Addiction Flashcards
what is the ICD-10 criteria for dependence
3 or more of: a strong desire to take the substance difficulties in controlling substance use physiological withdrawal tolerance neglect of alternative pleasures persistence despite evidence of harm
way to remember criteria of dependence
Catherine Never Takes Drugs Woo Hoo
C - controlling difficulties N - Neglect of alternative pleasures T - tolerance D - Desire to take W - withdrawal H - harm but persisting
what is the name of the 4 question process that aims to detect alcohol dependence and abuse
CAGE Cut down Annoyed Guilty Eye opener
what is incentive salience
attributing want to a stimulus
what is the key neurotransmitter in the reward pathway
dopamine
what are the main areas of the brain involved in the reward pathway
mesolimbic and cortical areas
ventral tegmental area –> nucleus accumbens –> prefrontal cortex
dopamine release from a stimulus/activity motivates an individual to do what
repeat behaviour
what is meant by the term once use drugs
significant dopamine release causes the brain to seek out the substance to the point that normal things in life do not stimulate enough dopamine so ignore other things and only crave the substance
how does tolerance develop
overstimulate pathway –> dopamine receptors down regulate
what dopamine receptors are decreased by addiction
D2 receptors
what is meant by positive reinforcement
taking the drug gives a reward
what is meant by negative reinforcement
taking the drug alleviates feeling rubbish
the initial stages of drug taking are driven by ____ reinforcement
positive
eventually drug taking is driven by ____ reinforcement
negative
what part of the brain modulates the powerful effects of the reward pathway and keeps emotions and impulses under control
pre-frontal cortex
cortical maturation occurs in what direction
back to front
cortical maturation begins with what and ends with what
begins with primary motor cortex and ends with prefrontal cortex developing last (in 20s)
prefrontal cortex activity is _____ in substance misuse people
lower
true/false
the earlier the age at which drug experimentation starts the longer the relationship with drugs lasts
true
what 3 brain areas are critical in acquisition, consolidation and expression of drug stimulus learning - meaning that learned drug assoc. can que internal state of craving
hippocampus
amygdala
striatum
what part of the brain is the key creator of motivation to act
orbitofrontal cortex
addicts show _____ activity of the OFC when faced with drug ques
increased
what circuit decides whether you will do it or not
OFC
what circuit is involved in inhibitory control
anterior cingulate gyrus and prefrontal cortex
what circuit is involved in reward/salience
nucleus accumbens and ventral pallidum
what circuit is involved in motivation/drive
OFC and subcallosal cortex
if you have low D2 receptors are you lower or higher risk of drug addiction
higher - will seek out rewarding behaviours
acute stress triggers release of ____
dopamine
chronic stress leads to ______ of dopaminergic activity which _____ sensitivity to normal rewards
dampening through down regulation of D receptors
reduces
the ____ develops late and is vulnerable during development
PFC
the ____ puts the breaks on the reward system
PFC
what is conditioning
process of behaviour whereby an individual comes to assoc. a desired behaviour with a previous or unrelated stimulus
what are the 2 types of conditioning
classical (pavlovian) - a classic pavlova
operant (skinnerian)
what is classical conditioning
through repeated pairing with the cue a previously neutral stimulus will come to elicit the same response
what is operant conditioning
instrumental value - learning by connecting the consequences of an action with the preceding behaviour
reinforcement _____ frequency of behaviour
punishment _____ frequency of behaviour
reinforcement - increases
punishment - decreases
being shouted at by a partner is an example of _____ punishment
positive
losing a family member and home due to using is an example of _____ punishment
negative
what is a habit
an acquired behaviour pattern regularly followed until it becomes almost involuntary
name 5 thinking errors that lead to substance taking
permission giving “its just a treat”
minimisation “its only one
rationalisation “i havent used for a week”
denial “i can use and stay in control”
blaming “she made me so angry i had to use”
1 unit is how many mls of alcohol
10mls
how can you calculate no of units
% x volume / 10
what is higher risk drinking
regularly consuming over 35 units per week
what is increased risk drinking
regularly consuming between 15 and 35 units per week
what is the recommended alcohol intake
no more than 14 units per week
spread over 3 days or more
what is considered harmful use of alcohol
pattern of psychoactive substance use that is causing damage to health (physical or mental)
what is considered binge drinking for males
> 8 units
what is considered binge drinking for females
> 6 units
what is AUDIT
alcohol user disorders identification test - 10 questions which aim to detect hazardous drinking
what is the screening tool used in pregnant women for alcohol problems
TWEAK tolerance worries eye opener kut down
name 3 other screening tools for alcohol problems
MAST
FAST (abbreviated audit for A+E)
TACE
what liver enzyme is raised in alcohol problems
GGT
AST
carbohydrate deficient transferrin detects what
men drinking 5 or more units per day for 2 weeks
an audit score of what would identify alcohol dependence syndrome
20
over how many units daily would identify alcohol dependence syndrome
15
alcoholism causes a _____ MCV
raised
what is FRAMES
brief intervention model
- feedback
- responsibility
- advice
- menu
- empathy
- self-efficacy
what is the feedback part of FRAMES looking at
identifying problems caused by alcohol
what is detoxification
the process by which a patient becomes alcohol free
what is relapse prevention
combination of psychosocial and pharmacological interventions aimed at maintaining abstinence or problem free drinking following detox
alcohol inhibits the action of what ion channels
excitatory NMDA-glutamate controlled ion channels
chronic alcohol use leads to ______ of glutamate receptors
up-regulation
alcohol potentiates the actions of what ion channels
inhibitory GABA type A controlled ion channels
chronic alcohol use leads to _____ of GABA a receptors
down-regulation
alcohol withdrawal leads to ______
excess glutamate activity
reduced GABA activity
excess glutamate activity and reduced GABA activity in acute alcohol withdrawal leads to what
CNS excitability and neurotoxicity
1st symptoms of alcohol withdrawal syndrome occur within how long of last drink and when do they peak
4-12 hours
peak 24-48 hours
what are some s/s of alcohol withdrawal syndrome
restlessness tremor sweating anxiety N+V loss of appetite insomnia
what is the HR and BP like in alcohol withdrawal syndrome
tachycardia
systolic hypertension
when does delirium tremens occur
within 2 days of abstinence
how does delirium tremens present
often insidiously with night time confusion
confusion, disorientation, delirium, ataxia, course tremor, hallucinations, delusions, paranoid ideations
what is the treatment of alcohol withdrawal syndrome
benzodiazepines - diazepam, chlordiazepoxide
reduce gradually over 7 days
what vitamin supplementation should be given as prophylaxis against wernickes encephalopathy
thiamine
parenteral
is wernickes reversible
yes
what causes wernickes
thiamine deficiency –> lactic acidosis in brain
what does wernickes look like
ataxia, abnormal eye movements
is korsakoff’s syndrome reversible
no irreversible brain damage
what causes korsakoff’s syndrome
thiamine deficiency
what is seen in korsakoff’s syndrome
memory loss
confabulation
what are some psychosocial interventions for relapse prevention
CBT
12 step
motivational enhancement therapy
are benzos used in alcohol relapse prevention past detoxification period
no
what is disulfiram
antabuse
what happens if people taking disulfiram drink alcohol
flushed skin
tachycardia
N+V
how does disulfiram work
inhibits acetyl dehydrogenase leading to accumulation of acetaldehyde if alcohol is ingested
what is the downfall of using disulfiram
requires compliance
what are 2 other drugs used in relapse prevention
acamprosate
naltrexone
how does acamprosate work
acts centrally on glutamate and GABA systems to reduce craving
how does naltrexone work
opioid antagonist and reduces reward from alcohol
what is the first line agent for relapse prevention
naltrexone
what makes heroin so addictive
rapid onset of action
short half life
what is opium
mixture of alkaloids (codeine and morphine)
what is diamorphine
heroin - addition of 2 acetyl rings to morphine
codeine and heroin are broken down to what
morphine
how can you tell the difference between heroin and morphine in a blood screen
heroin has a unique intermediate that sticks around for 6 hours
what is the active metabolite of heroin
morphine
what would the pupils of someone who had taken heroin look like
pin point
opioid overdose does what to BP and HR
hypotension
bradycardia
what is the treatment for opioid overdose
naloxone
what happens in opioid withdrawal
agitation tachycardia hypertension diarrhoea N+V dilated pupils rhinorrhoea watery eyes
when does opioid withdrawal occur
within 6-8 hours
why does opioid withdrawal occur
locus caerulus releases lots of NA
what is opiate substitution therapy
replacement of a short acting opiate with a long acting opiate in a once daily oral dose
name 2 long acting opiates
buprenorphine
methadone
methadone is a
long acting full agonist
buprenorphine is a
long acting partial agonist
is OST taken under supervision
yes initialy
why is methadone given as a liquid not as a tablet
tablets can be hidden and sold on
what is opioid detoxification
achieve complete abstinence from all opiates - gradually taper dose until opioid free
what are people who have completed outpatient detoxification at high risk of
relapse and overdose - take large dose they previously needed
