Week 1 Introduction and the typical course of Addiction
Lectures
Ingmar Franken: What is addiction: an introduction
➔ Over 3 million annual deaths due to alcohol and drug use
➔ Lifetime prevalence of any substance use in the NL— 19.1%
➔ Higher prevalence of male users in majority of substances
➔ Social relevance
◆ Impact on health— health care burden
◆ Crime– more than 50% of crimes are substance related
◆ Public safety— driving
◆ Impact on productivity at work
DSM-5 Diagnostic Criteria: Substance (e.g., Alcohol) Use Disorder
A problematic pattern of alcohol use leading to clinically significant impairment or distress, as
manifested by 2 of the 11 following symptoms, occurring within a 12-month period:
● Alcohol (or the substance in question) is often taken in larger amounts or over a longer
period than was intended.
● There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
● A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or
recover from its effects.
● Craving, or a strong desire or urge to use alcohol.
● Recurrent alcohol use resulting in a failure to fulfill major role obligations at work,
school, or home.
● Continued alcohol use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of alcohol.
● Important social, occupational, or recreational activities are given up or reduced
because of alcohol use.
● Recurrent alcohol use in situations in which it is physically hazardous.
● Alcohol use is continued despite knowledge of having a persistent or recurrent physical
or psychological problem that is likely to have been caused or exacerbated by alcohol.
● Tolerance, as defined by either of the following:
○ A need for markedly increased amounts of alcohol to achieve intoxication or
desired effect.
○ A markedly diminished effect with continued use of the same amount of alcohol.
● Withdrawal, as manifested by either of the following:
○ The characteristic withdrawal syndrome for alcohol.
○ Alcohol (or a closely related substance, such as a benzodiazepine) is taken to
relieve or avoid withdrawal symptoms.
, ➔ Types of substances
◆ Tobacco
◆ Stimulants– cosine, amphetamines, XTC
◆ Depressants— alcohol, benzodiazepines
◆ Opioids— heroin, morphine
◆ Hallucinogens— LSD, cannabis, ketamine
➔ Drugs and neurotransmitters
◆ Agonists: Certain drugs can mimic the effects of neurotransmitters by binding to
the same receptor site as the endogenous transmitter & producing the same
functional response
◆ Antagonists: bind to the same receptor site as neurotransmitters, but, instead of
initiating the chain of events, they block the response
◆ Cocaine
● Dopamine agonist
● Inhibits reuptake of dopamine
◆ MDMA
● Serotonin agonist
● Increases serotonin and dopamine levels in the synaptic cleft
● Increased release & reduced reuptake
◆ Alcohol
● Gaba agonist
● Nmda antagonist
● Opioid agonist
● Serotonin agonist
Nora de Bode: Social and cultural aspects of Addiction
➔ Neurocognitive profile of addiction
◆ Imbalance between the approach-oriented motivation system and regulatory
control system
● Reduced cognitive control (-)
● Increased motivation— craving, attentional biases (++)
◆ The environment plays an important role in these processes
➔ Social and cultural factors
◆ Social factors
● one’s immediate environments: peers, family, friends, social norms
, ● Social environment affects the likelihood that someone will use drugs
● Social influence affects most of our behavior
● Age: adolescents are more likely to be affected by social influence
● Peer group: the peer group and acceptance of peer pressure within this
group
● Individual differences: people differ in the extent to which they are likely
to adapt their behavior
● Social attunement: tendency to harmonize one’s social behavior with the
environment
● Social norms: expectations or rules that are socially reinforced
○ Injunctive norms: how you think people feel about certain
behaviors— e.g. Don’t use drugs
◆ How much injunctive norms affect our behavior differs by
person
○ Descriptive norms: how people actually behave– e.g. whether
people actually use drugs or not
◆ Has a lot of influence on our behavior, and drug use
◆ Can influence the way we see perceived harm and
perceived benefit of drug use
◆ E.g. Everyone uses drugs, so it must be fine!
◆ Results from a drug use study on NL college students
● Risk perceptions & attitudes affected drug usage
● Students overestimated general usage in the NL
● overestimation of the usage of one substance was a reflection of one’s
own use
◆ Cultural factors
● more widespread shared beliefs and values: legislations, language,
history, religion, local traditions
● Legislations
○ Whether a substance is legal or illegal affects SUD severity, and
also how your social environment views your drug use
, ○ Legislation leads to normalization— alcohol, tobacco, cannabis in
some places
● cultural factors can affect brain processes, and isn’t always seen on the
behavioral level
● Study comparing attitudes of cannabis use disorder individuals in NL vs
Texas
○ Legislation does not always match attitudes
○ Personal attitudes are more associated with the heaviness of
use, whereas legislation is more associated with addiction
severity
○ Attitudes may affect brain processes underlying addiction
○ Texan users overall reported more positive beliefs, as well as
friends and family
○ Less positive beliefs moderated the association between grams
consumed per week and working memory functioning
Literature
Week 1: Introduction and the typical course of addiction
The history of addiction concepts: from ‘addiction’ to ‘addictions’
➔ It has been known for centuries that certain substances had psychoactive effects, were
not always beneficial or cause issues for the users and the others
➔ Different terms have been used to describe long-term, compulsive and damaging
substance use
Lectures
Ingmar Franken: What is addiction: an introduction
➔ Over 3 million annual deaths due to alcohol and drug use
➔ Lifetime prevalence of any substance use in the NL— 19.1%
➔ Higher prevalence of male users in majority of substances
➔ Social relevance
◆ Impact on health— health care burden
◆ Crime– more than 50% of crimes are substance related
◆ Public safety— driving
◆ Impact on productivity at work
DSM-5 Diagnostic Criteria: Substance (e.g., Alcohol) Use Disorder
A problematic pattern of alcohol use leading to clinically significant impairment or distress, as
manifested by 2 of the 11 following symptoms, occurring within a 12-month period:
● Alcohol (or the substance in question) is often taken in larger amounts or over a longer
period than was intended.
● There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
● A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or
recover from its effects.
● Craving, or a strong desire or urge to use alcohol.
● Recurrent alcohol use resulting in a failure to fulfill major role obligations at work,
school, or home.
● Continued alcohol use despite having persistent or recurrent social or interpersonal
problems caused or exacerbated by the effects of alcohol.
● Important social, occupational, or recreational activities are given up or reduced
because of alcohol use.
● Recurrent alcohol use in situations in which it is physically hazardous.
● Alcohol use is continued despite knowledge of having a persistent or recurrent physical
or psychological problem that is likely to have been caused or exacerbated by alcohol.
● Tolerance, as defined by either of the following:
○ A need for markedly increased amounts of alcohol to achieve intoxication or
desired effect.
○ A markedly diminished effect with continued use of the same amount of alcohol.
● Withdrawal, as manifested by either of the following:
○ The characteristic withdrawal syndrome for alcohol.
○ Alcohol (or a closely related substance, such as a benzodiazepine) is taken to
relieve or avoid withdrawal symptoms.
, ➔ Types of substances
◆ Tobacco
◆ Stimulants– cosine, amphetamines, XTC
◆ Depressants— alcohol, benzodiazepines
◆ Opioids— heroin, morphine
◆ Hallucinogens— LSD, cannabis, ketamine
➔ Drugs and neurotransmitters
◆ Agonists: Certain drugs can mimic the effects of neurotransmitters by binding to
the same receptor site as the endogenous transmitter & producing the same
functional response
◆ Antagonists: bind to the same receptor site as neurotransmitters, but, instead of
initiating the chain of events, they block the response
◆ Cocaine
● Dopamine agonist
● Inhibits reuptake of dopamine
◆ MDMA
● Serotonin agonist
● Increases serotonin and dopamine levels in the synaptic cleft
● Increased release & reduced reuptake
◆ Alcohol
● Gaba agonist
● Nmda antagonist
● Opioid agonist
● Serotonin agonist
Nora de Bode: Social and cultural aspects of Addiction
➔ Neurocognitive profile of addiction
◆ Imbalance between the approach-oriented motivation system and regulatory
control system
● Reduced cognitive control (-)
● Increased motivation— craving, attentional biases (++)
◆ The environment plays an important role in these processes
➔ Social and cultural factors
◆ Social factors
● one’s immediate environments: peers, family, friends, social norms
, ● Social environment affects the likelihood that someone will use drugs
● Social influence affects most of our behavior
● Age: adolescents are more likely to be affected by social influence
● Peer group: the peer group and acceptance of peer pressure within this
group
● Individual differences: people differ in the extent to which they are likely
to adapt their behavior
● Social attunement: tendency to harmonize one’s social behavior with the
environment
● Social norms: expectations or rules that are socially reinforced
○ Injunctive norms: how you think people feel about certain
behaviors— e.g. Don’t use drugs
◆ How much injunctive norms affect our behavior differs by
person
○ Descriptive norms: how people actually behave– e.g. whether
people actually use drugs or not
◆ Has a lot of influence on our behavior, and drug use
◆ Can influence the way we see perceived harm and
perceived benefit of drug use
◆ E.g. Everyone uses drugs, so it must be fine!
◆ Results from a drug use study on NL college students
● Risk perceptions & attitudes affected drug usage
● Students overestimated general usage in the NL
● overestimation of the usage of one substance was a reflection of one’s
own use
◆ Cultural factors
● more widespread shared beliefs and values: legislations, language,
history, religion, local traditions
● Legislations
○ Whether a substance is legal or illegal affects SUD severity, and
also how your social environment views your drug use
, ○ Legislation leads to normalization— alcohol, tobacco, cannabis in
some places
● cultural factors can affect brain processes, and isn’t always seen on the
behavioral level
● Study comparing attitudes of cannabis use disorder individuals in NL vs
Texas
○ Legislation does not always match attitudes
○ Personal attitudes are more associated with the heaviness of
use, whereas legislation is more associated with addiction
severity
○ Attitudes may affect brain processes underlying addiction
○ Texan users overall reported more positive beliefs, as well as
friends and family
○ Less positive beliefs moderated the association between grams
consumed per week and working memory functioning
Literature
Week 1: Introduction and the typical course of addiction
The history of addiction concepts: from ‘addiction’ to ‘addictions’
➔ It has been known for centuries that certain substances had psychoactive effects, were
not always beneficial or cause issues for the users and the others
➔ Different terms have been used to describe long-term, compulsive and damaging
substance use
