9. Addiction and its Rehabilitation Flashcards
What is substance abuse?
A pattern of drug use where people rely on a drug chronically and excessively, allowing it to occupy a central place in their lives.
We do NOT use this term anymore (it used to be differentiated to substance dependence - an advanced state of abuse)
define addiction
- brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences
- can be drugs, behaviours, etc
The word is omitted from DSM-5 because of uncertain definition and negative connotations
What is a substance use disorder?
A cluster of cognitive, behavioural and physiological symptoms indicating that the individual continues substance use despite significant substance related problems.
What is a substance-induced disorder?
Includes intoxication, withdrawal, and other substance/medication induced mental disorders (psychotic episodes, depressive disorder)
Outline the DSM-5 substance use disorder
A cluster of cognitive, behavioural and physiological symptoms indicating that the individual continues using substance despite adverse consequences
4 categories of symptoms:
- impaired control (criteria 1-4)
- social impairment (criteria 5-7)
- risky use (criteria 8-9)
- pharmacological (10-11_
Severity:
- mild use disorder = 2-3 symptoms
- moderate = 4-5 symptoms
- severe = 6+ symptoms
What is the prevalence of substance use disorder?
- 5% of the population have alcohol use disorders
- males experiencing substance use disorders at twice the rate as females in Australia
- 18-24 years have relatively high prevalence rates of every substance
Outline DSM 5 criteria for alcohol use disorder
A. problematic pattern of alcohol use leading to clinically significant impairment/distress –> 2 of the following within 12 month period:
Impaired control
1. taken in large amounts / over a longer period than intended
2. persistent desire / unsuccessful efforts to control alcohol use
3. time is spent in activities to obtain/use/recover-from alcohol
4. cravings
Social impairment:
5. failure to fulfil role obligations at work/school/home
6. continued alcohol use despite recurrent interpersonal problems as a result
7. important activities given up / reduced due to alcohol use
Risky use:
8. recurrent alcohol use in physically hazardous situations
9. continued use despite persistent physical / psychological problem caused / exacerbated by alcohol
Pharmacological criteria
10. tolerance (need for markedly increased amounts of alcohol to achieve desired effect)
11. withdrawal
United States prevalence of alcohol use disorder
among 12-17 year old - 4.6%
among 18+, 8.5%
adult men: 12.4%
adult women: 4.9%
Onset and risk factors of alcohol use disorder
Onset = late teens, early 20s
Risk factors
- cultural attitudes toward drinking
- availability of alcohol (price)
- acquired personal experiences with alcohol
- stress levels (or poor coping strategies)
- genetics (40-60%)
Outline the comorbidity of substance use disorder
Marel et al (2016);
High comorbidity with mood and anxiety disorders - correlating anxiety disorder is higher for women
Limitation: drug and alcohol services tend to be quite disconnected from mental health services - despite this comorbidity
When you see a client, you will try and apply one of these hypotheses for Substance Use disorder:
Direct causal hypothesis:
substance use –> mental health condition or other way
Indirect causal hypothesis
substance use –> intermediary factors –> mental health condition
or other way
Common factors hypotheses:
common factors contributing to both substance use and mental health condition
Outline neurochemical transmission process and the 7 mechanisms:
For a message to go from 1 neuron to the next, the chemical is released into the synapse. If the chemical is an agonist the message will propagate - if its an antagonist, the message will stop.
7 Mechanisms
- synthesis
- storage
- release
- receptor interaction
- deactivation
- reuptake
- degradation
There are 7 mechanisms by which an exogenous substance may exert influences over neural transmission in the brain: outline them
Synthesis: a substance can either promote or restrict the synthesis of a neural chemical
Storage: can effect how its stored
Release: can effect to what extent the endogenous chemical is released
Receptor interaction: can effect receptor sites on the post synaptic neuron
Deactivation in the synaptic clef: can deactivate
Reuptake: can influence this
Degradation of the endogenous substance
Explain how MAO inhibitors work
Monoamine oxidase degrades serotonin in the synaptic cleft.
The MAO inhibitor (agonist) stops the degradation of the serotonin, so that more serotonin is available for release.
Explain how SSRIs work
Selective serotonin reuptake inhibitors block serotonin reuptake so that the serotonin stays in the synaptic cleft longer.
Explain how amphetamines work
Block the reuptake of dopamine, keeping it present for longer in the synaptic cleft, making a dopaminergic signal more likely to propagate.
Also releases more dopamine.
Outline opponent process theory
- the brain aims for homeostasis
- when neural activity is suddenly changed (from an exogenous signal), there is an opposite down or up regulation of receptor sites
- when you take stimulants, this will cause an increase in activity, then the brain will endogenously try slow itself down (by regulating receptor sites)
- with each introduction of the substance to the brain, the brain doesn’t go back to the same baseline, in this one its a lower baseline.
Alcohol intoxication and withdrawal symptoms are
symptomatically opposites
What is allostasis? (Koob 2003)
Koob adapted Solomon’s Opponent Processes Theory to include allostasis:
the ability to attain stability but at an altered, potentially pathologic set point.
i.e. homeostasis is maintained but the ‘base level’ changes - i.e. every single time you take alcohol, you return to a higher baseline level of anxiety than before you had taken it
What is incentive sensitization theory?
Wanting = cravings for a drug
Liking = pleasure it produces
With repeated drug use, wanting increases (sensitizes) and liking decreases (tolerance develops)
What are the neural systems associated with Incentive Sensitization
Separate neural systems associated with wanting and liking.
Wanting (craving): Dopamine system
Liking: small liking ‘hotspots’ within regions to which dopamine neurons project
