Risk behavior and addiction in adolescence (201800007)
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Summary all articles risk behavior and addiction
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Risk behavior and addiction in adolescence (201800007)
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Universiteit Utrecht (UU)
Extensive summary of all articles including:
- A General Introduction to the Concept of Addiction and Addictive Effects - Sussman
- Addiction, adolescence, and the integration of control and motivation - Gladwin
- Cannabis use and the mental health of young people - Wayne D. Hall
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Risk behavior and addiction in adolescence (201800007)
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Reading material lecture 1
A General Introduction to the Concept of Addiction and Addictive Effects - Sussman
Substance and behavioral addictions
Both substance and behavioral (process) addictions describe behavior that results in clinically
significant impairment. Substance addiction pertains to repetitive intake of a drug (alcohol), whereas
behavioral addiction pertains to engaging in types of behaviors repetitively which are not directly
taken into the body such as gambling. Until recently, the scientific community focused on, or
considered seriously as an ‘addiction’ only misuse of drugs that led to physiological withdrawal
symptoms: the appearance of both physical and psychological symptoms which are caused by
physiological adaptations in the central nervous system and the brain due to chronic exposure to a
substance. In general, researchers considered those objects on which one could become addicted as
being drugs which cross the blood-brain barrier
The reality of multiple types of addictions: general theoretical considerations
A variety of behaviors very recently have come to be considered addictions by researchers and
practitioners, delineated by common features (e.g. appetitive effects (impact on mood, arousal, or
thinking), preoccupation, subjective sense of loss of control, negative consequences). Obtaining a
measurable description of a scientific concept such as addiction is useful to be able to make
inferences regarding how the concept is related to other concepts and subsequently how the concept
can guide the development of useful applications.
Evolution of definitions of addiction
As its origin, addiction is generally referred to ‘giving over’ or being ‘highly devoted’ to a person or
activity or engaging in a behavior habitually, which could have positive or negative implications.
History of Substance Addictions
- Tobacco: suspicion that tobacco may cause various diseases dates back at least 400 years. The public
consensus that nicotine was addictive and the driving force behind regular tobacco use, occurred
with publication of the Surgeon General’s report on nicotine addiction in 1988
- Alcohol: perhaps the best-known addiction. The substance from which the 12-step movement
arose, and which has influenced the general concept of addiction is alcoholism. Alcohol misuse has
been noted throughout written history
- Opium: initial use of opium was described as ‘divine enjoyment’. Social embarrassment while using
opium and a tendency to walk among the poor in London at night were documented, with an overall
favorable attitude toward opium. Recognition of the consequential increasing prevalence of opium
misuse and addiction led to development of patent medications used to treat it.
- Cocaine: replacement medications that did not contain opiate derivatives to treat opiate addictions
also led to new problematic drug use (cocaine for the cure of an opium habit). Both opium and
cocaine were contained in numerous products back in 1900.
- Marijuana: this was referred to as a ‘hilarious herb’ that was purchased frequently and without
good sense (one person spent his daily wage, after a little food, to purchase marijuana). Pre-
occupation of marijuana use replaced the pursuit of all other types of excitement, with continuous
intoxication, attempts to quit with only relapse to follow, craving, depression, abnormal dreaming and
seeking the care of a physician to try to quit marijuana use.
- Food: there is no ancient history regarding food addiction. Thinking about food or eating as an
‘addiction’ appears to be a recent notion
,History of Behavioral Addictions
The historical literature presents descriptions of gambling and sex addictions. Other behavioral
addictions have been less often discussed in historical writings, or more ambiguously depicted, for
example writings about ‘diseases of the spirit’ which had a major impact on conceptualization of
behavioral addictions. Except for gambling addiction, 12-step organizations created for behavioral
addictions were established only from the 1970’s. Some addictive behaviors have a relatively very
short history (social media).
Intensional and Extensional Concepts of Addiction
Intensional definition of addiction: pertains to causal or process model type statements of
addictions. That is, intensional models attempt to describe at minimum an addictive behavioral
process (this happens, that leads to this and then to that), and at maximum an etiology (a causal
story). These types of models have relatively good explanatory power though they often are more
distant from observables than descriptive (extensional) models.
Extensional definition of addiction: or listing/classification of addiction features, provides a
taxonomy of addiction elements, which subsequently might be organized into a (more) intensional
theory-based perspective
Major Examples of Intensional Definitions of Addiction
Intensional: physiological and psychological dependence (cellular or acquired tolerance and
withdraw), impulsive-obsessive-compulsive behavior, self-medication, self-regulation and addiction
entrenchment (overwhelming involvement with an addiction object).
Extensional: Six-component definition (salience, mood, modification, tolerance, withdrawal
symptoms, conflict and relapse), five-component definition (appetitive effects, satiation,
preoccupation, loss of control and negative consequences), DSM-V
Marjo examples of Intensional definitions of addiction
Physiological and psychological dependence
The physiological/psychological dependence definition of addiction pertains to prolonged
engagement in a behavior that results in its continued performance being necessary for physiologic
and psychological equilibrium. Tolerance, withdrawal, and craving are hallmark criteria of a
dependence definition of addiction. The addict is ‘trapped’ into an pattern of increasing involvement
with the behavior, while feeling more and more negative when trying to cut down or stop the
behavior.
- Tolerance refers to the need to engage in the behavior at a relatively greater level than in the past to
achieve previous levels of appetitive effects (or achieving diminished effects at previous levels of
behavior)
- Withdrawal: upon abrupt termination of the addictive behavior, an abstinence syndrome, also
known as withdrawal, will occur. Withdrawal symptoms vary across drugs of abuse.
- Craving: is now one of the criteria of substance use disorder in the DSM-V. Craving refers to an
‘intense desire’ to engage in a specific act.
Impulsive-Obsessive/Compulsive Behavior
- Positive reinforcement: an impulsive-obsessive/compulsive definition of addiction generally
pertains to engaging in the behavior due to a ‘building up of tension’ which is released, resulting in
pleasure and perhaps later leading to self-reproach. Cyclically, what occurs is another building up of
tension or craving for pleasure again (an impulsion, positive reinforcement mostly).
,- Negative reinforcement: alternatively, this intensional model of addiction may involve a building up
of tension, anxiety and stress which is released, resulting in relief from anxiety but no particular
pleasure; then, cyclically, leading to obsessions which produce anxiety and stress leading to a craving
for relief again.
- Both: it is plausible that both processes operate in the same person. That is, one may experience
craving for pleasure and craving to release anxiety (positive and negative reinforcement). Some
researchers have speculated that positive reinforcement operates early on in the addiction, whereas
negative reinforcement operates relatively more later on.
Self-Medication
A self-medication perspective of addiction pertains to relief from disordered emotions and sense of
self-preservation through engaging in the addictive behavior. The emphasis here is one where a
person engages in the behavior because he or she feels ‘sick’ and wants to feel ‘well’.
Trauma and self-medication
A recent variant of this perspective is the view that in childhood one has experienced significant
trauma which sensitizes function of the amygdala. One attempts to remove subjective experience of
anxiety, depression or PTSD-like symptoms through engagement in the addiction.
Self-regulation
In a self-regulation model, the ‘present state’ of being cues attempts to reach a standard at which
point satiation is achieved, until the present state is no longer at the desired standard state. This type
of system model metaphorically is like that of a thermostat turning on and off depending on whether
or not room temperature has reached the set-point temperature.
BAS-BIS Model (self-regulation model)
- The behavioral approach system (BAS): mediated by dopamine pathways (associated with novelty
and reward), involving the ventral tegmental area, ventral striatum, and nucleus accumbens. An
active BAS is linked to more impulsive-type behaviors
- The behavioral inhibition system (BIS): mediated by the septo-hippocompal system (which detects
competing goals and leads to approach or avoidance behavior). An active BIS is associated to
inhibiting behavior. Persons with difficulty in emotional self-regulation may be particularly prone to
engage in addictive behaviors in order to achieve an immediate temporary sense of comfort.
Incentive-Sensitization Theory
Incentive-sensitization theory focuses on the influence of neural adaptation (sensitization) to
addictive behaviors and addictive behavior-conditioned stimuli as the underlying mechanism
perpetuating the addictive behaviors. They differentiate neural processes involved in motivational
mechanisms or incentive salience to addictive behavior cues (wanting) and the neural substrates of
pleasurable effects (liking).
Through repeated engagement in the behavior, behavior-associated stimuli that acquire incentive
salience through neural representation (motivational ‘wanting’ attribute encoded by the brain to
reward-predicting stimuli) become motivational magnets, able to ‘grab’ the addict’s attention.
Allostatis Theory
Allostasis is another explanation of addiction due to dysregulation, in this case of the
neurotransmission-hormonal (modulator) system that results from repetitive engagement in the
, behavior. According to the notion of allostasis, addictive behavior leads to dopamine opponent-
process counteradaptation that masks the effects of the addictive behavior.
Addiction Entrenchment
In this model, one is said to have an over-attachment to a drug, object, or activity. That is, one has
developed an excessive appetite. One may act along one’s own unconventional attitudinal
preferences, initially leading one to try out an addictive behavior.
Entrenchment and Behavior Economic-Related Models
The entrenchment notion is, perhaps, consistent with behavioral economics-type models of
addiction-related behavior as being a choice, based on the existence of a multiple schedules or
reinforcement associated with different behaviors and involving different reinforcement values and
delays in delivery of reinforcement
Summary of Intensional Addiction Models
The previous five notions of addiction were labeled as intensional, rule-based, or theory-based
definitions.
Major Examples of Extensional Definitions of Addiction
Extensional models of addiction include the six-component perspective, five-component model and
DSM criteria
Six-component perspective
These components are: salience, mood modification, tolerance, withdrawal symptoms, conflict and
relapse. Salience refers to the tendency for the addiction to dominate one’s thoughts, feelings and
behavior. Each of these components is treated as just that – components which might be placed into
higher-order theorizing later on. It is fair to say that the six-component model is the most influential
of the extensional models of behavioral addictions
Five-component perspective
These components are: appetitive effects, satiation, preoccupation, loss of control and negative
consequences.
Brief History and Current Status of DSM Addiction Disorders (I, II, III, IV, V)
The best-known extensional definition of addiction is a set of diagnostic criteria based on work
conducted in the context of framing substance use disorder in the DSM. These addiction criteria have
been used solely pertaining to drugs of abuse (except in the DSM-V). However, the same criteria have
been adapted widely to describe behavioral addictions.
DSM-V
May of 2013, the current diagnostic criteria for substance use disorder were established.
a. use more than intended (larger amounts or longer period)
b. desire, but inability to quit or cut down
c. consumes life (great deal of time to obtain, use, or recover from effects)
d. craving, an intense desire or urge to use (new criterion)
e. failure to fulfill major role obligations at work, school, or home
f. continued use despite related social problems
g. other social, job, or recreational activities are neglected or given up
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