NOTES LITERATURE RISK BEHAVIOR AND ADDICTION IN ADOLESCENCE
WEEK 1
Sussman (2017) – A General Introduction to the Concept of Addiction
and Addictive Effects
Substance and Behavioral Addictions
- Substance addictions: repetitive intake of a drug (such as alcohol) or food
- Behavioral addiction: engaging in types of behavior repetitively which are not
directly taken into the body such as gambling or sex
Both result in clinically significant impairment
- Until recent research, science only focused on addiction in the sense of misuse of
drugs that lead to physiological withdrawal symptoms
Researchers considered drugs which cross the blood-brain barrier, and
exogenous ligands or endogenous ligand functions (naturally occurring
neurotransmitter)
Behavioral addiction alter endogenous ligand functions
- Obtaining a measurable description of scientific concept such as addiction is useful to
be able to make inferences regarding how the concept is related to other concepts,
and subsequently how the concept can guide the development of useful application
- Currently available definitions of addictions – not mutually exclusive
- Historical records: show increasing engagement in certain behavior and reduction of
alternative behavior
- Addiction – referring to binding a person to something to being a brain disease
- Addition to tobacco: brief public history, alcohol misuse has been noted throughout
written history
- Furthermore, the initial use of opium was described as divine enjoyment. Medication
used to treat opium misuse often contained opium themselves. Replacement
medications that did not contain opiate led to new problematic cocaine use. Marijuana
also has a history of misuse. Contradictory, there is no ancient history regarding food
addiction. Historical literature presents descriptions of gambling and sex addictions.
Behavioural addictions have been studied empirically since the 1980s and are also
referred to as process addictions. Many behaviours that now refer to addictions were
considered examples of vice, that is, behaviours which are pleasurable, popular,
possibly voluntary, and wicked
- Two conceptions of addiction
Intensional definition of addiction: causal or process model type
statements of addictions
Extensional definition of addiction: taxonomy of addiction elements, which
subsequently might be organized into a (more) intensional theory-based
perspective
Physiological and psychological dependence (intensional)
- States that an addiction is a prolonged engagement in addictive behavior that results
in its continued performance being necessary for physiological and psychological
equilibrium
- Criteria of dependence definition of addiction tolerance, withdrawal, craving
Tolerance: need to engage in the behavior at a greater level than in the past
to achieve previous appetitive effects – if this increases, one likely spends
more time locating and engaging in the addiction
Withdrawal: abstinence syndrome, involves intense physical disturbance in
the case of some types of drug abuse
, NOTES LITERATURE RISK BEHAVIOR AND ADDICTION IN ADOLESCENCE
Craving: intense desire to engage in a specific act, reoccurs and is compelling,
might be considered as part of the withdrawal syndrome in a dependence
model of addiction
Impulsive obsessive/compulsive behavior (intensional)
- Pertains to engaging in the behavior due to a building up of tension which is released,
resulting in pleasure or relief
- What occurs: another building up of tension or craving for pleasure again positive
reinforcement
- When building up of tension doesn’t result in pleasure but in relief of anxiety, it leads
to obsessions which procedure anxiety and stress leading to a craving for relief again
compulsion, negative reinforcement
- Withdrawal (negative factor) engagement in addictive behavior
- Compulsions involve spontaneous desires to act a particular way; subjective sense of
feeling temporarily out of control, psychological conflict pertaining to the imprudent
behavior, settling for less to achieve the same ends, and a disregard for negative
consequences
- Obsessive-compulsive disorder (OCD) and addiction may be overlapping constructs
- However, many researchers use the term compulsion more narrowly, defining it as ‘a
simple but intese urge to do something’
- OCD-related behaviors are defined as an intense ego-dystonic urge to engage a
simple, repetitive activity to remove anxiety
- Conversely, addiction involves the attempt to achieve some desired appetitive effect
and satiation through engagement in some behavior
Self-medication (intensional)
- Relief from disordered emotions and sense of self-preservation through engaging in
addictive behavior (e.g. reaction of trauma
- Emphasis is on where a person engages in the behavior because the person feels sick
and want to feel well
- Different behaviors (drugs) will relieve different negative emotions (anger)
Self-regulation (intensional)
- In a self-regulation model, the present state of being cues attempt to reach a
standard at which point satiation is achieved, until the present state is no longer at
the desired standard state people engage in addictive behavior in order to achieve
an immediate temporary sense of comfort
- The BAS-BIS model: Behavioral approach system and the behavioural inhibition,
affects individual differences in behavioural responses to cues for reward
These interdependent systems influence whether an individual is likely to
withdraw from or avoid situations that involve novel or threatening cues or
whether a person is likely to engage in novel or risky behavior in response to
cue for reward
- An active BAS (mediated by dopamine) is linked to more impulsive-type behavior
- An active BIS (mediated by septo-hippocampal) is linked to inhibiting behavior
- Persons with difficulty in emotional self-regulation may be prone to engage in
addictive behaviors in order to achieve an immediate temporary sense of comfort
more likely to utilize the BAS which is not working in sync with the BIS
- Incentive-sensitization theory: focuses on the influence of neural adaption to
addictive behaviours and addictive behavior-conditioned stimuli as the underlying
mechanism perpetuation the addictive behaviors
, NOTES LITERATURE RISK BEHAVIOR AND ADDICTION IN ADOLESCENCE
Theory differentiates neural processes involved in motivational mechanisms or
incentive salience to addictive behaviour cues (wanting) and the neural
substrates of pleasurable effect (linking)
- A progressive dysregulation of neural substrates occurs through repeated
engagement in the behavior, which In turn is, associated with an increase in
behavioral sensitization contributing to addicts’ wanting the behavior becoming
disproportionate to the pleasure derived from the behavior
- Through repeated engagement in the behaviour, behaviour-associated stimuli that
acquire incentive salience through neural representation (motivational wanting)
become motivational magnets, able to grab the addict’s attentions
- Adaptions in the wanting affected by pharmacological effects of drugs, alternations
in endogenous ligand transmissions, or associative learning
- Another explanations = Allostasis: addictive behavior leads to dopamine opponent-
process counteradaptation (reduced dopamine and activation of brain stress systems)
that masks the effects of the addictive behavior
to increases dopamine availability and initially control feelings of anxiety or
stress, the addictive behavior may be repeated again and again
new set points of homeostatis may then be established
Addiction entrenchment (intensional)
- One has an over-attachment to a drug, object or anxiety (excessive appetite)
- Intrinsic and extrinsic addiction-promoting cognitive beliefs and expectancies drive
the addictive behavior forward
- The qualities that make the behavior defined as addictive are in part the
conventionality of the behavior and one’s initial preferences, the excessiveness of
involvement in the behavior, and one’s place in society
- With repeated participation in the behavior, the salience of alternative behavior
decreases
- Furthermore, it becomes more difficult to find the alternative (variance)
- This notion is consistent with behavioural economics-type models of addiction-
related behaviour as being a choice (a self-destructive operant behaviour)
- Both show the existence of multiple schedules of reinforcement associated with
different behaviours (addictive vs. non-addictive), and they both involve different
reinforcement values and delays in delivery of reinforcement
Six-component perspective (extensional)
- This perspective: six different components
Salience: tendency for the addiction to dominate one’s thoughts, feelings, and
behaviour
Mood modification: rush, escape, or satisfaction that the addictive behaviour
serves
Tolerance: process in which more of the behaviour is required to achieve a
level of mood modification
Withdrawal symptoms: unpleasant feeling states or physical effects of not
engaging in the addictive behaviour
Conflict: discord between engaging in the addictive behaviour and relations
with others, oneself, or engagement in other activities
Relapse: tendency to return to out-of-control addictive behaviour after periods
of trying to stop or control it.
Five-component perspective (extensional)
- This perspective considers appetitive effects, satiation, preoccupation, loss of control,
and negative consequences as components
, NOTES LITERATURE RISK BEHAVIOR AND ADDICTION IN ADOLESCENCE
- Tolerance and withdrawal symptoms are not included because this perspective
regards those components as preoccupation
As tolerance increases, one likely spends more time locating and engaging in
an addiction
If withdrawal symptoms exist, and worsen, one is likely to be spending more
and more time recovering from the after-effects of the addiction and be
focused in thought and action on how to cope
- Both indicate increasing preoccupation
DSM-5 (extensional)
- The DSM-5 diagnoses a substance use disorder if the individual reports two or more of
11 criteria
- These criteria intend to reflect impaired control, social impairment, risky use, and
pharmacologic effects
- In the DSM-1, alcoholism and drug addiction were subsumed within a sociopathic
personality disturbance category (mental condition)
- In the DSM-2 a category of drug dependence was included that was composed of
physiologic (addiction) and psychic (state) components
Alcoholism was placed in its own category (with four subdivisions)
- The DSM-3 distinguished between abuse and dependence. It attempted to provide
more empirical and within-person-based symptomatology by considering multiple life
dimensions
- The DSM-4 defined drug abuse as a maladaptive pattern of drug use leading to
clinically significant impairment. They also had the diagnoses of substance
dependence, a more severe disorder
- The DSM-5 established the current diagnostic criteria for substance use disorder
- The criteria are mostly a recombination of the DSM-4 criteria.
First, the abuse and dependence categories were combined into one substance
use disorder diagnosis.
Second, the legal consequences criterion was removed
Finally, a craving criterion was added. The DSM-5 does not recognize a food
addiction category.
Gladwin et al (2011) – Addiction, adolescence, and the integration of
control and motivation
Introduction
- Adolescence is a key developmental phase where motivation and cognitive control
undergo major changes
- These changes make adolescents particularly vulnerable to risky behaviours,
including substance use
- Motivation is not simply about wanting something but involves complex interactions
between desire and the ability to regulate behavior
- Adolescence and addiction both illustrate how imbalances between motivational and
control systems can lead to maladaptive risk-taking
Risky decision making in adolescence
- Adolescents engage in higher levels of risk-taking (unsafe sex, reckless driving,
substance use) than children and adults
- This follows an inverted U-shaped curve: low in childhood, peaking in adolescence,
then declining in adulthood
- Laboratory studies differentiate between ‘hot’ (emotional, affect-driven) and
‘cold’ (deliberate, cognitive) decision-making contexts
WEEK 1
Sussman (2017) – A General Introduction to the Concept of Addiction
and Addictive Effects
Substance and Behavioral Addictions
- Substance addictions: repetitive intake of a drug (such as alcohol) or food
- Behavioral addiction: engaging in types of behavior repetitively which are not
directly taken into the body such as gambling or sex
Both result in clinically significant impairment
- Until recent research, science only focused on addiction in the sense of misuse of
drugs that lead to physiological withdrawal symptoms
Researchers considered drugs which cross the blood-brain barrier, and
exogenous ligands or endogenous ligand functions (naturally occurring
neurotransmitter)
Behavioral addiction alter endogenous ligand functions
- Obtaining a measurable description of scientific concept such as addiction is useful to
be able to make inferences regarding how the concept is related to other concepts,
and subsequently how the concept can guide the development of useful application
- Currently available definitions of addictions – not mutually exclusive
- Historical records: show increasing engagement in certain behavior and reduction of
alternative behavior
- Addiction – referring to binding a person to something to being a brain disease
- Addition to tobacco: brief public history, alcohol misuse has been noted throughout
written history
- Furthermore, the initial use of opium was described as divine enjoyment. Medication
used to treat opium misuse often contained opium themselves. Replacement
medications that did not contain opiate led to new problematic cocaine use. Marijuana
also has a history of misuse. Contradictory, there is no ancient history regarding food
addiction. Historical literature presents descriptions of gambling and sex addictions.
Behavioural addictions have been studied empirically since the 1980s and are also
referred to as process addictions. Many behaviours that now refer to addictions were
considered examples of vice, that is, behaviours which are pleasurable, popular,
possibly voluntary, and wicked
- Two conceptions of addiction
Intensional definition of addiction: causal or process model type
statements of addictions
Extensional definition of addiction: taxonomy of addiction elements, which
subsequently might be organized into a (more) intensional theory-based
perspective
Physiological and psychological dependence (intensional)
- States that an addiction is a prolonged engagement in addictive behavior that results
in its continued performance being necessary for physiological and psychological
equilibrium
- Criteria of dependence definition of addiction tolerance, withdrawal, craving
Tolerance: need to engage in the behavior at a greater level than in the past
to achieve previous appetitive effects – if this increases, one likely spends
more time locating and engaging in the addiction
Withdrawal: abstinence syndrome, involves intense physical disturbance in
the case of some types of drug abuse
, NOTES LITERATURE RISK BEHAVIOR AND ADDICTION IN ADOLESCENCE
Craving: intense desire to engage in a specific act, reoccurs and is compelling,
might be considered as part of the withdrawal syndrome in a dependence
model of addiction
Impulsive obsessive/compulsive behavior (intensional)
- Pertains to engaging in the behavior due to a building up of tension which is released,
resulting in pleasure or relief
- What occurs: another building up of tension or craving for pleasure again positive
reinforcement
- When building up of tension doesn’t result in pleasure but in relief of anxiety, it leads
to obsessions which procedure anxiety and stress leading to a craving for relief again
compulsion, negative reinforcement
- Withdrawal (negative factor) engagement in addictive behavior
- Compulsions involve spontaneous desires to act a particular way; subjective sense of
feeling temporarily out of control, psychological conflict pertaining to the imprudent
behavior, settling for less to achieve the same ends, and a disregard for negative
consequences
- Obsessive-compulsive disorder (OCD) and addiction may be overlapping constructs
- However, many researchers use the term compulsion more narrowly, defining it as ‘a
simple but intese urge to do something’
- OCD-related behaviors are defined as an intense ego-dystonic urge to engage a
simple, repetitive activity to remove anxiety
- Conversely, addiction involves the attempt to achieve some desired appetitive effect
and satiation through engagement in some behavior
Self-medication (intensional)
- Relief from disordered emotions and sense of self-preservation through engaging in
addictive behavior (e.g. reaction of trauma
- Emphasis is on where a person engages in the behavior because the person feels sick
and want to feel well
- Different behaviors (drugs) will relieve different negative emotions (anger)
Self-regulation (intensional)
- In a self-regulation model, the present state of being cues attempt to reach a
standard at which point satiation is achieved, until the present state is no longer at
the desired standard state people engage in addictive behavior in order to achieve
an immediate temporary sense of comfort
- The BAS-BIS model: Behavioral approach system and the behavioural inhibition,
affects individual differences in behavioural responses to cues for reward
These interdependent systems influence whether an individual is likely to
withdraw from or avoid situations that involve novel or threatening cues or
whether a person is likely to engage in novel or risky behavior in response to
cue for reward
- An active BAS (mediated by dopamine) is linked to more impulsive-type behavior
- An active BIS (mediated by septo-hippocampal) is linked to inhibiting behavior
- Persons with difficulty in emotional self-regulation may be prone to engage in
addictive behaviors in order to achieve an immediate temporary sense of comfort
more likely to utilize the BAS which is not working in sync with the BIS
- Incentive-sensitization theory: focuses on the influence of neural adaption to
addictive behaviours and addictive behavior-conditioned stimuli as the underlying
mechanism perpetuation the addictive behaviors
, NOTES LITERATURE RISK BEHAVIOR AND ADDICTION IN ADOLESCENCE
Theory differentiates neural processes involved in motivational mechanisms or
incentive salience to addictive behaviour cues (wanting) and the neural
substrates of pleasurable effect (linking)
- A progressive dysregulation of neural substrates occurs through repeated
engagement in the behavior, which In turn is, associated with an increase in
behavioral sensitization contributing to addicts’ wanting the behavior becoming
disproportionate to the pleasure derived from the behavior
- Through repeated engagement in the behaviour, behaviour-associated stimuli that
acquire incentive salience through neural representation (motivational wanting)
become motivational magnets, able to grab the addict’s attentions
- Adaptions in the wanting affected by pharmacological effects of drugs, alternations
in endogenous ligand transmissions, or associative learning
- Another explanations = Allostasis: addictive behavior leads to dopamine opponent-
process counteradaptation (reduced dopamine and activation of brain stress systems)
that masks the effects of the addictive behavior
to increases dopamine availability and initially control feelings of anxiety or
stress, the addictive behavior may be repeated again and again
new set points of homeostatis may then be established
Addiction entrenchment (intensional)
- One has an over-attachment to a drug, object or anxiety (excessive appetite)
- Intrinsic and extrinsic addiction-promoting cognitive beliefs and expectancies drive
the addictive behavior forward
- The qualities that make the behavior defined as addictive are in part the
conventionality of the behavior and one’s initial preferences, the excessiveness of
involvement in the behavior, and one’s place in society
- With repeated participation in the behavior, the salience of alternative behavior
decreases
- Furthermore, it becomes more difficult to find the alternative (variance)
- This notion is consistent with behavioural economics-type models of addiction-
related behaviour as being a choice (a self-destructive operant behaviour)
- Both show the existence of multiple schedules of reinforcement associated with
different behaviours (addictive vs. non-addictive), and they both involve different
reinforcement values and delays in delivery of reinforcement
Six-component perspective (extensional)
- This perspective: six different components
Salience: tendency for the addiction to dominate one’s thoughts, feelings, and
behaviour
Mood modification: rush, escape, or satisfaction that the addictive behaviour
serves
Tolerance: process in which more of the behaviour is required to achieve a
level of mood modification
Withdrawal symptoms: unpleasant feeling states or physical effects of not
engaging in the addictive behaviour
Conflict: discord between engaging in the addictive behaviour and relations
with others, oneself, or engagement in other activities
Relapse: tendency to return to out-of-control addictive behaviour after periods
of trying to stop or control it.
Five-component perspective (extensional)
- This perspective considers appetitive effects, satiation, preoccupation, loss of control,
and negative consequences as components
, NOTES LITERATURE RISK BEHAVIOR AND ADDICTION IN ADOLESCENCE
- Tolerance and withdrawal symptoms are not included because this perspective
regards those components as preoccupation
As tolerance increases, one likely spends more time locating and engaging in
an addiction
If withdrawal symptoms exist, and worsen, one is likely to be spending more
and more time recovering from the after-effects of the addiction and be
focused in thought and action on how to cope
- Both indicate increasing preoccupation
DSM-5 (extensional)
- The DSM-5 diagnoses a substance use disorder if the individual reports two or more of
11 criteria
- These criteria intend to reflect impaired control, social impairment, risky use, and
pharmacologic effects
- In the DSM-1, alcoholism and drug addiction were subsumed within a sociopathic
personality disturbance category (mental condition)
- In the DSM-2 a category of drug dependence was included that was composed of
physiologic (addiction) and psychic (state) components
Alcoholism was placed in its own category (with four subdivisions)
- The DSM-3 distinguished between abuse and dependence. It attempted to provide
more empirical and within-person-based symptomatology by considering multiple life
dimensions
- The DSM-4 defined drug abuse as a maladaptive pattern of drug use leading to
clinically significant impairment. They also had the diagnoses of substance
dependence, a more severe disorder
- The DSM-5 established the current diagnostic criteria for substance use disorder
- The criteria are mostly a recombination of the DSM-4 criteria.
First, the abuse and dependence categories were combined into one substance
use disorder diagnosis.
Second, the legal consequences criterion was removed
Finally, a craving criterion was added. The DSM-5 does not recognize a food
addiction category.
Gladwin et al (2011) – Addiction, adolescence, and the integration of
control and motivation
Introduction
- Adolescence is a key developmental phase where motivation and cognitive control
undergo major changes
- These changes make adolescents particularly vulnerable to risky behaviours,
including substance use
- Motivation is not simply about wanting something but involves complex interactions
between desire and the ability to regulate behavior
- Adolescence and addiction both illustrate how imbalances between motivational and
control systems can lead to maladaptive risk-taking
Risky decision making in adolescence
- Adolescents engage in higher levels of risk-taking (unsafe sex, reckless driving,
substance use) than children and adults
- This follows an inverted U-shaped curve: low in childhood, peaking in adolescence,
then declining in adulthood
- Laboratory studies differentiate between ‘hot’ (emotional, affect-driven) and
‘cold’ (deliberate, cognitive) decision-making contexts
