Mood Disorders and Substance Abuse/Addiction

• how many people with mood disorders have a co-occuring substance use disorder?

  -30% of people

  -high in bipolar disorder than depressive disorder
• what is a dual diagnosis?

  an individual who has both mental disorder and substance use disorder
• have depressive disorder = 2-3.5x MORE LIKELY for a substance use disorder in one's lifetime
• have bipolar disorder = 4-7.5x MORE LIKELY for a substance use disorder in one's lifetime
• what changes for dual diagnosis?

  -greater severity of illness

  -worse course of illness

  -greater difficulties in functioning

  -poorer treatment response

  -increase suicidality
• what is the onset for dual diagnosis?

  onset in late adolescence/early adulthood
• what is the secondary psychiatric disorder model?

  incidence of substance use disorder increases the risk for mood disorder
• what is the secondary substance abuse model?

  incidence of mood disorder increases risk for substance use disorder
• what is the bidirectional model?

  each disorder involves separate etiologies, but exacerbate each other
• what is the third variable or common factor models?

  shared mechanisms for development of both disorders
• what are the separate classes of substance use disorders in the DSM?

  alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, other
• what are substance use disorders divided into in the DSM?

  substance use disorders and substance-induced disorders (intoxication, withdrawal, specific disorders)
• what are addictive disorders in the DSM?

  -gambling disorder

  -more research needs to be done on internet, sex, exercise, shopping (behavioral addictions)
• what is the criteria of a substance-use disorder?

  must be at least TWO of the following within a 12-month period:

  -increased drug taking

  -unsuccessful efforts to cut down

  -a great deal of time spent: obtaining, using, recovering from the drug

  -craving or strong desire to use (can not think of anything else)

  -social, occupation, or recreational activities reduced due to drug use

  -physically hazardous use

  -continued use despite physical or psychological problem made worse by drug

  -tolerance (increase dose to achieve desired effect)

  -withdrawal (emergence of negative affective state)
• what are specifiers for substance use disorder?

  -mild (2-3 symptoms)

  -moderate (4-5 symptoms)

  -severe (6 or more symptoms) -> generally thought of as addiction
• what is addiction?


  addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry (american society of addiction medicine)
• what is addiction characterized by?

  -inability to consistently abstain from use

  -impairment in behavioral control and craving

  -diminished recognition of significant problems with one's behaviors and interpersonal relationships

  -dysfunctional emotional response
• what are the stages of addiction?

  -vicious cycle of 3 stages

  -each stage becomes more intense as drug exposure increases

  A) sensitization

  B) spiraling distress

  
• what shifts occur as addiction progresses?

  -shift from positive reinforcement (I take the drug because it makes me feel good) to negative reinforcement (I take the drug so I don't feel bad anymore)

  -shift from impulsivity (tension, arousal, actions poorly conceived/risky) to compulsivity (stress, anxiety, persistent inappropriate actions, can't stop)
• what are the initial actions of drugs of abuse?

  -all drugs of abuse affect the MESOCORTICOLIMBIC dopamine system to cause rapid DA increases

  -dopamine ISN'T pleasure, its involved in motivation and learning

  -dopamine will increase firing to rewarding events and fire on cues that predict reward
• what is the biological framework for addiction adaptations?

  -neuroplastic alternations in different brain regions
• what is the addiction adaptions for binge/intoxication (reward)?

  -habits, goal-directed action, reward-seeking

  -ventral tegmental area, nucleus accumbens, basal ganglia
• what is the addiction adaptions for withdrawal (stress/emotion)?


  -dysphoria, negative emotional states, irritability, stress, anxiety

  -amygdala, BNST (anti-reward system)
• what is the addiction adaptions for preoccupation/anticipation (executive control)?

  -craving, decision-making, self-regulation (inability to resist strong urges), memory impairments

  -hippocampus, prefrontal cortex regions
• what is the diathesis-stress in drug addiction?

  -addiction has a heritable component to the disease (40-60% of addiction risk is due to genes) -> diathesis

  -early life experiences/environment can affect vulnerability to addiction -> stress
• why does drug use often co-occur with other disorders?

  -1.diagnostic confounding: drug abuse symptoms can mimic mood disorder symptoms, misdiagnosis is a legitimate concern

  ie. lack of concentration, restlessness, agitation: result of depressant use or an anxiety disorder?

  
  

  2.disorder fostering disorder/kindling hypothesis: effect of mood disorder increases risk for the other

  
  

  3.self-medication: treat symptoms via drugs of abuse to relieve distress/suffering/emotions
• what is substance-induced bipolar/depressive disorder?

  -describes a disturbance in mood that could be elevated, expansive, or irritable WITH or WITHOUT depressed mood OR a significant loss of interest or pleasure in acitivities

  -if symptoms develop during or soon after substance intoxication/withdrawal/after taking medication, and if the substance or medication can cause these symptoms = disorder

  -if evidence that mood disturbance existed before substance/medication use, and if it persists even after effects of substance use has work off = independent mood disorder
• what are the specifiers for substance-induced bipolar/depressive disorder?


  -onset during intoxication: mood disturbance happens because of recently taking a substance

  -onset during withdrawal: mood disturbance happens because of stopping or reducing substance use
• what is disorder fostering disorder/kindling hypothesis?

  -effect of mood disorder or addiction, biologically, increases the risk for the other (one disorder could "unmask" the vulnerability to the other)

  -one disorder may sensitize the brain to make individuals more vulnerable to another disorder when a potential "insult" occurs

  -due to overlapping genetic vulnerabilities and brain dysfunction in shared regions
• what is self-medication in drug addiction comorbidity?

  -treat symptoms via drugs of abuse to relieve distress/suffering/emotions

  -substances used as coping mechanisms to deal with their associated difficult symptoms (23-41% of people with mood disorders self medicate)
• what are treatments for drug addiction comorbidity?


  -truest form of treatment: patient abstinent (off drugs) before making an accurate diagnosis/treatment (isn't feasible in most cases)

  -no medications for dual diangosis

  -strategy: wait to start medication until after detox/withdrawal ends

  1.symptoms could resolve on their own

  2.removes confounding symptoms of withdrawal and medication side effects (ie nausea, headache, anxiety, agitation)
• what is integrated group therapy for drug addiction?

  -form of CBT designed to treat dual diagnosis of bipolar disorder and substance use disorder (12-20, 1 hours sessions)

  -rather than viewing the patient as having two distinct disorders, the patient/therapist should view it as having a single disorder

  -goal: treat both disorders with equal weight and understand the relationships between the two

  -focus on similarities between "addictive thinking" and "depressive thinking"