Addictive Disorders Flashcards
Give the two groups of substance related disorders.
Substance use and substance-induced.
What do substance induced disorders include?
Specific mental health problems induced as a result of substance use, like stimulant induced psychosis and alcohol induced depression.
Explain the placement of substance use disorders on a continuum from mild to severe.
Mild disorders show 2 or 3 of the 11 symptoms, moderate 4 to five, and 6+ is severe.
Give the listed substances or classes of substances. (9)
Alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives (hynoptics or anxiolytics), stimulants, tobacco, and unknown substances.
How could caffeine be classed as a substance?
It results in intoxication and subsequent withdrawal symptoms.
Define physiological dependence.
Tolerance and withdrawal.
Give Edwards and Gross’ precise description of alcohol dependence syndrome. (6)
Behaviours like priority given to drinking over other activities, a subjective awareness of a compulsion to drink, increased tolerance to alcohol, repeated alcohol withdrawal symptoms, consuming alcohol to avoid withdrawal symptoms and a rapid reinstatement of dependence even after a period of abstinence.
Give the eleven diagnostic criteria for substance use disorder.
Larger amounts of the substance are consumed than intended; a persistent desire, or unsuccessful attempts, to reduce substance use; a large amount of time is spent, obtaining, using or recovering from the effects of the substance; craving for the substance; failure to fulfil major role expectations; continued substance use even when it interferes with social or interpersonal activities; reduction or ceasing of social or occupational activities; substance abuse occurs in physically hazardous situations; continued use of the substance even when the individual is aware of the problems it causes, and tolerance and withdrawal are present.
An individual must have at least __ of the following symptoms within a __ month period, which have resulted in ____ ____ ____ or ____ to be diagnosed with a substance use disorder.
2, 12, clinically significant distress or impairment.
Describe tolerance, as defined by the DSM-5. (2)
A need to increased amounts of the substance in order to achieve the same effect, or a markedly diminished effect for the same amount of the substance.
Describe withdrawal, as defined by the DSM-5. (2)
A range of characteristic physical and psychological symptoms that emerge after cessation or reduction in substance use, or taking the substance (or a related substance) in order to alleviate these symptoms.
What does withdrawal refer to?
The development of a set of symptoms that occur upon cessation of using the substance, especially after prolonged or heavy use.
Which substance withdrawal state is life-threatening?
Alcohol withdrawal.
Give some symptoms of alcohol withdrawal within 12 to 24 hours. (8)
Autonomic hyperactivity, nausea or vomiting, shakiness (increased hand tremor), insomnia, psychomotor agitation, increased anxiety, hallucinations, and grand mal seizures.
When is the risk of death from severe withdrawal highest from alcohol withdrawal?
When the individual has a history of very heavy continuous drinking followed by an abrupt cessation in use.
Name three opioids.
Morphine, heroin, and methadone.
Give the symptoms of opioid withdrawal. (7)
Nausea and vomiting, diarrhoea, running nose and eyes, yawning and insomnia, muscle aches, piloerection and negative mood.
How long can the symptoms of opioid withdrawal last?
5-7 days.
Give the symptoms of stimulant withdrawal. (5)
Fatigue, vivid and unpleasant dreams, sleep disturbances, increased appetite and psychomotor agitation or retardation.
Give the symptoms of cannabis withdrawal. (8)
Depressed mood, irritability, restlessness, sleep difficulty, increased anger and aggression, decreased appetite, nervousness/anxiety, and headache.
Give the ICD-10’s definition of harmful use.
A pattern of psychoactive substance use that is responsible for clear physical or psychological harm, which may lead to disability or adverse outcomes for relationships.
Give the ICD-10’s definition of substance dependence.
Three of more symptoms occurring over the previous month or repeatedly over the previous 12 months.
Name all 6 of the symptoms for substance dependence.
A strong desire of compulsion to use, impaired control over use, physiological withdrawal symptoms, evidence of tolerance, preoccupation with substance use, and persistent use despite clear evidence of harm.
What does ICD stand for?
International Classification of Diseases.
What is the most commonly used drug in Australia?
Alcohol.
ICD categories of harmful use and dependence occur in how many people, regarding alcohol?
1 in 20.
One of the reasons that substance use and substance use disorders predominate in the young relates to:
Birth cohort effects. Younger generations have been exposed to the easier availability of alcohol and drugs.
What does earlier first use of a drug increase the chance of?
Developing that substance use disorder in later life.
For each year that first use of alcohol is delayed, the risk of developing alcohol use disorder decreases by what percent?
5-9%.
Psychosis is how many times more common among regular amphetamine users?
11.
Describe methamphetamine powder, or speed.
The lowest purity of methamphetamine since it is easiest to cut with adulterants, with a median purity of 10%.
Describe damp/oily methamphetamine, or base.
More potent that speed, and less likely to be cut with adulterants, with a median purity of 21%.
Describe crystal methamphetamine, or crystal meth/ice.
The purest form, with a median purity of 80%, but there is an adultered form with a median purity of 19%.
What percentage of people with a drug use disorder have a comorbid mental disorder?
53%
What percentage of people with a alcohol use disorder have a comorbid mental disorder?
37%
Those with comorbid conditions typically have worse outcomes than those with single disorders on a range of measures including: (7)
Physical health, social and occupational functioning, self-harm and suicide, violence, homelessness and relationship problems.
Explain why substance use disorders have a high frequency of comorbidity with other psychological disorders. (3)
Individuals become dependent on a substance to escape negative feelings caused by mental health, or substances may cause mental health problems, or a third factor, like childhood trauma, may cause both substance abuse and mental illness.
How many times more likely are opioid users to self-harm or commit suicide?
6 times more likely to self-harm and 14 to commit suicide.
What percentage of suicide attempts involve the use of alcohol?
30-40%.
How does older age interact with substance abuse, and what effects foes it cause?
Higher blood concentration from alcohol use, higher use of prescription medication with can interact with alcohol, mortality from falls, motor vehicle accidents and suicide.
What has been linked to dementia?
Smoking and higher levels of alcohol use.
The misuse of what is likely to increase in the elderly?
Prescription medications.
What does the prevalence of substance use disorders decline with age?
Death from excessive use of substances reduces the number of people with these disorders who reach older age.
Those with a substance use disorder have a life expectancy of about __ years less than the general population.
14.
How does heavy alcohol use in the early 20s increase mortality?
Death from accidents, violence, and suicide.
How does heavy alcohol use increase mortality in later life?
The medical complications of excessive alcohol consumption, like liver cirrhosis and certain cancers.
Give four causes of death from illicit drug use.
Trauma, suicide, overdose, and infectious diseases like HIV or hepatitis related complications.
Explain the concept of DALYs, or disability adjusted life years.
The amount of time lost to both fatal and non-fatal events, or years of life lost due to premature death, coupled with years of healthy life lost due to disability.
In Australia, alcohol use accounts for what percent of the total burden of disease?
3.2%.
In Australia, illicit drug use accounts for what percent of the total burden of disease?
2%
In Australia, tobacco use accounts for what percent of the total burden of disease?
7.8%
How many Australian adults have been affected in some way by the drinking of others.
3/4.
What percentage of Australians reported serious harm like being threatened, physical assaulted or property damage, as a result of the drinking of strangers.
43%
What is the disease model of addiction?
The view than substance abuse is an incurable physical disease, such that only total abstinence can control it.
What is central to the disease model of addiction?
Loss of control.
Explain Skog’s choice theory.
The apparent loss of control seen in those with a substance use disorder as a consequence of individuals changing their minds.
First-degree relatives of individuals with a substance use disorder are _ times more likely to suffer from such a disorder themselves.
8.
Give some supporting evidence for a genetic component to substance use.
Monozygotic twins have a higher concordance rate fro substance use disorders, and adoptees have a higher chance of developing substance use disorders if their biological parent had the disorder.
What are the brain’s two major reward systems?
Dopaminergic reward system and the endogenous opioid system.
What is the endogenous opioid system?
The system within the body that produces and responds to both internally produced opioids (endorphins) and ingested opioids or opiates.
Levels of what increase following the administration of most drugs of dependence, like alcohol, nicotine, cannabis, opioids, cocaine and amphetamines.
Dopamine.
After administration of drugs, where does dopamine activity increase?
The nucleus accumbens.
Where does the nucleus accumbens receive information from?
The ventral tegmental area in the midbrain.
What is the pathway between the nucleus accumbens and the ventral tegmental area in the midbrain called?
The mesolimbic dopamine pathway.
Where are messages from the nucleus accumbens sent?
The prefrontal cortex where they are encoded as experiences.
What is the reward pathway from the nucleus accumbens to the ventral tegmental area in the midbrain implicated in?
A range of pleasurable activities, like eating and sex.
What kind of effect do substances have on the reward pathway?
A much greater effect than other activities.
Who proposed Inhibition Dysregulation Theory? (3)
Lubman, Yucel and Pantelis.
Describe Inhibition Dysregulation Theory.
Explains addiction as being underpinned by impairment of the neural system that is responsible for inhibiting rewarding behaviour.
What brain areas are implicated in Inhibition Dysregulation Theory? (2)
Orbitofrontal cortex and the anterior cingulate cortex.
Explain classical conditioning.
A form of learning in which a neutral stimulus, through its repeated association with a stimulus that naturally elicits a certain response, acquires the ability to produce the same response.
Explain the instrumental or operant learning model.
A model with posits than substance use problems develop as a result of conditioning based on instrumental learning principles.
What can classical conditioning be use to explain in substance use disorders? (3)
Tolerance, withdrawal and craving.
What conditioned response has been proposed as the reason why tolerance develops?
Unrelated stimuli that becomes associated with drug use elicits a response that prepares the body for administration of the drug, meaning that the body begins to compensate for the effects of the drug and reduces the effects of it.
What is neuroadaptation?
The brain adapts to the presence of a drug, and is unbalanced when it isn’t present, leading to unpleasant symptoms of withdrawal.
When does negative reinforcement occur?
When a drug alleviates an unpleasant state.
Explain the opponent-process theory of addiction.
Brain processes act automatically once the balance or affective equilibrium of the brain has been disrupted; a drug will activate one process (the ‘a’ process) which then triggers an opponent process (the ‘b’ process) to bring the brain back to a state of affective equilibrium.
When does the individual experience a pleasant feeling in opponent-process theory of addiction?
When the ‘a’ process in greater than the ‘b’ process.
When does the individual experience an unpleasant feeling in opponent-process theory of addiction?
When the ‘b’ process is greater than the ‘a’ process.
What accounts for the process of tolerance in opponent-process theory?
The opponent process increases in strength and duration with each administration of the drug.
What accounts for the process of withdrawal in opponent-process theory?
The opponent process will be triggered fully by even a small reduction in the dose of the drug.
Explain the incentive-sensitisation theory of addiction.
Drugs of addiction change the areas of the brain that are responsible for the incentive to use drugs, causing the brain to become sensitised to the rewarding effects of the drugs and the stimuli associated with drugs via classical conditioning.
Define the incentive-sensitisation theory of addiction’s pathological wanting.
A term for how much the individual wants the drug, because the incentive has been increased.
What sets incentive-sensitisation theory of addiction apart from other theories of drug-addiction?
Pathological wanting can be experienced consciously or unconsciously.
The incentive-sensitisation theory of addiction proposes that the pleasure associated with drugs becomes less important as physical dependence develops: dependent individuals ___ rather than ___ the drug over time.
Want, like.
Explain Cloninger’s Tri-Dimensional Personality Theory.
A general personality theory which suggests that the interaction between three dimensions of personality influences vulnerability to developing a substance use disorder.
Give Cloninger’s three traits.
Novelty-seeking, harm avoidance, and reward-dependence.
What are the characteristics of novelty-seeking?
Risk taking and impulsivity.
What are the characteristics of harm avoidance?
Caution and inhibition.
What are the characteristics of reward dependence?
Sensitivity to social cues and emotional dependence.
Describe Cloninger’s individuals with type II alcohol use disorder.
Earlier onset, male, and have more problems.
Individuals with type II alcohol use disorder have been found to have:
High novelty-seeking, low harm avoidance and low reward dependence.
What is outcome expectancy theory?
A cognitive approach to substance use, where an individual’s expectations of positive consequences from substance use increase their propensity to use the substance.
What was outcome expectancy theory originally developed to explain?
Heavy alcohol use.
What evidence supports outcome expectancy theory?
Positive expectations about alcohol (increased confidence and reduced tension) predict drinking to excess.
Describe Beck’s cognitive theory of substance use.
Those who develop a substance use disorder have a network of dysfunctional beliefs.
How did Beck explain relapse after an extended period of abstinence?
External stimuli (being in a former substance-using environment) and internal stimuli (stress) activate the individual’s substance-related beliefs.
Explain relapse-prevention theory.
A cognitive-behavioural theory of substance use and disorders, which argues that individuals in high-risk situations will use the substance if they do not have the appropriate coping strategies, have positive expectations of the substance, and have a low degree of self efficacy.
