Addictions

Question 1

What is the first point in the 10 things to know about addictions?

Answer 1

1. altering consciousness is a natural human (and mammalian) phenomenon

Question 2

How do people change their consciousness alterations? and what are three reasons why? (physical, psychological and social)

Answer 2

people change their consciousness alterations through drugs and alcohol (i.e caffeine)

it has benefits on the:
physical level: pain relief, help with sleep, increased endurance, appetite control
2. psychological : relaxation, stress relief, increased alertness, mood alterations, pleasure, enhancement of performance or creativity
3. social –> social interaction, religious or spiritual, or ceremonial use…

number one drug used to alter consciousness worldwide is caffeine

Question 3

What are FIVE main MAJOR drug classes?

Answer 3

1. CNS depressants
2. stimulants
3. Hallucinogens
4. Cannabis
5. ‘club drugs’

Question 4

what are some examples of CNS depressants?

Answer 4

1. sedative hyponicts
2. barbiturates
3. opiates –> morphine, codeine, heroine, FENTANYL and alcohol

Question 5

What are some examples of stimulants?

Answer 5

cocaine and amphetamines (meth)

Question 6

What are some examples of hallucinogens?

Answer 6

LSD, Mescaline, PCP, Magic muschrooms

Question 7

what are some examples of club drugs?

Answer 7

ecstacy, ketamine..etc..

Question 8

What is number one most top 20 drugs in the last 12 months?

Answer 8

ALCOHOL… is the ‘heavy weight champion’ with 90.8% consumption rate over the past 12 months

fentanyl stands at 8.7%

Question 9

What is the second out of 10 facts about addictions?

Answer 9

accition has three faces: Moral, medical and economic

Question 10

What does the moral perspective think about addictions?

Answer 10

They think that addictions are fundamentally a case of moral failure and deviant behaviour

they think taking psychoactive drugs violates sociocultural norms regarding legitimate vs. illegitimate drugs

they think that a method of intervention for these individuals who are addicted is sanctions and criminal sentences

Question 11

What does the medical perspective think about addicts and addictions?

Answer 11

they think that addiction is a fundamental disease or illness

• they think that repeated use of drugs causes a change in brain structure and function
• they think its chronic disease

they view treatment methods to be a method of intervention such as drugs

Question 12

What does the economic perspective thing about addicts and addictions?

Answer 12

they think that addiction is fundamentally a consequence of market demand for goods and services that deliver consciousness alterations

• at each level of good or bad drug exchange theres always cash involved
• at the population level, economic transactions related to addictions are a significant source of government revenue and support an enormous global underground black market economy ….

they view intervention methods on addictions to be taxation

Question 13

What is the third out of 10 facts about addictions?

Answer 13

addictive behaviours occur across a continuum that includes beneficial and harmful effects

Question 14

What do acute effects of drugs depend on at the individual level? (4)

Answer 14

1. type of drug (i.e. stimulant, depressant, hallucinogen) used
2. dose taken
3. drug metabolism and pharmokinetics
4. route administration

i.e. inhalation and injection have the greatest concentration of the drug going into ur brain and affecting ur mind set vs. snorting and injection

people who use inhalation and injection also have a faster drug metabolism and need to re-take the drug more often to have the effects

Question 15

Explain Drug, Set and Setting?

Answer 15

Drug –> type, quality, frequency/quantity, route of administration

Set –> expectations, history of use, current physical state and other body characteristics

Setting –> where used, with whom, licit or illicit context

Question 16

What are the effect range across a continuum?

Answer 16

beneficial use –> casual/non-problematic use (i.e. recreational drinking) –> problematic use (i.e. impaired driving, binge consumption..) –> chronic dependence (compulsive despite negative health and social impacts)

Question 17

what are the effects of drugs on a population level?

Answer 17

participation in addictive behaviours almost always follows a positively skewed frequency distribution

this shows that a vast amount of people take the drug recreationally (for example alcohol) and moderately and then a small amount of people abuse it and consume high amounts

Population size MATTERS!!! alcohol kills more people than illicit drugs, but theres a flaw bc majority of people drink alcohol and theres more access to it

Question 18

How does addiction have a massive impact on population health at high levels?

Answer 18

causes substance abuse disorder and causes 1 in 5 of canadian deaths under the age of 70

addictions are more common among socially marginalized subgroups and over 50% of homeless people use illicit drugs and are addicted

Question 19

how can addictions be a burden on the health system and economy?

Answer 19

each year it costs the government 4 million dollars to provide acute care hospital days and 772,925 potential years of life lost

in canada the economic impact of substance misuse is estimated to be 39.8 billion in a single year…

Question 20

What is the fourth out of 10 facts about addictions?

Answer 20

At high levels of problem severity, addiction is fundamentally about compulsive habitual behavior

Question 21

What are some neuroscientific consensus on dependence?

Answer 21

connects between PFC and midbrain become dissociated with repeated substance misuse. Loss of supanses between these areas cause addiction behaviour

the midbrain is responsible for impulsive actions, feelings of desire and for stimulus response learning

the prefrontal cortex, is responsible for cognitive control and self regulation

Question 22

what are the areas of the brain that contribute to addiction?

Answer 22

1. prefrontal cortex
2. nucleus accumbent
3. VTA
4. hippocampus
5. subsantia nigra
6. striatum

Question 23

What happens in the brain as we transition to dependence?

Answer 23

drugs of abusve active dopamine producing neurons in the brains reward system that gives us feelings of euphoria which alters our consciousness and gets us what we want

over time a person becomes accustomed to the addictive behaviour being the source of pleasure rather than going to family, friends or doing a goo job

Question 24

What is neuroadaptation to drug exposure associated with?

Answer 24

neuroadaptation to repeated drug exposure is associated with transition from impulsive to compulsive behaviou

Question 25

what is compulsive behaviour associated with? (5)

Answer 25

1. narrowed attentional focus
2. decreased self control
3. compulsive drug taking
4. inflexible routinized behaviour
5. negative emotional states

Question 26

How do we change our thoughts about only drugs being able to give rise to this compulsive behavior>

Answer 26

theres been growing evidence that things like gambling, internet gaming, sex, shopping all illicit the same responses in the brain as if they were psychoactive drug addictions that can lead to compulsive behaviour. Human activities can also become addictive to people

Question 27

What is the fifth out of 10 facts about addictions?

Answer 27

its a mistake to over-emphasize the drugs and the neurobiology

Question 28

what are some dangers of over emphasizing drugs?

Answer 28

• we can’t assume that drugs hijacking the brain is only way we can get addicted theres also:

1. genetic susceptibility (40-50%)
2. life history
3. comorbid mental disorders
4. rat PARK –> social support groups
5. price sensitivity and availability (if the price is increased on addictive substances than people buy less of it.. if they were truly hooked on it neurobiologically they would not care if the price was raised and it would remain consistent)

Question 29

how can we treat the overdose of fentanyl?

Answer 29

naloxone is extremely effecting but the kits have been slow to be distributed and theres restrictions on who can administer it

treatment for other opiod problems include Not using absence programs because that makes overdose happen more likely

Question 30

How are addictions always identified in practical settings?

Answer 30

because theres no blood test or anything that can help identify an addiction through science, addictions are always identified in practical settings through evaluation and interpretation of behavioural and social factors of a person presenting for services

Question 31

what are some treatment methods that are yet to work for addictions and whats the most common treatment used?

Answer 31

pharmacotherapy drugs treatments like agonist treatment, antagonist treatments, and anti-craving medications like for nicotine

other things like drug vaccines and neurosurgical approaches like DBS have not provided a good cure

lack of pharmaceutical vaccine or treatment tools means that a psychosocial intervention are the most common treatment used around the world like support groups, motivational enhancement and CBT

Question 32

What is the sixth out of 10 facts about addictions?

Answer 32

any treatment can be effective but no one approach is superior and many drop out

Question 33

what is Project MATCH?

Answer 33

matches alcoholism treatments to client heterogeneity

its a trial designed to match the most effective psychosocial treatment to individual patient characteristics

the drinkers of alcohol are random assigned to CBT, motivational enhancement therapy and twelve step facilitation

results were tabulated based on percentage of days abstinent and days to first drink alcohol (relapse)

results showed that all treatments helped bu no one differences across types

Question 34

what is one of the most consistent factors related to favourable outcomes across all addiction treatment approaches?

Answer 34

treatment completions

associated with abstinence, lower crime, fewer relapses and greater employment

it is more common for patients to drop out of addiction treatment than it is for them to complete it which results in more relapse rates

Question 35

does relapse meant that the treatment has failed?

Answer 35

no it doesn’t it just means they have to try and get better treatment services by changing deeply imbedded behaviours

Question 36

What is the seventh out of 10 facts about addictions?

Answer 36

theres a massive service gap for people living with addictons

Question 37

what do the majority of individuals who are addicts say about government meeting their services ?

Answer 37

they say

1. didn’t receive desired service at all
2. didn’t receive enough service
3. there are way higher rates of unmet service needs than the general AB population

Question 38

What is case finding in primary care?

Answer 38

percentage of alberta adults meeting past eye screening criteria for major depression and alcohol problems who also perorated they had been diagnosed by a health progressional in the past year is VERY LOW. most health professionals don’t look at the associations between the psychological disorders and addictions

Question 39

What is the eighth out of 10 facts about addictions?

Answer 39

meaningful behaviour change occurs but it takes time, often outside of health care

Question 40

What is natural recovery and what population does it happen towards?

Answer 40

self-change is very common among people with moderate addiction problems and those who are dependent… 50-80% people overcame alcohol addiction through self change which is a natural process of just aging

it has to do with social group

Question 41

what are some common processes in treatment assisted and natural recoveries?

Answer 41

development of self regulation skills and its best done in social, community and policy environments

Question 42

What is the ninth out of 10 facts about addictions?

Answer 42

we can’t afford to promote abstinence as the only outcome that matters

Question 43

What are some example of abstinence encouraging programs?

Answer 43

like Alcoholics anonymous, and peer support groups and the twelve step programs

Question 44

what are some evidence for these abstinence encouraging programs?

Answer 44

evidence for:

• has saved many lives worldwide
• the 12 step involvement is associated with better outcomes on substanc related, psychological and social measures

evidence against:

• many people experiencing addiction problems are not attracted to the spiritual underpinnings of these associations such as “doing it for god”
• others at lower levels of severity prefer to seek moderate use rather than complete abstinence
• consistant evidence that controlled use is possible for some but not all

Question 45

what is harm reduction?

Answer 45

its a way to reduce mortality of severely addicted individuals to psychoactive substances without requiring them to stop using the drugs…

things like seat belts, emission controls..etc.. are ways of harm reduction but not completely getting rid of harm

its there to reduce mortality and morbidity associated with the addiction but does not require them to stop

Question 46

what are some harm reduction methods?

Answer 46

syringe exchange programs (giving people clean syringes) and peer driven programs

Question 47

what type of outcome does heroine assisted therapy give?

Answer 47

promising outcomes

Question 48

what type of outcomes do opiod substitutions give?

Answer 48

strong outcomes

Question 49

what should systems strive to do?

Answer 49

2. reduce harms related to addiction as a first line response
3. stop or reduce addictive behaviour (facilitate access to variety of treatments that best addresses the problem severity)
4. achieve productive functioning in family, work and social life and integrate with other health and social services

Question 50

What is the tenth out of 10 facts about addictions?

Answer 50

its time to invest in new approaches built on evidence

Question 51

in what ways can we invest in new approaches?

Answer 51

1. reconsidering sector funding .. instead of putting money towards prevention we should put money towards treatment
2. reconsider psychoactive drug classifications: what is considered legal or not… in canada right now theres three categories: legal, prescription and illegal.. the classification is not based on pharmacology, economic analysis or objective risk of harm estimates its actually made from cultural precedent from a long time ago that was made from a moral approach
3. reconsider regulatory frameworks… different drugs need different degrees of regulation

Question 52

what do revised policy frameworks need to include (5)?

Answer 52

1. broad population health focus
2. impartial evidence-based priorities
3. balanced approach that takes into account determinants of harmful addictions as well as harm reduction strategies
4. evaluative research
5. legislative and regulatory structures and processes that are not rigid and that can adapt to evolving real world experience and new evidence

Question 53

what is CRISM and their objective?

Answer 53

translate evidence based interventions for illicit and prescription drug misuse into clinical practice, community based prevention and health care system changes