Addiction Flashcards
Can addiction be cured?
No. Addiction (substance use disorder) is a chronic illness that can be put in remission, but not cured. It needs lifelong follow up.
“Once you are a pickle, you can never go back to being a cucumber.”
Neuronal Reward System
Patterns of behaviour that are important to species survival are “rewarded” in neural structures (eg. obtaining food, mating, cuddling, etc.)
This involves dopaminergic (DA) neurons in the ventral tegmental area (VTA) projecting to the nucleus accumbens (NAc). It involves the niagrostriatal pathway, meso-limbic pathway, and meso-crotical pathway.
These parts of the brain are involved in addiction which is why addicts will often do stupid, self-destructive behaviours to activate this reward system.
Dopamine Theory of Addiction
Certain substances / behaviours / stimuli can preferentially trigger dopaminergic neural rewards over “natural” adaptive triggers, effectively hijacking the system.
Because this takes precedence over the natural triggers, these reward-seeking behaviours become maladaptive and destructive.
Incentive Sensitization Theory (IST)
There is a difference between liking something and experiencing pleasure and wanting something.
Most drugs of abuse tend to cause pleasure. When you experience that, you want it again. But over time, the wanting continues to be reinforced but the liking starts to decrease and you end up with someone wanting something that they don’t even like.
Methamphetamine Receptor Reset
Takes 14 months to go back to normal.
Need complete abstinence so the brain can re-establish a normal population of dopamine receptors.
Stigma
Human have an inherant want to help others who are in distress, however when individuals in distress are displaying aberrant behaviour, people are much much much less inclined to want to help. This is very primal and you need to combat that.
Additionally, stigma is a common reaction to illnesses we don’t understand and don’t know how to easily fix, so we blame the patient.
DSM-5 Diagnosis
A problematic pattern of use leading to clinically sigificant impairment or distress, with _>_2 of the following over a period of 12 months.
- Substance often taken in larger amounts or for longer than intended
- Persistent desire or unsuccessful efforts to cut down or control
- Great deal of time spent in the activity
- Craving or strong desire
- Recurrent failure to fulfill major roles obligations
- Continued use despite interpersonal problems
- Important activities reduced
- Recurrent use in physically hazardous situations
- Continued use despite knowledge of problems (insight)
- Tolerance
- Withdrawal
2-3 Sx = Mild
4-5 Sx = Moderate
>6 = Severe
The 3 C’s of Addiction
Consequences - such as impairment or suffering
Compulsion/Craving - time spent in efforts to procure and use substance
Control - loss of this
Not DSM Criteria but works for most addictions criteria, broadly
Risk Factors for Addiction
Biological - inherited and genetic
Psychological - self concept and coping skills
Social - modelled, learned behaviour and interpersonal skills
Red Flags for Addiction Screening
Signs of emotional attachment to the drug –> patient gets animated, makes jokes, shows affect, is defensive
Minimizing defensive posture –> patient rationalizes use, makes excuses, justifies (lacking insight and deceiving self). Trying to change the topic etc.
CAGE Questionnaire
1 yes has a 90% chance of detecting alcohol-related disorders
Cut back
Annoyed
Guilty
Eye opener
Can also use T-ACE which is tolerance, annoyed, cut back, and eye opener
Subtance-Induced Psychiatric Syndromes vs. Concurrent Disorders
This is important because it affects management.
You must determine whether there is a primary and a secondary disorder or whether there are two primary disorders.
The only way to do this is through a careful, detailed history.
Common Substance-Induced Syndromes
Sleep disorder (alcoholics might want sleeping pills)
Alcohol-induced mood disorder
Alcohol-induced depression
Cocaine/amphetamine/cannabis-induced psychotic disorder
Don’t prescribe long-term psych meds until you rule out…
A substance-induced disorder OR if the patient is unwilling to address substance use
Very very commonly when the patient stops using the substance, the original problem will disappear.
Social Sequelae of Addiction
Healthy relationships deteriorate and disappear when addiction goes unchecked. Healthy people drop away. The addicted person has another lover and it’s not you.
As healthy people drop away, the addicted person becomes more isolated and becomes surrounded by other addicted people and co-dependent enablers.
Physical health and employment are usually end-stage losses.
