1 = Less than 1 hr/day or occasional performance of compulsive behaviors 2 = From 1 to 3 hrs/day, or frequent performance of compulsive behaviors 3 = More than 3 and up to 8 hrs/day, or very frequent performance of compulsive behaviors 4 = More than 8 hrs/day, or near constant performance of compulsive behaviors (too numerous to count) 7. Aside, we believe that items lb (obsession-free interval), 6b (compulsion-free interval), and 12 (avoidance) may provide information that has bearing on the severity of obsessive-compulsive symptoms. Item 11 (insight) may also furnish useful clinical information. We are least secure about the usefulness of items 13-16.
Artie Strauss And Judd Steiner
Most of the really important things in life—such as love and death—
happen unexpectedly. I know that my escape from Dartmoor did.
We had just left the quarries—eighteen of us, all dressed in that depressing
costume which King George provides for his less elusive subjects—and we
were shambling sullenly back along the gloomy road which leads through
the plantation to the prison. The time was about four o'clock on a dull
In the roadway, on either side of us, tramped an armed warder, his carbine
in his hand, his eyes travelling with dull suspicion up and down the gang.
Fifteen yards away, parallel with our route, the sombre figure of one of the
civil guards kept pace with us through the trees. We were a cheery party!
Suddenly, without any warning, one of the warders turned faint. He
dropped his carbine, and putting his hand to his head, stumbled heavily
against the low wall that separated us from the wood. The clatter of his
weapon, falling in the road, naturally brought all eyes round in that
direction, and seeing what had happened the whole eighteen of us
The gruff voice of the other warder broke out at once, above the shuffling
'What are you stopping for? Get on there in front.'
From the corner of my eye I caught sight of the civil guard hurrying
towards the prostrate figure by the wall; and then, just as the whole gang
lurched forward again, the thing happened with beautiful abruptness.
A broad, squat figure shot out suddenly from the head of the column, and,
literally hurling itself over the wall, landed with a crash amongst the thick
undergrowth. There was a second shout from the warder, followed almost
instantly by a hoarse command to halt, as the civil guard jerked his carbine
to his shoulder.
Jonathan Kellerman Compulsion
A Rogue By Compulsion
A Rogue By Compulsion
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Alcohol journal homepage: http://www.alcoholjournal.org/
ABSTRACTS Alcoholism and stress: A framework for future treatment strategies VOLTERRA, ITALY MAY 9 e 12, 2017
PL1 STRESS, NEGATIVE REINFORCEMENT AND COMPULSIVE DRUG SEEKING George F. Koob Ph.D. Director National Institute on Alcohol Abuse and Alcoholism, Washington, DC, USA Compulsive alcohol seeking can derive from 3 multiple sources that comprise neuroadaptations in the 3 stages of the addiction cycle binge/ intoxication stage, withdrawal/negative affect stage, and preoccupationanticipation (“craving”) stage. A powerful driving force in both the withdrawal/negative affect and preoccupation-anticipation stages in alcohol use disorders is the construct of negative reinforcement, deﬁned here as drug taking that alleviates a negative emotional state created by drug abstinence. The negative emotional state that drives such negative reinforcement is hypothesized to derive from allostatic dysregulation of key neurochemical circuits that form the brain stress and anti-stress systems. Speciﬁc neuroplasticity in these circuits includes extrahypothalamic corticotropinreleasing factor (CRF), the dynorphin-opioid, vasopressin, hypocretin, norepinephrine, glucocorticoids and neuroimmune factors all converging on elements of the extended amygdala. Brain anti-stress systems such as neuropeptide Y, nociception, endocannabinoids and oxytocin buffer the changes in the brain stress systems providing another potential source of allostatic dysregulation of brain stress function. Excessive drug taking is also accompanied by deﬁcits in executive function produced by neurocircuitry dysfunction in the medial prefrontal cortex that may facilitate the transition to compulsive-like responding and relapse. Thus, compelling evidence exists to argue that plasticity in the brain stress systems is triggered by acute excessive drug intake, is sensitized during the development of compulsive drug taking with repeated withdrawal, persists into protracted abstinence, and contributes to the development and persistence of compulsive alcohol seeking. The neuroplasticity of the brain stress systems in compulsive alcohol seeking not only provides understanding of the neurobiology of negative reinforcement mechanisms alcohol use disorders, but also provides a compelling framework for a more comprehensive diagnosis, treatment and prevention of alcohol use disorders. PL2 HABITUAL BEHAVIOR IN ADDICTION & STRESS: NEUROGENETIC APPROACHES TO PTSD COMORBIDITY Kerry Ressler MD, Ph.D. Professor of Psychiatry, Chief Scientiﬁc Ofﬁcer. Harvard Medical School, McLean Hospital, Belmont, MA, USA Exposure to traumatic experiences, especially those occurring in childhood, has been linked to substance use disorders (SUDs), including abuse and dependence. Childhood and adult trauma, as well as SUDs, are also highly associated with Posttraumatic Stress Disorder (PTSD) and other mood-related psychopathology. I will examine the relationships between trauma, substance use, and PTSD, as well as markers of resilience, in a sample of urban primary care patients. Further we examine genetic polymorphisms that appear to be associated with increased risk for both
disorders, and neural circuit activity associated with risk for both addiction and unregulated fear responding. We hypothesize that similar genetic and neural biological processes associated with increased habitual and decreased goal-directed behaviors are associated with both SUDs and PTSD and their comorbidity in clinical populations. I will ﬁrst present data from animal models showing that similar genetic manipulations of both medial prefrontal cortex and amygdala can lead to deﬁcits in extinction of both stress-related fear behavior, as a model for PTSD, and extinction of cocaine place preference, a model of addiction. Then, in our at-risk human cohorts, the data show strong links between trauma history, SUDs, and their joint associations with PTSD outcome. Additionally, the fMRI data suggest that the same circuits involved in behavioral inhibition appear to be involved in fear inhibition processes during differential fear conditioning and extinction. These ﬁndings suggest that enhanced awareness of PTSD and substance abuse comorbidity in high-risk, impoverished populations is critical to understanding the mechanisms of substance addiction as well as in improving prevention and treatment. Our ﬁndings also add to a nascent body of literature suggesting that resilience characteristics mitigate risks not only for PTSD, major depression, and suicidality, but also for substance use problems in adults exposed to childhood abuse or other traumatic experiences. In conclusion, shared neural circuitry may mediate risk for both SUDs and PTSD, and the concept of habitual behavior may be equally applied to both addiction and fear-related behavior. Thus a neural-circuit and behaviorbased framework for treating SUDs, such as alcoholism, and stress-related disorders, such as PTSD, is crucial for improvement in treatment and prevention. PL3 SEX DIFFERENCES IN ANIMAL MODELS: FOCUS ON STRESS AND ADDICTION Jill B. Becker Ph.D. University of Michigan, Ann Arbor, MI, USA Addiction is characterized by compulsive drug taking that supersedes other recreational, occupational or social pursuits. Sex differences are seen in the motivation to take drugs of abuse and in the escalation of drug taking behavior and stress can differentially affect drug-taking behaviors in males vs. females. Using the rat as an animal model, we ﬁnd that in females there are rapid effects of estradiol on the ascending dopamine system that enhance the female’s motivation to engage in these behaviors. Female rats exhibit greater behavioral sensitization to cocaine, acquire cocaine selfadministration more rapidly, and work harder to receive cocaine than males, and estradiol enhances these sex differences. We ﬁnd that in rats vulnerability to addiction can be identiﬁed within the larger population based on their preference for cocaine over palatable food rewards. These cocaine-preferring rats increase their drug intake at the expense of pellets, displayed greater motivation for cocaine, attenuated motivation for pellets and an attenuated cocaine-induced dopamine release in nucleus accumbens, compared with animals that preferred palatable food pellets. Females are more likely to develop this cocaine preference than are males. Prenatal stress can differentially affect acquisition of and motivation for self-