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integrated studies in mental health > ADDICTION AND DRUG ABUSE > Flashcards

ADDICTION AND DRUG ABUSE Flashcards

1
Q

TWO TYPES OF ADDICTION?

A

Physiological addiction
Psychological addiction

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2
Q

DIFFERENCE BETWEEN ADDICTION AND HABIT?

A

Habit – repeated behaviour in which the repetition may be unconscious

Compulsion – if the habit occurs by compulsion and considerable discomfort is experienced if the behaviour is not performed, then the repetition or habit is considered an addiction

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3
Q

WHAT ARE THE TYPES OF ADDICTION

A

Money addictions
Compulsive gambling
Compulsive shopping and borrowing
Work addiction

Exercise:
Addictive exercisers
Muscle dysmorphia

Internet
Sexual
Multiple

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4
Q

THE INDICATION OF ADDICTION IS DESCRIBED AS HAVING 4 OR MORE SERVERE SYMPTOMS SUCH AS:

A

Tolerance 🡺 Larger doses needed; lower dosage does not produce typical effect

Withdrawal 🡺 Negative physical and psychological effects from stopping usage

Using more than intended amounts

Trying unsuccessfully to stop

Having physical or psychological problems made worse by drug

Experience problematic relationships

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5
Q

DSM-5 SUBSTANCE USE DISORDERS ARE CATEGORISED BY SPECIFIC SUBSTANCES SUCH AS?

A

Alcohol
Caffeine
Cannabis (e.g., marijuana)
Hallucinogens
Inhalants
Opioid (e.g., heroin)
Sedatives, Hypnotics, or Anxiolytics (e.g., diazepam)
Stimulants (cocaine, methamphetamine)
Tobacco

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6
Q

Neurobiology of Drug Addiction:

An endpoint of a series of transitions from

A

initial drug use—drug is voluntarily taken because it has reinforcing (REWARDING OR WITHDRAWAL) effects

through loss of control over this behaviour

becomes habitual and ultimately compulsive

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7
Q

addiction is an endpoint of a series of ____________________

A

addiction is an endpoint of a series of CHANGES within brain STRUCTURE AND FUNCTION

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8
Q

WHAT ARE THE TWO THEORIES OF DRUG ADDICTION?

A

Negative Reinforcement Models

Positive Reinforcement Models

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9
Q

DESCRIBE NEGATIVE REINFORCEMENTS MODELS?

A

Physical dependence (withdrawal) theory 🡺 opiates, barbiturates, alcohol
Distinguished by TOLERANCE and PHYSICAL DEPENDENCE 🡺 need the drug

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10
Q

DESCRIBE Positive Reinforcement Models

A

Positive incentive (reward) theory 🡺 cocaine, amphetamine, nicotine
Distinguished by REWARD and REINFORCEMENT 🡺 want the drug

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11
Q

Drug Addiction BEHAVIOUR IS CORRELATED WITH:

A

Brain regions
Brain pathways
Neurotransmitter systems

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12
Q

STATE FACTS ABOUT THE REWARD PATHWAY?

A

There is a axonal network in the brain labeled the ‘reward pathway’

This reward pathway is activated by:
Food, water and sex, activities (such as sky diving, paragliding etc) and exercise

This reward pathway is also activated by drugs
and alcohol

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13
Q

WHAT ARE THE NEUROTRANSMITTERS INVOLVED IN THE acute reinforcing effects of drugs of abuse?

A

DOPAMINE

GABA

GLUTAMATE

OPIOID PEPTIDES

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14
Q

WHAT ARE THE ANATOMICALSITES INVOLVED WITH DOPAMINE?

A

Ventral tegmental area, nucleus accumbens

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15
Q

WHAT ARE THE ANATOMICALSITES INVOLVED WITH OPIOID PEPTIDES

A

Nucleus accumbens, amygdala, ventral tegmental area

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16
Q

WHAT ARE THE ANATOMICALSITES INVOLVED WITH GLUTAMATE?

A

Nucleus accumbens

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17
Q

WHAT ARE THE ANATOMICALSITES INVOLVED WITH GABA?

A

Amygdala, bed nucleus
of stria terminalis

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18
Q

WHAT ARE THE NEUROTRANSMITTERS THAT ACT ON THE REWARD PATHWAY?

A

Dopamine

Serotonin

Opioid peptides (Endorphins, Enkephalins)

Cannabinoids

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19
Q

WHAT IS THE REWARD PATHWAY OF DOPAIMINE?

A

Receptors: D1, D2
Function: pleasure, euphoria, mood, motor function

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20
Q

WHAT IS THE REWARD PATHWAY OF Serotonin

A

Receptors: 5HT3
Function: mood, impulsivity, anxiety, sleep, cognition

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21
Q

WHAT IS THE REWARD PATHWAY OF Cannabinoids

A

Receptors: CB1, CB2
Function: Pain, appetite, memory

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22
Q

WHAT IS THE REWARD PATHWAY OF Opioid peptides (Endorphins, Enkephalins)

A

Receptors: Kappa, Mu, Delta
Function: pain

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23
Q

In all rewards, ________ is the final activation chemical

A

In all rewards, dopamine is the final activation chemical

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24
Q

WHAT ARE NARCOTICS?

A

OPIATES
(morphine
Heroin)

OPIOIDS
(oxycodone
hydrocodone
codeine
Fentanyl

25
Q

WHAT ARE HALLUCINOGENS?

A

LSD
PSILOCYBIN
MDMA
MESCALINE
PCP
MARIJUANA

26
Q

WHAT ARE DEPRESSANTS?

A

Alcohol
Benzodiazepines

27
Q

WHAT ARE STIMULANTS?

A

DEXEDRINE
CAFFEINE
METHEDRINE
AMPHETAMINE
COCAINE

28
Q

NARCOTICS ARE _______ADDICTING?

A

PHYSICALLY

29
Q

HALLUCINOGENS ARE _____ ADDICTING?

A

Psychologically
Addicting

30
Q

DEPRESSANTS ARE _________ ADDICTING?

A

Physically Addicting

31
Q

STIMULANTS ARE ___________ADDICTING?

A

Physically &
Psychologically
Addicting

32
Q

DESCRIBE DIRECT DRUG ACTION IN ADDICTION?

A

Drugs of abuse may work via direct action on a DA receptor or DA transporter
🡺 increased DA receptor activation eg cocaine

33
Q

DESCRIBE INDIRECT DRUG ACTION IN DRUG ADDICTION?

A

Drugs of abuse may modulate dopamine via other receptor system and neurotransmitters that then modulate a different system
Downstream effects on dopamine from above systems
e.g. Alcohol

34
Q

MECHANISM OF ACTION DURING INDIRECT DRUG ACTION WHEN TAKING ALCOHOL?

A

ALCOHOL Binds to subreceptors GABAA: Dopaminergic activity is eventually increased in the VTA by inhibiting GABAergic interneurons
Also binds to NMDA, endorphins, activates secondary messages and has direct serotonergic effects

35
Q

MECHANISM OF ACTION FOR ALCOHOL

A

Inhibit GABAergic neurons that project to dopaminergic neurons in the VTA

36
Q

MECHANISM OF ACTION FOR HEROIN

A

Binds to opioid receptors that inhibit GABAergic neurons that project to dopaminergic neurons in the VTA

37
Q

MECHANISM OF ACTION FOR COCAINE?

A

Blocks the function of DAT (by binding to the DAT and slowing transport)

38
Q

MECHANISM OF ACTION FOR NICOTINE

A

Activates cholinergic neurons that project to dopaminergic neurons of the VTA

39
Q

WITHDRAWAL SYNDROME INVOLVES?

AND WHAT DOES IT LEAD TO?

A

activation of the thalamus
release of corticotrophin releasing hormone (CRH)
activation of the noradrenergic nucleus locus coeruleus (LC)

Results in the stress response

Increased discomfort/anxiety during withdrawal as well as other negative effects

Can lead to further consumption and thus relapse

40
Q

WHAT ARE THE INTOXICATION EFFECTS FOR THESE NEURO TRANSMITTERS?

DOPAMINE

OPIOID PEPTIDES

SEROTONIN

GABA

A

Dopamine: euphoria
Opioid Peptides: analgesia, relaxation
Serotonin: elevated mood
GABA: decreased anxiety, less panic, relaxation

41
Q

WHAT ARE THE WITHDRAWAL EFFECTS INVOLVED WITH THESE NEUROTRANSMITTERS?

DOPAMINE

SEROTONIN

OPIOID PEPTIDES

GABA

NPY

NE

GLUTAMATE

CRF

DYNORPHIN

A

Dopamine: dysphoria

Dynorphin: dysphoria

Serotonin: dysphoria

CRF: stress

Opioid Peptides: increased pain

GABA: anxiety, panic attacks

Norepinephrine: stress

NPY: anti-stress

Glutamate: hyperexcitability

42
Q

WHAT IS THE NOVEL TREATMENT FOR?

A

Nicotine gum/patch: activate nicotinic receptors

43
Q

PSYCHOSTYMULANT DEPENDENCE NOVEL TREATMENT?

A

Rimonabant: blocks cannabinoid receptors (CB1)

44
Q

GIVE A BRIEF SUMMARY OF THE Neurobiology of Addiction

A

Anatomical areas of the brain involved in the reward pathway include the nucleus accumbens, ventral tegmental area and the prefrontal cortex

Dopaminergic activity is the final chemical action in most behaviors relating to reward

Drugs of abuse may work with receptors and transporters to directly or indirectly influence dopaminergic activity

Withdrawal occurs following an abrupt cessation of drug of abuse following changes to the nervous system

Addiction is the result of and results in lasting changes to neurocircuitry, cellular and molecular mechanisms

45
Q

WHAT ARE THE 3 WAYS TO MANAGE ADDICTION?

A

Medical intervention
Pharmacotherapy
Psychosocial treatment.

46
Q

WHAT ARE THE PAHRMACOLOGICAL STRATEGIES AIMED AT?

A

treating acute withdrawal symptoms

preventing relapse

substitution therapy

47
Q

WHAT IS THE MA OF ALCOHOL?

A

Has its own binding site on the GABA-A receptor complex to enhance the effects of GABA.

Acts as an indirect antagonist at glutamate NMDA receptors 🡺 blocks ion channel associated with the glutamate NMDA receptor

Chronic blockade of glutamate NMDA receptors by alcohol 🡺 upregulation of these receptors.

Consequences of the upregulation of glutamate NMDA receptors include tolerance to the effects of alcohol 🡺 increase the risk of seizures during withdrawal.

48
Q

NALTREXONE FACTS IN RESPECT TO

RECEPTOR IT WORKS ON OR MA

CLINICAL TRIALS

ADVERSE EFFECTS

USUAL DOSE

A

𝜇-opioid receptor antagonist that blocks the reinforcing effects of alcohol on the opioid system and reduce craving for alcohol

Clinical trials show that naltrexone is effective in reducing alcohol intake and in preventing relapse.

Naltrexone is usually taken orally in doses of 50 mg/d for up to 12 weeks or given as an intramuscular injection in the gluteus muscle at a dose of 380 mg every four weeks.

The main adverse effects are nausea, vomiting, loss of appetite, abdominal pain, dizziness, anxiety and dysphoria.

49
Q

FACTS ABOUT DISULFRAM IN RESPECT TO

MA OF ETHANOL

MA OF DISULFRAM

USUAL DOSE

EFFECTIVENESS AND WHO IT SHOULD BE PRESCRIBED TO?

A

Ethanol 🡺 metabolised to acetaldehyde by the enzyme alcohol dehydrogenase 🡺 to acetic acid by the enzyme acetaldehyde dehydrogenase 🡺 the acetic acid enters the Krebs cycle 🡺 broken down into water and carbon dioxide.

Disulfiram 🡺 blocks the oxidation of ethanol at the aldehyde stage by inhibiting the enzyme aldehyde dehydrogenase 🡺 accumulation of acetaldehyde produce palpitations, throbbing headaches, hypotension, nausea, emesis, flushing, dizziness, chest pains and thirst.

Taken orally at a dose of 500 mg per day for 2 weeks and then maintained at a dose of 250 mg per day.

When taken daily, disulfiram is effective in preventing relapse in some people, but not all. It is recommended that disulfiram be prescribed to motivated patients as an adjunct to cognitive behavioural therapy and abstinence-based rehabilitation programmes.

50
Q

FACTS ABOUT ACAMPROSATE?

WITH RESPECT TO

MOA

SIDE EFFECT

EFFECTIVE NESS IN PERCENTAGES

WHAT COMBINATION THERAPY IS MOST EFFECTIVE?

A

An anti-craving drug that is used to sustain abstinence in alcoholics after detoxification.
MOA
Agonist activity at GABA-A receptors and antagonist activity at glutamate NMDA receptors 🡺 mimics the actions of alcohol at these receptors.
Oral dose
The main adverse effect is diarrhoea.
It reduces frequency of drinking by 30–50%.
Combining drug therapy with CBT and abstinence-based rehabilitation programmes has been found to reduce relapse rates further.
Administering acamprosate with naltrexone has greater beneficial effects than either of the drugs alone in attenuating the occurrence of relapse.

51
Q

Alcoholics Anonymous (AA). IS A GROUP SUPPORT METHOD OF ACOHOL ABSTINENCE

STATE FACTS ABOUT IT?

A

The basic tenet of AA is that alcoholism is an incurable condition and the only way to manage the condition is life-long abstinence.

Alcoholics will attend regular meetings where they discuss the circumstances that lead them to abuse alcohol and become addicted.

Members of the group will give each other support to avoid relapse.

Such group therapy is effective in maintaining abstinence in a large number of alcoholics.

52
Q

STATE FACTS ABOUT HEROIN
WITH RESPECT TO

MOA

HOW LONG IT TAKES TO DEVELOPE

DEPENDENCE AND TOLERANCE

WITHDRAWAL SYMPTOM

HOW ARE SOME OF THE WITHDRAWAL SYMPTOMS MANAGED?

A

Heroin is a 𝜇-opioid receptor agonist and mimics the reinforcing effects of naturally released enkephalins in the brain.

If heroin is taken regularly for a few weeks, tolerance and dependence develop.

People who are dependent on heroin will display withdrawal symptoms that include restlessness, spasms of agonizing pain, involuntary twitching of the leg muscles, fever and sweating followed by hypothermia, vomiting and diarrhoea.

Addicts who undergo withdrawal may be given medication to help with the withdrawal symptoms: loperamide for diarrhoea, metoclopramide for nausea and vomiting, ibuprofen for headache and lofexidine (an 𝛼-adrenoceptor agonist) for hypertension.

53
Q

HOW IS HEROIN ADDICTION MANAGED?

A

METHADONE

BUPRENOPHINE

54
Q

MOA OF METHADONE?

A

is a long-acting 𝜇-opioid receptor partial agonist that is administered as an oral solution once daily. The normal dose varies depending on the patient, but is in the range 15 to 40 mg. Methadone should be given eight hours after the discontinuation of heroin.

55
Q

MOA OF BUPRENORPHINE?

A

Buprenorphine is a partial agonist at 𝜇-opioid receptor but also has antagonist activity at 𝜅 (kappa) opioid receptors. It is given as a sublingual tablet. Buprenorphine should be given 6–12 hours after the discontinuation of heroin. A combination preparation that contains buprenorphine and naloxone may be prescribed for addicts likely to inject the drug iv.

56
Q

What are the dopamine pathways involved in addiction and drug abuse?
Answer: The dopamine pathways involved in addiction and drug abuse are the reward pathway, pleasure pathway, euphoria pathway, motor function pathway, and decision-making pathway.

A
57
Q

Question: What region of the brain is involved in reward processing?
Answer: The nucleus accumbens is a region of the brain that is involved in reward processing.

A
58
Q

Question: What is the role of serotonin in addiction and drug abuse?
Answer: Serotonin is involved in regulating mood, memory, sleep, and cognition. Chronic drug use can lead to changes in the serotonin pathways, leading to altered mood and anxiety levels.

A
59
Q

Question: What can chronic cocaine use lead to in terms of serotonin levels and behavior?
Answer: Chronic cocaine use can lead to reduced serotonin levels in the prefrontal cortex, leading to increased impulsivity and risk-taking behavior. This can contribute to drug-seeking behavior and addiction.

A

integrated studies in mental health (20 decks)

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