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14 Cards in this Set

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Alcohol Dependence
IS NOT RELATED TO QUANTITY!

3 domains over 12 months:

Tolerance, spending more time searching for, trying to cut back, withdrawal, social/occ/rec effects
Addiction is a chronic disease? true/fase
true
Treatment types for alcohol dependence?
AA meetings, individual counseling, CBT, pharmacodynamics. Treat withdrawal symptoms to prevent DT's
What are alcohol's acute and chronic effects on brain reward pathways?
ACUTE = ACTIVATION. Chronic use leads to changes and ultimately, CHRONIC = DISRUPTION of brain reward system
Discuss how the addicted brain thinks in terms of salience, drive, memory, and control.
Normally, control (behavioral inhibition = medial/dorsolateral pfc) inhibits one's drive (nuc.acc/vta = reward pathway). Other factors weak players. In addicted brain, memory (hippocampus) and their emotions (limbic system) drive salience (nuc.acc.) which overpowers and inhibits control and activates drive to use substance.
What part of the brain can prevent salience-mediated relapse?
PREFRONTAL CORTEX deals with REGISTERING CONFLICT BETWEEN GOOD/BAD. CONFLICT REGISTRATION = STOP SIGNAL.
Can antagonists eliminate cravings?
NOT in a chronic user! Cravings are stimulated in large part to memories and limbic inputs. ANTAGONISTS BLOCK EXPOSURE EFFECTS
What drugs are used for alcohol dependence?
Antabuse, Acamprosate, Naltrexone
What is naltrexone?
mu opioid receptor ANTAGONIST. Attenuates alcohol consumption. Alcohol affects overall activity of opioid peptides.

EFFECTIVENESS OF NALTREXONE IS INVERSELY PROPORTIONAL TO BASELINE LEVELS OF B-ENDORPHINS. more effective for people with low levels of B-endorphins...alcohol drinking is related to relative increases in b-endorphin levels. Genetic traits more responsive.
What are B-endorphins?
endogenous opioid agonists. analgesic. people with low baseline levels generally at higher risk for alcoholism because increase in b-endorphin is dose-dependent w/ alcohol intake.
What does naltrexone do?
Decreases average number of haevy drinking days per month.
What are Asp40 mutation and 118 A-G polymorphism in relation to alcohol use?
mutations make less protein = fewer receptors (txn problems), bind b-endorphins w 3x more potency. G allele makes mu opioid receptor HYPORESPONSIVE. Greater cortisol release in patients with G polymorphism. Greater stimulation to alcohol AND GREATER RESPONSE TO NALOXONE/NALTREXONE.
What is acamprosate?
Acamprosate is an NMDA ANTAGONIST. Can reduce intensity of cue-induced, post-cessation cravings. Blocks c-fos. Suppresses withdrawal effects (increased glutamate and decreased DA)
What is c-fos?
C-fos is an immediate early gene associated with alcohol withdrawal.