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WINTER 2024 > 337 SUD/AUD > Flashcards

337 SUD/AUD Flashcards

1
Q

SUD in HiTOP

A
  • under disinhibited externalizing, then under substance-related
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2
Q

alcohol: historical context

A
  • beer consumption very normative (with breakfast)
  • until the temperance movement in the US (religious and feminist movements)
  • now alcohol becomes a moral issue; consuming alcohol as a character issue that alienates you from God and your community
  • many conflicting attitudes about alcohol (can be glamorized in certain contexts and considered a moral defect)
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3
Q

shift in perspective in DSM for alcohol

A
  • DSM-I: symptom of sociopathic personality disorder - alcohol and drug dependence without specific criteria
  • DSM-II: still a personality disorder, but started classifying drugs, criteria are about cravings
  • DSM-III: separated from personality disorders, each drug is a separate disorder, distinguishes between abuse (pathological use, impairment, duration of 1 month) and dependence (physiological tolerance and withdrawal)
  • DSM-III-R, IV: removed the word addiction, minor tweaks
  • DSM-5: no distinction between abuse and dependence, single disorder for all substances, added a craving symptom
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4
Q

DSM-IV substance abuse criteria

A
  • maladaptive pattern of use leading to distress or impairment indicated by one or more of:
  • failure to fulfill role obligations
  • consumption in physically hazardous situations
  • legal problems
  • social problems
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5
Q

DSM-IV substance dependence criteria

A
  • next step up from abuse (if you have this, you probably meet criteria for abuse)
  • maladaptive pattern of use leading to distress or impairment indicated by 3+ of the following:
  • tolerance
  • withdrawal
  • drinking more than intended
  • failure to cut down
  • lots of time spent consuming
  • other activities given up
  • physical or psychological problems
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6
Q

problems with DSM-IV criteria

A
  • assumes that if you meet criteria for dependence, you also meet criteria for abuse (which isn’t always the case)
  • ‘legal problems’ disproportionately affects minorities and certain ethnicities, legal criteria are different depending on where you are
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7
Q

five main categories of substances

A
  1. depressants: behavioural sedation (alcohol, anxiolytics)
  2. stimulants: increase alertness and improve mood (cocaine, caffeine)
  3. opiates: analgesia and euphoria (heroin, morphine, codeine)
  4. hallucinogenics: alter sensory experience/contact with reality (marijuana, LSD)
  5. other: inhalants, steroids, drugs not used as prescribed
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8
Q

non-substance addictive disorders

A
  • addictive disorders now include (DSM-5) Gambling disorder
  • the only new entry in behavioural addiction
  • hypothesized to be similar in clinical expression, neural origins, comorbidity, physiology, treatment
  • but this opens the door to pathologizing any socially undesirable behaviours (like sex addiction, shoplifting)
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9
Q

addiction

A
  • how difficult it would be for people to not engage in the behaviour (stop using the substance), inability to stop despite negative consequences
  • nicotine is most addictive
  • need state/craving overwhelms other impulses
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10
Q

4 groupings of SUD indicators

A
  1. impairment of control
  2. social impairment
  3. risky use
  4. pharmacological dependence (tolerance, withdrawal)
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11
Q

prevalence rates of substance use

A
  • use of any illict drug gets common in 10th grade, then very common in college age
  • polysubstance use disorder: concurrent dependence is more common than not (alcohol + nicotine, cocaine + alcohol) which is a more dangerous pattern of use
  • alcohol use more prevalent in western Europe
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12
Q

prevalence of AUD

A
  • still according to DSM-IV criteria
  • abuse: 13.2%
  • dependence: 5%
  • men have typically had 2-5 times higher rates, but women catching up
  • rates higher in White and Native American/First Nation populations and lower in Black and Hispanic populations
  • East Asian and Jewish populations have very low rates because of a gene polymorphism that makes alcohol harder to metabolize (makes it less fun), but use of other substances is similar
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13
Q

course of AUD

A
  • 35-40% meet criteria for another disorder
  • onset in later adolescence/early adulthood
  • women deteriorate more quickly than men (in clinical samples, which are more severe)
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14
Q

gateway theory

A
  • alcohol and marijuana as ‘gateway drugs’ which increase the likelihood of use of other drugs
  • this theory doesn’t rule out a general tendency towards substance abuse (marijuana and alcohol are more accessible)
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15
Q

Mz and Dz twin study of the gateway theory

A
  • twins discordant for marijuana use (one was using, the other wasn’t)
  • twin that used marijuana was more likely to still be using marijuana + using other substances at follow-up
  • effects could be because you’re choosing social groups who also use drugs (nonshared environment)
  • could be gateway drugs because of their social correlates rather than their chemical properties
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16
Q

course/risk of AUD

A
  • heavy drinking associated with higher rates of vulnerability to injury, marital discord, intimate partner violence, illness, neurocognitive impairments (white matter decrease)
  • decreased lifespan, especially men
  • suicide (proximal predictor)
  • chronic course more likely than recovery
  • controlled drinking outcome is a possibility
  • after 5 years of abstinence, unlikely to relapse
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17
Q

AUD treatment follow-up

A
  • 3, 7, 9 years post-treatment outcomes
    (1) low-functioning frequent heavy drinkers
    (2) low-functioning infrequent heavy drinkers
    (3) high-functioning heavy drinkers
    (4) high-functioning infrequent drinkers (both abstinent and controlled drinking)
  • most people are high functioning
  • abstinence isn’t necessarily the only positive outcome to be striving for
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18
Q

vulnerability factors for AUD

A
  • early drinking (before 15)
  • family history of AUD (but also see higher rates of almost all disorders, slight tendency toward more externalizing disorders but internalizing are also present)
  • adoptees from biological parents with AUD = higher rates, so some biological predisposition
  • higher tolerance for alcohol = need to drink more, slower to recognize the effects of alcohol, builds up your tolerance even more (sons of fathers with AUD tend to have better balance and coordination, the better they perform on these tasks, the more likely they are to develop AUD later)
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19
Q

twin studies of AUD

A
  • Mz and Dz who are concordant (have disorder) or discordant (one does, the other doesn’t)
  • looking at the offspring of the twins
  • group 1: offspring of fathers who have AUD (high genetic and environmental risk)
  • group 2: dad is a Mz twin without AUD, but his co-twin has AUD (high genetic, low environmental) group of interest
  • group 3: dad is a Dz twin without AUD but his co-twin has AUD (moderate genetic risk, low environmental)
  • group 4: offspring of fathers without AUD (low genetic, low environmental)
  • group 1 more likely than 4 to have AUD, neither 2 or 3 was more likely to have AUD than group 4
  • indicates that genes aren’t deterministic, the environment is important
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20
Q

positive affect regulation theory

A
  • positive reinforcement: it feels good to drink
  • people feel confident and happier
  • some people may be higher on sensation-seeking, reward-seeking which be a vulnerability
21
Q

Catherine Fairbairn research on AUD prevalence in males

A
  • men report their bonding with friends occurs in the context of drinking
  • drinking may be more rewarding for men
  • both males and females show increased mood after drinking
  • men experienced an increase in reciprocal smiling + longer duration of smiles = contagion more likely (more positive reinforcement from friends)
  • we don’t see this reciprocal smiling in men with women or women with women
22
Q

negative affect regulation theory

A
  • negative reinforcement: for many people, it feels bad not to drink
  • self-medication, decreases anxiety/sadness/self-consciousness
  • evidence that some people with more trait negative affectivity may be vulnerable to AUD
23
Q

mesocorticolimbic pathway

A
  • reinforcement learning
  • ventral tegmental area, nucleus accumbens, PFC
  • dopamine: mood, motivation, learning, experience of pleasure
  • dopamine produced in VTA, goes to NAcc, amygdala, hippocampus, PFC (production increases in response to reward)
24
Q

craving

A
  • when learning: at first dopamine only fires in response to reward, but after learning the cues that indicate reward, dopamine response shifts to the cue
  • if you get the cue (so predict the reward) but not the reward, dopamine activity decreases
  • dopamine response shifts to the cue, indicating craving state (and if you don’t get it, dopamine crashes)
  • not just disregard for consequences, but a need you can’t control
  • focus of treatment to regulate the need state
  • more intense cravings associated with chronicity and severity of AUD
25
Q

deviance proneness

A
  • SUD part of a deviant pattern of behaviour that is attributable to deficient socialization in early childhood
  • SUD more common in people engaging in criminality or recklessness (causality difficult to follow)
26
Q

physiological effect of alcohol

A
  • both a stimulant and a depressant
  • while drinking: stimulant (increases elation, excitement, extraversion and decreases fatigue, restlessness, depression, tension)
  • after drinking: depressant (decreases vigor and increases fatigue, relaxation, confusion, depression)
  • increases in norepinephrine which mobilizes the brain and body for action (arousal, also associated with impulsivity)
27
Q

limbic system and PFC in physiological effects of alcohol

A
  • limbic system responsible for motivation, PFC controls the energy and inhibits when necessary
  • PFC becomes less active with alcohol consumption
  • alcohol also affects the temporal lobe (reduced activity in the hippocampus can explain why people black out
  • also reduced activity in the cerebellum = difficulty walking straight, fine motor control
28
Q

GABA and alcohol

A
  • GABA necessary for reducing neuronal excitability throughout the nervous system (inhibitory synapses)
  • alcohol mimics GABA and inhibits dopamine neurons found in PFC, cerebellum, hippocampus
  • over time, alcohol will affect those areas (decrease white matter)
  • certain people with polymorphisms concerning GABA activity might be at increased risk for AUD
  • GABA associated with disinhibition during drinking and depressant effects after drinking
29
Q

stimulants

A
  • most widely used and abused category
  • amphetamines, cocaine, nicotine, caffeine increase alertness and energy
  • produce elation, vigor, pleasure, reduce fatigue (similar to effects of adrenaline) followed by a ‘crash’
  • increase dopamine and NE in the brain
  • can cause psychotic symptoms (DDx)
  • high risk of dependency and withdrawal, must be discontinued carefully
  • methamphetamines are highly addictive and can re-wire/shape the brain with repeated use
30
Q

cocaine use disorder

A
  • stimulant blocking re-uptake of dopamine = elation, vigor, less fatigue
  • highly addictive, but addiction develops slowly
  • withdrawal can be painful (boredom, paranoia, tolerance)
  • crack: crystallized form of cocaine that is more used by lower SES and is more pathologized/more legal consequences, could be more pleasurable and addictive
  • prevalence = 0.7%
31
Q

opiate

A

natural chemical in opium poppy (narcotic effect)

32
Q

opioids

A
  • class of natural and synthetic substances with narcotic effects
  • activate endogenous opioid receptors which can produce euphoria
  • blocking pain receptors = inhibitory effect
  • first used morphine for severe injuries (too addictive) then heroin (still too addictive) then methodone
  • withdrawal: anxiety, nausea, vomiting (very difficult to stop taking)
  • in low doses: euphoria, drowsiness, slurred speech, memory impairment, slowed breathing
  • in high doses: can be fatal (high sedation = respiratory failure and heart arrest)
  • prescription opioids are more common than recreational use
33
Q

expectancy theory

A
  • alcohol expectancies: information about the reinforcement value of alcohol is stored as a memory template that can affect behavioural patterns of alcohol use
  • positive expectancies predict more alcohol use
34
Q

tension reduction theory/stress-response dampening theory

A
  • alcohol’s ability to reduce tension or dampen stress
  • certain moderators affect the stress-dampening effects
  • genetic predisposition to stress reactivity could mediate effects of alcohol
35
Q

personality theory Cloninger

A
  • type 1 alcoholics: early onset with antisocial traits
  • type 2: late onset and tendency toward negative affect
36
Q

personality theory Babor

A
  • type A: later onset, fewer childhood risk factors, less severe dependence, fewer alcohol‐related problems, and less psychopathological dysfunction (better prognosis)
  • type B: childhood risk factors, familial alcoholism, early onset of alcohol‐related problems, greater severity of dependence, polydrug use, a more chronic treatment history, greater psychopathological dysfunction, more life stress
37
Q

social learning theory

A
  • social-environmental variables: situational factors that become paired with alcohol use (triggers)
  • coping skills: ability to cope with stressors without reverting to alcohol
  • cognitive factors: self-efficacy (ability to enact a behaviour/obtain an outcome) and outcome expectancies (beliefs about consequences)
  • relapse occurs from lack of coping skills = low self-efficacy beliefs about coping = positive alcohol expectancy
38
Q

psychostimulant theory of addiction

A
  • substances with high potential for abuse produce psychomotor stimulation which acts as a reinforcer
  • effects are produced by the mesocorticolimbic pathway (which also contributes to craving)
39
Q

incentive sensitization model of craving

A
  • mesolimbic DA activation attributes salience to alcohol cues = motivation
40
Q

allostatic model of dependence

A
  • dysregulated reward and stress circuits due to repeated exposure to alcohol
  • integration of positive and negative reinforcement effects of alcohol
41
Q

CBT for AUD

A

teaching skills for coping with drinking urges, including identifying triggers and preventing relapses

42
Q

twelve-step therapies

A
  • AA, most widely used
  • goal of long‐term complete abstinence and generally discourage the use of any psychiatric medications
43
Q

project MATCH

A
  • comparing CBT, MET, 12-step
  • 12-step patients more likely to remain abstinent
  • at 3-year follow-up, all Tx had similar outcomes
  • initial client level of anger was the best moderator of Tx outcome (higher anger = MET better, lower anger = CBT or 12-step)
44
Q

psychosocial Tx for AUD

A
  • motivational enhancement therapy
  • CBT, 12-step
  • behavioural marital therapy
  • community reinforcement approach
  • contingency management
  • cue-exposure therapy
  • mindfulness-based therapies
45
Q

pharmacological Tx for AUD

A
  • often used to manage withdrawal symptoms
  • Naltrexone: decreasing alcohol consumption and treating alcohol dependence
  • disulfiram
46
Q

African Americans and alcohol use

A
  • show more abstention from alcohol, less frequent, less heavy drinking
  • but when they do engage in drinking, higher risk for alcohol-related problems (chronic health problems, legal and interpersonal problems)
  • alcohol use and intoxication have historically been negatively viewed
  • tend to have conservative norms and attitudes about maintaining control (drinking not assimilated into daily life)
  • parents have less positive perceptions of alcohol, socialize their kids to be wary of it because of severe legal consequences
  • higher levels of religiosity
47
Q

biological factors in African American AUD

A
  • alcohol dehydrogenase (ADH) breaks down alcohol into acetaldehyde which is broken down by mitochondrial aldehyde dehydrogenase (ALDH2) into acetate
  • protective factors against AUD: ADH variant that metabolizes alcohol more quickly and ALDH2 variant that breaks it down slower
  • ADH variant found only in Afr.Am. - positive experiences with alcohol, more physiological effects which protects against heavy drinking but also makes intoxication more overt (and contributes to negative consequences with law and social groups)
  • ALDH2 variant found in Asian - sensitivity to positive and negative effects of alcohol = lower drinking rates
48
Q

standard life reinforcers (SLRs)

A

basic set of rewarding circumstances or experiences that persons strive for (housing, economic security, work opportunity, knowledge, relationships)

49
Q

behavioural choice theory

A
  • choose one behaviour among alternatives because others are more costly, less available
  • choice to consume alcohol depends on access to it and availability of alternatives
  • Afr.Am. men have less access to alternatives and SLRs which reduces the disincentive to drink
  • Afr.Am women may have more access to SLRs through caregiving
  • limited access to SLRs doesn’t improve with age, so older men drink more

WINTER 2024 (28 decks)

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