2 - addiciton lecutre — pathophysiology + clinical management

Question 1

definition of drug abuse

Answer 1

substance used in a manner that does not conform to social norms. can abuse drugs without being dependent or addicted

Question 2

definition of drug dependence (physical)

Answer 2

individual depends on drug for normal physiological functioning. abstinence produced physical withdrawal reactions

Question 3

definition of drug dependence (psychological)

Answer 3

acquiring and using drug are strong motivators of behaviour. compulsive use

Question 4

definition of drug addiction

Answer 4

not a clinical diagnosis. typically used to emphasise psychological dependence. idea that people can be physically dependent but not addicted

Question 5

diagnosing substance dependence pre 2013

Answer 5

3+ in last year:
- tolerance
- physical withdrawal state
- difficulties controlling use (amount, onset, stopping)
- strong desire/compulsion to take the substance
- progressive neglect of other interests
- persistence with substance despite detrimental effects — social, cognitive, physical

Question 6

diagnosing substance use disorder from 2013

Answer 6

2-3: mild, 4-5: moderate, 6-7: severe
- tolerance
- withdrawal
- continuing to use despite the -ve personal consequences
- repeatedly unable to carry out major obligations
- recurrent use in physically hazardous situations
- continued use despite persistent or recurring social or interpersonal problems
- using greater amounts of using over a longer period of time than intended
- persistent desire or unsuccessful efforts to cut down
- spending a lot of time obtaining, using, or recovering
- stopping or reducing important social, occupational, or recreational activities
- consistent use despite persist or recurrent physical or psychological difficulties
- craving or a strong desire to use

Question 7

when does drug tolerance occur?

Answer 7

when decreased sensitivity to a substance develops as a result of its continuous use

Question 8

sites along where are really critical in the way the brain processes pleasure and reward?

Answer 8

medial forebrain bundle — extends from the ventral tegmental area in the brainstem, up towards the medial prefrontal cortex

Question 9

what areas are there along the medial forebrain (sites of rewarding brain stimulation)?

Answer 9

Question 10

all drugs of abuse increase dopamine levels in _____?

Answer 10

nucleus accumbens

Question 11

what does cocaine block? effect?

Answer 11

the transporter that takes up excess dopamine — therefore increase in dopamine in synapse — increase in post-synaptic binding

Question 12

what does GABA inhibit?

Answer 12

dopamine

Question 13

what do opiates inhibit?

Answer 13

GABA — therefore more dopamine

Question 14

describe drug tolerance

Answer 14

• chronic effect
• diminished response to drug — decreased effect or need more for same effect
• changes in endogenous dopamine release
• decreased receptors, receptor desensitisation and down-regulation
• need more drug to release same amount of dopamine and get same “high”

Question 15

describe drug withdrawal

Answer 15

• “normal” function needs drug
• sudden cessation produces symptoms resulting from neurochemical cascade
• changes to release and receptors mean that functioning depends on exogenous dopamine
• without eternal stimulation, normal function compromised

Question 16

describe cocaine in terms of acute use vs chronic use vs withdrawal

Answer 16

Question 17

why do some people become dependent?

Answer 17

GXE interaction — dependence

> genetic/biological — familial, multi-gene eg. DA genes, brain changes

> environment — childhood, peer pressure, availability

Question 18

what are the differences in clinical management of withdrawal in the acute term, medium term, and long term?

Answer 18

• acute : management of withdrawal
• medium : harm reduction, substitution
• long : maintaining abstinence

Question 19

what % of people who go through short term detox treatments will relapse within a year?

Answer 19

75%

Question 20

symptoms of 3 vs 10 vs 30 days of abstinence

Answer 20

Question 21

what agonist can be used in opiate relapse prevention?

Answer 21

methadone

Question 22

what partial agonist can be used in opiate relapse prevention?

Answer 22

buprenorphine

Question 23

what antagonist can be used in opiate relapse prevention?

Answer 23

naltrexone

Question 24

why are most deaths in opiate addicts accidental?

Answer 24

• accidental overdoses after detox
• detox removes tolerance
• people relapse to pre-detox dose — with no tolerance, it proves fatal

Question 25

describe substitution pharmacotherapy in opiate addiciton

Answer 25

A : effects of opiates wanted by addicts — pleasure, reward
B : effects of opiates primarily not wanted — respiratory depression

IDEAL : give A, but not too much, without B

Question 26

name 2 full agonists - opiates

Answer 26

• morphine
• methadone

Question 27

how does naltrexone (opiate antagonist) work?

Answer 27

• blocks the mu opiate receptor
• leads to reduced DA-ergic activity
• reduced craving
• however…. bad adherance

Question 28

what are 3 psychological treatments for addiction?

Answer 28

1. motivational interviewing — non-confrontational, targets ambivalence
2. community reinforcement — ‘earn’ tokens/money with clean urines
3. relapse prevention — cognitive behavioural strategies, skills training (practise saying no), alternative cognitions (what else could i do?), lifestyle changes (relaxation training)

Question 29

what is decriminalisation of drugs?

Answer 29

— NOT the same as legalisation
- for drug use and possession, criminal charges are not applied
- decriminalisation may replace criminal penalties with civil penalties eg. referral to an education or treatment program
- production, distribution and supply are still criminal offences

Question 30

what are the advantages/disadvantages of drug decriminalisation?

Answer 30

+ves:
- civil cases do not lead to criminal records and will not affect employment, housing or travel opportunities
- treating drug use as a health and social issue rather than a crime can reduce stigma and increase the likelihood that a person will seek help

-ves:
- would drug use increase?????

Question 31

what is drug legalisation?

Answer 31

• drug possession and use are legal
• regulations control production, distribution and supply
• no penalties if regulations are complied with
• may be criminal penalties if regulations aren’t followed

Question 32

what are some reasons for and against cannabis legalisation?

Answer 32