8. Substance Abuse Disorders Flashcards
What is a problem with the concept of “addiction”?
Addiction is often self-reported
Is addiction used in the DSM-5?
No. “Addiction” is omitted from the DSM-V when describing substance use disorder diagnostic terminology because it is an unclear definition and has a negative connotation
What was substance abuse previously thought of as?
People with substance abuse disorders were previously considered “weak-willed”, that they had a flaw in their moral character
What is the most important neurotransmitter to understand when considering substance-abuse?
Dopamine
What is the dopaminergic pathway
- considered the “reward pathway”: functions in reward, pleasure, fine tuning motor function, compulsion, preservation
- *-VTA (ventral tegmental area) transmits dopamine to the frontal cortex or to the nucleus acumbens**
- Substantia nigra transmits to caudate nucleus or putamen
What are the three main types of opioid receptors?
Mu, Kappa & Delta
Which receptor do opiods respond most readily to?
Mu receptor
Which drugs attach to all three receptors but in different ways?
Morphine, fentanyl, sufentanil
What is an agonist?
Agonists activate; ex. when someone takes heroine they get the Mu response where dopamine will flow through their system
What is an antagonist?
Antagonists shut an agonist response down; ex. malaxone is a prominent Mu opioid antagonist
What are cannabinoid receptors?
They are receptors located throughout the body part of the endocannabinoid system which is involved with appetite, pain sensation, mood and memory. CBD, CBN, and TCH fit like a lock and key into these receptors
What are the two cannabinoid receptors and where are they located?
CB1 is in the central nervous system and CB2 is in the peripheral organs, especially in the gut area (what activates the “munchies”) and associated with the immune system
What is rimonabant
An antagonist: specifically a CB1 receptor blocker
What is GABA?
GABA is the inhibitory neurotransmitter that is activated by alcohol
Opiate receptors in which region of the brain are most involved in opioid addiction?
Receptors in the periaquaductal gray
What has recently become the most abused drug in the US?
Fentanil
Why is it difficult to quit when taking opioids?
Opioids alter the dopamine neurotransmitters, once they have been changed it makes killing extremely difficult
In 1980, what was a false claim made regarding opioid addiction?
- Claimed that opioids were not as addictive for patients with no history of addiction.
- WRONG because opioids are extremely addictive no matter who the person
Why was the war on drugs not successful?
They went into it with the wrong approach
What is the difference between a schedule 1 and a schedule 5 drug?
- Schedule 1: drugs with no currently accepted medical use and high potential for abuse, most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence (ex. heroin, marijuana, LSD, ecstasy)
- Schedule 5: drugs with lower potential for abuse and consist of preparations containing limited quantities of narcotics, usually used for antidiarrheal, antitussive and analgesic purposes (robitussin, lomotil, lyrica)
What is a Schedule 2 drug?
Drugs with high potential for abuse with potential for severe psychological or physical dependence (methamphetamine, methadone, oxycodone, fentanyl)
What is a Schedule 3 drug?
Drugs with moderate to low potential for physical and psychological dependence (ex. products containing 90 mg of codeine, ketamine, testosterone)
What is a Schedule 4 drug?
Drugs with low potential for abuse and low risk of dependence (ex. xanax, ativan, ambien)
What drug unusually is still considered a schedule 1 drug?
marijuana
What is the dopamine mechanism that contributes to the cycle of drug abuse?
- When initially taking drugs, the user has a great increase in dopamine which then dips during recovery to the point of undershooting.
- Each time they abuse, they undershoot dopamine levels even more.
- The user attempts to reach the initial high they first felt by combining drugs, which may help them attain that peak, but they are not able to achieve it again –> get stuck in a cycle of trying to achieve initial high
What are Bath Salts?
- Bath salts are a combination of methamphetamine and cocaine which results in critical over doses
- They drive you into a zombie state where you do not realize what you are doing
- Ex. 20 y/o on bath salts that ate the face off a homeless guy
What is EDWS?
Early drug warning system that allows investigators to find out and warn communities about drugs attempted to target kids
Ex. used to identify candy that was laced with Flakka targeting kids
What is “Pink”?
- U-47700, a new type of synthetic opioid
- part of the “grey death” mix
- never know what combination of drugs you are getting, no one knows the potency of it
What is “Krokodil”?
- desomorphine, synthetic opioid
- originated in siberian military base: combination of desomorphine and a lot of other things (never sure of combination)
- cook it with gasoline –> terrible side effects for those who inject
- considered the “flesh eating” disease
- Side effects: tooth decay, rotting flesh, blood poisoning, loss of limbs, brain damage.
- been around since 1942 but it is so fatal that number of addicts is low, most die within 2 years
What is N-bomb/smiles?
It is a serotonin psychadelic hallucinogen
-first synthesized in 2003 by a chemist in Berlin
What is “Grey Death”?
a combination of heroine, fentanol, and pink
What is the most prominent transit country for opiates produced?
Afghanistan
What is the most prominent region for transit of opiates?
Latin America
Where is cocaine predominantly produced from?
South America
What is Peyote and who is it used by?
button cactuses that are used by Native Americans in ritual practices
How are coco leaves consumed?
- coco leaves are where cocaine originates from
- primarily used in South America where they are actively chewed in the Andean region
- Coco leaves help with altitude sickness; primarily used for their medicinal properties –> don’t get the same high as cocaine gives
What is Khat?
- stalks containing cathonoids which is an amphetamine-like substance
- primarily used in the Arabian Peninsula/Horn of Africa
- people chew the leaves and stick it in their mouth to chew throughout the day
- public health issue: need to educate people that this is not safe to chew massive quantities of Khat because of it’s long-term fatal effects, also cause of refractive cardiac issues
What is Beetle Nut?
- nuts that are used for sedation and contain amphetamine-like substances
- primarily used in South and Southeast Asia, East Africa
- contains a LOT of carcinogens, prolonged chewing of beetle nut will eventually lead to oral cancer
- produces a distinct, bright orange color that stains your teeth
What is Kratom?
- M. Speciosa, leaves that are used in SouthEast Asia
- taken as an opioid substitute
- contains Mitragynine which targets the mu & delta opioid receptors, adrenergic receptor, COX-2 receptor
- cross several subtypes of drugs which makes it difficult to classify
- resulted in 44 deaths which could be attributed to the different receptors it influences at once
What is Ayanuasca?
- P. viridis leaves (has DMT) & B. Caapi vine (has MAO-I): important to have both because the MAOI is what allows the DMT to cross the blood-brain barrier and act as the hallucinogen
- brewed beverage used in South America; used by shamans to treat “susto”
- extremely acidic substance that can create problems with overdosing and make you violently ill by producing gastric issues
What is the one thing that is actually defined as an addiction in the DSM?
Gambling
