Psychological dependence

Psychological dependence is a cognitive disorder that involves emotional–motivational withdrawal symptoms—e.g. anxiety and anhedonia—upon cessation of prolonged drug abuse or certain repetitive behaviors. It develops through frequent exposure to a psychoactive substance or behavior, though behavioral dependence is less talked about. The specific mechanism involves a neuronal counter-adaption, which could be mediated through changes in neurotransmittor activity or altered receptor expression.[5][6][7][8][9] Environmental enrichment and physical activity can attenuate withdrawal symptoms.[10][11] Psychological dependence is not to be confused with physical dependence, which induces physical withdrawal symptoms upon discontinuation of use. However, they are not mutually exclusive.[10][12]

Not to be confused with Addiction.
Addiction and dependence glossary[1][2][3][4]
  • addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences
  • addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems
  • dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)
  • drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose
  • drug withdrawal – symptoms that occur upon cessation of repeated drug use
  • physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens)
  • psychological dependence – dependence that involves emotional–motivational withdrawal symptoms (e.g., dysphoria and anhedonia)
  • reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them
  • rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach
  • sensitization – an amplified response to a stimulus resulting from repeated exposure to it
  • substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress
  • tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

Symptoms

Symptoms of psychological dependence include:

Development

Psychological dependence is caused by consistent and frequent exposure to a drug or behavioural activity.[13] It is often associated with effects of drug use, but it can also be caused by behavioural activity e.g. pornography.[14]

The mechanism that generates dependence involves a neuronal counter-adaption, which is localized to areas of the brain responsible for a drug's positive reinforcement. This adaption occurs as a change in neurotransmitter activity or in receptor expression.[5]

Change in neurotransmitter activity

Studies have shown that in rats experiencing ethanol withdrawal, stimulant withdrawal or opioid withdrawal, the nucleus accumbens shows lower levels of serotonin and dopamine than controls. These decreases are associated with depression and anxiety.[6][7]

In anatomically distinct areas of the rat brain, withdrawal is linked to lower levels of GABA and neuropeptide Y as well as higher levels of dynorphin, corticotropin-releasing factor, and norepinephrine; these fluctuations can contribute to psychological dependence.[5]

Altered receptor expression

Changes in receptor expression have also been linked to various symptoms of drug withdrawal. For example, in a study of rats undergoing nicotine withdrawal there has been observed a down regulation of α6β2*n-icotinic acetylcholine receptors in the mesostriatal dopaminergic pathways.[8]

Methods for reducing dependence

A study examined how rats experienced morphine withdrawal in different surroundings. The rats was either placed in an standard environment (SE) or in an enriched environment (EE). The study concluded that EE reduced depression and anxiety withdrawal symptoms.[10]

Another study tested whether swimming exercises affected the intensity of perceivable psychological symptoms in rodents during morphine withdrawal. It concluded that the anxious and depressive states of the withdrawal were reduced in rats from the exercise group.[11]

Distinction between psychological and physical dependence
Table 1: List of different drugs and which type of dependence they induce[12]
Physical dependence Psychological dependence
Alcohols Stimulants
Opioids Hallucinogens
Benzodiazepines Cannabis products
Barbiturates Inhalants
SSRIs

The major differences between psychological dependence and physical dependence are the symptoms they cause. While symptoms of psychological dependence relate to emotional and motivational impairment, physical dependence entails somatic symptoms e.g. increased heart rate, sweating, tremor. The type of dependence experienced after chronic use varies between different substances (see table 1).[12]

Although psychological dependence and physical dependence are distinct entities, they should not be characterized as mutually exclusive. Empirical studies have shown that cravings, which are traditionally associated with psychological dependence, involve a physiological element.[12][15]

See also

References
  1. Malenka RC, Nestler EJ, Hyman SE (2009). "Chapter 15: Reinforcement and Addictive Disorders". In Sydor A, Brown RY (eds.). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. pp. 364–375. ISBN 9780071481274.
  2. Nestler EJ (December 2013). "Cellular basis of memory for addiction". Dialogues in Clinical Neuroscience. 15 (4): 431–443. PMC 3898681. PMID 24459410. Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.41. ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.
  3. "Glossary of Terms". Mount Sinai School of Medicine. Department of Neuroscience. Retrieved 9 February 2015.
  4. Volkow ND, Koob GF, McLellan AT (January 2016). "Neurobiologic Advances from the Brain Disease Model of Addiction". New England Journal of Medicine. 374 (4): 363–371. doi:10.1056/NEJMra1511480. PMC 6135257. PMID 26816013. Substance-use disorder: A diagnostic term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) referring to recurrent use of alcohol or other drugs that causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Depending on the level of severity, this disorder is classified as mild, moderate, or severe.
    Addiction: A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicated by compulsive drug taking despite the desire to stop taking the drug. In the DSM-5, the term addiction is synonymous with the classification of severe substance-use disorder.
  5. Koob, George F.; Le Moal, Michel (2008). "Addiction and the brain antireward system". Annual Review of Psychology. 59: 29–53. doi:10.1146/annurev.psych.59.103006.093548. ISSN 0066-4308. PMID 18154498.
  6. Diana, M; Pistis, M; Carboni, S; Gessa, G L; Rossetti, Z L (1993-09-01). "Profound decrement of mesolimbic dopaminergic neuronal activity during ethanol withdrawal syndrome in rats: electrophysiological and biochemical evidence". Proceedings of the National Academy of Sciences of the United States of America. 90 (17): 7966–7969. Bibcode:1993PNAS...90.7966D. doi:10.1073/pnas.90.17.7966. ISSN 0027-8424. PMC 47268. PMID 8367449.
  7. Parsons, L. H.; Koob, G. F.; Weiss, F. (1995). "Serotonin dysfunction in the nucleus accumbens of rats during withdrawal after unlimited access to intravenous cocaine". The Journal of Pharmacology and Experimental Therapeutics. 274 (3): 1182–1191. ISSN 0022-3565. PMID 7562486.
  8. Mugnaini, M.; Garzotti, M.; Sartori, I.; Pilla, M.; Repeto, P.; Heidbreder, C. A.; Tessari, M. (2006). "Selective down-regulation of [(125)I]Y0-alpha-conotoxin MII binding in rat mesostriatal dopamine pathway following continuous infusion of nicotine". Neuroscience. 137 (2): 565–572. doi:10.1016/j.neuroscience.2005.09.008. ISSN 0306-4522. PMID 16289885. S2CID 26730060.
  9. Yoneda, Yukio (2005). "Functional Proteins Involved in Regulation of Intracellular Ca2+ for Drug Development: Preface". Journal of Pharmacological Sciences. 97 (3): 337–338. doi:10.1254/jphs.fmj04007x1. ISSN 1347-8613.
  10. Hammami-Abrand Abadi, Arezoo; Miladi-Gorji, Hossein; Bigdeli, Imanollah (April 2016). "Effect of environmental enrichment on physical and psychological dependence signs and voluntary morphine consumption in morphine-dependent and morphine-withdrawn rats". Behavioural Pharmacology. 27 (2 and 3 - Special Issue): 270–278. doi:10.1097/fbp.0000000000000197. ISSN 0955-8810. PMID 26397757. S2CID 11212134.
  11. Fadaei, Atefeh; Gorji, Hossein Miladi; Hosseini, Shahrokh Makvand (2015-01-15). "Swimming reduces the severity of physical and psychological dependence and voluntary morphine consumption in morphine dependent rats". European Journal of Pharmacology. 747: 88–95. doi:10.1016/j.ejphar.2014.11.042. ISSN 1879-0712. PMID 25498794.
  12. "What is pshychological dependence?". 2018-10-29.
  13. "Understanding Tolerance, Dependence, and Addiction". DrugAbuse.com. 2016-06-29. Retrieved 2019-02-23.
  14. "Porn Addiction". PsychGuides.com. Retrieved 2019-03-07.
  15. De Masi, Franco (2016). "Le concept de pulsion de mort est-il encore utile en clinique ?". L'Année Psychanalytique Internationale. 2016 (1): 157–173. doi:10.3917/lapsy.161.0157. ISSN 1661-8009.
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