AB: Substance use disorders

Question 1

How do medieval, sociological and psychiatric approaches differ in regards to too much alcohol?

Answer 1

Medical- 7 units for women, 14 for men and when there’s physical consequences
Sociological- problems and personal consequences
Psychiatric- substance use disorder

Question 2

Name five typical addiction symptoms (From behavioural to cognitive to physical)

Answer 2

Loss of control
Pre occupation
Craving
Tolerance
Withdrawal

Question 3

How does the DSM define substance use disorder? (11)

Answer 3

1. Taking the substance in larger amounts or for longer than you’re meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Question 4

What can account for differences across countries?

Answer 4

Cultural differences

• Rituals
• Popularity of substance
• Early vs. late onset
• Definition of problems/functioning/distress

Genetic differences
-Tolerance

Question 5

What is meant by the brain disease model of addiction

Answer 5

That it is a disease based on genetic disposition and should be treated as such.

Question 6

What is the effect of environment once addicted

Answer 6

When in a place you often use, craving is often stronger. Overdose may actually have a higher chance in an unfamiliar place because the body doesn’t prepare for the substance

Question 7

What phases are there in the general development process of addiction?

Answer 7

Positive attitude
Experimental use
Regular use
Heavy use 
Dependance or abuse

Question 8

What steps of recovery did the lecturer add to this process?

Answer 8

Maintenance and relapse

Question 9

What is the neurobiology theory of addiction (6)

Answer 9

1. Drugs/alcohol stimulate the “reward system” (ie mesolimbic pathway, a dopamine system)
2. Produces rewards or pleasurable feelings
3. Dopamine system -> sensitive to the drug and drug cues (classical conditioning)
4. Incentive salience to cues
5. Cue sensitivity -> wanting
6. wanting vs liking

Question 10

What psychological model is proposed for drinking motives? Give examples

Answer 10

Valence x source of outcome
Positive outcome x internal= enhance positive mood (pos. reinforcement)
P.O x Ex: Social rewards (pos. reinforcement)
N.O x In: Coping: reduce/ regulate negative effect (neg. reinforcement)
N.O x Ex: Avoid social rejection (neg. reinforcement)

Question 11

What other psychological factors regarding the effects of the drug are explained in the lecture?

Answer 11

Mood alteration- tension reduction due to “alcohol myopia.” There is a reduced cognitive capacity and a focus on immediate distractions which results in less attention focused on tension producing thoughts.
Expectancies about drug effects: Coping- people who expect alcohol to reduce stress and anxiety drink more frequently. (self medication)

Question 12

When may alcohol and nicotine increase tension?

Answer 12

When there are no distractions present

Question 13

Name three predictors of the onset of substance use disorder?

Answer 13

• Negative emotionality/ neuroticism
• desire for increased arousal and positive effect (sensation seeking)
• Low constraint (impulsivity, low control)

Question 14

What sociocultural factors come into play in regards to government choices?

Answer 14

• Availability (age, selective stores etc)

- Advertising and media

Question 15

What family factors come into play?

Answer 15

• Parental alcohol use
• Marital discord, psychiatric or legal problems in the family
• lack of emotional support from parents
• lack of parental monitoring

Question 16

How does your social network play a part?

Answer 16

Those around you will influence your behaviour and you will socially select people who do the same stuff as you

Question 17

How is the severity off a substance use disorder decided?

Answer 17

How many criteria it meets of the DSM:
Mild: 2-3
Moderate: 4-5
Severe: 6+

Question 18

What are the symptoms of a gambling disorder?

Answer 18

(4 or more needed to meet the diagnosis)

1. Gambling often occurs when feeling negative emotions
2. Efforts to stop or reduce gambling causen egative feelings and restlessness
3. Repeated reliance on other people to fix financial con- sequences of gambling
4. Continued gambling despite relationship, job, or school problems caused by it
5. Continued gambling even after losing to try to recoup losses
6. Lying to others about gambling
7. Gambling with more money is needed to get the de- sired good feelings
8. Efforts to reduce or control gambling do not work
9. Much time spent thinking about and planning gambling

Question 19

What are delirium tremens and how are they caused?

Answer 19

In relatively rare cases, a person who has been drinking heavily for several years may also experience delirium tremens (DTs) when the level of alcohol in the blood drops suddenly. The person becomes delirious as well as tremulous and has hallucinations that are primarily visual but may be tactile as well.

Question 20

What is classed as heavy drink use and binge drinking?

Answer 20

binge drinking, defined, as noted earlier, as having five drinks in a short period of time (e.g., within an hour), and heavy-use drinking, defined as having five drinks on the same occasion five or more times in a 30-day period.

Question 21

What is alcohol use disorder comorbid with?

Answer 21

Alcohol use disorders are comorbid with borderline and antisocial personality disorders, mood disorders, and anxiety disorders. Alcohol use disorder is associated with other drug use. It is estimated, for example, that 80 to 85 percent of people who abuse alco- hol are smokers.

Question 22

How does alcohol interact with neurotransmitters?

Answer 22

It stimulates gamma-aminobutyric acid (GABA) receptors, which may account for its ability to reduce tension. (GABA is a major inhibitory neurotransmitter; the benzodiazepines, such as Xanax, have an effect on GABA receptors similar to that of alcohol.) Alcohol also increases lev- els of serotonin and dopamine, which may be the source of its ability to produce pleasurable effects. Finally, alcohol inhibits glutamate receptors, which may cause the cognitive effects of alcohol intoxication, such as slowed thinking and memory loss.

Question 23

What long term consequences can prolonged alcohol abuse have

Answer 23

• adversely affects every tissue and organ of the body.
• impairs the digestion of food and absorption of vitamins. In older people who have chronically abused alcohol, a deficiency of B-complex vitamins can cause a severe loss of memory for both recent and long-past events.
• Prolonged alcohol use plus reduction in the intake of proteins contributes to the develop- ment of cirrhosis of the liver
• Other common changes to the body due to drinking include dam- age to the endocrine glands, brain, and pancreas, as well as heart failure, erectile dysfunction, hypertension, stroke, and capillary hemorrhages,

Question 24

What is the leading known cause of intellectual disability among children?

Answer 24

Heavy alcohol consumption by a woman during pregnancy; The growth of the fetus is slowed, and cranial, facial, and limb anoma- lies can be produced, a condition known as fetal alcohol syndrome (FAS).

Question 25

How is nicotine addictive?

Answer 25

The neural pathways that become activated stimulate the dopamine neurons in the mesolimbic area that seem to be involved in producing the reinforcing effects of most drugs

Question 26

Is there race differences in the effects of smoking?

Answer 26

African American cigarette smokers are less likely to quit and are more likely, if they continue to smoke, to get lung cancer. It turns out that they retain nicotine in their blood longer than do European Americans

Question 27

What is the danger of ETS

Answer 27

The smoke coming from the burning end of a cigarette, so-called secondhand smoke, or environmental tobacco smoke (ETS), contains higher concentrations of ammonia, carbon monoxide, nicotine, and tar than does the smoke inhaled by the smoker - Non smokers can suffer lung damage, possibly permanent, from extended exposure to cigarette smoke. Babies of women exposed to secondhand smoke during pregnancy are more likely to be born prematurely, to have lower birth weights, and to have birth defects. • Children of smokers are more likely to have upper respiratory infections,ashma,bronchitis, and inner-ear infections than are their peers whose parents do not smoke.

Question 28

What negative effects have been shown with cannabis?

Answer 28

- Accumulated scientific evidence indicates that marijuana can interfere with cognitive functioning, including areas such as attention, planning, decision making, working mem- ory, and problem solving - long-term use of marijuana can impair lung structure and function

Question 29

How does marijuana affect the brain?

Answer 29

Researchers have identified two cannabinoid brain receptors, called CB1 and CB2. CB1 receptors are found throughout the body and the brain, with a particularly high number in the hippocampus, an important region of the brain for learning and memory.

Question 30

Are there withdrawal symptoms associated with marijuana use?

Answer 30

restlessness, depression, anxiety, tension, stomach pains, and insomnia can occur if marijuana is discontinued

Question 31

When do people most often start using heroin

Answer 31

after first taking prescription pain medicines

Question 32

How does heroin affect the brain?

Answer 32

by stimulating neural receptors of the body’s own opioid system (the body naturally produces opioids, called endorphins and enkephalins). Heroin, for example, is converted into morphine in the brain and then binds to opioid receptors, which are located throughout the brain

Question 33

What negative effects are associated with methamphetamine?

Answer 33

everal animal studies have indicated that chronic use of methamphetamine causes damage to the brain, affecting both the dopamine and the serotonin systems. Neuro- imaging studies have found that methamphetamine use is associated with reductions in brain volume (size) in areas in the temporal and frontal cortices Meta-analyses of brain imaging studies indicate that areas of the brain impacted by meth- amphetamine use involve areas associated with reward and decision making, such as the insula, areas of the frontal and temporal cortex, and striatum

Question 34

Where does the pleasurable symptoms of cocaine come from?

Answer 34

Cocaine yields plea- surable states because dopamine left in the synapse facilitates neural transmission. Self-reports of pleasure induced by cocaine are related to the extent to which cocaine has blocked dopamine reuptake

Question 35

What can an overdose of cocaine induce?

Answer 35

chills, nausea, and insomnia, as well as strong paranoid Wesley Bocxe/Science Source © John Wiley & Sons, Inc. Volume feelings and terrifying hallucinations of insects crawling beneath the skin.

Question 36

What can chronic use of cocaine induce?

Answer 36

heightened irritability, impaired social relationships, paranoid think- ing, and disturbances in eating and sleeping. Some, but not all, users develop tolerance to cocaine. Cocaine is a vasoconstrictor, causing the blood vessels to narrow. As users take larger and larger doses of the purer forms of cocaine, they are more often rushed to emergency rooms and may die of an overdose, often from a heart attack

Question 37

What can cocaine use during pregnancy cause?

Answer 37

the blood supply to the developing fetus may be compromised. An MRI study compared the gray matter (i.e., neural tissue of the brain) volume of ado- lescents who were exposed to cocaine prenatally with those who were not. Adoles- cents who had been exposed to cocaine prenatally were found to have lower volumes in areas of the frontal cortex and nearby regions that aid in cognitive control and emotion regulation compared with adolescents who were not prenatally exposed to cocaine

Question 38

How do hallucinogens assert their effects?

Answer 38

Hallucinogens appear to exert their effects via the serotonin system and the 5-HT2A receptor (Halberstadt, 2015). In addition to hallucinations, LSD can alter a person’s sense of time (it seems to go slowly). A person using LSD may have sharp mood swings but can also experience an expanded consciousness such that he or she seems to appre- ciate sights and sounds as never before.

Question 39

What three psychological factors may have an impact?

Answer 39

Emotional regulation, expectancies about the effects and personality factors (neuroticism, low levels of agreeableness and conscientiousness, and high levels of disinhibition)

Question 40

How is emotion regulation relevant to smoking?

Answer 40

Research suggests that people expe- rience a greater reduction of negative emotion when starting to smoke than when regularly smoking or when in relapse after treatment

Question 41

Name 6 treatments for alcohol abuse disorder

Answer 41

``` In patient hospital treatment Alcoholics anonymous Couples therapy Motivational Interventions Moderation in drinking Medications ```

Question 42

Review the effectiveness of nicotine patches and gun

Answer 42

Nicotine gum ap- pears to be somewhat effective, though users may never stop chewing the gum. Nicotine patches are more effective than placebo patches, but 9 months after the treatment, abstinence differences between those receiving the drug and those receiving a placebo disappear. Adding bupropion or therapy along with nicotine patches may be effective but not for adolescents.

Question 43

What features do residential homes often feature (5)

Answer 43

* Separation of people from previous social contacts, on the assumption that these relationships have been instrumental in maintaining the drug use disorder * A comprehensive environment in which drugs are not available and continuing support is offered to ease the transition from regular drug use to a drug-free existence * The presence of role models, people formerly with a drug use disorder who appear to be meeting life’s challenges without drugs * Direct, often intense, confrontation in group therapy, in which people are urged to accept responsibility for their problems and for their drug habits and are encouraged to take charge of their lives * A setting in which people are respected as human beings rather than stigmatized as failures or criminals

Question 44

What two widely used medications are there for opioid users?

Answer 44

opioid substitutes, drugs chemically similar to opioids that can replace the body’s craving for it, and (2) opioid antagonists, drugs that prevent the user from experiencing the high.