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This 22 page Bundle was uploaded by Arielle Reiner on Friday October 2, 2015. The Bundle belongs to PSY 0160 - 1030 at University of Pittsburgh taught by Cynthia Lausberg, Kimberly Olsen in Summer 2015. Since its upload, it has received 53 views.
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Date Created: 10/02/15
Addiction part 4 10022015 2 types of drug dependence 0 physical dependence de ned by the occurrence of withdrawal syndrome 0 withdrawal syndrome set of de ned symptoms associated with a decrease in the blood levels of a particular drug 0 symptoms tend to be opposite from the effects of the drug if a drug makes you sleep withdrawal may cause insomnia if a drug makes you numb withdrawal may cause pain if a drug makes you happy withdrawal may cause sadness o detox is a set of procedures designed to get a person through withdrawal syndrome but does not address psychological dependence psychological dependence desire or compulsion to experience effects of a drug because it produces pleasure or reduces comfort 0 comes about because of the rewarding effects of the drug dopamine system 0 psychological dependence may also be related to an individual s fears about experiencing withdrawal symptoms 0 characterized by cravings tolerance produces dependence 0 physical dependence is de ned as the presence of withdrawal syndrome tolerance involves the body and brain changing setpoints to compensate for and counteract the effects of a drug 0 when the drug is no longer in the body the compensatory mechanisms are still present leading to withdrawal symptoms 0 in order for withdrawal symptoms to occur the body must have developed tolerance to the drug s effect how does drug addiction develop and progress Biopsychosocial risk factors contribute to initiating and continuing drug use 0 The brain s reward circuitry reinforces drugtaking behaviors despite negative consequences 0 Motivation and compulsion to take drugs increases Tolerance develops requiring increasing drug taking 0 The body adapts 0 continued drug exposure by changing its set points leading to psychological and physical dependence 0 When abstinent withdrawal symptoms occur contributing to relapse How does it stop General treatment strategies Treating a biobehavioral disorder must go beyond just xing the chemistry 0 Pharmacologicaltreatments o Medications 0 Medical services Psychosocial therapy 0 Social services Why is it important to treat someone with a substance use disorder 0 Drug addicts have difficulty leading healthy and productive lives that are not a drain on the resources of our society 0 Health care costs Crime and criminal justice Accidents Spending resources to treat addicts will save resources in the long term 0 Personal suffering from a disease 0 Rehabilitation is an attainable goal 0 Rehabilitation is not the same as abstinence OOO Treatment strategies Pharmacotherapy o Antagonist therapy Antagonist drugs Give patients a medication that blocks the receptors for the drug someone is addicted to This prevents the addicted drug from producing a El high Antagonist medications are not addictive themselves No tolerance develops Do no relieve cravings Eg naloxone Used for treating morphine overdose Fast acting Works because it binds to opiate receptors and has a higher affinity than morphine and will eventually quotwin outquot so the morphine no longer can bind to the receptors Antagonist treatment for opioid dependence Naltrexone El Oral and long lasting Opioid antagonist with high affinity for opioid receptors Blocks effects of heroin for 24 hours No tolerance or dependence develops with naltrexone Relatively few side effects Frequent noncompliance patients don t take it Sustained release formulas are available Delivered as a depot injection 0 Drug goes into tissue eg muscle and is slowly released for up to 7 months so far 0 Agonist therapy Agonist drugs I Give patients a medication that is an agonist at the receptor for the drug someone is addicted to n Reduces drug cravings but does not cause intoxication high a Eg nicotine replacement such as nicotine gum or patch For opioid dependence n Methadone Is an agonist for opioid receptors Acts as a substitution for heroin or other opiates o Prevents opioid withdrawal symptoms 0 Can be used as a maintenance treatment 0 Currently the most successful maintenance treatment for chronic opioid dependence 0 Expensive Can be used as a detox treatment Methadone dose is gradually reduces the slower the better Relapse happens frequently 0 Eg LAAM is a longeracting alternative to methadone but it has not caught on in the US a Partial agonist treatment for opioid dependence o Buprenorphine O O 0 Is a partial agonist for opioid receptors Safer because overdose is less likely This limits is efficacy Can be used for maintenance treatment but has had limited success ls being considered as a detox treatment Because it is a partial agonist theoretically it would result in fewer withdrawal symptoms Results of clinical tests show it is not necessarily better than methadone for detox but there may be potential because the withdrawal symptoms follow a different pattern 0 Agonistreplacement therapy 0 Maintenance treatment 0 Detoxi cation detox Psychosocial o 12 step programs eg alcoholics anonymous 0 cognitive behavioral therapy CBT o psychotherapy pharmacotherapy can be highly ineffective in the long term without psychotherapy administered by trained mental health professionals a social workers MSW LCSW n psychiatrists MD a psychologists PhD a other licensed counselors and therapists often psychotherapy accompanies pharmacotherapies and can be conducted in multiple ways 0 12 step programs based on the model of alcoholics anonymous somewhat similar to group therapy but the therapists are recovered addicts who have been through all stages of the program basic path a admitting that one cannot control one s addiction or compulsion n recognizing that a higher power can give one strength In examining past errors with the help of a sponsor experienced member In making amends for these errors a learning to live a new life with a new code of behavior a helping others who suffer from the same addictions or compulsions o cognitive behavioral therapy CBT interactive n includes building a trusting relationship and following particular protocol to change behavior awareness a linkage between events and thoughts challenges maladaptive thinking patterns and tries to replace them with adaptive ones teaches coping skills like relaxation can be effective for substance use disorders as well as other psychiatric conditions is addiction a disease The disease model The most widely accepted model of addiction in the media by addicts and their treatment providers Originally applied to alcoholism goes all the way back to the alcohol temperance movement Was later applied to cocaine and opioid addiction This model is used both in treatment of alcoholics in professional settings and in self help groups such as AA or narcotics A The disease model does not exclude the neurobiological changes that occur with addiction or the biopsychosocial model It is based largely on evidence of the disregulation of brain function in addiction Dr Leshner former director of the national institute on drug abuse NIDA said that addiction is a brain disease because it is tied to changes in brain structure and function He claims it is as though a switch is thrown when someone goes from voluntary drug use to the state of addiction 0 Bene ts of the disease model 0 O O Addiction was previously seen as a sign of personal and moral weakness Despite large scale acceptance of the disease model there is still ambivalence about this including the fact that illicit drugs will get you arrested rather than treated Reduces stigma no one blames someone for coming down with a disease lnvolves the medical profession in treating addiction Can reduce guilt experienced by a recovering addict which helps in the recovery process eg a lapse is seen as part of the recovery process not a horrible thing Criticisms of the disease model 0 0 How does one de ne disease Does it require some sort of de nitive test a Eg blood test Addiction like psychiatric disorders can only be diagnosed through clinical signs and symptoms Additionally the disease model is criticized by people who use behavioral approaches to understanding and treating substance abuse and addiction Stimulants part 1 10052015 General characteristics of stimulants Stimulants include cocaine amphetamines caffeine and nicotine plus derivatives of these Stimulants in general cause a sense of energy alertness purposeful movement but also some euphoria Another term for these is quotpsychomotor stimulantsquot Drug classes for cocaine and amphetamines are all Schedule not accepted for medical use and high probability of abuse except drugs used for ADHD because they have a medical use Schedule II General dangers of stimulants Main dangers 0 High doses which could be taken accidentally can be lethal 0 Psychiatric o Profound addiction Can also be dangerous in combination with other drugs 0 OTC cold remedies 0 Some older antidepressant medications MAOl s 0 Anything that would affect heart rhythm 0 Anything that makes people more sensitive to seizures eg caffeine History of cocaine Cocaine is in the leaves of several species of plants including ones that grow commonly in the Andes mountains in South America Leaves from coca plants can be chewed to get a stimulating and appetite suppressant effect Coca was imported to Europe and chemists puri ed cocaine from it which made it possible to take cocaine in much higher doses and more quickly increasing the high but also the possibility of addiction quotI would rather have a life span of 10 years with coca than 1 of 1000000 centuries without cocaquot Italian neurologist Paolo Mantegazza Popularity of cocaine increased in Europe and the US 0 the Corsican chemist Angelo Mariani was partly responsible for popularizing the use of cocaine by inventing Vin Mariani in 1869 Vin Mariani was a medicinal wine made by steeping coca leaves in wine and it became the rage of Europe 0 then cocaine containing tonic was sold in the US including Coca Cola commonly used forms of cocaine 0 powder 0 puri ed directly from coca leaves 0 snorted or dissolved for injection 0 can be cut with other white powders either innocuous ones eg cornstarch talcum powder or with caffeine amphetamine or fentanyl an opioid analgesic this makes for a frequently deadly combination 0 crack 0 solid chunk of cocaine that is heated directly in a pipe to form a vapor that can be inhaled 0 prepared by boiling the powdered form with sodium bicarbonate baking soda 0 this increased the speed with which cocaine is absorbed in the body pharmacodynamics of cocaine routes of absorption 0 snorting powder slower way to get cocaine into the bloodstream relative to inhalation or IV because cocaine constricts blood vessels in the nose blood levels rise relatively slowly peaking after about 3060 minutes 0 inhaling cocaine from heated crack cocaine is delivered to the bloodstream nearly as quickly as if injected peak blood levels occur within several minutes and are much higher than similar doses of snorted powder high only lasts about 30 minutes with inhalation or IV administration O O ingestion as for chewing coca leaves is much less effective in part because the liver degrades the cocaine before it ever reaches circulation rstpass metabolism with any method what matters is not the blood levels but the amount that actually gets to the brain since cocaine is somewhat fat soluble it can pass readily through the bloodbrain barrier so it can reach high concentrations in the brain degradation 0 O O cocaine has a short half life about half an hour to an hour and a half cocaine is rapidly broken down degraded by liver and blood enzymes user is usually ready for another dose in 40 minutes or less the rapid increase in blood levels which causes the quotrushquot is followed by a rapid fall in blood levels the quotcrashquot this can lead to cocaine bingeing however while the halflife of cocaine itself is short the break down products metabolites can be present in the urine for days following the last dose behavioral effects of cocaine 0 stimulants including cocaine are known for their ability to increase attention cause alertness and eliminate fatigue 0 even Freud who experimented with cocaine on himself commented that the most probable use of cocaine would be for these properties 0 quotthe main use of coca will undoubtedly remain that which Indians have made of it for centuries it is of value in all cases where the primary aim is to increase the physical capacity of the body for a given short period of time and to hold strength in reserve to meet further demands coca is a far more potent and far less harmful stimulant than alcohol and its widespread utilization is hindered at present only by its high cost 0 the rush injection or smoking 0 a feeling of intense physical pleasure euphoria great self con dence and well being often compared to an orgasm o if snorted or taken orally 0 the feeling is less intense and is more a sense of well being 0 increased movement 0 constant motion talking moving dgeting exploring etc 0 at higher doses this movement becomes focused and repetitive psychotic like state delusions hallucinations 0 this happens at very high doses andor after prolonged use 0 resembles psychotic schizophrenia 0 can occur at the end of a several day binge when blood levels are very high short term physiological and psychological effects of cocaine why can a single dose of cocaine be lethal 0 As blood levels rise to toxic levels Initially the effects are exaggerations of the typical response to cocaine n Energy and alertness become jitteriness paranoia and hostility n Increased movement becomes repetitive aimless activities a Mild increase in heart rate becomes palpitations or chest pains Later effects include a Headaches strokes nauseavomiting heart attacks seizures in fact seizures are so common that an adolescent or young adult arriving in the emergency room with a seizure without a previous history is almost always screened for cocaine use Long term physiological and psychological effects of cocaine Due to a constriction of blood vessels cocaine can cut off blood supply to the area of administration eg ulcers in lining of the nose for snorting bleeding in the lungs for smoking Suppression of appetite can cause malnourishment Damage to heart Panic attacks Neurological changes such as a loss of brain tissue and function eg inability to think and remember Paranoid psychosis including hallucinations such as quotcocaine bugsquot which are hallucinations of tiny creatures crawling all over one s skin Social consequences of chronic cocaine use Increasing hostility paranoia and belligerence associated with higher blood levels of stimulants result in more overt violence Many high dose stimulant users become increasingly convinced that people are out to get them while they also become more agitated and inclined toward action In a country with relatively unrestricted gun laws this combination can be lethal and often is Cocaine in combination with heroin Some users take cocaine and heroin together and the effect is like adding the two The dreaminess of opiates takes the edge off of the jitteriness of cocaine But his combination can be particularly lethal because usually the jitteriness of the cocaine will often cause users to stop when it gets too intense Thus without that trigger to stop overdose of either drug is more likely This combination was being used by Chris Farley John Belushi and Chris Kelly when they died Psychodynamics of cocaine Effects of the brain 0 Cocaine mimics the effects of the sympathetic division of the autonomic nervous system lnitiates the ght or ight response Increases blood pressure and heart rate Narrows blood vessels 0 Cocaine binds to reuptake transporters in the axon terminals for the following monoamine neurotransmitters Serotonin Norepinephrine Dopamine this may be responsible for most of the effects of cocaine 0 Cocaine can also block voltage gated Na channels so it can be used as a local anesthetic in medicine and dentistry eg novocaine and xylocaine Cocaine blocks dopamine reuptake by blocking the dopamine transporters o The effects of dopamine depend on a person s baseline dopamine levels 0 Low baseline dopamine release blocking the transporter won t matter that much because there was not much dopamine in the rst place 0 High baseline dopamine release blocking the transporter will have a larger in uence What can lead to cocaine addiction Cocaine is highly addictive because it affects dopamine levels therefore it can be viewed as simply substituting a drug for natural reinforcers such as food and sex 0 Not all people who use cocaine become addicted so what are the potential differences Those who typically do not become addicted a Strong anxiety response as their initial response to cocaine n Unavailabilitycost a Social and legal consequences I Fears of becoming addicted Those who typically do become addicted a Friends and acquaintances respond well to the user s newfound energy and enthusiasm n Psychiatric disorders eg depression anxiety I Exposure to location or people where cocaine was previously used Cocaine withdrawal Cocaine withdrawal is rarely lethal Typical symptoms of cocaine withdrawal 0 Depressive symptoms 0 Exhaustionexcessive sleep 0 Rebound in appetite o Inability to feel pleasure of any kind This inability to feel any pleasure is considered one of the major reasons people start using again 0 In long time users cravings for cocaine can last for months quotcrack babiesquot 0 Use of crack during pregnancy can harm the fetus o Premature birth 0 Low birth weight 0 Strokes 0 Brain damage 0 Death 0 Note that these are not unique to cocaine use 0 They can be observed with tobacco use as well 0 This may be because both cocaine and nicotine constrict blood vessels that supply blood to the fetus 0 Long term prospects for such children include higher rates of learning disabilities and ADHD Treating cocaine and addiction Pharmacologicalstrategies 0 Reduce euphoric effects of cocaine andor craving upon cocaine withdrawal Receptor agonists and antagonists that might compete with cocaine for access to the dopamine transporter 1 possible new drug a moda nil acts on DA NE GABA and glutamate systems and is currently prescribed for narcolepsy n antabuse usually used for alcohol dependence treatment 0 many cocaine users also abuse alcohol and antabuse seems to help with both drugs AND can be effective for users only of cocaine 0 reduce cocaine levels in the bloodstream cocaine vaccines that prevent cocaine from binding to the dopamine transporters mixed results so far but is an active area of research behavioralpsychosocial strategies 0 counseling individual or group educate user promote behavioral change eg avoid situations that put user at a high risk for relapse o 12 step programs eg narcotics anonymous 0 contingency management program behavioral treatment based on the idea that drug taking is in part a result of the reinforcing property of a drug develop reinforcers that are not drug related for example if a person has a negative urine test ie no cocaine or cocaine metabolites present he or she will get a voucher for items not money because it could be used to buy the drugs this may be more effective than standard behavioral therapies Behaviorism 10062015 People viewed as machine like mechanisms 0 Explore how mechanisms learn 0 How to change in reaction to environment Determinism An event is caused determined by some prior event 0 Cause gt something able to be understood according to the basic laws of science 0 In direct opposition to belief in quotfree willquot Behaviorism Behavior must be explained in terms of casual in uence of the environment lnsistence on controlled laboratory research 0 Rooted on researcher s ability to control environment and record reactions to those changes 0 Physical laws 0 People are physical objects 0 Can be understood through scienti c analysis 0 Thoughts and feelings 0 Viewed as behaviors that are caused by the environment 0 Behaviorists do not attempt to record or explain thoughts or feeHngs Situational speci city Environment gt cause of behavior 0 Behavior expected to vary signi cantly in different environmentssituations o Abnormal behavior results from maladaptive environments 0 Faulty learning Behaviorism s science of personality 0 Focus on observable behaviors o Manipulate environmental variables 0 Carefully controlled laboratory settings 0 Personality shaped by environment 0 In real life we do not live in laboratory settings Simple systems 0 Eg Rats dogs cats pigeons etc o Enough similarity to provide valuable information Generalizable to humans Because it is not ethical to study humans in a laboratory while controlling their environment 0 Complexity of humans poses challenge 0 Practical and ethical issues Pavlov 18491936 Classicalconditioning 0 Association learning 0 Stimulus gt response 0 Re exive process Salivation when presented with food Pupil dilation when lights turned down 0 Before conditioning Food unconditioned stimulus produces salivation unconditioned response Tuning fork neutral stimulus does not produce anything 0 During conditioning Pair food with tuning fork neutral and unconditioned stimulus cause salivation 0 After conditioning Tuning fork conditioned stimulus alone causes salivation conditioned response 0 Generalization Once classical conditioning has occurs the conditioned stimulus can be confused for other things like it tuning fork sounds like something else so dog salivates to other things 0 Discrimination Conditioned response only occurs to a very speci c conditioned stimulus o Extinction Do not present conditioned stimulus with reward no food with tuning fork and conditioned response will eventually die out but it does not completely go away 0 Experimental neuroses Behavior becomes disorganized and anxious when asked to discriminate between very slight different variations in stimulus John Watson 18781958 Founder of behaviorism Worked from Pavlov s foundational work quotLittle Albertquot baby classically conditioned to be afraid of white lab rat when paired with loud noise 0 can condition fear into a child 0 unethical 0 never undone scandal fall from grace moved to advertising business from psychology 0 affair with graduate assistant conditioned fear 0 neutral stimulus white rat unconditioned stimulus loud noise unconditioned response fear of loud noise conditioned response fear of white rat conditioned stimulus white rat Generalized to whitefurry objects 0 quotfears are conditioned emotional responsesquot 0 if you can control the environment you control anyone into doing anything Jones unconditioning of a fear 0 Extinction 0 Direct conditioning Pleasant stimulus feared object gt change in response 0 Generalization of unconditioning Eric Kandel 2000 nobel prize in medicine 0 What happens in the brain when an organism acquires a new response to a stimulus o Alypsia sea slug with few nerve cells almost transparent and can see nerve cells 0 Findings conditioning process at the neural level which involves changes in the strength of connections among neurons as a result of conditioning o Gil withdrawal re ex by touching a part of body paired with shock to tail Able to demonstrate there are changes in the strength of connection of neurons when classical conditioning happens BF Skinner 19041990 quotradical behaviorismquot strong and unwavering opinions o thought environment was everything and nothing else matters born in Susquehanna PA 0 English literature major o PhD psychology Harvard 1931 0 University of Minnesota Indiana University returned to Harvard stayed here until retirement and did vast majority of work here 0 Wrote o 1938 behavior of organisms o 1948 walden two 0 1953 science and human behavior 0 1971 beyond freedom and dignity operant conditioning deemphasized concepts involving psychological structures behavior seen as adaptation to situational forces environment is everything expects that speci cs of behaviors and situations are what causes changes 0 no personality theory key structural unit a response 0 simple gt complex 0 response represents an external and observable piece of behavior that can be related to environmental events 0 some responses elicited by known stimuli 0 other responses are 0 operants responses that can t be associated with any stimuli emitted by the organism learning 0 association f responses to environmental events antecedent a something happens in environment behavior consequence reinforcerreinforcement follows a response and increases the probability that a response will occur again in the future 0 goal strengthen response 0 more likely that behavior will happen again 0 what counts as a reinforcer in any given situation de ned by the effects of the potential reinforce on behavior punishment 0 follows a response and decreases probability response will occur again in the future 0 goal weaken response 0 less likely that behavior will happen again 0 both reinforcement and punishment are consequences operant conditioning behavior can be emitted as well as elicited both reinforcements and punishments in uence learning pleasurable 0 give positive reinforcement give something you want 0 take away negative punishment take away something you don t want aversive 0 give positive punishment give something you don t want 0 take away negative reinforcement take away something you want Skinner box Electri ed box for rats Babytender Raise baby in a controlled environment 0 Gave Skinner national attention Daughter Deborah was put in 1
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