Mental Health

Non-Stigmatizing Language

An addict--> Person with a substance use disorder

"Drug abuser"--> Person who uses/misuses drugs

"Substance abuse" --> Substance use/substance misuse/substance use disorder

"Clean" --> In recovery / not currently using

"Dirty urine" -->Positive drug test

"Clean urine" --> Negative drug test

"Relapse" --> Return to use

"They are depressed" --> They have depression / are

experiencing depressive symptoms

Depression (MDD)

System: mood, reward, and stress regulation

Definition: Persistent constellation of symptoms affecting mood, motivation, cognition, physiology, and functioning

Symptoms: depressed mood, loss of pleasure, difficulty concentrating, negative thoughts, withdrawal, and sleep changes

Anxiety

System: threat detection and regulation

Threat-related responses become excessive, persistent, poorly regulated, and/or interfere with functioning

Addiction

System: reward learning, motivation, and control

Definition: Persistent drug seeking/use despite negative consequences

Symptoms: Changes in Motivation, Reward learning, Habit formation, Stress systems, Decision making, Behavioral control

Monoamine Hypothesis

Idea that depression may result from reduced

monoamine signaling (dopamine, norepinephrine, serotonin)

Note that this hypothesis is not 100% correct

Neurochemical Hypothesis of Anxiety

Hypothesis: insufficient inhibitory regulation (of GABA, serotonin, NE) may contribute to excessive neural excitability/threat responding.

Substance Use

taking a substance

Substance misuse

Using a substance in a harmful or inappropriate way

Substance use disorder

Problematic pattern associated with impairment/distress

Dopamine Signaling

Not always associated with pleasure: key to how we perceive rewards (critical in addiction)

Better than expected: ↑ dopamine

As expected: Little/no prediction error

Worse than expected: ↓ dopamine

Enforcement

Repeated drug exposure

↓

Drug-related cues acquire unusually strong incentive salience

↓

"Wanting" can become amplified

Incentive Salience

The motivational value of something relating to the conditioned stimulus provided or to predicting an unconditioned stimulus.

Drug related cues can caused increased wanting

HPA Axis

Hypothalamus, Pituitary, and Adrenal axis

Involved in chronic stress

These three regions work together to mediate stress signaling and homeostasis

Amygdala

Detects/assigns significance to potentially threatening stimuli

Hippocampus

Context and memory

"Where did this happen before?"

Ex: patients w/ PTSD cannot distinguish context

Prefrontal Cortex

Evaluation/regulation

"Is this actually dangerous?"

Hypothalamus & Brainstem

Generate physiological responses

Heart rate

Breathing

Autonomic/endocrine response

Positive reinforcement

increasing behavior by presenting positive stimuli

(getting candy for completing a task)

Negative reinforcement

increasing behavior by presenting negative stimuli

(You get grounded for skipping class, so you now attend classes every day)