Abnormal Psychology Chapter 11
Abnormal Psychology Chapter 11 PSYC 3014
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This 4 page Class Notes was uploaded by Megan Standiford on Monday April 4, 2016. The Class Notes belongs to PSYC 3014 at Virginia Polytechnic Institute and State University taught by Dr. John Richey in Winter 2016. Since its upload, it has received 16 views. For similar materials see Abnormal Psychology in Psychlogy at Virginia Polytechnic Institute and State University.
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Date Created: 04/04/16
Chapter 11 Additive disorders Why alcohol? Why is this particular substance attractive to humans and nonhuman primates? If given the choice, chimps in the wile will prefer to eat slightly fermented fruit o Because it contains alcohol Evolutionarily, alcohol preference is actually thought to confer a slight fitness advantage o Fitness= survival (and therefore reproduction) Most humans and nonhuman primates have an alcohol taste preference o Mice too History of alcohol o Some archaeological evidence that humans transitioned from nomadic to agrarian culture for the specific purpose of cultivating grain for fermentation o Keep in mind, our evolutionally context today is Much different than 10,000 or 40,000 years ago Alcohol was much more scare then o Earliest known evidence for a man-made fermented beverage= 9,000 years ago o The vast majority of humans are able to adaptively live with and enjoy alcohol o However, for a small subset of us, this relationship develops into an addiction o What is different about this group? What is alcohol addiction? o Addictive disorders are partly heritable and relapsing conditions o Alcohol use disorder 125 lifetime prevalence in the US o Is alcoholism a codable disorder? No o Alcoholism is an end-stage disease Patients with the condition are phenocopies of each other But arrive at the disease state through fundamentally different trajectories o This is actually pretty interesting, because it suggests equifinality in the disease state That is, multiple paths lead to the same state SO! What's the common thread? (is there one?) o Brain exposure to cycles of intoxication and withdrawal Induces progressive neuroadaptation that results in escalation of alcohol intake o An endogenous opioid-dopamine cascade is the result of alcohol consumption o Brain is rewarded for its pursuit of the substance Massive dopamine release in mesolimbic circuit Semi-permanently pairs the cue with the anticipated effect o This is totally separate from the effect of alcohol o Whats the point? Alcohol addiction is a problem with the brains reward circuit What is alcohol abuse? o DSM 4 Criteria A maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as manifested by one or more within 12 hours Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school Recurrent alcohol use in situations in which it is physically hazardous Recurrent alcohol-related legal problems What is alcohol dependence? o DSM 4 Criteria Tolerance: as defined by either 1. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect 2. Markedly diminished effect with continued use of the same amount of alcohol Withdrawal: as manifested by either 1. The characteristic withdrawal syndrome for alcohol 2. Alcohol is used to relieve or avoid withdrawal symptoms Alcohol abuse/dependence o Effects of alcohol on the human body o The A process Initial relaxing or euphoric effect o The B process Later, a depressant effect o Reward set point changes o Patient needs more of the substance in order to achieve o Who reports being drunk quicker? The experienced drinker The novice drinker o Explains why a syndrome of addiction can result from exposure to a wide variety of substances or activities Alcohol Drugs Gambling Sex o Cell death due to excitotoxicity can occur in chronic alcoholics if they stop drinking Delirium tremens Seizures, death o Central premise of M.I Motivation can only exist when a discrepancy exists between ones current state of functioning and a desired state Treatment o Yes there are effective treatments o Motivational interviewing The empirically validated treatment for addictions o Stages of change Precontemplation Contemplation Preparation Action Maintenance o Expressing empathy o Rolling with resistance Avoid arguments o Develop discrepancy o Build a floor underneath ambivalence o Alcoholics Anonymous Can be very effective The effectiveness of the intervention depends Mostly on the choice of the patient (that is whether they choose MI or AA) Transition to substance use Like alcohol, drugs of abuse powerfully activate the neuro-circuitry of reward o Depending on the drug though, they also have secondary effects Both induce long term changes in the brain DSM 5 substance use disorder criteria are basically the DSM 4 abuse and dependence criteria combined into one list Marijuana We all have endogenous (naturally produced) cannabinoid receptors We all produce our own endogenous cannabinoids The effect of cannabis/Marijuana/THC is to powerfully activate these receptors Different people experience the effects of marijuana differently Panic attacks are not an unusual consequence o Why? Hallucinogens LSD o Lysergic Acid Diethylamide Albert Hofmann Hofmann was a pharmaceutical chemist at Sandoz in Switzerland Nov. 19th, 1938 Synthesized LSD while attempting to make a respiratory stimulant 5 years later, accidentally absorbed a small amount through his fingertips And the psychedelic era was born However, the drug was outlawed on Oct. 6th, 1966 due to its association with counterculture Prior to that, it was used for clinical applications How does LSD work? o It is a powerful on-selective serotonin agonist o Increases glutamate release in targets downstream from serotongenic neurons Ecstasy/MDMA Methylenedioxymethylamphetamine Synthesized: December 24th, 1912 o Patented 1914 o Intended to be a pharmaceutical product to control bleeding Structurally similar to Mescaline and Methamphetamine Operates on the serotonin pathway (like LSD) o Inhibits reuptake of serotonin Subjective effects are due to massive serotonin release Cocaine Coca Plant Chewed by indigenous tribes in Peru, Mexico for >8,000 years Stimulant analgesic properties Massive dopamine agonist Serotonin-Dopamine reuptake inhibitor o Results in enhanced post-synaptic effect of dopamine Treatment of Alcohol/Substance problems Stages of change Motivational Interviewing o The empirically validated treatment for addictions