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PubMed2000

Cognitive social learning and related perspectives on drug craving.

Many modern theories of drug use and dependence assign central prominence to the role of craving in drug use and relapse. However, some continue to debate whether drug craving has any motivational significance in terms of drug-using behaviors. Cognitive social learning theory adds additional perspective by imbedding craving within a network of cognitive processes that, as they inter-relate, influence drug use and relapse. This paper reviews tenets of cognitive social learning theory as they relate to craving, focusing on theoretical models that have attempted to explain how craving fits our understanding of the process of drug relapse. In addition, cognitive social learning theory complements theories that emphasize more biological or information processing aspects of addictive behaviors. Studies of addiction that have assessed elements of social learning theory suggest the following: (1) there exists an inverse relationship between efficacy and craving; (2) there appears to be an association between affect and craving, but the precise nature and strength of this association is unclear; (3) the relationship between outcome expectations and craving is largely unknown; and (4) correspondingly little is known about relationships between coping and craving. More empirical study is needed to address the strengths and limitations of cognitive social learning theory as it relates to our understanding the motivational significance of drug craving.

Adaptation, Psychological↗

PubMed2000

Food craving and food "addiction": a critical review of the evidence from a biopsychosocial perspective.

Although certain commonalities exist between eating and drug use (mood effects, external cue-control of appetites, reinforcement, etc. ), it is argued that the vast majority of cases of (self-reported) food craving and food "addiction" should not be viewed as addictive behavior. An explanation is proposed that instead gives a prominent role to the psychological processes of ambivalence and attribution, operating together with normal mechanisms of appetite control, the hedonic effects of certain foods, and socially and culturally determined perceptions of appropriate intakes and uses of those foods. Ambivalence (e.g., "nice but naughty") about foods such as chocolate arises from the attitude that it is highly palatable but should be eaten with restraint. Attempts to restrict intake, however, cause the desire for chocolate to become more salient, an experience that is then labelled as a craving. This, together with a need to provide a reason for why resisting eating chocolate is difficult and sometimes fails, can, in turn, lead the individual to an explanation in terms of addiction (e.g., "chocoholism"). Moreishness ("causing a desire for more") occurs during, rather than preceding, an eating episode, and is experienced when the eater attempts to limit consumption before appetite for the food has been sated.

Affect↗

PubMed2001

An integrative approach for studying the etiology of alcoholism and other addictions.

Studies of alcoholism etiology often focus on genetic or psychosocial approaches, but not both. Greater understanding of the etiology of alcohol, tobacco and other addictions will come from integration of these research traditions. A research approach is outlined to test three models for the etiology of addictions--behavioral undercontrol, pharmacologic vulnerability, negative affect regulation--addressing key questions including (i) mediators of genetic effects, (ii) genotype-environment correlation effects, (iii) genotype x environment interaction effects, (iv) the developmental unfolding of genetic and environmental effects, (v) subtyping including identification of distinct trajectories of substance involvement, (vi) identification of individual genes that contribute to risk, and (vii) the consequences of excessive use. By using coordinated research designs, including prospective assessment of adolescent twins and their siblings and parents; of adult substance dependent and control twins and their MZ and DZ cotwins, the spouses of these pairs, and their adolescent offspring; and of regular families; by selecting for gene-mapping approaches sibships screened for extreme concordance or discordance on quantitative indices of substance use; and by using experimental (drug challenge) as well as survey approaches, a number of key questions concerning addiction etiology can be addressed. We discuss complementary strengths and weaknesses of different sampling strategies, as well as methods to implement such an integrated approach illustrated for the study of alcoholism etiology. A coordinated program of twin and family studies will allow a comprehensive dissection of the interplay of genetic and environmental risk-factors in the etiology of alcoholism and other addictions.

Alcoholism↗

PubMed2006

Youth gambling: not a safe bet.

PURPOSE OF REVIEW: To increase awareness and knowledge of the growing problem of adolescent gambling. RECENT FINDINGS: Some risk factors have been established for adolescent gambling. Many of the risk factors for gambling behavior can be addressed in effective prevention of problem gambling. There is an association between some psychiatric comorbid conditions and problem gambling (i.e. depression). Current treatment modalities are based on adult experiences and need further investigation for adolescents. Prevention strategies and education of youth, parents, teachers, educators, and professionals are essential in targeting this serious problem. SUMMARY: Given the increasing overall prevalence of adolescent gambling, it is imperative that pediatricians appreciate that gambling problems can also afflict adolescents. There is a clear link between problem gambling in adolescence and pathologic gambling in adulthood. Thus, like other addictive behaviors (cigarette smoking, alcohol and drug use), youth and parents should be screened and counseled about the risks associated with excessive gambling.

Adolescent↗

PubMed2006

Do adolescent indoor tanners exhibit dependency?

BACKGROUND: Indoor tanning is a common adolescent risk behavior that has been hypothesized to be motivated and maintained by the mood-altering effects of ultraviolet light. OBJECTIVE: Our purpose was to explore heretofore anecdotal reports that indoor tanning leads to dependency. METHODS: A telephone interview was conducted among 1275 adolescents, ages 14 to 17 years. Self-reported difficulty in quitting indoor tanning was assessed among 267 adolescents (20.9% of total) who tanned indoors more than once in the previous year in relation to age of initiation, frequency of use, and positive or negative consequences of the practice. RESULTS: Difficulty in quitting was more likely with younger age at initiation (age 13 years or younger vs ages 16 to 17; odds ratio = 4.3, 95% confidence interval 1.3-14.7) and higher frequency of use (P = .009), even after accounting for positive or negative consequences of indoor tanning and other demographic characteristics. LIMITATIONS: This was a cross-sectional study design with a limited outcome measure. CONCLUSION: Although preliminary, our findings for age at initiation and frequency of use in relation to difficulty in quitting indoor tanning are consistent with other potentially addictive behaviors taken up during adolescence.

Adolescent↗

PubMed2003

Genetics of pathological gambling.

Pathological gambling (PG) is an impulse control disorder and a model 'behavioral' addiction. Familial factors have been observed in clinical studies of pathological gamblers, and twin studies have demonstrated a genetic influence contributing to the development of PG. Serotonergic, noradrenergic, and dopaminergic dysfunction have been reported as biological factors contributing to the pathophysiology of PG. Molecular genetic techniques have been used to investigate the role of genetic factors in PG. Molecular genetic research has identified specific allele variants of candidate genes corresponding to these neurotransmitter systems to be associated with PG. Associations have been reported between pathological gamblers and allele variants of polymorphisms at dopamine receptor genes, the serotonin transporter gene, and the monoamine-oxidase A gene. Although preliminary data suggest that some of these differences are gender-specific, more research needs to be performed to substantiate gender-specific genetic contributions to the development of pathological gambling. The review of the current findings on genetics of PG suggests that liability to PG is in part mediated by genetic factors. Additional studies are needed to replicate and extend these findings, as well as to better understand the influence of specific allelic variants to differences in biological and behavioral functioning.

Behavior, Addictive↗

PubMed2006

Involvement of the AMPA receptor GluR-C subunit in alcohol-seeking behavior and relapse.

Craving and relapse are core symptoms of drug addiction and alcoholism. It is suggested that, after chronic drug consumption, long-lasting neuroplastic changes within the glutamatergic system are important determinants of addictive behavior. Here, we show that the AMPA type glutamate receptor plays a crucial role in alcohol craving and relapse. We observed, in two animal models of alcohol craving and relapse, that the AMPA antagonist GYKI 52466 [1-(4-aminophenyl)-4-methyl-7, 8-methylenedioxy-5H-2, 3-benzodiazepine] dose-dependently reduced cue-induced reinstatement of alcohol-seeking behavior and the alcohol deprivation effect. The involvement of the AMPA receptor in these phenomena was further studied using mice deficient for the GluR-C AMPA subunit [GluR-C knock-out (KO)]. GluR-C KOs displayed a blunted, cue-induced reinstatement response and alcohol deprivation effect, when compared with wild-type controls; however, no differences between genotypes could be observed regarding ethanol self-administration under operant or home cage drinking conditions. These results imply a role for GluR-C in alcohol relapse, although this phenotype could also be attributable to a reduction in the total number of AMPA receptors in specific brain areas. In conclusion, AMPA receptors seem to be involved in the neuroplastic changes underlying alcohol seeking behavior and relapse. Thus, AMPA receptors represent a novel therapeutic target in preventing relapse.

Alcoholism↗

PubMed2005

Pathological hypersexuality predominantly linked to adjuvant dopamine agonist therapy in Parkinson's disease and multiple system atrophy.

Pathological hypersexuality developed in 13 patients with PD and two patients ultimately diagnosed clinically with MSA. Hypersexuality began within 8 months after starting dopamine agonist therapy in 14 of 15 cases, including four on agonist monotherapy. It resolved in the four cases where the agonist was stopped, despite continued levodopa therapy. This was not an isolated behavioral problem in most, with additional compulsive or addictive behaviors coinciding in nine patients (60%). A systematic literature review of pathological hypersexuality in PD revealed similar medication histories; combining these cases with our series, 26 of 29 patients (90%) were on adjuvant dopamine agonists.

Adult↗

PubMed1998

The neuropsychiatry of chronic cocaine abuse.

This review integrates findings from neuropsychological, PET, and MRI studies in human subjects and neurochemical findings in animals to make inferences about neuropsychiatric consequences of chronic abuse of cocaine. It also aims to develop insights into brain-behavioral relationships that may explain the perpetuation of addictive behaviors. Such insights promise to lead to a better understanding of the neuropsychiatry of cocaine abuse and to promote the development of more efficacious treatments. The authors present evidence suggesting that cocaine abusers have specific dysfunction of executive functions (decision making, judgment) and that this behavior is associated with dysfunction of specific prefrontal brain regions, the orbitofrontal cortex, and anterior cingulate gyrus. Suggestions for future research and treatment are also discussed.

Aged↗

PubMed2000

On a roll: the process of initiation and cessation of problem gambling among adolescents.

As gambling becomes more accessible and acceptable in society, problems associated with gambling and gaming have begun to affect ever increasing numbers of adolescents. Although restricted from most forms of gambling by law, many adolescents are finding a path into problem gambling. Some are becoming compulsive gamblers early in their gambling career, facing a future filled with consequences and problems. Understanding the pathway or process by which these adolescents become engaged in gambling behavior and how they can extricate themselves from this addictive behavior can enhance the efficiency and effectiveness of our interventions. This article offers a perspective on the initiation and cessation of compulsive gambling using the basic elements of the process of intentional behavior change outlined in the Stages of Change from the Transtheoretical Model. The process of initiation of a problematic behavior is similar to the process of modification or cessation of a problematic behavior in terms of these stages of change. With adolescents it is important to distinguish between the process of initiation, which has implications for prevention of gambling problems, and the process of cessation, which often necessitates the assistance of treatment. Creating interventions that parallel the process of change offers the potential for personalizing and potentiating efforts to reduce the prevalence and consequences associated with compulsive or pathological and problem gambling. Application of this model to gambling behavior offers a heuristic that is intriguing and requires substantiation through rigorous research.

Journal Article↗

PubMed2004

[Psychometric properties and initial validation of the questionnaire on differentiated assessment of addiction].

The "Questionnaire on Differentiated Assessment of Addiction (QDAA)" is a multi-modal, selfrating instrument for the Assessment of addiction and abuse of psychotropic substances. The QDAA provides the diagnosis of addiction as well as an overview of relevant information needed for the treatment of addiction. Several subscales assess variables that contribute to the development and maintenance of addiction such as mood, stress, expectancy of drug effects, self-esteem, life satisfaction and coping ability. In the present study validity and reliability of the QDAA was tested in several dependent and non-dependent samples. A total of 575 non-dependent, alcohol-, heroin- and cannabis-dependent subjects was available for the present study. Six criteria (craving, tolerance, withdrawal, loss of control, addictive behavior, negative consequences), that form the basis of the addiction diagnosis were shown to have high internal consistency and can be reduced to one dimension by factor analysis. The resulting diagnosis of addiction is significantly correlated with the external criterion "dependence syndrome" of the ICD-10 by external experts. The assumed structure of the QDAA-subscales could be confirmed by factor analysis. In addition, the results of the subscale analysis provide empirical evidence for convergent validity. All subscales showed moderate to high internal consistency. The results suggest that the QDAA is a valid and reliable instrument for the differential assessment of substance addiction, abuse as well as relevant information in the context of addiction and its treatment.

Adult↗

PubMedDate not supplied

[Benzodiazepine addiction and symptoms of anxiety and depression in elderly subjects].

The relative works to the psychopathological aspects of benzodiazepines (BZD) addiction in elderly persons make the object of a large debate because the question of addiction remains whole. They concern: 1) the influence of age on the level of consumption of the BZD. The research permits to clear 4 explanatory major factors of the relation observed between age and the consumption of BZD: a) the morbidity increased of the aged people, b) the impact of the painful life events, c) the social isolation, d) the weight of the medical prescription; 2) the concepts of dependence (evolution of the definitions, type of physical, psychic or psychopathological dependencies) and of addiction (definitions, place in the international classifications, psychopathological perspective); 3) the reports of the anxiety and the depression with BZD addiction in elderly persons. To the look of these works, the objectives of this present study were to examine the variability of BZD addiction on the one hand within a population weakened by the effects of age (apparition of a chronic illness, for example) and on the other hand the relations that the anxious and depressive symptoms maintain with BZD addiction in elderly persons. Two self-questionnaires were administered: 1) BZD addiction scale, 2) Hospital Anxiety Depression Scale (HAD) to 28 elderly (18 women and 10 men; mean age is 73.25 years). To the exit of this work, the results put in evidence go in the sense of our hypotheses but cannot be generalized to the set of the elderly consumers of BZD, they let appear that age, the depression and the association anxiety/depression predict meaningful manner BZD addiction. Indeed, with regard to age, the polypathology as well as the changes of life induced by the aging process involved BZD addiction in old people. The old age can engender a depression that results in addictive behavior. However, anxiety alone is not experienced before drug addiction in a significant way. This result can explain itself by the fact that the anxiety is a symptom of depression. The present research is unique in several important aspects. First, the study shows that drug addiction in old people cannot be reduced to physiological addiction on product but understood in terms of a complex process requiring an analysis of the psychological addiction on product. Second, BZD addiction in the elderly acts as a psychological/existential medical care. Future research is needed to examine the psychological and psychopathological links that old people maintain with their drug medication.

Aged↗

PubMed2000

Alterations in dopaminergic and glutamatergic transmission in the induction and expression of behavioral sensitization: a critical review of preclinical studies.

RATIONALE AND OBJECTIVES: Repeated exposure to many drugs of abuse results in a progressive and enduring enhancement in the motor stimulant effect elicited by a subsequent drug challenge. This phenomenon, termed behavioral sensitization, is thought to underlie certain aspects of drug addiction. Behavioral sensitization is the consequence of drug-induced neuroadaptive changes in a circuit involving dopaminergic and glutamatergic interconnections between the ventral tegmental area, nucleus accumbens, prefrontal cortex and amygdala. METHODS: The literature was critically reviewed in an effort to discern the relative roles of glutamate and dopamine transmission in the induction and expression of sensitization to amphetamine, cocaine and mu-opioids. In addition, the literature was reviewed to evaluate distinctions between these drugs in the involvement of the relevant brain nuclei listed above. RESULTS: The common substrates between sensitizing drugs are glutamate transmission, especially at the NMDA receptor, and an action in the ventral tegmental area. In contrast, a role for dopamine is only clearly seen in amphetamine sensitization and critical involvement of nuclei outside the ventral tegmental area is found for cocaine and morphine. While enhanced dopamine transmission is associated with sensitization by all three drugs, a role for glutamate is clearly identified only with cocaine sensitization. Accordingly, glutamatergic cortical and allocortical brain regions such as the prefrontal cortex appear more critical for cocaine sensitization. CONCLUSIONS: The distinctions between drugs in the induction and expression of sensitization indicate that behavioral sensitization can arise from multiple neuroadaptations in multiple brain nuclei. This is not only the result of distinct molecular targets for the drugs, but may also include a differential involvement of learned associations. It is postulated that the relatively more robust pharmacological capacity of amphetamine to release dopamine may induce a form of sensitization that is more dependent on adaptations in mesoaccumbens dopamine transmission compared with cocaine and morphine sensitization.

Animals↗

PubMed2000

Opioids in chronic pain management: is there a significant risk of addiction?

In the last decade there has been significant controversy about the appropriateness, efficacy, safety, and wisdom of treating chronic pain patients (CPPs) with opioids. Arguments against their use have included concerns about tolerance, dependence, addiction, persistent side effects, and interference with physical or psychosocial functioning. However, considerable experience and research with long-term cancer pain treatment suggests that in appropriately selected patients, opioids have a low morbidity, and a low addiction potential, and in addition to the primary analgesic action, can facilitate reduction in suffering, enhance functional activity level, and improve quality of life without significant risk of addictive behaviors. Some patients, however, are at risk. Risk factors for addiction are discussed in this article.

Automobile Driving↗

PubMedDate not supplied

[Epidemiological study of cannabis abuse and dependence in 256 adolescents].

A study of cannabis use in French adolescents was implemented using a questionnaire derived from the French version of the Mini International Psychiatric Interview based on DSM IV criteria for cannabis dependence, among a population of 256 high school students from two high schools with different SES backgrounds. Among the adolescents studied, 41.4% (n = 106) reported using cannabis occasionally or regularly, 51.2% had never used cannabis, and 7.4% had used cannabis and subsequently quit. Incidence of usage appeared to increase as a function of age, 51.4% for those 18 years and over, 44.6% for 17 years-old, and 30.4% for 16 years-old, girls tending to consume less than boys (36.4% to 45.2%). With regards to results of the MINI, of the regular or occasional users (n = 106), 47.2% of the subjects indicated substance dependence while the remaining subjects indicated that they were recreational users only. Among users, data concerning tolerance, withdrawal, and excessive consumption indicated that subjects were significantly affected by their addictive behavior; 33% of users reported having smoked cannabis for one year or less with 10.4% reporting that they have smoked for more than three years. Among those having smoked one year or less, 31.4% reported signs of dependence versus 68.6% who consume on a recreational basis; among those having used cannabis for three years or more, 63.6% reported dependence while 36.4% admitted to recreational usage. This study indicates the seriousness of cannabis usage among high-school students, underlining addictive and dependent behavior and their effects on daily life as well as significant the increase of usage with age and as a function of number of years of smoking.

Adolescent↗

PubMed2004

Differential distribution of parvalbumin immunoreactive neurons in the striatum of cocaine sensitized rats.

Intermittent administration of psychostimulants such as cocaine and amphetamine can result in behavioral sensitization, which is believed to model the onset of drug addiction, as well as possible neural adaptations that lead to addictive behaviors. The dorsal striatum and the nucleus accumbens (NAc) have been shown to play an integral role in this phenomenon. However, these structures comprise a complex neuroanatomical organization, and few studies have correlated anatomical differentiation within these brain regions with functional (i.e. behavioral) outcome, particularly after psychostimulant exposure. Parvalbumin (PV)-containing GABAergic interneurons are a key neuronal cell population that can significantly regulate input-output functions in these brain regions. The present study quantified parvalbumin-immunoreactive cells in subterritories of the striatum and NAc in animals behaviorally sensitized to cocaine. Rats received a sensitization-inducing regimen of cocaine (twice-daily injections of 15 mg/kg i.p. for 5 consecutive days). Two or 14 days following the last injection, rats were given a challenge injection of cocaine (15 mg/kg i.p.), and killed 2 h later. Sections through the striatum (including the NAc) were processed for parvalbumin immunoreactivity, and the number of immunoreactive neurons was quantified. Repeated cocaine administration resulted in robust sensitization that correlated with transient increases in the number of PV immunoreactive neurons in the ventrolateral, dorsolateral and dorsomedial striatum. After a 2-week withdrawal period, sensitized animals showed a significant decrease in the number of PV+ neurons in the ventrolateral shell of the NAc and dorsomedial striatum, and no significant difference in any other area examined. These data suggest a dichotomous role for PV interneurons in different subterritories of the striatum and NAc during the short-term (induction) vs. long-term (expression) phases of cocaine sensitization.

Animals↗

PubMed2004

Subregion-specific down-regulation of 5-HT3 immunoreactivity in the nucleus accumbens shell during the induction of cocaine sensitization.

Repeated exposure to psychostimulants such as cocaine and amphetamine can result in behavioral sensitization, which is believed to model the onset of drug addiction, as well as neural adaptations that occur after repeated drug abuse that lead to addictive behaviors. Dopamine (DA) in the nucleus accumbens (NAc) has been shown to play an integral role in this phenomenon. However, cocaine also acts on the serotonin (5-HT) system, which has been shown to modulate psychostimulant-induced increases in motor behavior and DA release in the NAc. Recently, it has been demonstrated that the shell portion of the NAc can no longer be considered a homogeneous structure and can be subdivided into at least five separate regions. The present study examines 5-HT(3) receptors in the subdivisions of the NAc in cocaine-sensitized rats. Rats received a sensitization-inducing regimen of cocaine (twice-daily injections of 15 mg/kg ip for five consecutive days). Two or 14 days following the last injection, rats were given a challenge injection of cocaine (15 mg/kg ip) and sacrificed 2 h later. Sections of the NAc were processed for 5-HT(3) immunoreactivity (5-HT(3)-IR), and the number of puncta was quantified in each of the subregions of the shell, as well as the core of the accumbens. Repeated cocaine administration resulted in robust sensitization that correlated with a transient decrease in the density of 5-HT(3) immunoreactive puncta in the intermediate zone of the accumbens shell. After a 2-week withdrawal period, sensitized animals no longer showed any differences in any of the areas examined. These data suggest a possible role for 5-HT(3) receptors in the intermediate zone during the induction of cocaine sensitization.

Animals↗

PubMed2003

Pretreatment task persistence predicts smoking cessation outcome.

R. Eisenberger's (1992) learned industriousness theory states that individuals display differing degrees of persistence depending on their history of reinforcement for effortful behavior. These differences may influence the development, maintenance, and cessation of addictive behaviors. In cross-sectional studies, E. P. Quinn, T. H. Brandon, and A. L. Copeland (1996) found that cigarette smokers were less persistent than nonsmokers, and R. A. Brown, C. W. Lejuez, C. W. Kahler, and D. R. Strong (2002) found that smokers who had previously abstained for 3 months were more persistent than those who had never quit. The present study extended these findings by using a prospective design. A pretreatment measure of task persistence (mirror tracing) completed by 144 smokers predicted sustained abstinence throughout 12 months of follow-up. Moreover, persistence predicted outcome independent of other significant predictors: gender, nicotine dependence, negative affect, and self-efficacy.

Adolescent↗