Alcohol and substance use Flashcards
What category does substance related disorder fall under?
Disinhibited externalizing
How was substance abuse seen throughout the editions of the DSM?
DSM-I
- Personality disorder/ character failing
- No criteria or specific drugs specified
DSM-II
- Still a personality disorder
- Specific drugs specified
- Some criteria specific (still mostly up to clinician)
DSM-III
- Substance use disorders separated from personality disorders (NO LONGER PERSONALITY DISORDER)
- Each class of substance its own disorder
- Specified between Abuse (life interference) and dependance (physiological component)
- Calls it a pattern NOT an addiction –> A maladaptive pattern of substance abuse leading to distress or impairment
- Cannot reach diagnosis for dependence without reaching criteria for abuse first ( that isn’t the case now because you can have dependence without abuse!)
Abuse:
Includes 1 or more of:
- failure to fulfill role obligations
- physically hazardous situation (i.e. drinking while driving)
- legal problems
-social problems
Dependence:
Includes 3 or more of:
- tolerance
- withdrawal
- drinking more than intended
- failure to cut down
- more time spent drinking
- other activities given up
- physical/phycological problems
DSM-IV
- No longer recognizes the distinction between abuse and dependence
- Now a disorder with mild, moderate, and severe presentation
- More heterogeneous
- Removed legal aspect
- Cravings now a part the presentation
What are the 5 categories of substances?
Depressants
Stimulants
Opiates
Hallucinogens
Other
What are the changes made to DSM-IV
- Introduction of cravings
- Removal of legal aspect
- Change from substance disorders to Substance-Related and addictive disorders
What is the only category included in the behavioural addictions?
Gambling Disorder
What is the most addictive substance?
Nicotine
What are the 4 signs of substance use disorders?
- Impairment of control (tried and failed to cut-down, use it longer or more than intended)
- Social impairment (failure to fulfill role obligation)
- Risky use (i.e. while driving)
- Pharmalogical dependance (tolerance or withdrawal)
What is polysubstance use disorder?
- Using multiple substances
- Concurrent dependence more common than not
- Related to more severe pathology
Is the use of any illicit drugs common in youth?
Yes, not abuse though but USE is around 30%
50% of adults over the age of 18 are regular drinkers
Which race has the most common prevalence? Why are East Asian and Jewish populations the lowest?
- White and Native Americans have the highest prevalence
- East Asians and Jewish have the lowest rates of alcohol dependence due to a genetic variant that makes alcohol unpleasant –> rates of other substance abuse is similar
Explain the gender differences in substance abuse?
- Rates in men are higher but women deteriorate faster
What is the gateway theory of substance use?
- Alcohol and marijuana are gateway drugs meaning they increase the likelihood of subsequent drug use
- What it doesn’t account for is that people who tend to abuse alcohol and weed have a general propensity to substance abuse –> alcohol and weed are just easier to get
Is it true that one sip will lead to a relapse?
NO!
If people are abstinent for 5 years, they are unlikely to relapse. In fact, many people are recovered and engage in controlled drinking
Explain the Witkiwitz’s study on functioning after substance use recovery.
- Around 70% of those who recovered were high-functioning on psychosocial markers 9 years later
- Of those that recovered, 20% were STILL heavy drinkers
Evidence that abstinence isn’t necessary for recovery
What are some vulnerability factors for developing AUD?
- Drinking before age 15
- Family history of AUD –> general liability for psychopathology with an inclination towards externalizing disorders
Explain the study of offspring of twins with and without AUD.
Group 1: Offspring of Mz and Dz twins with AUD –> high genetic risk, high environmental risk
Group 2: Offspring of Mz twins without AUD but their Uncle does –> high genetic risk, low environmental risk
Group 3: Offspring of Dz twins without AUD but uncle does –> moderate genetic risk, low environmental risk
Group 4: Offspring of Mz and Dz twins without AUD –> low genetic risk, low environmental risk
ONLY a high genetic risk and a high environmental risk increases risk of developing AUD compared to controls. Group 2 and 3 are NOT more likely than controls –> suggests genetics play a role BUT they are not deterministic
How does genetic risk relate to tolerance?
- Those who have a higher genetic risk of developing AUD have a higher tolerance of alcohol
- ppl with fathers who have AUD have better balance and coordination after drinking
- Are less sensitive to the effects of alcohol and therefore have to drink more
How does alcohol dependence relate to reinforcement?
Positive reinforcement –> The effects of alcohol feels good, increases positive affect/confidence, etc.
- people who are high on reward or sensation-seeking more vulnerable to AUD
negative reinforcement –> Self-medicating, decreases bad emotions
- people who are high on trait negativity more likely to develop AUD
What did Fairbairn discover about reciprocal smiling?
Alcohol is more socially rewarding for men –> men in men only groups engage in more reciprocal smiling while drinking –> more positive reinforcement while drinking
How does dopamine play a role in cravings related to AUD?
- Dopamine plays a role in motivation and learning (pathway of reinforcement)
- plays a role in perpetuating and maintaining the disorder
No cue + reward = increased dopamine after reward
Cue + reward = increased dopamine after cue (cue is reinforced, increased dopamine when things remind you of the drug)
Cue + no reward = decreased dopamine at the reward time –> explains why cravings are hard to resist
What is deviance proneness?
SUD arises due to a general propensity towards externalizing disorders and a general deviant pattern of behaviour
