The symposium consists of three presentations addressing different aspects of substance use disorders (SUDs), with a focus on similarities and differences between opiate and stimulant dependence. The first part of the symposium focuses on diagnosis, neurobiology and etiology of SUDs. The diagnostic criteria of the official classification systems ICD-10 and DSM-5 are examined and different etiological models for development and maintenance of SUDs are considered by focusing on key biological, psychological and environmental susceptibility factors. The second part of the symposium focuses on personality aspects of substance use disorders and discussion of differences in underlying personality risk factors predisposing to distinct types of drug addictions. The third part of the symposium focuses on the role of the multidimensional construct of impulsivity in SUDs. Recent neurocognitive models and empirical findings from the neurocognitive, neuroimaging, and genetic literatures are presented and the utility of various personality, psychiatric, neurocognitive, and computational dimensions of impulsivity as candidate endophenotype(s) for addiction in general and for opiate and stimulant addiction in particular are reviewed. Finally, the potential for personality and neurocognitive aspects of addictions to serve as novel behavioral targets for prevention and intervention programs for SUDs are discussed.
Jasmin Vassileva1*, Kiril Bozgunov2, Georgi Vasilev2
1.Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond VA, USA
2.Bulgarian Addictions Institute, Sofia 1336, Bulgaria
Assessment and diagnostics of SUDs
2Bulgarian Addictions Institute, Sofia 1336, Bulgaria
This presentation is focused on the diagnosis, neurobiology and etiology of substance use disorders (SUDs). The diagnostic criteria for SUDs of the official classification systems ICD-10 and DSM-5 are examined, providing a review of the main difficulties in the diagnostic process. Different etiological models for the development and maintenance of SUDs are considered, focusing on central biological, psychological and environmental susceptibility factors. Special attention is given to the addiction neurocircuitry implicated in the three stages of addiction: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. The important distinction between substance-specific vulnerability (i.e. vulnerability for dependence on specific drug class, e.g. stimulants) and common vulnerability (vulnerability to develop SUD in general, regardless of drug class) is discussed. Key findings from the field are presented and discussed, including both common and unique predispositions for the development of substance dependence to different classes of drugs.
Personality aspects of SUDs. Implications for treatment
2Bulgarian Addictions Institute, Sofia 1336, Bulgaria
The second part of the symposium focuses on personality aspects of substance use disorders (SUDs). Addiction continues to be regarded as a unitary phenomenon in the literature, based on important similarities between different classes of drugs. However, recent research in the field, including findings from our research program in Bulgaria, reveals fundamental differences in the underlying personality factors predisposing to addiction to different type of drugs. Specific externalizing and internalizing personality traits commonly observed among substance dependent individuals are discussed, emphasizing their differential relations to dependence on different classes of drugs. Research reveals that an in-depth understanding of the role of personality traits for the development and maintenance of SUDs has significant implications for prevention and treatment of SUDs. The Preventure program by Conrod and colleagues is reviewed as one of the most successful applications of the personality model to the prevention of SUDs. Preventure focuses on the role of four basic personality traits (impulsivity, sensation seeking, hopelessness and anxiety sensitivity), which are identified as key vulnerability factors predisposing to distinct types of substance dependence. Implications for treatment and potential applications of the personality model of addiction in therapy are explored.
Neurocognitive correlates of SUDs: Impulsivities and Addictions
1Institute for Drug and Alcohol Studies, Departments of Psychiatry and Psychology, Virginia Commonwealth University, Richmond VA, USA
The third part of the symposium reviews neurocognitive aspects of substance use disorders (SUDs), focusing on the multidimensional construct of impulsivity, implicated both as an antecedent risk factor as well as a consequence of chronic subtance use. Unlike the appreciation of the multidimensionality of impulsivity, addiction continues to be considered as a unitary phenomenon, despite mounting evidence of fundamental differences between addictions to different classes of drugs. We give an overview of the multiple facets of impulsivity, highlighting neurocognitive dimensions of “impulsive choice” and “impulsive action” and their associations with personality and psychiatric aspects of impulsivity in different types of addictions. We present findings from the international reseach program in addiction developed by our team of Bulgarian and US collaborators, which investigates various personality, psychiatric, neurocognitive, and computational dimensions of impulsivity among rare populations of mono-substance dependent (‘pure’) opiate and stimulant users in Bulgaria. Our findings challenge the unitary account of addiction and suggest that different mechanisms may underlie opiate and stimulant dependence.The utility of various dimensions of impulsivity as candidate endophenotypes for drug addiction in general and for opiate and stimulant addictions in particular, and their potential to serve as novel behavioral targets for prevention and treatment of SUDs are discussed.
Supported by the National Institute on Drug Abuse (NIDA) and the Fogarty International Center under grant number R01DA021421 (PI Jasmin Vassileva).
Georgi Vasilev has ownership interests in the Bulgarian Addiction Institute, where data collection took place.