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Samenvatting GGZ2029 Addiction
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- Maastricht University (UM)
Alle college's en taken van het blok GGZ2029 Addiction
[Meer zien]Voorbeeld 4 van de 124 pagina's
Voorbeeld 4 van de 124 pagina's
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Voorbeeld van de inhoud
GGZ2029 – AddictionProblem 1 – What is addiction? 2
Problem 2 – Addiction is learned behavior 12
Problem 3 – Addiction is a brain disease 22
Problem 4 – Addiction is a choice 34
Problem 5 – Dual processes 45
Lecture 1 58
Lecture 2 – diagnosing addiction 64
Lectures problem 2 70
Lectures problem 3 88
Lectures problem 4 101
Lectures problem 5 111
1
,Problem 1 What is addiction?
ANSWERS
1. What is the definition / classification of addiction? Where does one draw the
line from common behavior to addiction? How can addiction be diagnosed
(+key points of behavior)
It’s not easy to define addiction because addiction takes many forms. There is a wide
variation in who is addicted, what they are addicted to, and the precise form, health
effects and motivation for the addiction.
Addictive substances are illegal drugs (heroin, cocaine, morphine,
barbiturates), amphetamines, legal drugs (alcohol, nicotine, caffeine and prescribed
medications) and behavior (gambling, sex, work, food, shopping and gaming).
There is also variation in who gets addicted (across levels of SES, IQ and
education). Still, rates of addiction are positively correlated with low SES and IQ,
adolescence and early childhood, childhood abuse, stress, psychiatric disorders and
religion.
Müller and Schumann identify goals for non-addictive consumption: (1)
improved social interaction, (2) facilitated sexual behavior, (3) improved cognitive
performance, (4) coping with stress, (5) alleviating psychiatric symptoms, (6) novel
perceptual and sensory experiences, (7) hedonia or euphoria, and (8) improved
physical and sexual appearance. Once addicted, people may use drugs to maintain
normal functioning and avoid withdrawal.
The variation issues a challenge to define addiction. A definition needs to specify
what is common and peculiar to all these cases that make them count as cases of
addiction.
A precising definition is needed. This picks out a relatively precise class of
conditions that lies within the limits of common usage but does not reflect all the
vagueness of common usage. The goal of precising definitions is to be useful, either
theoretically or practically.
Clinicians need to decide whom to treat. Health insurance companies need to
decide for whom they are willing to pay for treatment. Law courts need to decide
whether a defendant is criminally responsible. Scientists want a definition that allows
them to collect data in ways that enable precise scientific generalizations and
theories. Individuals need to decide how to think and feel about friends and family
members who abuse drugs.
The DSM-IV defines substance dependence as:
2
, This definition is useful for at least one clinical purpose. If a prospective patient
had 3 or more of these symptoms, along with clinically significant impairment or
distress, that could be a reasonable basis for treating the individual for addiction. It
could also justify inclusion of addiction as a condition that we expect health insurers
to cover and public health providers to treat.
The polyethnic nature of this definition means that very different patterns of
substance use and attendant problems will count as addiction. This limits this
definition’s capacity to establish prognosis and indicate treatment course.
The DSM-IV definition of substance dependence cannot adequately serve
scientists who study the neural bases or psychological mechanisms of addiction. For
scientists and philosophers, we need a different definition.
Philosophical definitions of addiction tend to be pithy. Foddy and Savulescu define it:
“An addiction is a strong appetite”. They define an appetite as: “a disposition that
generates desires that are urgent, oriented toward some rewarding behavior,
periodically recurring, often in predictable circumstances, sated temporarily by their
fulfillment, and generally provide pleasure”. This definition does not restrict addiction
to substances.
This definition enables scientists to seek the neural bases and psychological
mechanisms for such strong appetites, and philosophers to ask whether people are
responsible for what they do as a result of such strong appetites.
Nonetheless, Foddy and Savulescu’s definition is too narrow. Their definition
of appetite seems to combine liking with wanting. They mention “rewarding behavior”
and “pleasure,” so liking seems essential to addiction on their account. Hence, they
seem to require that addicts both (strongly) like and (strongly) want to use drugs.
This double requirement is a problem, because some extreme addicts report
no longer liking the drugs that they nonetheless want. Perhaps that is why Foddy and
Savulescu add “generally” before “provide pleasure” in their definition, since people
in general do get pleasure from drugs. However, Foddy and Savulescu’s definition is
also too broad, because it fails to distinguish addiction from heavy use based on
strong desire.
The difference between heavy use and addiction is control. The importance of control
is reflected in the diagnostic criteria: (3) using more than was intended, (4) persistent
desire or unsuccessful efforts to control use, and (7) continued use despite
knowledge of resulting persistent or recurrent physical or psychological problems.
The persons physical and psychological ability to control use is reduced:
people lack the degree of control that we normally expect people to have over their
behavior. In the meaning of control are 2 accounts common:
- Want based account: Focusses on wants and claims that an agent has control
over a type of action if:
o If they want overall to perform that type of action, then usually they do
o If they want overall not to perform that type of action, then usually they
don’t do it
→ The qualification ‘usually’ is necessary because they might fail to
play golf when they want because the course is closed. The
qualification ‘overall’ is necessary because desires can conflict. If a
golfer decides not to play, even though he has some desire to play,
because he has a stronger desire to go swimming, then the golfer still
has control over whether he golfs or swims.
3
, - Reasons-responsiveness account: An agent has control over a type of action
o If they have a strong overall reason to perform that type of action, then
usually they do it
o If they have a strong overall reason not to perform that type of action,
then usually they don’t do it
→ On this account, golfers have control over playing golf if and only if
they usually play golf when they have strong overall reason to play golf
and usually do not play golf when they have strong overall reason not
to play golf
If agents have no reason to fulfill some desires, then those agents can act on their
desires without being responsive to reasons. For example, some heavy users claim
that they want drugs in the sense of having a strong desire even though they no
longer like them or get any pleasure from them. If so, these users might have control
over their drug use on the want-based account because they take drugs when they
want to and cease when they don’t. However, such users would lack control on
reasons-responsiveness accounts if they continue to use drugs because of their
strong wants even when they know that they have little or no reason to use drugs
and strong reason not to use drugs.
There are various factors that remove of reduce control. Suppose that one
wants overall to lift a heavy weight off the floor for a substantial period of time. How
could one fail to lift the weight for that time? One might not be strong enough to lift
that much weight (either because the weight is too heavy or because one is
weakened by disease, one might get tired of holding up the weight). Some factors:
- The desire to use drugs can become strong and habitual. Immoderate long-
term drug use can affect neural mechanisms. Many drugs directly increase
levels of synaptic dopamine, which, over time, may affect normal processes of
associationist learning related to survival and the pursuit of rewards. Once
drug-related pathways are thus established, cues associated with the drug use
cause addicts to be motivated to pursue the reward of drugs to an unusually
strong extent.
- It takes effort and resolve to keep exercising willpower. The longer willpower is
exercised, the more depleted resources may become. So, the need for addicts
to persevere in resisting the desire to use drugs, especially in the face of
strong associations and cues, may weaken their willpower, potentially to
depletion.
- Attention and cognition affect the capacity for long-term control. Drug
associations and cues may cause intrusive, incessant, obsessional drug-
related thinking. This in turn may make it very difficult for addicts to recall and
attend to non-drug-related desires and values or to the positive consequences
of abstinence and the negative consequences of use.
- An addict who resolves to stop using drugs will still experience some
motivational conflict with the appetite that constitutes their addiction. Even if
they want overall to stop using, the desire for drugs does not thereby
disappear.
- Abstinence of many addicts requires undergoing withdrawal symptoms, which
may be physically unpleasant or even life threatening.
These factors, in combination, show how or why control can be reduced in addiction.
Desires for drugs can be strong and habitual. Willpower can get depleted. Drug-
related associations and cues can affect cognition and attention. Drug use may serve
psychological, social, and economic functions that produce motivational conflicts and
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