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Presentation on theme: "CRAIG STRICKLAND, PH.D., OWNER BIOBEHAVIORAL CONSULTATION & EDUCATION HTTPS://SITES.GOOGLE.COM/SITE/BIOEDCON Personality, Brain Function."— Presentation transcript:


2 Learning Objectives Describe the concept of “addictive personality” based on traits associated with current personality disorders Summarize the structural and chemical processes associated with addiction Using gambling addiction as a model, list several areas of the brain which might account for some behavioral traits associated with addiction

3 Addictive personality disorder is not formally recognized as a personality disorder

4 Addictive Personality: Is there such a thing? Criterion A: Elements of Personality Functioning (from emerging models DSM5, Section III) includes:  Self:  Identity: Experience of oneself as unique; clear boundaries between self and others; stability of self- esteem; accuracy of self-appraisal; capacity for and ability to regulate a range of emotional experience(s)  Self-direction: Pursuit of coherent/meaningful short- term goals; use of constructive & prosocial internal standards of behavior; ability to self-reflect productively

5 Addictive Personality: Is there such a thing? Elements of Personality Functioning (from emerging models DSM5, Section III) includes:  Interpersonal:  Empathy: comprehension/appreciation of others’ ex- periences & motivations; tolerance of differing perspectives; understanding the effects of one’s behavior on others  Intimacy: depth and duration of connection with others; desire and capacity for closeness; mutuality of regard reflected in interpersonal behavior

6 At this point, after reading the previous two slides, I am sure you have decided that we ALL have a personality disorder…but wait…  Long standing  Pervasive  Patterned and repeated  Lesson: Be careful when you read the DSM!

7 Addictive Personality: Is there such a thing? Criterion B: Five Pathological Personality Traits 1.Negative Affectivity (vs. Emotional Stability)  Emotional lability; Anxiousness; Separation insecurity; Submissiveness; Hostility; Perseveration 2.Detachment (vs. Extraversion)  Withdrawal, Intimacy avoidance, Anhedonia; Depressivity; Restricted Affectivity; Suspiciousness

8 Addictive Personality: Is there such a thing? Criterion B: Five Pathological Personality Traits 3.Antagonism (vs. agreeableness):  Manipulativeness; Deceitfulness; Grandiosity; Attention Seeking; Callousness; Hostility 4.Disinhibition (vs. Conscientiousness):  Irresponsibility; Impulsivity; Distractibility; Risk Taking; Rigid Perfectionism 5.Psychoticism (vs. Lucidity):  Unusual beliefs/Experiences; Eccentricity; Cognitive and Perceptual Dysregulation

9 Addictive Personality: Is there such a thing? Criterion C: Pervasiveness Criterion D: Stability Criteria E, F and G  E: Impairments not better explained by another mental disorder  F: Impairments not solely attributable to physiological effects of a substance or another medical condition e.g. head trauma  G: Impairments not better understood as normal for an individual’s developmental stage or sociocultural environment

10 Addictive Personality Traits If we are talking about a true personality disorder, then the traits must be longstanding & pervasive  So perhaps we need to look at what traits may have existed before the substance use began… Report prepared for the National Academy of Sciences: there is no single set of psychological characteristics that embrace all addictions but there may be some common elements across different addictions (next slide)

11 Traits Across Different Addictions Impulsivity Difficulty delaying gratification Antisocial Personality traits Disposition toward sensation seeking A high value on nonconformity combined with weak commitment to the goals for achievement valued by society Sense of social alienation; general tolerance for deviance Sense of heightened stress

12 Risk Factors Note: there is probably an interaction effect between traits and risk factors (as seen in other personality disorders)  Lack of self-esteem  Marked depression or anxiety  Physical/sexual abuse or other traumatic exposure in especially in childhood (Adverse Childhood Events {ACE} study)  Sharply conflicting parental expectations  Biology

13 What causes Behavioral Health Disorders? The Diathesis Stress Model  Environmental Risk Factors AND/OR  Genetic vulnerability: Neurobiology Personality Traits

14 The Neurobiology of Addiction

15 The Reward System and Dopamine (DA)

16 Play Video here

17 The Brain & Reward 1954: James Olds was trying to stimulate the reticular formation  Electrode ended up in another part of the brain  Animals would press a lever to receive stimulation  Press 700 times or more per hour  A very potent reinforcer

18 Neuroanatomy of Reward: The Rat

19 Neuroanatomy of Reward: The Human

20 The Nucleus Accumbens

21 Evidence for Dopamine & Reward Electrical stimulation of the Nucleus Accumbens is reinforcing Animals will press lever for substances which enhance DA release which includes most drugs of abuse Non-drug reinforcers e.g. Sex, water, food, gambling, etc. produce release of DA in the N. Accumbens

22 Evidence for Dopamine & Reward Psychostimulants:  Cocaine: blocks re-uptake (increases available DA)  Amphetamines: blocks re-uptake & stimulates DA release Medications/Drugs which block DA release reduce the ability to experience pleasure Craig’s Research on the Reward System

23 Neuroanatomy of Substance Abuse

24 Neural Communication: Iontotropic

25 So addictive tendencies (traits) could arise from: Underactive reward system (cellular level) Not enough dopamine being produced in the brain Increased sensitivity to drugs of abuse  Could lead to faster development of tolerance which would lead to quicker development of withdrawal Higher than normal amounts of the enzyme which degrade dopamine  Monoamine oxidase (MAO)  Catechol-O-methyltransferase (COMT) Enhanced liver enzyme activity Enhanced dopamine reuptake processes

26 Let’s apply some of this neurobiology to a specific addiction

27 Neurobiology of Gambling

28 Play Video here

29 Pathological Gambling (PG): A Compulsive Disorder or an Addiction?

30 Diagnostic and Statistical Manual (DSM) of MH Disorders: PG Classification Pathological Gambling (PG) first recognized by the DSM in 1980 Historically, PG: considered an “impulse control disorder” rather than a behavioral addiction Thus, PG was included in impulse control disorders along with pyromania, kleptomania, trichotillomania and intermittent explosive disorder (IED) DSM-5 considers PG to be an addiction. Is there a role for impulsivity (trait) within PG diagnosed as a behavioral addiction?

31 The Case for PG as an Addiction Drug dependence and PG share several characteristics  Continued engagement in the behavior despite negative consequences  Diminished self-control over the behavior  Compulsive engagement in the behavior  An appetitive urge or craving state prior to engagement in the behavior

32 The Case for PG as an Addiction Drug dependence and PG share several characteristics (cont.)  Tolerance and withdrawal  Repeated unsuccessful attempts to cut back or quit  Interference with major areas of life functioning

33 Overview of Critical Brain Areas Researched in Addiction and PG The Brain’s Reward System Frontal Cortex  Ventral portion  Dorsal portion Prefrontal Cortex Cingulate Cortex  Dorsal Anterior portion  Ventral Anterior portion Other

34 The Brain’s Reward System (ventral striatum) Ventral Tegmental Area (VTA) Nucleus Accumbens Prefrontal Cortex Amygdala & Other Limbic System Structures

35 Reward System Research (Potenza, M. 2008) Those with Pathological Gambling (PG) showed decreased activity in the brain’s reward system (ventral striatum) when viewing videos of gambling activities  Similar result when subjects are those with drug addictions viewing videos of addictive activities  Points to hypoactivation as common to both conditions…  Hypoactivation….hmmm…

36 Reward System Research (Potenza, M. 2008) Again, those with PG showed decreased activity in the brain’s reward system (ventral striatum) when viewing videos of gambling activities  But why hypoactivation versus hyper-activation?  Is hypoactivation a cause of or a result from addiction?  Note: control subjects showed increased activation  Tolerance!!!

37 Ventromedial Prefrontal Cortex (vmPFC)

38 Ventromedial Prefrontal Cortex (vmPFC) Decrease in brain activity in this and other prefrontal cortical areas in PG and addiction  Controls showed increased activity  PGs show decrease in activity related to decrease in ability to process monetary gains and losses (e.g. behaviors are “riskier”)  Another way of saying this, decreased ability to relate behavior & consequence

39 Inferior Parietal Lobule

40 Inferior Parietal Lobule (Potenza, 2008) Brain region implicated in the response inhibition component of impulse regulation  Compared to controls, there was less activity in this region for both PG and drug-dependent study subjects  Not certain whether this impulse dysregulation due to inappropriate use of cues/stimuli (sensory) or behavioral (movement)

41 Summary Decrease in ventral striatum (reward) system activity Decrease in ventro- medial prefrontal cortex activity Decrease in parietal lobe activity Cause of PG? or tolerance? Changes in behavior- reinforcement relationship Decrease in impulse regulation/response inhibition

42 Example of the Biology of Traits Phineas Gage (1848):

43 The Neurochemistry of Pathological Gambling

44 The Chemicals in Question Norepinephrine/epinephrine (NE/E also known as noradrenaline/adrenaline) Serotonin (5-HT or 5-hydroxytryptamine) Dopamine (DA) The Opioids Glutamate

45 Norepinephrine/Epinephrine (NE/E) Associated with the autonomic nervous system (fight or flight response and general arousal)  Gambling & associated behaviors associated with autonomic arousal  Men with PG show higher NE/E levels compared with controls

46 Norepinephrine/Epinephrine (NE/E)  Medications which block/reduce NE/E levels could have therapeutic effects  Clonidine, guanfacine, Inderal, Tenex  Interestingly, these meds. used to treat ADHD and perhaps other impulsive disorders  In the elderly, need to be cautious given the effects of these medications on lowering blood pressure

47 Serotonin (5-HT) Low serotonin levels have been associated with impulsivity, depression, anxiety, etc. Those with PG or impulsive aggression show low levels of 5-hydroxy indoleacetic acid (5-HIAA), a serotonin metabolite

48 Serotonin (5-HT) SSRIs (Prozac, Paxil, Zoloft, etc.)  Data is somewhat mixed but promising  SSRIs may also help with co-occurring anxiety disorders, depression, etc.  As a function of aging, density of serotonin receptors decreases in the CNS  Thus, these medications could be particularly beneficial for an older population

49 Dopamine (DA) DA strongly associated with reward, reinforcing behaviors and addiction; however DA modulating medications have not been studied in PG  Using DA agonists for people with Parkinson’s Disease (PD) can initiate impulse control dysfunction including that seen in PG  Effect also seen when these drugs are used with people suffering from restless leg syndrome (RLS)

50 Dopamine (DA) In study of subjects with RLS without PG  Dopamine agonists increased activity in the brain’s reward system (ventral striatum)  Note: time course re: ventral striatum activity

51 Dopamine (DA) Other behaviors in addition to PG noted as a result of DA agonist use:  Hypersexuality  Compulsive shopping & eating  Punding (compulsive fascination with and performance of repetitive, mechanical tasks) What is needed are studies where DA modulating meds. are directly with those with PG

52 Opioids Opioids implicated in pleasure and reward Opioids influence activity in the ventral striatum Given this, opioid antagonists were investigated  Naltrexone superior to placebo in reducing gambling associated behaviors (some issues with liver functioning however)  Nalmefene: also superior to placebo, no liver function issues  A family history of alcoholism was strongly associated with a positive drug response

53 That’s my story and I am stickin’ to it!


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