Addiction Flashcards
What is the moral model of addiction
The idea that addicts use drugs through choice with no regard for the consequences of the drug use
This model leads to the criminal justice approach to management of drug addiction through prisons etc.
The individual is the cause
What is the medical model of addiction
The idea that being addicted to drugs and repeatedly taking them causes neurobiological changes in the brain which decrease the persons ability to exercise free choice
This leads to more compassionate care and better treatment
What are the symptoms of substance dependence
A strong desire to take the substance Difficulties in controlling substance use A physiological withdrawal state Tolerance Neglect of alternative pleasures Persistence despite evidence of harm
Which NT is the motivating signal in the reward pathway
Dopamine
The more that is released, the more a person is incentivised to perform that behaviour
How do drugs trigger the reward pathway
They all cause dopamine release by acting on a variety of targets in the nucleus accumbens
Cocaine and amphetamines act on dopamine receptors which is why they have such significant effects
What is meant by tolerance to reward
The dopamine pathway is overstimulated (by drug use) and is downregulated
This means that normal pleasure activities will no longer be enough to trigger the pathway
This leads to continued drug use to cause pleasure
How long does tolerance to reward last
The changes in the dopamine pathway will persist for an extend period even with prolonged abstinence
This leads to high relapse rates
What drives drug addiction
Initially it is driven by the reward pathway - positive reinforcement
Then it becomes a thirst - negative reinforcement
What is the function of the prefrontal cortex
It’s involved in executive function - making sound decisions and keeping emotions and impulses under control
Last part of the brain to develop - still developing into 20s
How is the prefrontal cortex involved in addiction
It is often much less developed in those who are addicted
Could be genetic or caused by substance use before it is developed
Makes it harder to stop drugs in the long term - less executive functioning
How is the hippocampus involved in drug behaviour
It is important in memory and learning
Learned drug/substance associated such as rolling a cigarette will cue a state of craving by stimulating the dopamine pathway
How is the orbito-frontal cortex involved in drug use
It is the key creator of motivation to act
Highly associated with cravings
Does substance use have a genetic component
Yes = 40-60% of risk is due to genetics
May affect how the body responds to drugs, the dopamine response and behavioural traits
How does stress affect the dopamine pathway
Acute stress leads to dopamine release within the neural reward pathways
Chronic stress leads to downregulation of the receptors which reduces sensitivity to normal rewards - this encourages exposure to highly rewarding behaviour such as drug taking
What is incentive salience
When you attribute want to a stimulus
The reward pathway is involved
Describe the current trend in drug deaths
Numbers are rising
List the effects of heroin (and other opiates)
Euphoria Analgesia Constipation Reduced conscious level Respiratory depression Hypotension and bradycardia Pupillary constriction Tolerance develops with repeated use
How long does it take for withdrawal to start
Typically occurs within 6-8 hours
Describe drug tolerance
As you contribute to use drugs you become tolerant to that dose
Usual dose no longer has an effect and so the person takes more - cycle
What often causes a drug death
People try to come off the drug and their tolerance drops
If they re-take their usual dose which is now far too high
Describe the symptoms of opiate withdrawal
Dysphoria and cravings Agitation Tachycardia and hypertension Piloerection Diarrhoea, nausea and vomiting Dilated pupils Joint pains Yawning (constant) Runny nose (rhinorrhoea) and watery eyes (Lacrimation)
Which route of administration of heroin gives a stronger affect
Injecting it
Stronger effect and often cheaper
What infections can be caused by IV drug use
Local: cellulitis, abscess, thrombophlebitis, necrotising fasciitis
Distant: e.g. infective endocarditis,
Systemic: Hep B, HIV, Hep C
Do opioids cause psychosis
No
Cannabis, hallucinogens and alcohol are much more likely to do this
What psychiatric issues are common in opioid misuse
Anxiety and depression
Which drugs are used for opioid replacement therapy
Methadone or buprenorphine
Which drugs are used for opioid detox
Methadone
Buprenorphine
Lofexidine
Which drugs are used as opioid antagonist
Naloxone
Naltrexone
Used to treat an overdose
Recommended to all that use opiates and their families
What are the characteristics of an ideal substitution treatment
Safe and well tolerated
Stop withdrawal symptoms
Should not be addictive
Have a long affect
Which of the opioid replacement drugs has the strongest effect
Methadone - it is a pure opioid agonist
Buprenorphine is a partial agonist so is less potent
If someone is on very high doses of heroin which opioid replacement drug is the better choice
Methadone
It has the stronger effect
Which of the opioid replacement drugs is safer
Buprenorphine
Less risk of overdose
It is less sedative
Has a blocking effect so reduces effect of using on top of it
Has a longer effect and quicker titration
Easier to detox from
How long does it take to titrate up buprenorphine
2-3 days
How long does it take to titrate up methadone
Weeks to months
This is due to the high risk of overdose
Why is buprenorphine not indicated for patients who use high doses of opiates
There is a risk of induced withdrawal as it has a lower effect
It can be misused - injected or snorted
It is less sedative
What is the correct maintenance dose (in general)
The dose where the patient stops using and is not getting cravings
This can be much higher than the dose that would stop withdrawal symptoms
What is the starting dose of methadone
10-30mgs
What is the starting dose of buprenorphine
4-8mgs
How do you titrate up methadone
Start on 10-30mgs
First week – increase by maximum 10mgs per day and max 30mgs per week
Takes 5 days to reach steady state which means that on one dose the blood level and effect will rise for 5 days
No maximum dose
How is opioid replacement administered
• Supervised consumption – there is daily pick up from the pharmacy and the pharmacist will observe the patient taking their dose
Describe the dispositional disease model
Individual is still considered the ‘problem’ but they have lost control of their impulses
The addiction is seen as irreversible but you can manage it with total abstinence
What is the role of the amygdala in drug use
It is responsible for the withdrawal affect
It makes the person feel like their body is in danger without the substance
Can addiction affect the connections in the brain
YES - It can actually change them
It triggers the reward pathways
Also get a lot of anticipation of using
What is the primary disorder in addiction
It is a behaviour disorder primarily - impulse to use
What is conditioning
The process of behaviour modification whereby an individual comes to associate a desired behaviour with a previous unrelated stimuli
Substance misuse is a learned behaviour
What is the difference between positive and negative punishment
Psoiitve is when something is being ‘added’ - such as stimulus of being shouted at
Negative punishment is when something is taken away - home or family etc
What are the intended outcomes of reinforcement and punishment
Reinforcement aims to increase the frequency of a behaviour
Punishment aims to decrease frequency
What is the definition of a habit
An acquired behaviour pattern regularly followed until it becomes almost involuntary
More we do something, the more it becomes a habit
Acquired by learning mechanisms
What is attention bias and how does it affect drug addicts
Attention is drawn to specific things
Addicts are more likely to notice stimuli related to their addiction (e.g. others smoking)
How are addicts affected by memory bias
When presented with substance, the brain only recalls the positives of using and forgets the negatives
Can encourage addictive behaviour
Describe slow cognitive processing
Deliberate and conscious process
Under the persons control and requires cognitive effort
Describe fast cognitive processing
Unintentional and automatic process
Usually occurs out of the persons awareness
No effort required
What are the functions of substance misuse (why do people do it)
People often use substances to block out unpleasant memories or to feel numb
Escape overwhelming thoughts/feelings
Substance can also provide a good feeling - more of something
Commonly used in social or celebratory situations
What is the biopsychosocial model
Concerned with the interaction of biological factors (physical health, genetics), psychological factors and social
Look at all aspects of a persons life - no factor is dominant
List biological/physical factors which can affect substance misuse
Current non-prescribed drug use Current prescribed drug use Physical dependency Use and treatment history Injecting behaviour Physical health - BBV
List psychological factors which can affect substance misuse
Personal history -family, social etc
Coping skills and cognitive functioning
Current/past psych problems
List social factors that can affect substance misuse
Significant relationships Housing Employment Financial Legal
