PSYC 491 Psychopharmacology

Study Guide

Chapter 8 - Drug Abuse, Dependence, & Addiction: 8. Describe some of the risk factors for developing drug addiction and some of the protective factors that may reduce risk. Risk Factors: Environmental factor is the occurrence of stress and the ability of the person to cope with stress. Significant comorbidity of drug abuse or addiction with various personality or mood disorders. Three different personality-related pathways to addiction I. Behavioral disinhibition II. Stress reduction III. Reward sensitivity Self-medication hypothesis predicts that individuals suffering from elevated anxiety should prefer alcohol and other sedative-anxiolytic drugs, whereas depressed individuals should seek out stimulant drugs such as cocaine or amphetamines. Genetic factors predispose individuals to exhibiting a variety of pathological characteristics involving drug use
Genetic differences in sensitivity or toxic responses to drugs of abuse Genetic variability in the liability to abuse substances
E.g., genetic factors may account for 73% of the variability in males in liability for alcoholism and 61% in female variability

Race
Whites have highest lifetime use of illicit drugs except crack and heroin Blacks have the highest rate of secondary problems (e.g., liver damage, cancer, etc) Hispanics have higher prevalence of alcohol Blacks have higher prevalence of heroin and crack

Factors affecting dependence (2)

Religion: the more religious, the less the problem with drug abuse / dependence (Gorsuch, 1988)
Especially if the religion bans the substance

Sociological Factors; the strongest of which is the users selling of drugs, which is linked to
Drug availability Significant others labeling of the person as deviant Peer influence Early childhood deviance Poor school adjustment Weak family influence

Factors affecting dependence (3)

Exposure complex issue, but in general, people progress from socially acceptable drugs (like tobacco and beer) to more illicit drugs (like marijuana and cocaine) = the Gateway Hypothesis Age: Illicit drug use is highest among those 18 to 25 years of age (20%), then those 12 to 17 years (11%), followed by those age 26 and above (5.8%)
Initiation to drug and alcohol abuse begins before the age of 21 most of the time

Personality characteristics, such as the following, correlate with substance abusers (Marlatt et al., 1988)
sensation- or novelty-seeking traits history of antisocial behavior (e.g., nonconformity, acting out, and impulsivity)

 high levels of depression

Factors affecting dependence (4)

Comorbidity: presence of substance abuse plus another psychological disorder, referred to as dual diagnosis occurs in 33% of drug or alcohol addictions
Drug use as a form of self-medication Among alcohol abusers, 78% of men and 86% of women have at least 1 other psychiatric disorder Of individuals with a lifetime diagnosis of schizophrenia, 47% have met criteria for substance abuse or dependence Of those with an anxiety disorder, 23.7% met criteria for substance abuse or dependence Of those with obsessive-compulsive disorder, 32.8% Of those with bipolar disorder, 50% Of those with depression, 32%

Factors affecting dependence (5)

Pre-existing motivation factors interact with physiological and psychological conditioning factors once drug taking begins
Reinforcing effects of taking drugs Negative reinforcement of taking drugs to avoid unpleasant withdrawal symptoms Classical conditioning of drug cravings and compensatory reactions (withdrawal CRs)
E.g., behavioral withdrawal symptoms and subjective craving responses have been shown to occur in abstinent narcotic users while watching videotapes of themselves or others administering drugs or seeing other drug-related stimuli (Childress et al., 1986)

Protective Factors:
An absence of the various risk factors described in the previous section will help protect against drug abuse or addiction Help maintain a stable abstinence in previously drug-abusing or addicted individuals.

General Factors in Treatment for Drug Dependency

First step is to recognize the problem (realize that dependency has occurred and is causing detrimental consequences) Second step is for the user to have the motivation to change Difficult because:
Denial a defense mechanism whereby users dont consciously recognize that they have a problem Enabling when significant others do things to actually encourage the persons drug use
Helping them escape the harmful consequences of drug use

Treatment (1)
If sufferer is dependent upon a legitimate prescription drug, he or she can be weaned off the drug slowly (assuming they recognize the problem and wish to stop the dependency) If the substance abuser doesnt recognize or want help, then coercion is an acceptable and/or effective means for getting the person treatment
Consequences will be allowed to occur if they dont (loss of job, legal action, etc.)

Treatment (2)
Deal with predisposing psychological and/or sociological factors which led to drug taking. Made

more difficult if person

Has a poor self-image Sees themselves as a drug user Has a history of deviance Comes from a broken home Has few education-related skills

Get rid of cue dependent cravings by

Removing user from drug-associated environmental stimuli Extinguish the CS-UCS association by exposing the user to the cues in the absence of the UCS, repeatedly

9. Why might the evaluation of drug-reinforcing properties in animals be valuable in the assessment of human experiences?
How do you determine if a drug has reinforcing properties, or is likely to become a drug capable of producing psychological dependence? One determines the degree to which an animal self-administers a drug
E.g., cocaine is self-administered to excess by rats, squirrels, monkeys, rhesus monkeys, pigtail macaques, baboons, dogs, and humans

If self-administration in multiple species of animal occurs, then one can assume:

The drug serves as a positive reinforcer The person that abuses the drug does not have some kind of inherent pathological condition

Nonhuman animals will show many of the same aspects of substance abuse as humans.
Take more and more of it.

Animal Models
Devote a lot of time and energy to getting it. Continue taking it despite adverse consequences. Undergo a withdrawal syndrome if the drug is not available. Relapse in response to environmental or stressful cues or re-exposure.

Means we can address some of the same questions about human drug abuse by studying nonhuman subjects.
Has implications for the question: Is there an addictive personality?

10. Explain the mechanism that underlies the behavioral reinforcing properties of abused drugs. 11. Distinguish between context-specific tolerance and pharmacodynamic tolerance. Describe both. Context-specific tolerance (also called Behavioral tolerance) is demonstrated when tolerance occurs in the same environment in which the drug was administered, but tolerance is not apparent or is much reduced in a novel environment. Pharmacodynamic tolerance occurs when changes in nerve cell function compensate for the the continued presence of the drug. 3


Pharmacodynamic = functional = cellular-adaptive:
Neuronal receptors become desensitized through cellular changes so that the drug affects neurons less

Behavioral = learned = associative = Contextspecific:

Habituation; person learns to compensate for the drug and learns to perform while under its influence Pavlovian conditioned tolerance involving homeostatic mechanisms Instrumentally conditioned tolerance

12. The FDA approved the use of olanzapine (Zyprexa) in the treatment of schizophrenia (a few years ago). In general, what are the implications of this approval for psychiatrists in terms of what they may prescribe olanzapine for?

13. Controlled substances are categorized by the DEA into 5 schedules. What differentiates drugs placed into these schedules? Schedule I---Substances have no accepted medical use in the U.S., and have a high abuse potential. Ex: Heroin, LSD, mescaline, marijuana, THC, MDMA Schedule II---Substances that have a high abuse potential with sever psychic or physical dependence liability. Ex: opium, morphine, codeine, Ritalin, Demerol, cocaine, PCP Schedule III---Substances that have an abuse potential less than those in Schedules I and II, including compounds containing limited quanitities of certain narcotics and nonnarcotic drugs. Ex: paregoric, barbiturates Schedule IVSubstances that have an abuse potential less than those in Schedule III.Ex: Xanax, Valium, phenobarbital Schedule V- Substances that have an abuse potential less than those in Schedule IV, consisting of preparations containing limited amounts of certain narcotic drugs generally for antitussive and antidiarrheal purposes. 14. What changes take place after the chronic use of a drug of abuse that affects a persons ability to experience natural pleasurable experiences? According to the exposure model, chronic drug use leads to alterations in brain function that are responsible for loss of control and compulsive drug-seeking and drug-taking behaviors.

15. What happens when an addicted or recovering person is exposed to cues of drug use?
Craving is largely a conditioned response (CR) to powerful cues to use drugs, which the (recovering) addict may encounter e.g., people, places, things associated with drug use). Cues evoke powerful emotional memories of high, can trigger near-irresistible urges to use. Even in the absence of drugs, associated stimuli become capable of producing drug craving. Therefore, people recovering from addiction usually are advised to avoid friends and locations that have previously

been associated with drug use.