Addiction and its rehabilitation Flashcards
What is substance abuse and substance dependence?
• Substance abuse is a pattern of drug use in which people rely on a drug chronically and excessively, allowing it to occupy a central place in their lives.
• A more advanced state of abuse is substance dependence, popularly known as addiction.
Dependence is usually distinguished from abuse, they’re not usually on a continuum in the litterature
What is addiction? (3)
• Addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences.
• Addiction happens when someone compulsively engages in behaviour such as drug taking, gambling, drinking or gaming . Even when bad side effects kick in and people feel like they’re losing control, addicts usually can’t stop doing the thing they’re addicted to without help and support.
• “Some clinicians will choose to use the word addiction to describe more extreme presentations, but the word is omitted from the official DSM-5 substance use disorder diagnostic terminology because of its uncertain definition and its potentially negative connotation.”
What is substance use disorder? (+ 4 categories of symptoms and estimate of severity)
• A substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems substance brings about changes in bvr. thoughts and emotions
• Four categories of symptoms:
• impaired control (criteria 1-4)
• social impairment (criteria 5-7)
• risky use (criteria 8-9)
• pharmacological (criteria 10-11)
• As a general estimate of severity:
• a mild substance use disorder is suggested by the presence of two to three symptoms,
• moderate by four to five symptoms,
• severe by six or more symptoms.
What is substance induced disorder?
• A substance-induced disorder includes intoxication, withdrawal, and other substance/medication-induced mental disorders (e.g., substance-induced psychotic disorder, substance-induced depressive disorder)
What is the prevalence of SUD? (3)
• Individuals aged 18-24 years have relatively high prevalence rates for the use of virtually every substance.
Males are more than twice as likely to exp SUD
Alcohol accounts for 80% of all SUD in Au
What is alcohol use disorder? (11)
• A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 month period:
Impaired Control
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
Social Impairment
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
Risky use of the substance
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
Pharmacological criteria
10. Tolerance, as defined by either of the following:
a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b) A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
a) The characteristic withdrawal syndrome for alcohol.
b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
What is the prevalence, onset and 5 risk factors of alcohol use disoder?
- Prevalence
• In the United States, the 12-month prevalence of alcohol use disorder is estimated to be 4.6% among 12- to 17-year-olds and 8.5% among adults age 18 years and older in the United States.
• greater among adult men (12.4%) than among adult women (4.9%) - Onset
• Late teens to early 20s - Risk factors
• cultural attitudes toward drinking and intoxication
• availability of alcohol (including price)
• acquired personal experiences with alcohol
• stress levels (or poor coping strategies)
• 40%-60% of the variance of risk explained by genetic influences
What is comorbidity and its link to SUD?
More than one patho or disorder in the same patient
For every 3 males with anxiety, 1 will also have a SUD
For every 2 females with anxiety, 1 will also have a SUD
What are the 7 steps of the neurotransmission mechanism?
- Synthesis
- Storage
- Release
- Receptor interaction
- Deactivation
- Reuptake
- Degradation
Diff psychoactive sub have their effects on diff steps of the mechanism
What are the brain bases of tolerance and withdrawal? (5)
Opponent processes theo
• Brain aims for homeostasis – a steady state
• When neurotransmission is suddenly increased or decreased, there is down or up-regulation of receptor sites
• These changes in receptor densities partly explain tolerance and withdrawal
• The withdrawal effect is often the opposite to the intoxication effect
What are 8 alcohol intoxication symptoms and 9 withdrawal symptoms?
- Intoxication
• Relaxation
• Drowsiness or sleepiness
• Disinhibition
• Slowed thinking/reaction time
• Loss of coordination
• Unsteady gait
• Slurred speech
• Loud, argumentative or aggressive behaviour - Withdrawal
• Irritability/restlessness
• Agitation
• Anxiety/panic attacks
• Palpitations/sweating
• Insomnia
• Headache/migraine
• Hallucination/psychosis
• Tremors
• Seizures
What is allostasis and its link to SUD?
• Allostasis is the ability to attain stability but at an altered, potentially pathologic set point
Addicts dont get effects of drug anymore, just trying to get away from withdrawal effects
What is the Wanting and liking (incentive sensitization) theory?
• Wanting is equivalent to cravings for a drug
• Liking is the pleasure that drug taking produces.
• The theory proposes that with repeated drug use, tolerance for liking develops, and wanting sensitizes.
Wanting and liking are dissociated in ppl with addiction, they’re initially correlated but with time they’re not liking the effects as much but they crave it more The wanting syst becomes sensitized and the liking syst becomes habituated
Same effect for the neural syst
• Separate neural systems are associated with wanting and liking.
• The dopamine system is the proposed neural basis for wanting (craving).
• The neural system for liking consists of a number of small liking “hot spots” within the regions to which dopamine neurons project. These hot spots may consist of neurons that use endogenous opioids as neurotransmitters.
What is Substance/Medication-Induced Neurocognitive Disorder? (5)
A. The criteria are met for major or mild neurocognitive disorder.
B. The neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication and acute withdrawal.
C. The involved substance or medication and duration and extent of use are capable of producing the neurocognitive impairment.
D. The temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use and abstinence (e.g., the deficits remain stable or improve after a period of abstinence).
E. The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder
What is Mild Neurocognitive Disorder? (6)
A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition) based on:
1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and
2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
B. The cognitive deficits do not interfere with capacity for independence in (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required).
C. The cognitive deficits do not occur exclusively in the context of a delirium.
D. The cognitive deficits are not better explained by another mental disorder major depressive disorder, schizophrenia)
What are 2 neuropsychological disorders caused by alcohol?
• Acts on GABA, as well as serotonin and dopamine systems.
• Two distinct groups
1. Those with severe cognitive impairments (Alcohol Induced Major NCD) neuro cog disorder
• 10% of those with alcohol dependence synonymous
• Associated with Wernicke-Korsakoff syndrome
• Poor reversibility
• Risk increases with age and nutritional deficiencies esp thiamine (B12)
2. Those with mild to moderate cognitive impairments
• 45% of those with alcohol dependence
• Greater chance of reversibility
