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ACD exam 1 summary
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LEARNING OBJECTIVES ACDModule 1
1. Name the DSM-5 criteria for Substance Use Disorder [paraphrasing] and recognize
in a case study
2. Name protective and risk factors for substance use [paraphrasing]
3. Explain the role of withdrawal symptoms in substance abuse [analyzing]
4. Describe the history of the concept of addiction (i.e., the different models)
[paraphrasing]
5. Give 3 arguments in favour of a neurobiological perspective on substance abuse, and
3 against [evaluating] (*this will partly be covered during the first ACD tutorial)
6. Indicate the difference between Pavlovian and instrumental conditioning
[paraphrasing] and be able to apply this to a concrete example of behaviour
[analyzing]
7. Explain how structural differences in the dopamine system can contribute to
substance abuse [paraphrasing]
8. Explain how “prediction error” is encoded by the mesolimbic dopamine pathway, and
how it is affected by substances of abuse [analyzing]
9. Explain how the “incentive sensitization theory” explains relapse in substance abuse
[analyzing]
10. Explain the different roles of liking and "wanting" in substance abuse [analyzing]
11. Explain how incentive sensitization is measured [paraphrasing and analyzing]
12. Apply the above-mentioned research methods to a new research question in the field
of liking and "wanting" [independent thinking]
13. Describe the neural basis of liking and "wanting" [paraphrasing]
14. Evaluate the role of craving in substance abuse and relapse, using arguments on both
a behavioral and neuroscientific level [evaluating and independent thinking]
DSM-5 Criteria for Substance Use Disorder
Drug and alcohol use cause significant impairment/distress may have a SUD.
Diagnosis:
In-depth examination (by a psychiatrist/psychologist) with most commonly used
guidelines in the DSM-5
10 separate classes: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly
acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids;
,sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances,
cocaine, and other stimulants); tobacco; and other or unknown substances.
11 diagnostic criteria categorized into following issues:
Loss of control
Strain to one’s interpersonal life
Hazardous use
Pharmacologic effects
DSM-5 requires that individual have significant impairment or distress from their pattern of
drug use, and at least two of the symptoms listed below in a given year. The criteria are the
same for alcohol use disorder.
DSM-5 Substance Use Disorder
SEVERITY: 2-3 (mild). 4-5 (moderate). 6+ (severe)
The substance is often taken in larger amounts or over a longer period than was intended
There is a persistent desire or unsuccessful efforts to cut down or control the substance use
A great deal of time is spent in activities necessary to obtain the substance, use it, or
recover from its effects
Craving, or a strong desire or urge to use the substance
Continued substance use resulting in a failure to fulfill major role obligations at work,
school, or home
Continued substance use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by substance’s effects
Important social, occupational, or recreational activities are given up or reduced because of
substance use
Recurrent substance use in situations in which it is physically hazardous
Substance use is continued despite knowledge of a persistent or recurrent physical or
psychological problem most likely caused or exacerbated by it
Tolerance, as defined by either of the following:
a. A need for markedly increased amounts to achieve intoxication or the desired
effect
b. A markedly diminished effect with continued use of the same amount
Withdrawal, as manifested by either of the following:
a. Characteristic withdrawal syndrome for the substance
b. The substance, or a closely related substance, is taken to relieve or avoid
, withdrawal symptoms
To illustrate, the DSM questions are posed here specifically for alcohol use disorder:
1. Have you had times when you ended up drinking more or longer than you intended?
2. Have you, more than once, wanted to cut down or stop drinking, or tried to, but couldn’t?
3. Have you spend a lot of time drinking? Or being sick or getting over after-effects?
4. Have you wanted a drink so badly that you couldn’t think of anything else?
5. Have you found that drinking – or being sick from drinking – often interfered with taking
care of your home or family? Or caused job troubles? Or school problems?
6. Have you continued to drink even though it was causing trouble with your family or
friends?
7. Have you given up or cut back on activities that were important or interesting to you, or
gave you pleasure, in order to drink?
8. Have you – more than once – gotten into situations while or after drinking that increased
your chances of getting hurt(such as driving, swimming, using machinery, walking in a
dangerous area, or having unsafe sex)?
9. Have you continued to drink even though it was making you feel depressed or anxious or
adding to another health problem? Or after having had a memory backout?
10. Have you had to drink much more than you once did to get the effect you want? Or found
that your usual number of drinks had much less effect than before?
11. Have you found that when the effects of alcohol were wearing off, you had withdrawal
symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart,
or a seizure? Or sensed things that were not there?
Addiction is a Brain Disease, and it Matters
Alan Leshner
Scientific advances over the past 20 years have shown that drug addiction is a chronic
relapsing disease that results from the prolonged effects of drugs on the brain.
There is a lag between the advances in science and their appreciation by the general public or
application in either practice or public policy settings.
Reasons for the lag:
Normal delay in transferring any scientific knowledge into practice and policy
Stigma attached to being a drug user/addict
, The people who work in the fields of drug abuse prevention and addiction treatment
also hold ingrained ideologies
Drug Abuse and Addiction as Public Health Problems
Drug use has consequences for the health of the user and the general public:
Major vector for the transmission of many serious infectious diseases – AIDS,
hepatitis, tuberculosis – violence
The strategies should include a committed public health approach – extensive education and
prevention efforts, treatment and research
Research has demonstrated the effectiveness of well-delineated outreach strategies in
modifying the behaviors of addicted individuals that put them at risk for acquiring the human
immunodeficiency virus (HIV), even if they continue to use drugs and do not want to enter
treatment.
What Matters in Addiction
It does not matter what physical withdrawal symptoms occur:
First, even the florid withdrawal symptoms of heroin addiction can now be easily
managed with appropriate medication.
Second, and more important, many of the most addicting and dangerous drugs do not
produce severe physical symptoms upon withdrawal.
What matters is whether or not a drug causes what we now know to be the essence of
addiction: compulsive drug seeking and use, even in the face of negative health and social
consequences.
Addiction is a Brain Disease
Drugs have an effect on the mesolimbic reward system, that extends from the ventral
tegmentum to the nucleus accumbens, with projections to areas such as the limbic system and
the orbitofrontal cortex.
The addicted brain is distinctly different from the nonaddicted brain, as manifested by
changes in brain metabolic activity, receptor availability, gene expression, and
responsiveness to environmental cues. Some of these long-lasting brain changes are
idiosyncratic to specific drugs, whereas others are common to many different drug.
But Not Just a Brain Disease
Exposure to conditioned cues can be a major factor in causing persistent or recurrent drug
cravings and drug use relapses even after successful treatment.
A Chronic, Relapsing Disorder
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