Risk Behavior and addiction in adolescents
articles
Sussman 2017 chapter 1
Substance and behavioral addiction both describe behavior that results in
significant impairment.
Substance addiction: repetitive intake of a drug or food
Behavioral addiction engaging in types of behavior repetitively like gambling or sex.
Previously scientist only considered something an addiction if there was misuse of drugs
that led to physiological withdrawal symptoms and if the drug was a substance that
could cross the blood-brain barrier. They also had to be exogenous ligands (= non-
natural neurotransmitter) that block, facilitate or mimic endogenous ligands (= naturally
occurring neurotransmitter) functions.
Endogenous ligand functions are also altered by behavioral addictions > dopamine
levels get altered by intensive gambling activity. These kinds of activities can also cause
withdrawal symptoms upon abrupt termination of the addictive behavior. However, there is
no direct contact with brain synapses through exogenous ligands (like drug effects).
Having a measurable description of a scientific concept, such as an addiction, is useful to be
able to make inferences regarding how the concept is related to other concepts. The different
current definitions are not mutually exclusive, which is why the concept ‘addiction’ has been
very debatable.
As its origin ‘addiction’ referred to ‘giving over’ or being ‘highly devoted’ to a person or
activity or engaging in a behavior habitually. Over the last 200 years though, the word has
become more a disease-like concept, where people consider it like a brain disease.
History of substance addictions:
- Tobacco addiction: dates back 400 years > Washington wrote a letter to send
tobacco instead of money to the warfront, what suggests that tobacco had some sort of
importance and compulsive use.
o Flue curing: caused tobacco smoke to be light, sweet flavored and high in
nicotine > caused the deep inhalation of tobacco and increased the likelihood of
compulsive use.
o 1988: nicotine addiction was reported
- Alcohol addiction: records from 450 BC, Pompeii (70 AD) etc. > long history
o Lincoln discussed the negative effects of alcohol abuse but also supported
treatment for alcoholics.
- Opium-related addiction: dates back to 1822 where use of opium’s was described as
divine enjoyment.
o During the opium war (1839-1860) between Great Britain and China, the opium
trade was legalized and production in China increased > caused more addiction
and social problems
o Recognition of the negative sides and addiction of opium’s, led to development
of patent medications used to treat it.
- Cocaine addiction: replacement medications that did not contain opiate derivatives
to treat opiate addictions also led to a new problematic drug in 1880 > cocaine.
o In WW1 soldiers used cocaine instead of alcohol and though they fought better >
later suffered negative side effects
o Opium and cocaine were contained in products back in 1900 like coca cola.
- Marijuana addiction: in 1857 Ludlow stated that he had a preoccupation with
marijuana, followed with continuous intoxication, craving, depression etc.
,Behavioral addictions like sex were noted in writings of ancient Rome, in that it was occurring
in many forms and excessively. Other out-of-self control behaviors may have been considered
as addictive behavior. Since the 1980s behavioral addictions have been studied empirically.
The intensional definition of addiction: causal or process model type statements of
addiction, describing a causal story and the addictive behavioral process > this happens, that
leads to this, that leads to that.
More of an explanatory type of definition that gives information about what happens
etc.
Extensional definition of addiction: listing of addiction features
Definition that just states feature or facts
ALL THE major INTENSIONAL definitions of ADDICTION
- Physiological/psychological dependence: prolonged engagement in a behavior
that results in its continued performance being necessary for physiological and
psychological equilibrium
o Tolerance: you constantly need to do or take more if you still want the same
dopamine effect
o Withdrawal: physical disturbances upon abrupt termination of drug abuse
Behavioral addiction withdrawal also exists > restless or irritability
symptoms
o Craving: intense desire to engage in a specific act
- Impulsive obsessive/compulsive behavior: engagement in addiction leads to
RELIEF instead maintaining an equilibrium > build up tension that gets a relief after
engaging in addiction
o Positive reinforcement: engaging gives pleasure which results in a craving for
more pleasure.
o Negative reinforcement: engaging gives anxiety which results in craving for
relief of anxiety.
o OCD is different from this behavior > OCD may involve repetitive simple
behaviors to remove anxiety, whereas an addiction may involve more complex
behaviors to achieve an appetitive effect of some type (affect, arousal, thought
regulation)
- Self-medication: relief from disordered emotions and sense of self-preservation
through addiction
o E.g. someone wants to get rid of trauma symptoms by doing drugs.
- Self-regulation: self regulation in addiction involves difficulties establishing standards
of behavior, misdirected attempts at regulation, planning, self-monitoring and emotion.
o BAS-BIS Model: two general motivational brain systems – BAS (mediated by
dopamine pathways, linked to more impulsive type behaviors) and BIS (detects
competing goals and leads to approach or avoidance behavior, linked to more
inhibiting behavior). These systems influence whether an individual is likely to
withdraw from or avoid situations or engage.
o Incentive-sensitization model: theory that focuses on the influence of neural
adaptation (sensitization) to addictive behavior and stimuli. Neural processes
salience to addictive behavior gives cues (wanting) and the neural substrates of
pleasurable effects (liking)
Dysregulation of neural substrates occurs through repeated engagement
in behavior. This dysregulation is associated with increase in sensitization
contributing to wanting.
Wanting can be triggered by cues, without necessarily an amplification of
liking.
o Allostatis theory: the body wants to bring the organ systems back to
homeostatic conditions after a stressor has dissipated.
, Addictive behavior leads to dopamine opponent-process
counteradaptation (like reduced dopamine output) that masks the effect
of addictive behavior.
- Addiction entrenchment: one has an over-attachment to a drug/object/activity >
excessive appetite.
o Over time, one’s own unconventional preferences are leading one to try out
addictive behavior.
o With repeated participation in behavior, the salience of alternative behaviors
may decrease.
ALL THE major EXTENSIONAL definitions of ADDICTION
- Six-component perspective: Salience, mood modification (escape, satisfaction that
addiction serves), tolerance, withdrawal symptoms, conflict and relapse are 6
components of addiction.
- Five-component model: appetitive effects, satiation, preoccupation, loss of control
and negative consequences are 5 components of addiction, in an attempt to keep
criteria at a minimum.
- History of the DSM
o DSM1 1952: there was a category of drug addiction, but vague. Alcoholism and
other drug addiction were subsumed within a sociopathic personality disturbance
category.
o DSM2 1968: category of drug dependence that was composed of physiologic
(addiction) and psychic (state) components to make it less vague. Opium’s,
cocaine and other hypnotics were seen as drug addiction and alcoholism was
placed in its own category.
o DSM3 1980: distinguished between abuse and dependence. This version of the
DSM has now criteria where one must fit in to have a type of addiction/disorder.
Drug dependence was no longer under personality disorders, reflecting its
importance as a separate entity.
o DSM4 1994: less vague criteria
o DSM5 2013: current criteria for substance use disorder, with 10 different
addiction categories. Craving criteria and gambling disorder was added,
mentioning behavioral addictions.
Gladwin et al., 2011
The occurrence of the risk behaviors adolescents engage in follows an inverted U-shape
pattern across development, being relatively low in childhood, increasing and peaking in
adolescence and young adulthood, and declining again thereafter. There is also a socio-
emotional influence of peers on adolescents.
Neurobiological research suggests that adolescent brains are characterized by an imbalance
between two systems: a rapidly developing "hot" affective-motivational system
(reward-driven) and a slower-maturing "cold" cognitive control system (involving the
prefrontal cortex). This dynamic makes adolescents more prone to impulsive decisions. The
"bottom-up" motivational processes in adolescents are often stronger than their ability to
apply "top-down" self-control, leading to greater risk-taking compared to children and adults.
While adults can better resist immediate temptations and consider long-term
consequences, adolescents are more susceptible to risk in certain environments,
especially those involving peers.
Drug use is an example of risky behavior that adolescents engage in, but only a few of them
become addicted. This highlights the importance of better understanding individual
differences. However, adolescent substance use may exaggerate the normal inverted U curve
of risky behavior in adolescence.
According to the dual process theory, behavior is influenced by two competing processes:
impulsive (automatic, unconscious, and less controllable) versus reflective (controlled,
