Psychology of Addiction Lecture Notes PDF

**The Psychology of Addiction** Dependency psychology explores the complex dynamics of addiction in relationships. This presentation examines the differences between habits and addictions, various types of dependencies, and the psychological factors that contribute to addictive behaviors. We\'ll ex...

**The Psychology of Addiction** Dependency psychology explores the complex dynamics of addiction in relationships. This presentation examines the differences between habits and addictions, various types of dependencies, and the psychological factors that contribute to addictive behaviors. We\'ll explore how emotions, brain chemistry, and social connections play crucial roles in the development and treatment of addictions. **Habits vs. Addictions** Habits \- Difficult to change routines \- Not associated with identity loss \- Can be good or bad \- May cause discomfort when broken Addictions \- Associated with loss of identity or self \- Cause significant distress when unavailable \- Always harmful to the individual \- Involve loss of control and denial Key Differences \- Severity of impact on life \- Presence of withdrawal symptoms \- Degree of control over behavior \- Potential for harm Signs of Addiction 1. Discomfort and Withdrawal Experiencing significant distress and physiological reactions like sweating when the addictive substance or behavior is unavailable. 2. Loss of Control Inability to control the addictive behavior despite awareness of potential harm. 3. Continued Use Despite Harm Persisting with the addiction even when it causes clear damage to one\'s life or health. 4. Denial and Concealment Efforts to hide or deny the addiction, often making excuses for symptoms or behaviors. **Types of Addictions** ***Substance Addictions*** Alcohol, drugs, and other chemical dependencies that alter brain chemistry. ***Behavioral Addictions*** Compulsive behaviors like gambling, social media use, shopping, or gaming. ***Relationship Addictions*** Unhealthy dependence on others for emotional regulation or self-worth. ***Unusual Addictions*** Rare compulsions like staring at specific colors or eating non-food items. **Emotions and Addiction** 1. Internal Tension Experiencing emotions like anxiety, impulsivity, loneliness, or anger creates internal tension. 2. External Soothing Unable to self-regulate, individuals seek external sources to alleviate these feelings. 3. Dependency Development Repeated use of external soothing leads to reliance and eventual addiction. 4. Self-Medication The addictive behavior becomes a quick, albeit harmful, solution to emotional discomfort. **Emotion Regulation and Addiction** 1. Regulation Problem Difficulty in managing and regulating emotions effectively. 2. Addiction Cycle Inability to regulate leads to addiction, which further impairs regulation abilities. 3. Treatment Goal Developing skills to manage emotions using internal resources without external dependencies. 4. Skill Building Learning to identify, accept, and cope with emotions like loneliness without relying on addictive behaviors. **Why Addiction Treatment is Challenging** 1. Evolutionary Predisposition We are naturally inclined to repeat behaviors that make us feel good, which can reinforce addictive patterns. 2. Initial Relief Addictive substances or behaviors often provide immediate relief from uncomfortable emotions or situations. 3. Tolerance Development Over time, the brain requires more of the addictive stimulus to achieve the same effect, leading to escalation. 4. Neurochemical Changes Addiction alters brain chemistry, making it difficult to find pleasure in normal activities without the addictive stimulus. **The Paradox of Addiction: Wanting Without Liking** Initial Pleasure At first, the addictive behavior or substance provides enjoyment and relief. Shift in Experience Over time, the pleasure diminishes, but the craving or \"wanting\" remains strong. Compulsive Behavior The individual continues the addictive behavior despite no longer enjoying it, often to avoid withdrawal or discomfort. Neurochemical Explanation This paradox is rooted in changes to the brain\'s reward system, particularly involving dopamine pathways. **The Role of Dopamine in Addiction** 1. Motivation Chemical Dopamine is crucial for motivation and reward-seeking behavior, essential for survival. 2. Reward Anticipation Dopamine levels increase not just with rewards, but with the expectation of rewards. 3. Addiction\'s Impact Addictive behaviors cause unnaturally high dopamine spikes, leading to tolerance and altered reward perception. 4. Pleasure-Seeking Loop The brain becomes wired to seek the addictive stimulus, even when it no longer provides pleasure. **Dopamine Imbalance in Addiction** Overstimulation Excessive dopamine release from addictive behaviors leads to receptor desensitization. Tolerance Development The brain requires more of the addictive stimulus to achieve the same dopamine effect. Anhedonia Normal activities no longer provide satisfaction due to altered dopamine sensitivity. Compulsive Seeking The brain drives behavior to restore dopamine levels, perpetuating the addiction cycle. **The Power of Quick Rewards in Addiction** 1. Rapid Onset Substances or behaviors that quickly produce positive feelings have higher addiction potential. 2. Immediate Gratification The brain naturally prefers fast, intense rewards over delayed gratification. 3. Reinforcement Quick rewards strengthen the neural pathways associated with the addictive behavior. 4. Coping Mechanism Fast-acting rewards become go-to solutions for emotional discomfort, reinforcing dependency. **The Marshmallow Test and Addiction Susceptibility** The Experiment Children were offered one marshmallow now or two if they could wait. This test measured delayed gratification ability. Long-Term Findings Children who couldn\'t resist immediate gratification showed higher rates of addiction, obesity, and lower academic achievement in adulthood. Implications The ability to delay gratification may be a protective factor against addiction and other impulsive behaviors later in life. **Factors Influencing Addiction Susceptibility** **The Rat Park Experiment: Environment\'s Role in Addiction** Isolated Rats When placed alone in cages, rats consistently chose drug-laced water over regular water. Social Environment When placed together, rats showed decreased interest in the drug-laced water. Rat Park In a stimulating environment with social interaction, almost no rats became addicted to the drugs offered. Implications The experiment suggests that environment and social connections play crucial roles in addiction susceptibility and recovery. **Reasons for Drug Use (Part 1 )** 1\. Coping Mechanism Some individuals use drugs to cope with stress, anxiety, or other negative emotions. This can lead to a temporary escape from unpleasant feelings. 2\. Emotional Regulation Drugs can alter mood and emotional states. Individuals may use substances to enhance positive emotions or to numb negative ones. 3\. Physical Changes Drugs can impact physical functions like appetite, sleep patterns, and energy levels. Individuals may use substances to alter these bodily processes. 4\. Boredom and Depression Drugs can provide a temporary distraction from boredom or feelings of depression. Individuals may turn to substances to fill a void in their lives. **Reasons for Drug Use (Part 2)** Social Reasons Drugs are often used as a symbol of rebellion against societal norms. Individuals may use drugs to fit in with peers, enhance social interactions, or achieve a sense of belonging. Some drugs are associated with specific social activities, such as sports or nightlife. Psychological Reasons Drugs can be used to manage stress, anxiety, or depression. They can temporarily alleviate emotional pain, reduce inhibitions, or provide a sense of euphoria. Some people use drugs to escape from difficult realities or to cope with trauma. **Substance Abuse / Misuse** Health Problems Drug misuse can lead to various health issues, including addiction, organ damage, and mental health complications. Work Issues Drug use can affect job performance, attendance, and even lead to job loss. Relationship Problems Drug abuse can strain relationships with family, friends, and partners. Legal Consequences Drug use can result in legal charges, arrests, and potential incarceration. Substance abuse, also known as drug misuse, occurs when someone uses a drug in a way that\'s not intended or prescribed. This can involve taking a drug more frequently or in larger quantities than recommended, or using it for reasons other than its intended purpose. **Substance Abuse / Misuse** Improper Combination Combining drugs can lead to dangerous and even deadly side effects. For example, mixing alcohol with tranquilizers can suppress the nervous system, potentially causing respiratory failure. No Addiction Needed Substance use can become problematic even if you\'re not addicted or an alcoholic. Engaging in substance use in ways that cause harm to yourself or others can be considered misuse. **Withdrawal Process** Symptoms Appear When drug use is stopped, psychological or physiological symptoms, known as withdrawal symptoms, manifest. These symptoms vary depending on the drug and individual. Relief or Avoidance To alleviate or avoid withdrawal symptoms, individuals may turn to using a closely related substance, even if it\'s not the original drug. Cycle of Dependence The withdrawal process is a vicious cycle. Drug use initially offers relief, but the body quickly builds a tolerance, leading to a need for increased doses and a heightened risk of withdrawal. **Craving** Intense Urge Craving is a powerful drive to use a substance. It is a common experience among those with substance dependence. Overcoming Cravings Cravings can be intense, but they are not insurmountable. It\'s important to remember that it\'s possible to get past them and regain control. Seeking Help If you are struggling with cravings, seeking support from a healthcare professional can help you manage them and find ways to cope. **DSM IV - Substance Dependence Criteria (Part 1)** Tolerance Tolerance occurs when a person needs more of a substance to achieve the desired effect or experiences a diminished effect with continued use of the same amount. Withdrawal Withdrawal symptoms occur when a person stops using a substance, and these symptoms can be physical or psychological. Amount/Duration Substance dependence is characterized by using the substance in larger amounts or for a longer period than intended. **DSM IV - Substance Dependence Criteria (Part 2)** Time A significant amount of time is spent obtaining, using, or recovering from the effects of the substance. Activities / Commitments Important social, occupational, or recreational activities are given up due to substance use. Negative Consequences Substance use continues despite persistent or recurrent physical or psychological problems caused by it. **Practical Definition of Addiction** Control Individuals with substance dependence often struggle to cut back or control their use. They may experience periods of abstinence, followed by episodes of uncontrolled use. Compulsion There is a compelling urge to use the substance. This urge can be driven by tolerance, withdrawal symptoms, or psychological dependence, creating a sense of need. Consequences Substance use persists despite significant negative consequences, such as health problems, relationship issues, or legal trouble. The individual continues to use even when the harm outweighs the benefits. **Substance Use Disorders**  **Trends in Annual Prevalence Use** The image displays the annual prevalence of drug use for 2002-2020. While the prevalence of illicit drug use has steadily increased, the prevalence of alcohol and tobacco use has decreased. The prevalence of marijuana use has fluctuated over the years, but it has remained relatively stable. The graph shows trends in drug use, but not the full extent of use. metin, ekran görüntüsü, diyagram, çizgi içeren bir resim Açıklama otomatik olarak oluşturuldu **Age of Onset** 1\. Normative Behavior A certain amount of substance use during adolescence is considered typical. 2\. Critical Risk Factor The age of first use is a significant risk factor for developing substance use disorders. 3\. Delayed Onset For every year that the onset of drinking is delayed, the odds of developing alcohol dependence decrease by 9%. 4\. Early Use Alcohol use before age 14 strongly predicts subsequent alcohol abuse or dependence. **Why Adolescents?** Adolescence is a time of significant risk for the development of substance use disorders. This is because adolescents are going through many changes, including hormonal shifts, social pressures, and increased independence. These changes can make them more vulnerable to experimentation with substances. The National Institute on Drug Abuse estimates that about 1 in 10 teens have misused prescription drugs. Adolescents are more likely to develop substance use disorders due to their developmental stage. They are more susceptible to peer pressure and social influences, making them more vulnerable to experimentation and abuse. Adolescents are still developing their brains and decision-making abilities, which makes them more prone to impulsive behaviors and risky choices, including substance use. **Course of Substance Use** Typical Pattern Substance use peaks around late adolescence and declines during young adulthood. Influence on Behavior Alcohol use often leads to engagement in other high-risk behaviors, including unsafe sexual activity, smoking, and driving under the influence. Dating Aggression Girls who experience dating aggression are more likely to use alcohol compared to those in non-violent relationships. **Risk Factors - Personal Factors** Lack of Attachment A lack of attachment to healthy adults or mainstream culture can increase susceptibility to drug use. Genetics & Biology Genetic predisposition, biological factors, and the effects of drugs themselves can influence drug use. Personal Characteristics Individuals with high vulnerability to anxiety or depression, impulsivity, or other personal characteristics may be more likely to engage in drug use. Health & Mental Illness Preexisting health conditions or mental illness can contribute to the development of drug use disorders. **Risk Factors - External Factors** *Social Environment* Peers who use drugs can exert a strong influence, normalizing drug use and making it more accessible. Exposure to drug-related content in media can create a false sense of normalcy and glamorize drug use. *Family Dynamics* Family history of substance abuse increases an individual\'s risk due to genetic and environmental factors. Lack of parental supervision and communication creates opportunities for drug experimentation and can contribute to substance abuse. **Functions of Addiction** Role and Identity Addiction provides a sense of belonging and social connection. It can define a person\'s identity and social circles. Escaping the Past Addiction can be a way to cope with traumatic experiences or painful memories. It provides temporary relief and distraction. Avoiding Responsibility Addiction can allow individuals to escape obligations and avoid facing challenging situations. It can be a way to numb emotional pain. Withdrawal from Intimacy Addiction can be a defense mechanism against emotional vulnerability and intimacy. It creates a barrier to close relationships. **Addiction to Other Experiences** Sex Sex addiction is a compulsive sexual behaviour that can lead to serious consequences, such as relationship problems, financial difficulties, and legal trouble. Gambling Gambling addiction is characterized by an uncontrollable urge to gamble despite negative consequences, such as financial ruin, relationship problems, and legal trouble. Exercise Exercise addiction is a disorder characterized by an obsessive compulsion to exercise, often to the detriment of one\'s physical and mental health. Pornography Pornography addiction is a compulsive use of pornography that can lead to problems in relationships, work, and social life. **The Process of Dependency** The process of substance dependency is often gradual and can vary depending on several factors, including the substance used, individual vulnerabilities, and environmental influences. While some individuals may experience a rapid progression to dependence, others may develop it over time, starting with occasional use that evolves into regular use and eventually becomes dependent. **Non-Users** Personal Choice Some individuals decide to abstain from substance use for personal health, social, or family reasons. This reflects an intentional decision to prioritize well-being and avoid potential risks associated with drug use. Religious and Cultural Beliefs Membership in certain religious or cultural groups may strongly discourage or prohibit substance use. These beliefs and values often influence personal choices regarding drug use. Negative Experiences Individuals who have witnessed the negative consequences of long-term substance abuse or addiction may choose to abstain from drug use altogether. This reflects a desire to avoid similar experiences. Unpleasant or Dangerous Some individuals may find substance use unpleasant or dangerous, leading them to abstain. This decision might be based on personal experiences, observations, or a desire to avoid potential harm. **Experimental Use** Definition Experimental use refers to the initial attempts of trying alcohol or other drugs. Contributing Factors Willingness to try Friends or acquaintances using drugs Sense of safety about the drug and setting **Experimental Use** *Social Setting* Experimentation often occurs in social settings, where individuals are trying new experiences. *Internal Exploration* Experimental use can involve exploring personal motivations and examining the effects of a substance on one\'s psyche. *Evaluating Preferences* After experimentation, individuals analyze their experiences and decide whether the substance aligns with their desires. *Returning to Non- Use* If experimentation does not yield positive results, individuals often revert to a non-use pattern. **Risks of Experimental Use** Dosage Misjudgment Experimenters may take too much due to inexperience. They may not know how much their body can handle. Unforeseen Reactions The consequences of drug use are often unpredictable. This is especially true for first-time users. Unknown Substances Street drugs are often adulterated or contaminated, increasing the risk of adverse reactions. Potential Overdose Binge use, a common pattern among teenagers, increases the risk of overdose. **Social Use** Social Setting Using a substance in a social context, but not the main reason for the gathering. No Priority Using doesn\'t override other activities and experiences. No Negative Impacts Substance use doesn\'t harm any aspect of one\'s life. **Instrumental Use** Pleasure Seeking Individuals may use substances to experience euphoria, altered states of consciousness, and reduced inhibitions. Avoiding Pain Substances can be used to suppress negative emotions, such as sadness, anxiety, or anger. Physical Discomfort People may use substances to alleviate physical discomfort, such as pain or fatigue. **Habitual Use** Regular Substance Use Habitual use involves frequent substance consumption, often becoming a routine behavior. Potential Problem Areas Habitual use may lead to problems in relationships, work/school, health, finances, or legal status. Narrowed Social Circle Social life often shrinks to include only other users and social functions centered around substance use. Choice Remains At this stage, individuals are not considered dependent and still have some control over their substance use. **Compulsive Use (Part 1)** Overwhelming Need Individuals with compulsive use experience an intense physical and psychological need to use the substance. They are driven by uncontrollable urges to seek out and consume the drug, regardless of negative consequences. Physical Dependence Physical dependence is a state where the body adapts to the substance, requiring increasing doses to achieve the desired effect. This is known as tolerance. **Compulsive Use (Part 1)** Psychological Dependence An all-consuming focus on the drug, including getting it, getting high, coming down, and finding more. This is due to changes in brain chemistry. Lack of Control The individual experiences no choice about using and feels no control over the amount consumed, despite the negative consequences. **Binge Use** Refers to heavy drinking or drugging on a sporadic basis, with periods of little or no use in between. 1\. Key Concept Binge use can be as problematic as regular use. The unpredictable nature of binge use can create a destructive set of stressors for those involved in the user\'s life. 2\. Potential Consequences Binge drinking is often associated with higher levels of hostility and aggression, police altercations, domestic violence, work problems, and hospital admissions, in comparison to heavy, steady users. 3\. Key Concept Binge use can be as problematic as regular use. The unpredictable nature of binge use can create a destructive set of stressors for those involved in the user\'s life. 4\. Potential Consequences Binge drinking is often associated with higher levels of hostility and aggression, police altercations, domestic violence, work problems, and hospital admissions, in comparison to heavy, steady users. **The Importance of Social Support in Addiction Prevention** Social Connections Having a strong support network and trustworthy relationships reduces addiction risk. Fulfillment and Creativity Engaging in meaningful activities and creative pursuits can provide natural rewards, reducing the need for addictive behaviors. Higher Pleasures Developing interests in art, philosophy, or spirituality can provide fulfillment beyond basic sensory pleasures. Avoiding Isolation Combating loneliness and social isolation is crucial in preventing and recovering from addiction. **Introduction to Addiction Theories** Addiction is a complex condition involving compulsive engagement in a rewarding activity, despite negative consequences. Many theories attempt to explain the nature of addiction, from biological and psychological to social and cultural perspectives. **The Disease Model of Addiction** 1\. Chronic and Relapsing Addiction is viewed as a chronic disease, characterized by periods of relapse. 2\. Brain Changes Addiction alters brain structure and function, leading to compulsive drug-seeking behavior. 3\. Genetic Predisposition Individuals may have a genetic vulnerability to developing addiction, though environmental factors are crucial. 4.Treatment Focus Treatment aims to manage addiction symptoms and prevent relapse through therapies and support. **The Moral Model of Addiction** Blame and Responsibility The moral model views addiction as a character flaw. It emphasizes personal responsibility for the individual's choices. It suggests that individuals lack willpower or moral compass. Judgment and Stigma The moral model often leads to judgment and stigmatization of individuals struggling with addiction. This can create shame and discourage them from seeking help. **The Biopsychosocial Model of Addiction** Biological Factors Genetics, brain chemistry, and physiological responses all play a role in susceptibility and addiction development. Psychological Factors Mental health conditions, personality traits, coping mechanisms, and stress levels can contribute to addiction. Social Factors Social environment, cultural influences, peer pressure, and availability of substances can influence addiction risk. **The Neurobiological Model of Addiction** 1\. Brain Regions and Pathways This model focuses on how drugs alter brain chemistry and neural pathways, particularly those involved in reward, motivation, and decision-making. 2\. Neurotransmitters and Their Roles Neurotransmitters, such as dopamine, are key players in addiction, influencing feelings of pleasure, motivation, and craving. 3\. Changes in Brain Function Addiction leads to changes in brain function, including decreased sensitivity to rewards, increased craving, and altered decision-making processes. **The Cognitive-Behavioral Model of Addiction** 1. Thoughts and Behaviors This model emphasizes the role of thoughts, feelings, and behaviors in addiction. It suggests that addiction is a learned pattern of behavior. 2. Reinforcement Addictive behaviors are often reinforced by positive or negative reinforcement, leading to a cycle of dependence. 3. Cognitive Distortions Cognitive distortions, such as denial or minimization, can contribute to the maintenance of addiction. 4. Cognitive Restructuring This model focuses on changing negative thoughts and behaviors through therapy, skills training, and coping mechanisms. **The Psychoanalytic Model of Addiction** 1. Early Experiences Early childhood experiences and trauma may contribute to addiction by shaping one's emotional regulation and coping mechanisms. 2. Unconscious Conflicts Addiction is viewed as a way to manage unconscious conflicts, relieve anxiety, or fill a void stemming from unresolved psychological issues. 3. Defense Mechanisms Addiction can be a defense mechanism against painful emotions or to avoid facing challenging situations. 4. Object Relations Addiction can be a way to attempt to meet unmet needs or to recreate problematic relationships from the past. **The Social Learning Theory of Addiction** Observational Learning This theory emphasizes the role of observing and imitating behaviors of others, particularly those with whom individuals identify. People learn addictive behaviors by witnessing others engaging in them. Modeling and Reinforcement The theory suggests that individuals are more likely to engage in addictive behaviors if they see others being rewarded or reinforced for such behaviors. Social Norms and Context Social norms and cultural contexts play a significant role in shaping an individual's perception of addictive behaviors, making them more or less acceptable. Social Support and Networks Social support networks can either encourage or discourage addictive behaviors. Strong support systems can help individuals resist addiction, while weak ones can increase vulnerability. **The Ecological Model of Addiction** Multiple Factors This model views addiction as a result of interactions between individual, family, community, and societal factors. Social Determinants Factors like poverty, access to healthcare, and social support networks significantly influence addiction risk. Systems Approach The Ecological Model emphasizes the importance of addressing addiction through a systems approach, involving multiple stakeholders. **The Stages of Change Model** 1\. Precontemplation Individuals in this stage are unaware of their addiction problem or are unwilling to change. 2\. Contemplation People in this stage are aware of their addiction and are considering change but are not yet ready to commit. 3\. Preparation Individuals in this stage are preparing to make a change and are starting to take steps to get ready for it. 4\. Action People in this stage are actively working on making changes in their behavior and lifestyle. 5\. Maintenance Individuals in this stage are maintaining their changes and working to prevent relapse. **The Harm Reduction Approach** Focus on Minimizing Harm Harm reduction aims to minimize the negative consequences associated with substance use. It acknowledges that complete abstinence is not always achievable for everyone. Pragmatic and Realistic This approach recognizes the realities of substance use and seeks to reduce risks and improve the lives of individuals who use drugs or alcohol. **The Abstinence-Based Approach** 1\. Complete Abstinence This approach emphasizes total avoidance of the substance or behavior that is causing addiction. 2\. Focus on Self-Control Individuals strive to develop willpower and resist temptations to engage in the addictive behavior. 3\. Support Groups Individuals often rely on support groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) to provide encouragement and accountability. 4\. Therapy Therapy can help individuals address underlying issues that contribute to addiction, such as trauma or mental health conditions. **The Medication-Assisted Treatment Approach** 1\. Integration of Medication This approach combines behavioral therapies with medications to address the physical and psychological aspects of addiction. Medications can reduce cravings and withdrawal symptoms, making it easier for individuals to engage in therapy and sustain recovery. 2\. Evidence-Based Treatment Medication-assisted treatment is supported by extensive research and has proven effective in helping individuals manage their addiction and achieve long-term recovery. 3\. Types of Medications Commonly used medications include methadone, buprenorphine, and naltrexone, each tailored to specific substances and individual needs. 4\. Holistic Approach While medication plays a crucial role, this approach emphasizes a comprehensive treatment plan that includes individual and group therapy, counseling, and support services. **The Holistic Approach to Addiction** Mind-Body Connection The holistic approach emphasizes the interconnectedness of physical, mental, and spiritual well-being in addiction recovery. Community Support Holistic programs often incorporate support groups, therapy, and alternative therapies to foster personal growth and well-being. Mindfulness and Self-Care Holistic approaches encourage mindfulness practices, stress management, and healthy lifestyle habits to support long-term recovery. Spiritual Growth Some holistic programs incorporate spiritual practices such as meditation, yoga, or art therapy to promote inner peace and purpose. **Conclusion and Key Takeaways** Understanding Addiction: Addiction is complex, involving biological, psychological, and social factors. Multiple Models: Various theories offer insights into addiction's causes and effects. Treatment Options: Effective treatment options exist, tailored to individual needs. Hope and Recovery: Recovery is possible with support, commitment, and personalized treatment. **Introduction to Liking and Wanting Theory** Liking and wanting theory is a prominent framework in the field of addiction. It delves into the distinction between the pleasurable experience of a substance and the motivational drive to obtain it. The theory posits that these two processes are distinct and can be influenced by various factors. **Defining Liking and Wanting** Liking Liking refers to the pleasurable experience associated with a stimulus or reward. It's the subjective feeling of enjoyment or satisfaction. Wanting Wanting, on the other hand, refers to the motivational drive or desire for a stimulus or reward. It's the urge or craving for something. Distinct Concepts Liking and wanting are distinct but interconnected concepts. They are both involved in the experience of pleasure and reward, but they operate through different neurobiological mechanisms. **The Neurobiology of Liking and Wanting** Liking and wanting are distinct processes involving different brain regions and neurochemicals. Liking, or hedonic pleasure, is associated with the activation of the ventral tegmental area (VTA) and nucleus accumbens (NAc) and the release of opioids and endocannabinoids. Wanting, or motivation, is driven by the mesolimbic dopamine system, which projects from the VTA to the NAc. Dopamine release in the NAc is associated with reward anticipation and seeking behaviors. **Hedonic Regulation Theory of Addiction** Hedonic regulation theory explains how people try to maintain a pleasurable state. 1\. Disruption Addiction disrupts this balance. 2\. Allostasis The body adapts to maintain a state of equilibrium. 3\. Homeostasis Natural balance of pleasure and discomfort. 4\. Withdrawal Creates a negative state, driving craving. This theory explains why individuals engage in compulsive substance use even when experiencing negative consequences. They are driven to restore their hedonic balance by seeking the pleasure associated with the drug, despite the harm it may cause. **The Role of Dopamine in Addiction** Dopamine is a neurotransmitter that plays a crucial role in the reward system of the brain. In addiction, dopamine release is heightened in response to drug use, creating a powerful reinforcing effect that drives cravings and compulsive drug-seeking behaviors. Repeated exposure to drugs leads to changes in the brain's dopamine system, including a decrease in dopamine receptors and altered signaling pathways. These changes contribute to the development of tolerance, withdrawal, and the persistent craving for drugs even after cessation of use. **Incentive Salience and Craving** Incentive Salience The brain assigns motivational value to drug-related cues and stimuli. This makes the drug a more desirable and appealing option. Craving This strong desire for the drug can be triggered by various factors, including drug-related cues, stress, and social situations. Time Course Craving often increases with the passage of time since last drug use, and this can be a major factor in relapse. **Tolerance and Withdrawal in Addiction** Tolerance and withdrawal are two key features of addiction. Tolerance refers to the decreasing effectiveness of a substance with repeated use. This means an individual needs to consume increasingly larger amounts to achieve the desired effect. Withdrawal refers to the unpleasant physical and psychological symptoms that occur when a person abruptly stops using a substance. 1\. Increased Tolerance Body adapts to substance. 2\. Withdrawal Symptoms Physical and mental discomfort. 3\. Compulsive Use To avoid withdrawal. Withdrawal symptoms can be severe and can drive individuals to continue using the substance to avoid them. The cycle of tolerance and withdrawal can contribute to the compulsive use and difficulty stopping substance use. **Compulsive Behaviors and Addiction** Loss of Control People with addiction struggle to control their substance use or behavior. They may engage in these activities despite negative consequences, such as job loss, relationship problems, or health issues. Craving Intense urges to use the substance or engage in the behavior, even when trying to abstain. **Cognitive Biases and Addiction** Cognitive biases are systematic errors in thinking that can influence our judgments and decisions. People with addiction often have cognitive biases that contribute to their substance use. For example, they may overestimate the positive effects of drugs and underestimate the negative consequences. They may also have difficulty resisting cravings and impulsively seek out drugs. **Environmental Cues and Relapse** Environmental cues can trigger cravings and relapse in individuals with addiction. These cues can be places, people, objects, or even smells associated with past drug use. Exposure to these cues can activate brain reward pathways, leading to a surge of dopamine and a desire to use drugs again. This can be a powerful trigger, even for individuals who have been in recovery for a long time. **Implications for Treatment Approaches** 1\. Targeting Wanting Treatments can focus on reducing cravings and cues that trigger wanting. Medications like naltrexone or acamprosate can decrease dopamine release and reduce wanting. 2\. Enhancing Liking Therapies can aim to increase the rewarding experiences of healthy alternatives, promoting a shift in preference away from addictive substances. 3\. Cognitive Behavioral Therapy (CBT) CBT helps individuals identify and challenge negative thoughts and behaviors associated with addiction. It promotes coping skills and relapse prevention strategies. 4\. Contingency Management This approach involves providing rewards for abstinence or desired behaviors, reinforcing positive choices and reducing the likelihood of relapse. **Dual Process Theory of Addiction** 1\. Impulsive System This system is driven by immediate rewards and gratification, often overriding long-term goals. It can lead to impulsive behaviors and cravings. 2\. Reflective System This system is more deliberate and thoughtful, weighing consequences and making decisions based on long-term goals. It helps regulate impulses and guide behavior towards healthy choices. 3\. Addiction as Conflict Addiction is seen as a conflict between the impulsive and reflective systems. The impulsive system drives craving, while the reflective system attempts to control it. **Allostatic Model of Addiction** The allostatic model of addiction proposes that repeated drug use leads to changes in the brain's stress response system, creating a state of dysregulation and an imbalance in the body's internal systems. This results in a chronic state of stress, characterized by increased levels of cortisol and other hormones that contribute to cravings and relapse. The model highlights the interplay between the brain's reward system, stress response system, and the body's physiological responses to drug use. This complex interplay contributes to the development of addiction and the difficulties associated with quitting.  Opponent Process Theory of Addiction Opponent Process Theory This theory suggests that repeated exposure to an addictive substance elicits a primary, pleasurable response and a secondary, aversive response. Withdrawal Symptoms The aversive response, or withdrawal symptoms, intensifies with repeated use and can become a major motivator for continued drug seeking. Opponent Process Over Time As addiction progresses, the pleasure-seeking response weakens, and the withdrawal response intensifies, making it increasingly difficult to abstain. **Conclusion and Future Directions** Understanding addiction is crucial for developing effective treatment strategies. The theories explored provide valuable insights into the complex nature of addiction. Future research should focus on integrating these theories to create a more comprehensive understanding of addiction. Further investigation into the role of genetics, epigenetics, and environmental factors is warranted. Developing personalized treatment approaches that address individual vulnerabilities and strengths is essential for improving outcomes. **The Brain Science of Addiction** What is addiction? Physiologic dependence and withdrawal avoidance do not explain addiction. The neurobiology of addiction attempts to explain how drug-seeking behaviors become consolidated into compulsive use: Long persistence of relapse risk Drug-associated cues controlling behavior American Society of Addiction Medicine (ASAM) Public Policy Statement: Short Definition of Addiction Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations, resulting in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. American Society of Addiction Medicine (ASAM) Public Policy Statement: Short Definition of Addiction Addiction is characterized by the inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one's behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can lead to disability or premature death. Why do some people become addicted to alcohol and drugs, while others don't? Vulnerability to addiction varies among individuals, as with any other health condition. Certain risk factors make addiction more likely. The Science of Addiction Evidence shows that the brains of some individuals are more vulnerable to alcohol and drug effects. Factors contributing to this vulnerability include: Genetics (which may account for up to 60% of vulnerability to addiction) Early developmental influences and environmental factors Effects of stressful life events across a person's life Mental disorders such as depression or anxiety The Brain and Addiction The brain controls both our behavior and mind. Neuroscience studies how people control behaviors, thoughts, and feelings and how these actions can sometimes spiral out of control. Neuroscience is providing new insights into the science of addiction. The Human Brain The human brain consists of several regions, each responsible for different essential functions: brainstem, cerebellum, limbic system, diencephalon, and cerebral cortex. Specific brain areas control functions such as seeing, hearing, and regulating emotions and motivations. The limbic system is the brain area responsible for regulating emotions, using memories, body information, and sensory input to generate emotional responses. The Brain's Limbic System The limbic system is involved in many emotions and motivations, especially survival-related emotions like fear and anger. It also regulates feelings of pleasure, such as those associated with eating and sex, which are part of the brain's "reward system." Drugs of abuse activate this reward system. Within this system, drugs increase dopamine levels, likely accounting for the rewarding effects. However, at some point, a given drug amount reaches a plateau in effectiveness, requiring a higher dose or quicker intake method to achieve the same effect. Addiction and the Brain's Reward System Disruption of the reward system is only part of the reason drug addictions are challenging to overcome, and relapses can occur even after years of abstinence. Neuroscientists discovered that drugs also alter brain circuits related to learning and memory, forming strong associations between the drug's pleasure and the conditions in which it was used. Memories appear to be a critical part of addiction: The amygdala is a part of the brain's limbic system which is critical for memory and responsible for evoking emotions. For someone with addiction, when a drug craving occurs, the amygdala becomes active and a craving is triggered. PET scans show that, in someone with a history of addiction, when presented with pictures of the drug or paraphenalia, the amygdala becomes very active. This craving demands the drug immediately. Rational thoughts are dismissed. A basic change has occurred in the brain. Addiction is a brain disease! So what about the behavioral effects? It seems natural to expect that, when individuals have experienced major problems due to drugs, they can just "wake up" and quit using. However, the areas of the brain that do self-reflection, assessment, planning, and careful listening to feedback are the areas most damaged by the substance use. The drug use impairs the part of the brain necessary to invent solutions to problems, both short term and in the longer term. Thus, the very thing that we are asking the individual to do is the one thing they will have the greatest difficulty doing. Reward Pathway There is a part of the brain called the "reward pathway." This pathway operates when you do things that make you feel good. Whenever you do something that feels good, you release the neurotransmitter dopamine. And when we feel good, we are more interested in doing that same event over again. This pathway was developed evolutionarily to help us pursue activities that would help us survive. Drugs like to take control of your reward pathway so you no longer have control over it. For example, when when a drug is used, it causes dopamine to be released. That is why people might initially feel good after using a drug. However, the brain continues to crave the dopamine release afterward and the user slowly lose control over their choice to use drugs. Reward Pathway Over time, drug use will cause the body to adapt, reducing the body's response to the drug. Eventually, the person using the drug will start craving more of the drug to feel the same high or even just to feel normal. This is referred to as an increase in tolerance. If the person using the drug stops using the drug they will experience negative side effects known as withdrawal symptoms. The combination of increased tolerance and withdrawal symptoms causes the drug user to crave the drug and avoid withdrawals at all cost. The brain experiences physical changes as a result of the drug use and gets rewired to prioritize getting more of the drug, even if it causes physical, emotional, and financial harm. Tolerance withdrawal VİDEO https://youtu.be/VI4KZWtROt0 Although addictive drugs are pharmacologically diverse... Stimulants (act as a serotonin-norepinephrine-dopamine reuptake inhibitors): Cocaine, amphetamines, MDMA Opioids (agonist action): Heroin, morphine, oxycodone, fentanyl GABAergic agonists/modulators: Alcohol, benzodiazepines, barbiturates Cannabis (binds cannabinoid receptors)...they all lead to a common pathway All addictive drugs pharmacologically release dopamine in the nucleus accumbens. The dopamine system The Dopamine Reward Pathway How Dopamine leads to behavior change Dopamine is required for natural stimuli (food, opportunity for mating, etc.) to be rewarding and drive behavior. Natural rewards and addictive drugs both cause dopamine release in the Nucleus Accumbens. Addictive drugs mimic the effects of natural rewards and thus shape behavior. The Dopamine Reward Pathway How Dopamine leads to behavior change Survival demands that organisms find and obtain needed resources (food, shelter) and opportunities for mating despite risks---survival-relevant goals. These goals have natural "rewards" (eating, safety, sex). Behaviors with rewarding goals persist to a conclusion and increase over time as they are positively reinforcing. The Dopamine Reward Pathway How Dopamine leads to behavior change Internal states (like hunger) increase the value of goal-related cues and increase the pleasure of consumption, raising the likelihood that a complex behavioral sequence (such as hunting) will be successfully concluded. The Dopamine Reward Pathway How Dopamine leads to behavior change Behavioral sequences involved in obtaining a reward (like the steps required to hunt) become overlearned and automatized. Automatized behavioral repertoires can be activated by cues predictive of the reward. Prediction Error Hypothesis Exposure to an unexpected reward causes transient firing of dopamine neurons, signaling the brain to learn a cue. Once the cue is learned, a burst of firing occurs at the cue, not at the reward. If the reward does not arrive, dopamine firing decreases below baseline levels---this serves as an error signal about reward predictions. If the reward comes at an unexpected time, dopamine firing increases---positive predictive error signal: "better than expected!" Dopamine Gating Hypothesis Because drugs cause dopamine release due to their pharmacological actions, dopamine firing upon use does not decay over time. The brain repeatedly receives a positive predictive error signal: "better than expected!" Drug cues become ubiquitous and difficult to extinguish. Cues predicting drug availability take on enormous incentive salience, consolidating drug-seeking behavior. Drug cues become powerfully overweighted compared to other choices, contributing to the loss of control over drug use. Cue Learning Glutamate is another excitatory neurotransmitter involved in cue learning: Specific information about cues Evaluation of cue significance Learned motor responses Enhances dopamine-dependent learning Source: Am J Psychiatry 2005;162:1414-1422 Measuring Pleasure Drugs boost normal brain levels of the neurotransmitter dopamine, producing feelings of pleasure and increasing energy. Drugs cause an excessive spike in dopamine, which scientists say contributes to the drug's destruction of the brain. Activity Dopamine Release Index Dopamine Index Cheeseburger 1.5 Sex 2.0 Nicotine 2.0 Cocaine 4.1 Methamphetamine 11.0 Drug Use and Addiction Brain imaging studies show physical changes in brain areas critical for: Judgment Decision making Learning and memory Behavior control These changes alter brain function and help explain compulsive use despite negative consequences. Effects of Cocaine on the Brain PET scans show how cocaine interferes with the brain's glucose metabolism. The left scan is taken from a person who is not using cocaine. The red color shows the highest level of glucose utilization (yellow represents less utilization and blue shows the least). The right scan is taken from a person using cocaine. It shows that the brain cannot use glucose nearly as effectively. Note that there is less red than in the scan on the left, indicating less glucose utilization. There are many areas of the brain that have reduced metabolic activity. The continued reduction in the neurons\' ability to use glucose (energy) results in disruption of many brain functions Dopamine and Substance Use Dopamine: A neurotransmitter released during pleasurable experiences Connected to the brain's reward circuit Reinforces pleasurable behaviors Leads to neural changes that help form habits Released during substance use, reinforcing the connection between the substance and pleasure Trains the brain to repeat the pleasurable experience (craving?) Dopamine Receptors in Addiction  By altering neurotransmission, drugs produce effects that make people want to use them repeatedly, leading to long-lasting health problems. PET images show that repeated exposure to drugs depletes dopamine receptors in the brain, essential for experiencing pleasure and reward. These brain changes make it harder for people to stop using drugs. Effects of Meth on the Brain (National Institute on Drug Abuse, 2013) Though a substance use disorder is a chronic, relapsing brain disease, there is hope. These images show the brain's potential to recover after prolonged abstinence from drugs---in this case, methamphetamine. Brain Disease Model of Addiction  Functional recovery of the methamphetamine-addicted brain. Imaging of dopamine transporter function by positron emission tomography. How drugs change the brain? https://www.youtube.com/watch?v=5f1nmqiHIII How Do Drugs Change Brain Function? Drugs alter normal brain chemistry. Neurotransmitters in the brain and body allow cells to communicate. Neurotransmitters and Neurotransmission: Chemicals released by one neuron onto another to produce an excitatory or inhibitory effect Excitatory or inhibitory effects depend on receptors on the second neuron Examples include dopamine, serotonin, and endorphins  Neurotransmitters Biologically, alcohol and other drugs interfere with or alter neurotransmitters that allow neurons to communicate, control body functions, react, and shape experiences. These changes occur in the "primitive" brain (survival section). The four major neurons involved in addiction are: 1\. Dopamine -- responsible for pleasure and reward 2\. Serotonin -- responsible for mood, sleep, appetite, perceptions 3\. GABA -- responsible for calming, sedation, anti-anxiety 4\. Endorphins -- responsible for pain 5\. Glutamate -- excitatory chemical involved in withdrawal Neurotransmitters and Neurotransmission  The availability of neurotransmitters at the synapse must be carefully regulated. Drugs Alter Normal Neurotransmission Levodopa Methamphetamine Naltrexone (and Naloxone) Chronic Drug Use Results in Neuroadaptation The brain attempts to normalize function in the continued presence of a drug, forming the basis for tolerance, sensitization, and dependence: Tolerance: Reduced brain response following repeated drug exposure Sensitization: Enhanced brain response following repeated drug exposure Dependence: Altered brain function upon stopping drug use, often producing effects opposite of the drug's initial impact  Explaining Substance Use A drug user may initially like the drug effects. However, after repeated use, drug tolerance and withdrawal symptoms may develop, leading to dependence. At this point, the user may want the drug even though they no longer like it, resulting in compulsive drug use. Even after months of abstinence, a user may still relapse. The field of **Addiction Neuroscience** seeks to explain the neurobiological basis of these phenomena. Major Theories Driving Addiction Neuroscience Research Wanting-and-Liking Theory (Robinson and Berridge, 2008) Hedonic Homeostatic Dysregulation (Koob and Le Moal, 1997) Wanting-and-Liking Theory Incentive-Sensitization Theory (Robinson and Berridge, 2008) Both wanting (craving) and liking (pleasure) of the drug change with repeated use. Wanting: Increases with repeated drug use (craving increases) Striatal dopamine systems Liking: Tolerance develops with repeated drug use (pleasure decreases) Brainstem opioid systems Wanting-and-Liking Theory Liking (the high) does not change or may even undergo tolerance. Wanting (craving) undergoes sensitization, or increases. Also known as 'incentive salience.' Contemporary Wanting-and-Liking Theory Decision to take a drug -- frontal cortical glutamate systems Pleasure (liking) associated with early drug use -- brainstem opioid systems-Tolerance develops over repeated use Craving (wanting) associated with chronic drug use -- ventral striatal dopamine systems-Sensitization develops over repeated use Voluntary control of drug-taking gives way to unconscious processes -- habit or compulsion- Dorsal striatal dopamine systems Hedonic Homeostatic Dysregulation Allostasis (Koob and Le Moal, 1997) Allostasis vs. Homeostasis Homeostasis: The ability of a biological system to maintain dynamic internal equilibrium in response to external/internal changes, maintaining around a set-point. Allostasis: Biological response when changes are too large for homeostasis to manage, creating a new set-point. Mood undergoes allostatic changes with repeated drug exposure  Hedonic Homeostatic Dysregulation Allostasis results in spiraling distress as the individual cycles through stages of drug use, creating new mood set-points: Preoccupation/Anticipation Binge/Intoxication Withdrawal/Negative Affect  Hedonic Homeostatic Dysregulation Key brain structures undergo neuroadaptation as the individual cycles through Preoccupation/Anticipation, Binge/Intoxication, and Withdrawal/Negative Affect stages. Necessary for Allostasis, setting new set-points. Addiction Neuroscience Research: Challenges Studies in human populations History of past drug use (exposure) is difficult to know. Variables like dose, frequency, age at first use, and poly-drug use impact research. Extent of any drug tolerance/sensitization. Ethical barriers limit the extent of experimental drug exposure and manipulation of brain function. Studies using animal models Animal models do not replicate all aspects of Substance Use Disorder (as defined in DSM-V): 1\. Hazardous use 2\. Social or interpersonal problems related to use 3\. Neglect of other roles in favor of use 4\. Escalation of use 5\. Repeated attempts to quit 6\. Increased time spent using 7\. Physical or psychological problems from use 8\. Activities given up in favor of use 9\. Tolerance 10\. Withdrawal 11\. Craving Endophenotypes of addiction must be studied (quantitative neurobehavioral traits that indicate genetic susceptibility). Modeling Binge Alcohol Drinking in Mice Produces binge-like alcohol drinking with blood levels exceeding 0.08 mg/dL. Mice show behavioral impairment, which undergoes tolerance with continued daily binge drinking. Mice escalate drinking over days and develop front-loading behavior by about the 7th day. Adolescent mice are more avid binge drinkers than adults. Drinking-in-the-Dark Modeling Edible Δ9-THC in Mice Mice routinely consume 5-10 mg/kg THC daily. Mice show behavioral impairment, which develops tolerance with continued daily consumption. Behavioral impairment is blocked by a CB1 receptor antagonist. Adolescent mice also engage in edible THC consumption.  Health Effects Addiction causes involuntary changes to the body. Addiction takes away the brain's ability to think and act independently. Living with addiction is like being a robot who is controlled by an outside force. Developing an addiction can also stunt physical and mental growth. The ability to reproduce and have children in a healthy way can be comprised by addiction. And one incredibly important fact to remember is, the earlier in life a person starts using drugs, the harder it is to break free from the addiction. When someone is using substances, their thinking and behavior are altered by the substance use. When someone stops use, it takes some time for the brain chemistry to begin to return to normal. If a parent was using a substance or recently stopped using substances, what might you see when on a home visit? **Are the changes from drug use permanent?** Yes and no. There is increasing evidence of brain recovery from addiction. Long term heavy alcohol use results in some permanent damage and alcohol is perhaps the most harmful drug to the central nervous system. However, much of the damage can either be restored or the brain can develop compensations for damaged areas. However, fundamental neurochemical "imbalances" that were present before the addiction may still need attention. No single factor determines whether a person will become addicted to drugs Genetic factors account for 40-60% of a person's vulnerability to addiction including the effects of environment on these factors Parents or older family members who abuse alcohol or drugs, or who engage in criminal behavior, can increase children\'s risks of developing their own drug problems The earlier a person begins to use drugs the more likely they are to progress to more serious abuse Method of administration. Smoking a drug or injecting it into a vein increases its addictive potential Some people will never develop diabetes because they never go over a certain weight --much like some people will never become drug dependent because they never try drugs. If they did, they would in both cases. Does drug abuse cause mental disorders, or vice versa? Drug abuse and mental disorders often co-exist. In some cases, mental diseases may precede addiction; in other cases, drug abuse may trigger or exacerbate mental disorders, particularly in individuals with specific vulnerabilities. 50-75% of all clients have some psychiatric disorder What is required for recovery? An understanding of co-occurring conditions such as depression, anxiety, and trauma. Accessible treatment professionals. Availability of resources Respect for the individual's autonomy Understanding of relapse Active use of recovery supports An understanding that addiction is as chronic health condition An appreciation of how difficult the journey of recovery can be The bottom line: Individuals make choices to begin using drugs. This voluntary initiation into the world of addictive drugs has strongly influenced society's view of drug abuse, drug addiction, and its treatment. When drug abuse becomes drug addiction, however, there is a loss of control over the drug use and it is no longer a matter of choice. Craving arises from the brain's need to maintain a state of homeostasis that now includes the presence of the drug. Using PET imaging, scientists have shown that cravings have a physical basis in the brain (Childress, Mozley, Elgin, Fitzgerald, Reivich, & O'Brien, 1999). Drug abuse and addiction lead to long-term changes in the brain. While the biological foundation for drug addiction does not absolve an individual from the responsibility of his or her actions, the stigma of drug addiction needs to be lifted so individuals can receive proper medical treatment, similar to other chronic diseases. Addiction is a recurring chronic disease While no cure is currently available, effective treatment is. Successful treatment for any chronic disease necessitates patient compliance with the prescribed treatment regimen. Adhering to a treatment plan is difficult for those with chronic disease. Treatment for drug addiction is statistically more successful than for other chronic diseases (such as heart disease, hypertension, asthma sufferers, etc.), but relapses happen (O'Brien & McClellan, 1998). Just saying "no" is unrealistic. It would be comparable to telling someone with diabetes to "just get over it." Treatment may include medications (Naltrexone, Vivitrol, Campral, Antabuse, Suboxone, anti-depressants, etc.) to help the brain re-establish equilibrium. The idea of "moral deficiency" is inappropriate and stigmatizing. Myths about addiction -MYTH "Addiction is just a lack of self control" "If I only use a drug occasionally then I can't be addicted." "It's always easy to tell when someone is addicted to a drug."