BEGRIPPENLIJST RISK BEHAVIOR AND ADDICTION IN ADOLESCENCE
LECTURE 1 → INTRODUCTION TO RISK BEHAVIOR AND ADDICTION
Risk behavior: behaviors that pose a risk to a healthy physical, cognitive,
psychosocial development of adolescents. Substance use is a form of risk
behaviour, but there are also other risk behaviors as well, e.g. gaming,
which can lead to addiction.
- What we tend to regard as risk behavior depends on characteristics of
the substance, cultural and societal norms and scientific knowledge on
the risks
The general developmental process: Contact with a substance →
experimenting with a substance → integrated use → excessive use (daily)
→ addicted use
Predictors of risk behavior: motivation, opportunity (access) and
capability
Adolescence: 10 – 24 years
- Early adolescence (10-13): physical growth, sexual maturation,
psychosocial development, social identity formation (how do others
perceive me?), parents less important
- Mid adolescence (14-18): experimenting with (risk) behaviors,
personal identity formation (how do I perceive myself? Need to be
unique)
- Late adolescence (19-24): practicing adult roles (first job, living
without parents)
Increase in grey matter/ pruning: decrease in grey matter: natural
process of synaptic elimination, where the brain selectively eliminates or
reduces the number of less used or unnecessary neural connections and
synapses. If you don’t use it, you lose it.
Increase in white matter: communication between brain regions
strongly improves
High plasticity of the brain: you can learn easier during adolescence.
Brain cells are eliminated if not used.
Affective motivational system/ nucleus accumbes: emotional brain/
reward center. This system (reward system) is overactive in early and mid-
adolescence. Adolescents experience stronger positive emotion than
adults when they receive a reward. This process is enhanced by
testosterone. Bottom-up.
Control system/ prefrontal cortex: rational brain. Develops slowly
(until about 25 years). The rational brain plays an important role in the
development of executive functions. Top-down.
,Executive functions: risk estimation, monitoring long-term goals, inhibit
the tendency to respond to (short-term) possibilities for reward. Impulse
control, behavioral inhibition, self-control)
The maturational imbalance model: There is an increased risk-taking
during adolescence due to an imbalance between reward sensitivity
(affective-motivational system, bottom-up) and impulse control (control
system, top-down). This model shows that there is an increase in the
bottom-up developments (reward system very active) and a slower
increase in top-down developments (risk estimation). So, there is a high
reward sensitivity versus immature impulse control.
Psychoactive substances: chemical substances that cross the blood-
brain barrier and affect the function of the central nervous system thereby
altering perception, mood or consciousness (euphoria, relaxation). They
often induce craving and loss of control.
- Differ in type of strength of the psychoactive effect and the degree to
which they elicit craving and loss of control.
Downers: alcohol, heroin, GHB
Uppers: Nicotine, cocaine/ amphetamine/ speed
Hallucinogens: LSD/ magic mushrooms
Intentional addiction: a definition of addiction: these definitions aim to
describe a causal addiction process
Extensional addiction: a definition of addiction: a classification of
characteristics of an addiction (DSM-5)
Positive reinforcement: learning principle underlying the development
of addiction. Occurs when the rate of a behavior increases because a
desirable experience (euphoria) is resulting from the behavior.
Negative reinforcement: learning principles underlying the
development of addiction. Occurs when the rate of a behavior increases
because an aversive event is prevented from happening (prevention of
withdrawal symptoms).
Neurobiology of withdrawal symptoms: Drug use → Dopamin release
in nucleus accumbens → feeling high/euphoria) → Brain adaptation: Your
brain is starting to anticipate another shot → withdrawal symptoms →
decrease in sensitivity of the brain
Decrease in sensitivity of the brain reward system: results from
reduction in the number of dopamine receptors
and the existing dopamine receptors become less
sensitive to dopamine.
- Result: Tolerance (needing a higher dose of the
drug to have the same effect), withdrawal
, symptoms (during abstinence) and a reduced sensitivity to natural
incentives (prikkels)
Associative learning: repeated use of drugs is having rewarding
outcomes (positive reinforcement). Stimuli related to drug use (drug-cues)
get associated with its rewarding outcome. Drug-cues itself becomes
salient (opvallend) because of its association with reward (incentive
salience)
Developing (implicit) cognitive biases: implicit and automatic
processing of addiction related cues is altered.
→ attentional bias, approach bias and craving create a cycle that
reinforces addictive behavior
Attentional bias: individuals with addictive behaviors develop an
(automatic) heightened attention towards drug-cues.
Approach bias: individuals with addictive behaviors develop an
automatic tendency (neiging) to approach, rather than avoid, drug-cues.
Addiction: an increasing imbalance between the affective- motivational
and the control system! Drug Cue affects motivation system (reward
system). If you want to overcome using, you need the control system.
Gambling disorder: the only officially recognized condition in the DSM-5
subsection ‘non-substance related disorder’.
Internet gaming disorder: included in the appendix of the DSM-5 as a
condition warranting more clinical research before considering it as a
formal disorder.
→ DSM-5 includes two categories: ‘substance-related and addictive
disorder’ and ‘non-substance-related disorders’
→ proposed definition: “Repeated behavior leading to significant harm or
distress of a functionally impairing nature, which is not reduced by the
person and persists over a significant period of time”.
LECTURE 2 → INDIVIDUAL VULNERABILITY FOR ADDICTION
Classical conditioning (Pavlov): takes place when an unconditioned
stimulus (UCS) and an unconditioned response (UR, or neutral stimulus)
are paired which results in a conditioned stimulus (CS). In relation with risk
behaviour and addiction, certain situations or environments are associated
with engagement in risk behaviour.
Law of effect (Thorndicke): states that actions that have a beneficial
effect will be repeated in the same situation under the same conditions. In
relation with risk behaviour and addiction, (risky) behaviour will be
repeated when the consequence is beneficial.
LECTURE 1 → INTRODUCTION TO RISK BEHAVIOR AND ADDICTION
Risk behavior: behaviors that pose a risk to a healthy physical, cognitive,
psychosocial development of adolescents. Substance use is a form of risk
behaviour, but there are also other risk behaviors as well, e.g. gaming,
which can lead to addiction.
- What we tend to regard as risk behavior depends on characteristics of
the substance, cultural and societal norms and scientific knowledge on
the risks
The general developmental process: Contact with a substance →
experimenting with a substance → integrated use → excessive use (daily)
→ addicted use
Predictors of risk behavior: motivation, opportunity (access) and
capability
Adolescence: 10 – 24 years
- Early adolescence (10-13): physical growth, sexual maturation,
psychosocial development, social identity formation (how do others
perceive me?), parents less important
- Mid adolescence (14-18): experimenting with (risk) behaviors,
personal identity formation (how do I perceive myself? Need to be
unique)
- Late adolescence (19-24): practicing adult roles (first job, living
without parents)
Increase in grey matter/ pruning: decrease in grey matter: natural
process of synaptic elimination, where the brain selectively eliminates or
reduces the number of less used or unnecessary neural connections and
synapses. If you don’t use it, you lose it.
Increase in white matter: communication between brain regions
strongly improves
High plasticity of the brain: you can learn easier during adolescence.
Brain cells are eliminated if not used.
Affective motivational system/ nucleus accumbes: emotional brain/
reward center. This system (reward system) is overactive in early and mid-
adolescence. Adolescents experience stronger positive emotion than
adults when they receive a reward. This process is enhanced by
testosterone. Bottom-up.
Control system/ prefrontal cortex: rational brain. Develops slowly
(until about 25 years). The rational brain plays an important role in the
development of executive functions. Top-down.
,Executive functions: risk estimation, monitoring long-term goals, inhibit
the tendency to respond to (short-term) possibilities for reward. Impulse
control, behavioral inhibition, self-control)
The maturational imbalance model: There is an increased risk-taking
during adolescence due to an imbalance between reward sensitivity
(affective-motivational system, bottom-up) and impulse control (control
system, top-down). This model shows that there is an increase in the
bottom-up developments (reward system very active) and a slower
increase in top-down developments (risk estimation). So, there is a high
reward sensitivity versus immature impulse control.
Psychoactive substances: chemical substances that cross the blood-
brain barrier and affect the function of the central nervous system thereby
altering perception, mood or consciousness (euphoria, relaxation). They
often induce craving and loss of control.
- Differ in type of strength of the psychoactive effect and the degree to
which they elicit craving and loss of control.
Downers: alcohol, heroin, GHB
Uppers: Nicotine, cocaine/ amphetamine/ speed
Hallucinogens: LSD/ magic mushrooms
Intentional addiction: a definition of addiction: these definitions aim to
describe a causal addiction process
Extensional addiction: a definition of addiction: a classification of
characteristics of an addiction (DSM-5)
Positive reinforcement: learning principle underlying the development
of addiction. Occurs when the rate of a behavior increases because a
desirable experience (euphoria) is resulting from the behavior.
Negative reinforcement: learning principles underlying the
development of addiction. Occurs when the rate of a behavior increases
because an aversive event is prevented from happening (prevention of
withdrawal symptoms).
Neurobiology of withdrawal symptoms: Drug use → Dopamin release
in nucleus accumbens → feeling high/euphoria) → Brain adaptation: Your
brain is starting to anticipate another shot → withdrawal symptoms →
decrease in sensitivity of the brain
Decrease in sensitivity of the brain reward system: results from
reduction in the number of dopamine receptors
and the existing dopamine receptors become less
sensitive to dopamine.
- Result: Tolerance (needing a higher dose of the
drug to have the same effect), withdrawal
, symptoms (during abstinence) and a reduced sensitivity to natural
incentives (prikkels)
Associative learning: repeated use of drugs is having rewarding
outcomes (positive reinforcement). Stimuli related to drug use (drug-cues)
get associated with its rewarding outcome. Drug-cues itself becomes
salient (opvallend) because of its association with reward (incentive
salience)
Developing (implicit) cognitive biases: implicit and automatic
processing of addiction related cues is altered.
→ attentional bias, approach bias and craving create a cycle that
reinforces addictive behavior
Attentional bias: individuals with addictive behaviors develop an
(automatic) heightened attention towards drug-cues.
Approach bias: individuals with addictive behaviors develop an
automatic tendency (neiging) to approach, rather than avoid, drug-cues.
Addiction: an increasing imbalance between the affective- motivational
and the control system! Drug Cue affects motivation system (reward
system). If you want to overcome using, you need the control system.
Gambling disorder: the only officially recognized condition in the DSM-5
subsection ‘non-substance related disorder’.
Internet gaming disorder: included in the appendix of the DSM-5 as a
condition warranting more clinical research before considering it as a
formal disorder.
→ DSM-5 includes two categories: ‘substance-related and addictive
disorder’ and ‘non-substance-related disorders’
→ proposed definition: “Repeated behavior leading to significant harm or
distress of a functionally impairing nature, which is not reduced by the
person and persists over a significant period of time”.
LECTURE 2 → INDIVIDUAL VULNERABILITY FOR ADDICTION
Classical conditioning (Pavlov): takes place when an unconditioned
stimulus (UCS) and an unconditioned response (UR, or neutral stimulus)
are paired which results in a conditioned stimulus (CS). In relation with risk
behaviour and addiction, certain situations or environments are associated
with engagement in risk behaviour.
Law of effect (Thorndicke): states that actions that have a beneficial
effect will be repeated in the same situation under the same conditions. In
relation with risk behaviour and addiction, (risky) behaviour will be
repeated when the consequence is beneficial.
