4343 exam 2: substance use disorders etiology

Sociocultural causes of SUD

• Stressful socioeconomic conditions • Families that value or tolerate drug use • Regular other stress

Operant conditioning and SUD

• Tension reduction rewards drug use • Self-medication

Expectancy and SUD

• Belief that the substance will be rewarding

Classical conditioning and SUD

• Cues present during use become linked to the high • Little research support as main factor

Psychodynamic view of SUD

• Powerful dependency needs from early years • Lack of parental nurturing

Genetic evidence for SUD

• Animals: offspring prefer alcohol • Identical twin concordance • Adoption studies • Abnormal D-2 receptor gene

Neurotransmitters in tolerance and withdrawal

• Brain cuts production of its own transmitter during chronic use • Lower GABA: alcohol, benzodiazepines • Lower endorphins: cocaine, amphetamines • Lower anandamide: marijuana

Reward circuit

• Pleasure pathway • Ventral tegmental area, nucleus accumbens, prefrontal cortex • Dopamine is the key neurotransmitter

Incentive-sensitization theory

• Repeated use makes reward center hypersensitive to the substance

Reward-deficiency syndrome

• Reward center not activated by normal life events • Person turns to drugs, especially under stress • D-2 receptor defects possible cause

Treatment settings

• Self-help groups most common (about 2.5M in AA/NA) • Outpatient and inpatient rehab • Mental health centers • Problems: not evidence-based, access barriers

Goals of SUD treatment

• Sustained abstinence • Drug-free lifestyle • Function in family and work • Cope with stress without drugs

Two phases of treatment

• Detoxification • Relapse prevention

Detoxification

• Body purged of the substance • Focus on coping with withdrawal

Motivational interviewing

• Addresses ambivalence • Weighs pros and cons of change • Pre-treatment, NOT a treatment itself

Aversion therapy

• Pairs substance with unpleasant experience

Contingency management

• Rewards for staying clean

Relapse-prevention training

• Identify and plan for high-risk situations • Overcome abstinence-violation effect • Lapse vs. relapse

Abstinence-violation effect

• Feeling a lapse means total failure • Leads to full relapse

Lapse vs. relapse

• Lapse: a slip • Relapse: return to regular use

Biological treatments for SUD

• Detoxification • Antagonist drugs • Drug maintenance therapy (methadone)

Sociocultural treatments for SUD

• Self-help and residential programs • Culture- and gender-sensitive programs • Community prevention programs

Self-help groups (AA and NA)

• Most common treatment • Supportive approach

Prevention of SUD

• Community prevention programs