Addiction

Question 1

What is addiction?

Answer 1

Relapsing-remitting disorder comprising behaviours that are performed in a compulsive matter in spite of the potential for self-harm.

Question 2

What is the difference between addiction and dependence?

Answer 2

Addiction = compulsive need for the substance
Dependence = state of withdrawal when substance is removed

Question 3

What are the main categories of behaviour associated with dependence?

Answer 3

1. Drug-seeking/ craving behaviours (anticipation)
2. Binging/ intoxication behaviours (‘highs’)
3. Withdrawal behaviour

Question 4

How can dependence be categorised?

Answer 4

Psychological (the need to keep performing compulsive behaviours, emotional distress on stopping behaviours)

Physical (the need for functional effect on body, physical symptoms on withdrawal)

Question 5

How is dependence syndrome classified in the ICD-10?

Answer 5

Cluster of behavioural, cognitive and physiological phenomena that develop after repeated substance use and that typically include a strong desire the take the drug, difficulty in controlling its use, persisting despite harmful consequences and sometimes a physical withdrawal state

Question 6

What is tolerance in regards to substance use?

Answer 6

The requirement for increasing amounts of drug/ behaviour to elicit the same level of positive reinforcement (“high”) as that experienced during previous exposure to the substance/ behaviour

Question 7

What behaviours could be indicative of an individual experiencing tolerance?

Answer 7

Requesting higher dosage

Attending multiple sites to obtain additional substance

Question 8

What are the 3 main types of tolerance?

Answer 8

Acute (caused by repeated exposure over short amount of time e.g. cocaine)
Chronic (caused by constant exposure to a substance over a prolonged period of time e.g. opioids)
Learned (caused by frequent exposure to substances that become integrated into normal routine e.g. alcohol)

Question 9

What causes the ‘crash’ (that generally occurs when the positive effects of a drug have worn off)?

Answer 9

Regional changes in neuronal activity

Negative aspects become dominant

Question 10

What are the common psychological symptoms of withdrawal?

Answer 10

Anxiety 
Confusion 
Irritability 
Fatigue
Headaches
Dysphoria (unease/ dissatisfaction) 
Anhedonia (lack of pleasure)

Question 11

What are the common physical symptoms of withdrawal?

Answer 11

Tremor 
Tachycardia
Tachypnoea 
Confusion 
Lacrimation (crying)
Rhinorrhea (blocked nose)
Hyperhidrosis (excessive sweating)

Question 12

What symptoms characterise post-acute withdrawal syndrome?

Answer 12

[Usually appears a couple of months after initial withdrawal]
Generally display psychological symptoms such as insomnia, mood swings, anxiety and anhedonia

Question 13

What class of neurotransmitter is Nicotine?

Answer 13

Parasympathomimetic (acts on parasympathetic nervous system)

Question 14

What type of receptor does Nicotine bind to?

Answer 14

Cholinergic

Question 15

What pharmacological interventions can be used to increase adherence to smoking cessation?

Answer 15

Nicotine replacement therapy (e.g. patches)
Bupropion (an atypical antidepressant)
Varenicline (partial agonist to nicotine receptor)

Question 16

What is AUDIT?

Answer 16

Alcohol Use Disorder Identification Test

Positive score = 5 or more

Question 17

What are the classic facial features of fetal alcohol syndrome?

Answer 17

Flat mid face
Ear abnormalities
Short nose
Low nasal bridge
Thin upper lip
Epicanthal folds 
Absent philtrum

Question 18

What are the 4 opioid receptor subtypes?

Answer 18

Mu
Delta
Kappa
Non-opioid receptors

Question 19

Neurologically, what is opioid dependence associated with?

Answer 19

Decrease in mu-receptors and increase in kappa-receptors

Question 20

How does caffeine work as a stimulant?

Answer 20

1. Adenosine receptor antagonists
2. Increases noradrenergic transmission
3. Increases release of calcium

Question 21

What causes a ‘caffeine headache’?

Answer 21

Changes in cerebral blood flow induced by caffeine use (causes increased cerebral activity but reduced cerebral blood flow)

Question 22

What is the mechanism of action for cocaine?

Answer 22

Prevents reuptake of monoamine neurotransmitters via the monoamine transporter

Question 23

What monoamine transporters does cocaine affect?

Answer 23

1. Serotonin
2. Dopamine
3. Noradrenaline

Question 24

How do amphetamines work?

Answer 24

Increase monoamine release by acting on intracellular vesicular monoamine transporters

Question 25

Name some examples of amphetamine-type stimulants?

Answer 25

MDMA
Crystal meth 
Mephedrone 
Ritalin 
Speed

Question 26

What are the 2 main types of tranquillisers?

Answer 26

Major (antipsychotics)

Minor (relaxants)

Question 27

What tranquillisers are common drugs of abuse?

Answer 27

Benzodiazepines (used for sedatives/ epilepsy)

Barbiturates (used for sedatives/ euthanasia/ epilepsy)

Question 28

What effects do psychotomimetic drugs have?

Answer 28

Cause changes in perception and sensory distortions (e.g. hallucination)

Question 29

What are the 2 groups of psychotomimetics?

Answer 29

Drugs acting on serotonin (e.g. MDMA, LSD)

Drugs acting on glutamate receptors (e.g. PCP, ketamine)