Requires at least 2 of 8 symptoms: high autonomic nervous system activity, hand tremors, insomnia, nausea/vomiting, hallucinations, restlessness, anxiety, or full tonic-clonic seizures.

Epidemiology of AUD (NESARC-III)

12-Month DSM-5 AUD prevalence is 13.9% (Males = 17.6%, Females = 10.4%); Lifetime prevalence is 29.1% (Males = 36.0%, Females = 22.7%). Average onset age is 26.2 years old. Costs the US economy $249 billion.

High-Risk Groups & Immigrant Paradox in AUD

Highest in Whites, Native Americans, and males. The "Immigrant Paradox" shows that foreign-born immigrants have a lower risk of AUD compared to US-born people of the exact same ethnic background.

Adolescent Initiation and AUD

Starting to drink before age 15 massively raises your lifelong addiction risk. Hanging out with drinking peers is the strongest immediate risk factor, while strict parent monitoring is protective.

Psychosocial Etiological Models of AUD

Expectancy Theory (positive mental beliefs about how fun alcohol will be predicts heavy drinking); Stress-Response Dampening (SRD) (drinking to chemically squash physical stress reactions).

Typologies of AUD

Cloninger Typology: Type 1 (late onset, high anxiety/harm avoidance) vs Type 2 (early onset, thrill-seeking novelty seekers, heavily linked to men and antisocial traits). Babor Typology: Type A (late onset, milder) vs Type B (early onset, severe, runs in families).

Biological Etiological Models of AUD

Dopamine & Opioid circuits: alcohol triggers dopamine release in the Nucleus Accumbens (NAC) by turning off the brakes in the Ventral Tegmental Area (VTA). Incentive Sensitization Theory (Berridge & Robinson): rewires brain pathways so that you intensely want the drug out of habit, even if you don't even like it anymore. Allostatic Model (Koob & Le Moal): chronic drug use damages brain stress systems (CRF and NPY) in the amygdala, creating the "dark side of addiction" (using just to feel normal).

Assessment Tools for AUD

AUDIT (10-item WHO screening tool), Timeline Followback (TLFB) interview calendar.

Psychosocial Treatments for AUD

Brief Interventions, Motivational Enhancement Therapy (MET), CBT (like "urge surfing"), Behavioral Couples Therapy (BCT), Community Reinforcement Approach (CRA) & Contingency Management (CM - giving rewards for clean drug tests).

Project MATCH findings

Compared CBT, MET, and Twelve-Step Facilitation (TSF). TSF had a slight edge for continuous 1-year sobriety; highly angry patients did better with MET; patients surrounded by drinking friends did better with TSF at the 3-year mark.

Pharmacotherapy for AUD

Naltrexone (blocks $\mu$-opioid receptors to kill the buzz); Acamprosate (balances glutamate NMDA/GABA); Disulfiram / Antabuse (makes you violently sick if you drink); Vivitrol (injectable monthly naltrexone).

COMBINE Study & Pharmacogenetics

Medication management combined with naltrexone or behavioral counseling gave the best results (acamprosate worked no better than a sugar pill placebo). Pharmacogenetics (OPRM1 gene): people carrying the Asp40 genetic variant who took naltrexone had an 87.1% success rate compared to only 54.8% for Asn40 homozygotes.

Temporal Discounting & Opponent-Process Theory in Behavioral Addictions

Temporal discounting means brains deeply undervalue future rewards compared to instant gratification. Opponent-Process Theory: your initial brain high (A-process) triggers a delayed, opposite crashing reaction (B-process / withdrawal and bad mood), which gets stronger with every single use, driving up tolerance and cravings.

Video Game & Social Media Addiction mechanisms

Dual system theory balances fast reward-seeking against weak self-control. Social media addiction uses the Hyper-Personal Model, letting people carefully curate a fake, hyper-attractive online identity.