Definitions

Drug Use
Taking a psychoactive substance for non-medical purposes, out of
curiosity

Drug Abuse
Drug use that leads to problems (e.g. loss of effectiveness in
society; behavioral psychopathology, criminal acts)

Drug Dependence
A maladaptive pattern of drug use leading to clinically-significant
impairment or distress, associated with difficulty in controlling
drug-taking behavior, withdrawal, and tolerance
The state of needing a drug to function within normal limits
Nature of Addiction - a continuum of
use?

Loss of control

However, addiction is more than mere drug use

 DSM-IV Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as

manifested by three (or more) of the following, occurring at any time in the same 12 month period:

Tolerance
Withdrawal
Substance taken in larger amounts or over a longer period than intended
Persistent desire or unsuccessful efforts to cut down or control substance use
Great deal of time spent in activities necessary to obtain substance, use
substance (e.g., chain smoking), or recover from effects
Important social, occupational, or recreational activities given up or reduced
because of substance use
Substance use continued despite knowledge of persistent or recurrent physical
or psychological problem likely to have been caused or exacerbated by
substance
 Physical vs. Psychological Dependence

Physical Dependence
Withdrawal symptoms in the absence of the drug
Tolerance to its effects with repeated use

Psychological Dependence
a relatively extreme, pathological state in which obtaining, taking, and
recovering from a drug represents a loss of behavioral control over drug
taking which occurs at the expense of most other activities and despite
adverse consequences (Altman et al)
a situation where drug procurement and administration appear to govern
the organisms behavior, and where the drug seems to dominate the
organisms motivational hierarchy (Bozarth)
 Classic Models of Addiction

Model Emphasized Causes Example Interventions

Moral Personal responsibility; self- Moral suasion; social/legal
control sanctions

Spiritual Spiritual defect Prayer; 12-step faith-based

treatment (e.g. AA)

Temperance Drugs Control of supply; calls for

abstinence

Educational Ignorance Education

Conditioning Classical/operant Counterconditioning;

conditioning extinction
 Classic Models of Addiction continued

Model Emphasized Causes Example Interventions

Biological Heredity; brain physiology; Risk identification; calls for
self-medication abstinence; medical treatment

Psycho- Personality; defense Psychoanalysis

dynamic mechanisms

Family Family dysfunction Family therapy

Dynamics

Social Modeling; expectancies Positive role models; rational

Learning restructuring of expectancies

Sociocultural Environmental; cultural; Social policy; social services

economic
 Physical Dependence or Withdrawal Model
(Negative Reinforcement)

Some drugs produce physical dependence and withdrawal

symptoms upon cessation of drug-taking.

Withdrawal symptoms are produced by the body in order to

compensate for the unusual effects of the drug.
Withdrawal symptoms are generally the opposite of the effect
produced by the drug.

Addicts continue to use drugs in order to avoid

withdrawal.

Over time, drugs no longer have the same rewarding

effects - they merely allow the person to feel normal.
 Inadequacies of Withdrawal Model
Not all abused drugs generate withdrawal symptoms
(cocaine, amphetamine).

Different drugs produce different withdrawal symptoms

with different neural bases.

Once dependent you should continue taking drug, but

people spontaneously stop.

Once drug-abstinent, users should not relapse since

motivation has disappeared, but they do.

No explanation as to why people take drugs in the first

place.
 Positive Incentive (Hedonic) Models
(Positive Reinforcement)

Drugs produce pleasure - a high.

Some drugs provide indirect positive incentive -
they disinhibit behavior that is normally
suppressed (e.g., alcohol and social skills).
Most drugs of abuse stimulate the brains reward
circuits.
All known drugs of abuse stimulate release of DA/opioids in the
nucleus accumbens
Animals will work to micro-inject drugs of abuse and electrically
stimulate the same parts of the brain
Normal rewards (food, drink, sex) also stimulate DA release
 Animal Models of Reinforcement (cont.)

Self-administration
Animals work for reinforcing
drugs (IV, oral, inhalant)
Schedules of reinforcement
(fixed, progressive ratio)
DA release following VTA stimulation
 Drugs that are and are not self
administered by animals
Alcohol Imipramine
Amphetamine Mescaline (abused by humans)
Barbiturates Phenothiazines
Caffeine Scopolamine
Cocaine
Nicotine
Opiates
Procaine (n.a. by humans)
PCP
THC
Drug Dependence Among Ever-Users

Tobacco

Heroin

Cocaine

Alcohol

Stimulants

Marihuana

0 10 20 30 40
% Dependent
 Opponent Process Model
(Solomon, 1977)
Drug-use initially motivated by positive reinforcement
Over time, tolerance to rewarding effects, but abstinence leads to
withdrawal
Drug use ultimately maintained by negative reinforcement
 Current Traditional View
(based on opponent process model)
Initiation of drug taking is primarily driven by anticipated pleasure
(facilitated by peer pressure, social facilitation, curiosity).

For most drugs, pleasure becomes primary motivator and drug craving
becomes cued by drug related stimuli.

For some drugs (e.g., alcohol, cocaine, heroin) pleasure is enhanced by

reversing unpleasant aspects of normal life.

For some drugs (e.g., nicotine, caffeine, heroin, alcohol), drug-taking

leads to dependence and withdrawal which adds additional motivation
to continue drug-taking habit and makes giving up difficult.

This withdrawal state can also be associated with environmental cues,

and increases the tendency for relapse.
 Limitations of Opponent Process Models

Drug withdrawal is much less powerful at

motivating drug-taking behavior
stress seems to be more powerful
Withdrawal symptoms are maximal within a few
days after cessation of drug use, but susceptibility
to relapse continues to grow for weeks to months.
Cues typically fail to elicit conditioned-
withdrawal.
Craving is different from withdrawal.
 Aberrant Learning
(beyond pleasure and pain)

Cues that predict the availability of rewards can

powerfully activate DA circuitry in both animals
and humans (Schultz, 1998), sometimes even
better than the reward itself.

Therefore, the transition to addiction results from

the ability of drugs to promote this type of
aberrant learning.
Monkey VTA Study (Schultz et al, 1990s)

Monkeys classically-conditioned to
associate light with food
After learning, VTA neurons
increase firing to light instead of
food
Decreased firing if light-cued food
doesnt appear
Baseline DA = expected reward
Increased firing = better than
expected
Reduced firing = worse than
expected
 Problems with Aberrant Learning Models

Most have focused at the level of neuronal systems

Few have provided a psychological step-by-step

account of how aberrant learning could actually
produce addiction.
Are the associations S-S or S-R learning? are they
explicit or implicit?
 Implicit Learning (Tiffany, 1990)

Drug-taking habits are caused by aberrant learning,

because drugs subvert neuronal mechanisms involved
in implicit learning (unconscious S-R or S-S
processes). Urges and cravings are of secondary
importance to force of habit (automaticity).
with sufficient practice, performance on any task
can become automatic and drug-use behavior in
the addict represent one such activity, controlled largely
by automatic processes
Over-learned habits become so automatic that they
essentially become compulsive
 Problems with Automaticity Models

They mistake automatic performance for

motivational compulsion.
Habits (brushing teeth, driving) are not intrinsically
compulsive, no matter how automatic they are
Would you sacrifice your home, your job, your friends
to engage in teeth brushing behavior?

Many aspects of addictive drug pursuit are flexible

and not habitual
 Incentive Sensitization Model
(Robinson and Berridge, 1993)

Addictive drugs produce long-lasting changes in

brain organization
The brain systems that are changed include those
normally involved in the process of incentive
motivation and reward.
Addiction renders these systems hypersensitive
(sensitized) to drugs and drug-associated stimuli
These sensitized systems mediate a component of
reward termed incentive salience or wanting (not
pleasure or liking).
 Incentive Sensitization

Drug-induced sensitization of brain systems (DA) that

mediate incentive-salience causes drugs and drug-
associated stimuli to become compulsively wanted

The activation of the sensitized system can occur both

implicitly or explicitly

These systems can be dissociated from neural systems that

mediate the hedonic effects of drugs (opioids), i.e., how
much they are liked (wanting is not liking).
 Psychomotor Sensitization

Many drugs produce psychomotor-activating

effects
amphetamines, cocaine, opiates, alcohol, nicotine,
MDMA
These effects last from months to years after drug
use is discontinued
Some individuals sensitize readily, whereas others
are more resistant (may explain susceptibility to
addiction)
genes, hormones, stress hormones, past trauma?
stress causes sensitization and may bias addiction
addiction may make an individual hypersensitive to stress
 Incentive-Sensitization Model

Addiction may be triggered by drug cues as a

learned motivational response but it is not a
disorder of aberrant learning per se
It is a disorder of aberrant incentive motivation
due to drug induced sensitization of neural systems
that attribute salience to particular stimuli.
 Cocaine Cues Study (Grant et al, 1996)

PET = Positron Emission Tomography

Radioactive marker injected
Scanner detects light waves from decay
 Cocaine Study continued

Cocaine addicts and

controls shown cocaine
cues and neutral cues

Cocaine cues in addicts

elicited craving, brain
activation

Activation correlated with

craving in Dorsolateral
Prefrontal Cortex,
Amygdala, Cerebellum
 Smoking Stroop Study (Gross et al, 1993)
Congruent Incongruent
Normal Stroop effect:
takes longer to name ink
RED RED
color when incongruent
with word BLUE BLUE
GREEN GREEN
Smoking Neutral
Smoking Stroop: 12-hour
abstinent smokers take MATCH BOARD
longer to name ink color
for smoking words than
neutral words
SMOKE PAINT
PACK BRUSH
 Impairments in Frontocortical Function

May be responsible for irrational behavior of

addicts

Poor decision-making

May exacerbate incentive-sensitization