ADDICTION LECTURE 1
- all addictions have the same mechanisms more or less
- Addiction is comorbid with many other disorders (scz, depression, anxiety etc.)
- top 3 disorders in NL:
o mood disorders (20.2%)
o anxiety (19.6%)
o substance disorder (19.1%) (1/5 people)
- not a lot of gender differences but addiction is mainly a male problem (only in
prescription drug addiction there’s more female)
- societal relevance:
o impact on health
o relationship with crime (>50% substance related)
o impact on public safety
o impact on work-related productivity
- not everyone will get addicted after using smt once, cigarettes are the most
addictive, but it’s also more available
- DSM 5 criteria for substance use
o 2 of the symptoms out of the 11:
taking the substance in larger amounts and for longer than meant to
wanting to stop, but not able to
spending a lot of time getting, using or recovering from use
cravings to use the substance
not managing responsibilities at work, home or school bc of substance
use
continuing use even when it causes problems in relationships
giving up important social, occupational or recreational activities bc of
use
using substances again, even when it puts you in danger
continuing to use even when you know you have a physical or
psychology problem caused or made worse by the substance
needing more of the substance to get the effect you want (tolerance)
developing withdrawal symptoms, relived by taking the substance
o tolerance and withdrawal – you don’t need to have these to be diagnosed
o craving added to dsm 5, it wasn’t in dsm 4
o “legal problems” criterion was taken out from dsm 5
- types of substances:
o tobacco (cigarettes)
o stimulants (cocaine, amphetamines, XTC)
o depressants (alcohol, benzodiazepines, GBH)
o opioids (heroin, prescription drugs)
o hallucinogens (cannabis, LSD, ketamine)
- neurotransmitters (chemical substance providing communication between cells)
o agonists: mimics the effects of neurotransmitters by binding to the same
receptor and produce the same effect
o antagonists: bind to the same receptor and block and prevent the functional
effects
, o cocaine: inhibits reuptake of dopamine, dopamine agonist (more dopamine in
the cleft)
o XTC (MDMA): increases serotonin (and dopamine) in cleft, increases release,
reduces reuptake
o alcohol: less understood, all systems influenced (GABA agonist, NMDA
antagonist, opioid agonist, serotonin agonist)
o https://drugsindehersenen.jellinek.nl/en/
- Number 1 killer: tobacco (by far), then alcohol then opioids, worse image then
actuality
- Pain killer problem in the US (codeine, oxycodone, methadone, morphine, fentanyl)
,LECTURE 2
Substance use and desire
- desire: definition of a high motivational state
- 2 types of desire:
o volitive desire: rational, more long term
o appetitive desire: makes you and want and crave something, more bodily
(what we talk in the literature)
forbidden fruits, sex, alcohol, drugs, unhealthy food
attracts attention
in psychopathology: it can be higher (like craving) or lowered (like in
apathy/anhedonia)
everyone experiences appetitive desire (e.g. being in love), but not
excessive levels
can be excessive and psychiatric levels (food, sex, psychoactive
substances)
Two key concepts:
- craving: subjective desire to experience the effects of a previously used drug
- relapse: full resumption of drug-seeking and drug-administration behavior after a
period of abstinence (this is debatable other literature also talks about different
definitions of relapse and abstinence)
o relapse after detoxification are high (50-80%)
o relapse rates are high for all substances
o relapse often preceded by craving
o detoxification is not the problem but craving is the most reported reason for
relapse
Causes of craving and relapse:
- 1. priming effect (just a small sip or puff)
o priming dose triggers craving and relapse
- 2. emotional stress (negative reinforcement)
o increase alcohol/drug craving
o very important in treatment
- 3. exposure to drug-related stimuli (pavlovian/classic conditioning)
o e.g. context
o addiction is a learning behavior
o should drug addiction be viewed as a learning
disorder? coordinator things yes
Operant (instrumental) conditioning:
o drugs and alcohol can be both positive and
negative reinforcement
o you like the taste or feeling of a cigarette, you
smoke (positive reinforcement), behavior
increases
, o taking away the stimuli, as an alcoholic you have a hangover, so you drink
more to get rid of it (behavior increases), it becomes a negative
reinforcement
hangover, withdrawal, stress, pain they drink to get rid of these
o operant conditioning cannot explain addiction, not everyone who uses
painkillers to relieve pain get addicted to it
Classical conditioning:
- when you use drugs for a long time then classical conditioning kicks in
- certain context every time you smoke a cigarette or drink alcohol, can be an
emotional state too (feeling upset)
- repeated pairings of particular events, emotional states, or cues (money, places,
people, time of the day) with substance use produce craving for that substance
- eventually exposure to cues alone produces drug or alcohol cravings and urges often
followed by substance use
o instrumental conditioning is more
in the beginning (effect of the
substance itself)
o then classical conditioning over
time (context)
Experiment by Robins (1975): role of context
- US Vietnam soldiers used heroin (34%) and
20% were dependent
- in the first year after returning to the US
only 1% became re-addicted
o strong effect of context, not being in Vietnam in war
Some other related phenomena
Conditioned withdrawal
- when you go to a conditioned location (e.g. where you used the drug), you start
getting withdrawal effects (sweating etc.)
- the urge to use drugs is also bigger because of the conditioned withdrawal
Drug opposite CR (conditioned response)
- negative effects of withdrawal
- when you use drug, you feel warm, drug opposite CR would be feeling cold
Conditioned tolerance
- your body prepares itself before taking drug or alcohol (body produces compensatory
responses)
- in a different location you would overdose with 2 doses
- but in your regular regulation you wouldn’t overdose with 2 doses
- “diminishment or loss of drug effect over the course of repeated administrations”
Social learning:
- modeling (friends etc.)
- self-efficacy (confidence you have about stopping)
- all addictions have the same mechanisms more or less
- Addiction is comorbid with many other disorders (scz, depression, anxiety etc.)
- top 3 disorders in NL:
o mood disorders (20.2%)
o anxiety (19.6%)
o substance disorder (19.1%) (1/5 people)
- not a lot of gender differences but addiction is mainly a male problem (only in
prescription drug addiction there’s more female)
- societal relevance:
o impact on health
o relationship with crime (>50% substance related)
o impact on public safety
o impact on work-related productivity
- not everyone will get addicted after using smt once, cigarettes are the most
addictive, but it’s also more available
- DSM 5 criteria for substance use
o 2 of the symptoms out of the 11:
taking the substance in larger amounts and for longer than meant to
wanting to stop, but not able to
spending a lot of time getting, using or recovering from use
cravings to use the substance
not managing responsibilities at work, home or school bc of substance
use
continuing use even when it causes problems in relationships
giving up important social, occupational or recreational activities bc of
use
using substances again, even when it puts you in danger
continuing to use even when you know you have a physical or
psychology problem caused or made worse by the substance
needing more of the substance to get the effect you want (tolerance)
developing withdrawal symptoms, relived by taking the substance
o tolerance and withdrawal – you don’t need to have these to be diagnosed
o craving added to dsm 5, it wasn’t in dsm 4
o “legal problems” criterion was taken out from dsm 5
- types of substances:
o tobacco (cigarettes)
o stimulants (cocaine, amphetamines, XTC)
o depressants (alcohol, benzodiazepines, GBH)
o opioids (heroin, prescription drugs)
o hallucinogens (cannabis, LSD, ketamine)
- neurotransmitters (chemical substance providing communication between cells)
o agonists: mimics the effects of neurotransmitters by binding to the same
receptor and produce the same effect
o antagonists: bind to the same receptor and block and prevent the functional
effects
, o cocaine: inhibits reuptake of dopamine, dopamine agonist (more dopamine in
the cleft)
o XTC (MDMA): increases serotonin (and dopamine) in cleft, increases release,
reduces reuptake
o alcohol: less understood, all systems influenced (GABA agonist, NMDA
antagonist, opioid agonist, serotonin agonist)
o https://drugsindehersenen.jellinek.nl/en/
- Number 1 killer: tobacco (by far), then alcohol then opioids, worse image then
actuality
- Pain killer problem in the US (codeine, oxycodone, methadone, morphine, fentanyl)
,LECTURE 2
Substance use and desire
- desire: definition of a high motivational state
- 2 types of desire:
o volitive desire: rational, more long term
o appetitive desire: makes you and want and crave something, more bodily
(what we talk in the literature)
forbidden fruits, sex, alcohol, drugs, unhealthy food
attracts attention
in psychopathology: it can be higher (like craving) or lowered (like in
apathy/anhedonia)
everyone experiences appetitive desire (e.g. being in love), but not
excessive levels
can be excessive and psychiatric levels (food, sex, psychoactive
substances)
Two key concepts:
- craving: subjective desire to experience the effects of a previously used drug
- relapse: full resumption of drug-seeking and drug-administration behavior after a
period of abstinence (this is debatable other literature also talks about different
definitions of relapse and abstinence)
o relapse after detoxification are high (50-80%)
o relapse rates are high for all substances
o relapse often preceded by craving
o detoxification is not the problem but craving is the most reported reason for
relapse
Causes of craving and relapse:
- 1. priming effect (just a small sip or puff)
o priming dose triggers craving and relapse
- 2. emotional stress (negative reinforcement)
o increase alcohol/drug craving
o very important in treatment
- 3. exposure to drug-related stimuli (pavlovian/classic conditioning)
o e.g. context
o addiction is a learning behavior
o should drug addiction be viewed as a learning
disorder? coordinator things yes
Operant (instrumental) conditioning:
o drugs and alcohol can be both positive and
negative reinforcement
o you like the taste or feeling of a cigarette, you
smoke (positive reinforcement), behavior
increases
, o taking away the stimuli, as an alcoholic you have a hangover, so you drink
more to get rid of it (behavior increases), it becomes a negative
reinforcement
hangover, withdrawal, stress, pain they drink to get rid of these
o operant conditioning cannot explain addiction, not everyone who uses
painkillers to relieve pain get addicted to it
Classical conditioning:
- when you use drugs for a long time then classical conditioning kicks in
- certain context every time you smoke a cigarette or drink alcohol, can be an
emotional state too (feeling upset)
- repeated pairings of particular events, emotional states, or cues (money, places,
people, time of the day) with substance use produce craving for that substance
- eventually exposure to cues alone produces drug or alcohol cravings and urges often
followed by substance use
o instrumental conditioning is more
in the beginning (effect of the
substance itself)
o then classical conditioning over
time (context)
Experiment by Robins (1975): role of context
- US Vietnam soldiers used heroin (34%) and
20% were dependent
- in the first year after returning to the US
only 1% became re-addicted
o strong effect of context, not being in Vietnam in war
Some other related phenomena
Conditioned withdrawal
- when you go to a conditioned location (e.g. where you used the drug), you start
getting withdrawal effects (sweating etc.)
- the urge to use drugs is also bigger because of the conditioned withdrawal
Drug opposite CR (conditioned response)
- negative effects of withdrawal
- when you use drug, you feel warm, drug opposite CR would be feeling cold
Conditioned tolerance
- your body prepares itself before taking drug or alcohol (body produces compensatory
responses)
- in a different location you would overdose with 2 doses
- but in your regular regulation you wouldn’t overdose with 2 doses
- “diminishment or loss of drug effect over the course of repeated administrations”
Social learning:
- modeling (friends etc.)
- self-efficacy (confidence you have about stopping)
