Addiction

Instructor: Maryam Tahmasebi, PhD

Disfunctions of the
nervous system

• From this point forward we will

study psychological presentation of
major psychiatric and neurological
disorders including addiction,
schizophrenia, affective disorders
• We will also look at aging and dementia
What is addiction?

• Drug addiction, or dependence, is the taking of a

chemical substance (the drug) for non-
nutritional and non-medical reasons, where the
drug taking behavior is compulsive
• An addict feels they have no control over taking
the drug
• Their lives often become centred around
acquiring and consuming the drug, to the
detriment of behaviours necessary for survival
• they often engage in risky or illegal behaviour in
order to feed their drug habit
Drug dependence

• Drug dependence must be distinguished from

drug use and drug abuse.
• Drug use is where the substance is taken in small
quantities, relatively infrequently, and
importantly with no damage to relationships or
daily function
• If drug use escalates to frequent and/or excessive
taking of the substance but without the
compulsivity, this would be termed drug abuse
• Drug dependence is when drug-taking is
compulsive
major stages of drug
addiction

• There are four major stages of drug addiction

• initiation, maintenance, abstinence and relapse

• each of which are likely to be driven by
different mechanisms
 Initiation
• Initiation is the first stage, where a person takes the drug for the first time
• The main factors which influence initiation are:
• the ‘pleasant’ feeling (hedonic impact) from taking the drug
• overcoming stress
• peer pressure and the desire to conform to a group
• simply to experiment
maintenance
Here the person no longer feels in control of the decision as to whether to take a drug, but rather
feels a compulsion to take it

The maintenance stage can be long-lasting

Tolerance is developed here

there is rarely an accompanying increase in hedonic impact from taking the drug

the drugs may even become aversive

Tolerance and sensitization

Tolerance refers to the process where a drug becomes less effective and it
produces a weaker response after repeated administration

Sensitization is where the drug becomes more effective over repeated

administration.

the processes involved in sensitisation are very long-lasting

we do not fully understand how these mechanisms are controlled

abstinent

when an addict refrains from taking a drug, they are not normally
considered to be ‘cured’ or ‘recovered’, but rather they are considered to
be abstinent

the addiction is still present, but is not expressed

the motivational drive to take the drug – that is, the craving – may still be
strong
relapse

• A single intake of the drug can reinstate

the maintenance phase in an addict who
may have been abstinent for many years
• Relapse is driven by cravings in the
individual
• Causes: by stress or by exposure to
people, items or situations associated to
previous drug taking
withdrawal

When an addicted person stops taking a drug, they often experience withdrawal
symptoms

These are behavioural changes, often opposite to the effects elicited by the drug,
and can be very aversive

In the early stages of abstinence these withdrawal symptoms are particularly

strong

avoiding withdrawal symptoms provides a strong motivation to take the drug

and can lead to relapse
Brain motivation circuits and Addiction

Many studies have been These mostly focus on

undertaken in experimental pathways controlling
animals to investigate the reinforcement and
neural circuitry underlying motivation often termed
addiction the reward pathway
 Reward is a term widely used in the discussion of
dopamine signalling in the mesolimbic pathway

However, the term ‘reward’ has several problems in the

scientific context

Reward or The term reinforcement refers to the ability of a

stimulus, situation, or outcome, to elicit a behaviour
reinforcement?
we can simply measure changes in the behaviour

reinforcement does not imply pleasure

 this pathway projects from cell bodies in the ventral
tegmental area (VTA) along the axons of the
mesolimbic pathway

the critical role of dopamine in driving the behaviour

effect
mesolimbic
pathway mesolimbic pathway is clearly involved in motivation
to undertake behaviours vital for survival

The importance of the mesolimbic dopamine system

can be confirmed with lesion experiments
 motivational effects of drugs is mediated via
dopamine neurons in the mesolimbic pathway

Dopamine Rats in studies with skinner box will also press a

moderates the lever to receive injections of certain drugs
behavior
amphetamine or cocaine, which enhance
dopamine signalling, increase the lever press
rate, whereas giving a dopamine antagonist
reduces the lever press rate
 two main methods:

Measuring
neurotransmitter Brain microdialysis involves implanting a small
release in the length of dialysis membrane into the brain, and
perfusing it continuously with artificial
brain cerebrospinal fluid (aCSF)

fast-scan cyclic voltammetry (FSCV) measures

the oxidation of chemicals when a voltage is
applied to a carbon fibre microelectrode
place preference experiments
the animal is given an injection of a drug and placed in one compartment or a
saline injection and placed in the other compartment

At test they show a preference for the compartment in which they have previously
received the drug

animals learn about the environment in which they receive reinforcing stimuli

given the choice, they return to that environment, even when the reinforcer is not
present
 Microdialysis and FSCV experiments have shown that, once
this learning has taken place, dopamine release in nucleus
associative accumbens is increased

learning in
These behaviours in experimental animals strongly resemble
addictive behaviours seen in drug addicts, where cues associated with
drug taking or the environment can be very strong
behavior motivational drivers, or cravings, to take the drugs

these conditioned effects can long outlast the period of

association
 at some stage there is a change from use or
abuse to the compulsive drug use
characteristic of dependence

learned neuro-adaptive processes involving

component of sensitisation of dopamine systems
dependence controlling motivation and seems to be
largely irreversible
in drug addicts places, acts or objects
associated with drug-taking become
especially powerful incentives
 The brain systems that are sensitised include the
dopaminergic mesolimbic pathway, responsible
for the incentive salience (‘wanting’) of the drug
or drug-associated cues

Addictive Systems mediating the pleasurable or euphoric

drugs change effects of the drug (‘liking’) are not sensitised

the brain
Psychostimulants, including amphetamine and
cocaine, cause increased locomotor activity in
rodents
 Several models have been proposed

prominent amongst which is the incentive

Models of sensitisation model was proposed by
addiction Robinson and Berridge in 1993

This model develops ideas taken from two

other prominent models, the opponent
process model and the aberrant learning
model
Aberrant learning model

abnormally strong learning is associated with drug taking, through two distinct components of
learning

First, explicit learning where the association between action (drug taking) and outcome (drug effect)
is abnormally strengthened leading to drug taking (even without hedonic effect)

Second, implicit learning where the action-outcome relationships (as above) change to more
automatic stimulus-response relationship (habit)

the stimulus evokes the response irrespective of any conscious expectations about the outcome
 It posits two processes, the A-process and the B-
process which oppose each other:

the A-process is activated by an external stimulus,

leading to a change in functioning
Opponent
process model the B-process is the body’s reaction to the change
brought about by the A process to return to the set
point level

In the context of drug taking A-process leads to the

hedonic state (‘high’) while the B-process leads to the
aversion from not taking the drug (withdrawl)
Incentive sensitisation
model
• The incentive sensitisation model describe two distinct
components of reinforcement:
• hedonic impact (‘liking’)
• incentive salience (‘wanting’)
• These are dissociable behaviourally and physiologically
• The subjective pleasure derived from taking the drug, the
hedonic impact or ‘liking’, is due the direct
psychopharmacological action of the drug
"wanting" of drugs has a
different process
• It The subjective pleasure derived from taking the drug, the
hedonic impact or ‘liking’, is due the direct
psychopharmacological action of the drug
• ‘wanting’ is sensitised over repeated drug taking
• addicts continue to seek and take drugs, even when they
derive little or no pleasure from it
Addictive behaviours
• Behaviours like gambling and exercise can become
compulsive with individuals carrying out the behaviours to
the detriment of normal daily function or family relationships
• ‘addictive behaviours’ share many of characteristics of drug
addiction, and evidence suggests that they may share similar
neural mechanisms
Treatment

The best long-term therapy is abstinence

In all therapeutic strategies for treating addiction, a vital

consideration is that the individual must recognize that they have
an addiction and they must be motivated to overcome it

Psychological therapies have proven fairly successful in sustaining

abstinence
detoxification

For psychological therapies to be

effective, the individual must first stop
taking the drugs

The four main approaches used are drug

elimination, agonist therapy, antagonist
therapy or aversion therapy
Drug elimination

the person simply does not take the drug any more

Sometimes the drug is simply withdrawn, in a single step

or daily intake of drug is slowly reduced under clinically
controlled conditions

person normally experiences withdrawal symptoms, which

can be extremely unpleasant
Antagonist therapy
• an antagonist for the addictive drug is given to block the
action of the drug
• it induces very severe withdrawal effects and the individual is
normally anaesthetised or heavily sedated
aversion therapy
• This is where drug taking is paired with an aversive
stimulus, such that a conditioned association is made
between the drug and the aversive stimulus
• emetic drug is given alongside the addicted drug to
induce sickness
• conditioning creates addiction and it can also be used to
treat it