[Addictive behavior of Alcoholics Anonymous in West Germany].
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Adult↗
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The behavioral economics of will in recovery from addiction.
Behavioral economic studies demonstrate that rewards are discounted proportionally with their delay (hyperbolic discounting). Hyperbolic discounting implies temporary preference for smaller rewards when they are imminent, and this concept has been widely considered by researchers interested in the causes of addictive behavior. Far less consideration has been given to the fact that systematic preference reversal also predicts various self-control phenomena, which may also be analyzed from a behavioral economic perspective. Here we summarize self-control phenomena predicted by hyperbolic discounting, particularly with application to the field of addiction. Of greatest interest is the phenomenon of choice bundling, an increase in motivation to wait for delayed rewards that can be expected to result from making choices in whole categories. Specifically, when a person's expectations about her own future behavior are conditional upon her current behavior, the value of these expectations is added to the contingencies for the current behavior, resulting in reduced impulsivity. Hyperbolic discounting provides a bottom-up basis for the intuitive learning of choice bundling, the properties of which match common descriptions of willpower. We suggest that the bundling effect can also be discerned in the advice of 12-step programs.
Behavior Therapy↗
Computer-assisted drug prevention.
Although the psychological treatment of addiction is premised on the notion that addictive behavior is learned behavior, addiction workers have been slow to exploit the capacity of the computer to promote new learning. The best computer-assisted learning programs are fully adaptive; their design anticipates the responses a user can make, classifies them, and provides feedback for each. This paper reports on two recent attempts to achieve this level of sophistication in computer-assisted drug prevention. One program seeks to prevent heroin relapse among currently abstinent prisoners, and the other promotes controlled drinking in alcohol abusers. Given the fact that most drug users can be expected to opt for self-help materials over the offer of formal therapy, and that most (licit) drug users who solve their addiction problems do so without recourse to professional help anyway, the use of computer-assisted drug prevention programs like these provides an important new direction in substance abuse treatment.
Alcoholism↗
L-tryptophan in neuropsychiatric disorders: a review.
Animal data indicate that serotonin (5-HT) is a major neurotransmitter involved in the control of numerous central nervous system functions including mood, aggression, pain, anxiety, sleep, memory, eating behavior, addictive behavior, temperature control, endocrine regulation, and motor behavior. Moreover, there is evidence that abnormalities of 5-HT functions are related to the pathophysiology of diverse neurological conditions including Parkinson's disease, tardive dyskinesia, akathisia, dystonia, Huntington's disease, familial tremor, restless legs syndrome, myoclonus, Gilles de la Tourette's syndrome, multiple sclerosis, sleep disorders, and dementia. The psychiatric disorders of schizophrenia, mania, depression, aggressive and self-injurious behavior, obsessive compulsive disorder, seasonal affective disorder, substance abuse, hypersexuality, anxiety disorders, bulimia, childhood hyperactivity, and behavioral disorders in geriatric patients have been linked to impaired central 5-HT functions. Tryptophan, the natural amino acid precursor in 5-HT biosynthesis, increases 5-HT synthesis in the brain and, therefore, may stimulate 5-HT release and function. Since it is a natural constituent of the diet, tryptophan should have low toxicity and produce few side effects. Based on these advantages, dietary tryptophan supplementation has been used in the management of neuropsychiatric disorders with variable success. This review summarizes current clinical use of tryptophan supplementation in neuropsychiatric disorders.
Dopamine↗
Addictive sexual behavior.
A rationale for the conceptualization of repetitive sexual behaviors as an addiction is presented. Five cases treated by individual psychotherapy are described and certain problems inherent in such treatments are delineated. Other treatment approaches, such as those involving the use of medication, twelve-step groups and cognitive-behavioral techniques are also detailed.
Adult↗
Addictive sexual behavior.
Case material is presented from two patients suffering from addictive sexual behavior. The term addiction is used because of the intense, driven quality of the behavior and because of its mood-elevating effects. Psychodynamically, the patients' sexual acts helped to undo feelings of rejection at the hands of their mothers and to enhance feelings of lovability and of self-esteem. The behavior also helped to neutralize powerful feelings of rage toward the mother. In one patient, the acts also helped to ease inner turmoil related to an underlying attention deficit disorder. I speculate that some adults with addictive sexual behavior may have underlying attention deficit disorders. In both my patients, the sexual behaviors served the self-regulatory function of alleviating inner feelings of anhedonia and depression. When they decreased their sexual activities during the course of the treatment, they required adjunctive antidepressant medication. The underlying meaning of the medication and countertransference attitudes toward such patients are explored.
Adult↗
[Addiction and personality traits: sensation seeking, anhedonia, impulsivity].
This study presents the evaluation of three dimensional traits of personality (Sensation Seeking, Anhedonia, Impulsivity) among 65 patients admitted in a psychiatric ward, with or without addictive behaviors. Our objective is to establish that these personality traits are commun to all addictive behaviors and to test the hypothesis that high scores on the three scales are linked to a greater probability of presenting with addictive behaviors. The two most frequent types of addiction were alcoholism and drug abuse. The subjects presenting with one or several addictive behaviors had higher average scores on the three scales. Our results printed in the same direction for the subjects having shown an addictive behavior in their past history. The risk to present with an addictive behavior increased with the total scores of these self-report questionnaires. There was a significant relationship between 3 sub-dimensions on the Sensation Seeking Scale and addictive behavior. Each time sub-scores of boredom susceptibility, disinhibition and thrill and adventure rise by one, the risk to present with an addictive behavior is multiplied by 1.4 for the first two and by 1.3 for the third one. Subjects with high scores on the anhedonia and impulsivity scales respectively show a risk multiplied by 1.6 and 3.3 of developing an addictive behavior. These results of this transverse study confirm the link between addiction behavior and these three personality traits.
Adolescent↗
Behavioral neurobiology of alcohol addiction: recent advances and challenges.
Addictive behavior associated with alcoholism is characterized by compulsive preoccupation with obtaining alcohol, loss of control over consumption, and development of tolerance and dependence, as well as impaired social and occupational functioning. Like other addictive disorders, alcoholism is characterized by chronic vulnerability to relapse after cessation of drinking. To understand the factors that compel some individuals to drink excessively, alcohol research has focused on the identification of brain mechanisms that support the reinforcing actions of alcohol and the progression of changes in neural function induced by chronic ethanol consumption that lead to the development of dependence. More recently, increasing attention has been directed toward the understanding of neurobiological and environmental factors in susceptibility to relapse.
Alcoholism↗
Extending the evidence hierarchy to enhance evidence-based practice for substance use disorders.
PURPOSE: This paper examines the evidence-based practice (EBP) movement in the context of the developmental status of theory, research and practice on substance use disorders. SCOPE: Hierarchical views that favor randomized controlled trials (RCTs) over other forms of evidence are reviewed, and the benefits and limitations of RCTs are considered as they intersect with contemporary issues in the field. FINDINGS: RCTs with lengthy follow-up intervals comprise an important piece of the relevant evidence base, especially for establishing treatment efficacy, but their continued centrality as the 'gold standard' of evidence for informing substance abuse practice is questioned. CONCLUSIONS: Given the status of knowledge, advances in science and practice will probably come from longitudinal studies of the changeable course of addictive behaviors and processes over long time frames and that investigate linkages with treatment selection factors and other surrounding contextual variables that also change through time. Benefits of evidentiary pluralism for advancing an interdisciplinary approach to research and practice are considered.
Behavior, Addictive↗
Diagnosis and treatment of sexual addiction.
Following a brief introduction to the concept of addiction, the definition of and diagnostic criteria for sexual addiction are presented. A theoretical framework for treatment of sexual addiction is then outlined, based on an understanding of the underlying addictive process: the compulsive dependence on external actions as a means of regulating one's internal states. Effective treatment addresses both addictive behavior and the addictive process. Addictive sexual behavior is addressed through behavioral symptom management, which includes relapse prevention and other cognitive-behavioral techniques. The addictive process is addressed by enhancing self-regulatory functions through individual psychotherapy, therapeutic group experience, and pharmacotherapy (medication treatment, when indicated). An integrated system for treatment of sexual addiction, which brings together these therapeutic methods in one theoretically coherent, clinically unified approach, is outlined.
Behavior, Addictive↗
Lack of association between parental alcohol or drug addiction and behavioral inhibition in children.
OBJECTIVE: "Behavioral inhibition to the unfamiliar" has been proposed as a precursor to anxiety. A recent study proposed that it may also be a precursor to alcoholism. The authors sought to replicate the latter finding through a secondary analysis of data from a large study of young children (age 2-6 years)-offspring of parents with panic and depressive disorders-who had been assessed for behavioral inhibition through laboratory-based observations. METHOD: The offspring were stratified on the basis of presence or absence of parental lifetime history of DSM-III-R alcohol dependence (N=115 versus N=166, respectively) or drug dependence (N=78 versus N=203). The rates of behavioral inhibition were then compared between groups. RESULTS: Despite adequate power to detect associations, neither parental alcohol dependence nor drug dependence was associated with a higher risk for behavioral inhibition in the offspring. CONCLUSIONS: These results are not consistent with the hypothesis linking behavioral inhibition to addictions.
Alcoholism↗
[Addiction-like behavior with continuous self-stimulation of the mediothalamic system (author's transl)].
In a patient with postamputation pain a continuous self-stimulation of the mediothalamic system by a chronic deep brain electrode induced a change in behavior, similar to addiction. At the same time various psychological tests (HAWIE, Benton, Hooper-VOT and concentration tests) were significantly disturbed. After interruption of the deep brain stimulation all induced psychic abnormalities normalized within a few days.
Adult↗
Similarity of behavior within addict couples. Part II. Addiction-related variables.
The similarity of behavioral patterns within addict couples before, during, and after a relationship is the focus of this paper. The correlations between partners in real and artificially constructed (pseudo) couples for employment, criminal activities, and other behaviors are examined. The effect of a relationship on behavior is also assessed before, during, and after treatment. Significant correlations during real relationships were found for employment, welfare, and illegal income. Joint couple entry into treatment appears to be more effective for women than men. Similarity within couples disappears when the relationship ends.
Behavior↗
Measuring the reinforcing strength of abused drugs.
Animal models for human diseases are highly valued for their utility in developing new therapies. Animals have long provided suitable platforms for the development of innovative surgical procedures and for the study of disease states that are relatively easy to produce in otherwise healthy animals, such as diabetes or hypertension. Increasingly, new strains of animals susceptible to common human illnesses are being introduced into medical research, promising new inroads into the treatment of a variety of organic disorders. Despite these advances in model development, psychiatric disorders, by and large, remain among the hardest to induce experimentally, and the search for reasonable animal procedures to study diseases of the mind is an ongoing challenge for experimental biologists. An exception to this limitation, however, comes in the study of drug abuse. Major developments in this area of research over the last several decades have steadily advanced our ability to identify pharmacological, genetic, and environmental determinants that contribute to the development of drug dependence and addictive behavior.
Animals↗
The role of incest issues in relapse.
Comprehensive studies have established that relapse is the most common outcome of recovery programs treating addictive behaviors. This article examines the fact that relapse is often related to uncovering painful early childhood incest experiences that have been defended against through self-destructive addictive behaviors. Another aspect of relapse is the phenomenon of multiaddictions: withdrawal from an identified addictive behavior will often lead to the unmasking of other addictive behaviors. The phenomenon of cross-addiction is widely acknowledged in the addictions field, but the connection between cross-addiction and relapse needs to be more fully explored. This article focuses on the following points: (1) addictive behaviors may serve to defend against memories of sexual abuse; (2) unidentified incest material may precipitate relapse or result from relapse, and therefore must be considered as a possible component of treatment in recovery--indications for treatment in terms of 12-Step recovery in conjunction with therapy are explored; (3) relapse may indicate the existence of additional addictions that must be identified and explored in order for recovery to proceed; and (4) sex and love addiction is often found in conjunction with alcoholism, codependency and compulsive overeating, and often comes to light through the emergence of incest memories. The identification and treatment of this hidden addiction (i.e., sex and love addiction) will determine the extent and depth of recovery.
Child↗
[Is cocoa a psychotropic drug? Psychopathologic study of a population of subjects self-identified as chocolate addicts].
The aim of this work was to search for eating disorders, DSM III-R Axis I mental disorders, personality disorders, and addictive behavior, in self-labeled "chocolate addicts". Subjects were recruited through advertisements placed in a university and a hospital. Fifteen subjects were included, 3 men and 12 women aged between 18 and 49. Most of them were not overweight, although 7 thought they had a weight problem. They consumed an average of 50 g per day of pure cacao and, for 13 subjects, this consumption was lasting since childhood or adolescence. The psychological effects of chocolate, as indicated by the subjects, consisted in feelings of increased energy or increased concentration ability, and in an anxiolytic effect during stress. Seven subjects described minor withdrawal symptoms. None of the subjects reached the thresholds for eating disorders on the EAT and BULIT scales. The structured interview (MINI) identified an important ratio of subjects with a history of major depressive episode (13/15), and one woman was currently experiencing a major depressive episode. Four people suffered, or had suffered from anxiety disorders. Although only one subject satisfied all criteria for a personality disorder on the DIP-Q, seven displayed some pathological personality features. The self-labeled "chocoholics" do not seem to suffer from eating disorders, but may represent a population of psychologically vulnerable and depression--or anxiety--prone people. They seem to use chocolate as a light psychotropic drug able to relieve some of their distress. The amount of cacao consumed, although very chronically, remains moderate, and they rarely display other addictive behaviors.
Adolescent↗
At-risk behaviors with regard to HIV and addiction among women in prison.
The bulk of studies pertaining to addiction among delinquents have been conducted on male subjects. However, the few studies examining female inmates show that a significant proportion of them present an addictive disorder. Furthermore, the HIV infection rate is higher among these women than among incarcerated men. This study attempts to verify if women presenting a combination of criminal and addictive behaviors are at a higher risk of developing an earlier and a more severe delinquency than other delinquent women. Another goal is to determine whether women showing this comorbidity present a higher incidence of HIV-related risk behaviors. The study was conducted on a sample of 210 women from the Montreal detention center. It shows that addicted inmates present earlier onsets of both drug use and criminal behaviors compared to other female inmates. Addicted women also exhibit significantly more HIV-related risky behaviors, both in their drug use and in their sexual practices.
Adolescent↗
Adenosine A2a blockade prevents synergy between mu-opiate and cannabinoid CB1 receptors and eliminates heroin-seeking behavior in addicted rats.
Relapse is the most serious limitation of effective medical treatment of opiate addiction. Opiate-related behaviors appear to be modulated by cannabinoid CB1 receptors (CB1) through poorly understood cross-talk mechanisms. Opiate and CB1 receptors are coexpressed in the nucleus accumbens (NAc) and dorsal striatum. These regions also have the highest density of adenosine A2a receptors (A2a) in the brain. We have been investigating the postsynaptic signaling mechanisms of mu-opiate receptors (MORs) and CB1 receptors in primary NAc/striatal neurons. In this article, we present evidence that MOR and CB1 act synergistically on cAMP/PKA signaling in NAc/striatal neurons. In addition, we find that synergy requires adenosine and A2a. Importantly, an A2a antagonist administered either directly into the NAc or indirectly by i.p. injection eliminates heroin-induced reinstatement in rats trained to self-administer heroin, a model of human craving and relapse. These findings suggest that A2a antagonists might be effective therapeutic agents in the management of abstinent heroin addicts.
Adenosine A2 Receptor Antagonists↗