Alcohol and Substance Use Disorders Flashcards
Excessive sue of alcohol or substance leads to:
When does it become an actual problem?
dangerous behaviour (e.g. driving while impaired)
continued use despite persistent problems:
- social
- psychological
- occupational
- health
- It’s a problem when its jacking you up and you’re still doing it anyway and the impact its having is negative to you.
What is alcohol and substance dependence?
Alcohol or substance abuse resulting in:
Tolerance
and/or
Withdrawal
we are looking at dependance when you have tolerance and/or withdrawal. The body is involved. This has something in common with self-harm and eating disorders is that it has a biological and physiological piece and once that kicks it in its really hard to stop.
What is tolerance?
Physiological need for ↑ alcohol & substance for
same effects (tolerance is a physiological need so you need more of it to get the effects. )
This results from biochemical changes affecting:
* Rate of metabolism
* Elimination of substance from body
(there are biochemical changes that change your rate of metabolism, the speed at which your body eliminates the substance from the body. )
What is Withdrawal?
Physical symptoms that result from stopping use
(when you know you are in withdrawal and you have physical problems as a result like nausea, sweating, tension, headaches, tremors)
Examples:
* Nausea
* Sweating
* Tension
* Headaches
* Tremors
What are the 5 stages of alcohol and substance Abuse?
- Positive attitude
(Start gerally with a posiotive attitude, you then move into experimentation and move into regular use, then heavy use, and then you get into physiological dependence and/or abuse. )
(when you get into dependence its like you need it to feel ‘normal’ aka you can’t function without it.)
- Experimentation
- regular use
- Heavy use
- Physiological dependence/abuse
What are the criteria for the DSM 5 for Alcohol use disorder?
Problematic pattern of ETOH use → impairment (ETOH is how the cool people refer to alcohol.) (when you have a problematic pattern that leads to impairment and then you have 2 or more of the following in the next 12 months)
(has to be 2 or more at the same time)
- 2+ symptoms within 12 months:
- More ETOH than planned
- Desire to control use
- Time spent in ETOH pursuits
- Craving
- Use → interpersonal problems
- Use despite above
- Activities given up because of use
- Use in physically dangerous situations
- Use despite physical/psychological problems due to ETOH
- Tolerance
- Withdrawal
What is the WHO criteria for Harmful use of alcohol?
Heavy episodic drinking:
(world health organization defines harmful use of alcohol as heavy episodic drinking 6 drinks or more more than once per month.)
- ≥ 6 drinks
- ≥ 1x/month
“Alcoholic” no longer used
What is prevalence of harmful drinking patters in undergraduate vs the rest of the population?
Harmful drinking patterns:
30% Canadian undergraduates
vs.
17% population
(if you’re an undergrad you’re twice as likely to have a harmul drinking pattern than the rest of the population)
Explain blood alcohol concentration level? what is the medicine wheel diagram for BAC?
Blood Alcohol Concentration (BAC)
how intoxicated you get dpeends on a whole bunch of things that are biologically true about your own system. Like being on certain medications can make your blood alcohol concentration higher faster/ If you have more fat you will have higher blood alcohol concentration and females typically have more fat than males.
- medication
- sex (fat, retains) vs. water (dilutes)
- food in the stomach (vs. absorption in small intestine)
- amount ingested in a period of time.
What are the 4 main categories of short term effects for alcohol and substance use disorder?
- stimulating, then depressant action (sleep/death). It starts as a stimulant and it becomes depressant.
- interference with complex thought and motor coordination. (it can interfere with complex thought and motor coordination.
- interactions with neural systems
- Stimulates GABA receptors
(tension & motor coordination) - Increases 5-HT & DA
(motivation for pleasure/craving,
addictive) - Inhibits glutamate r
- effects strongly tied to expectations
- Aggression
- Sexual drive
(effects of alcohol are strongly tied to expectations of the substance. You migh have an expectation that you are aggressive etc.)
What are the longterm effects of alcohol and substance abuse disorder?
- malnutrition (vitamin B deficiency = memory loss)
- cognitive impairment
- cirrhosis of the liver
- cardiovascular problems: heart failure, hypertension, stroke, capillary hemorrages
- reduced immune functioning (increased breast cancer risk)
- fetal alcohol syndrome
- psychosis
What is the biological etiology of substance and alcohol use disorders?
Genes
What is inherited?
- Alcohol risk
personality
(this is generally your ability to tolerate or metabolize alcohol. If you are more likely to tolerate it, you are more likely to use more and you will be more likely to develop a disorder )
- Ability to tolerate / metabolize alcohol
- Motivation for alcohol use
- Reinforcing effects of the alcohol
(there are some psycho social parts about this
- if you have an association with alcohol or something not so good you are less likely to develop the disorder/
What is the psychological etiology of substance and drug abuse disorders? According to the diagram she will test us on, who is most at risk?
Enhancement – sensation (or novelty) seeking
Coping – stress, tension reduction, reinforcement
Social – expectations of social success
Conformity – perceived benefits outweigh costs
enhancement and coping are the most at risk. If you have high negative affectivity and high neuroticism it is uncomfortablr to feel that way all the time and you may be more likely to develop a disorder for substances that relieve that. Coping is like people get reinforced
What is the sociocultural Etiology of substance abuse disorders?
Culture
* Attitudes/use patterns
* Tradition of aggression
* Religion
(religions who are really like no alcohol are less likely to see alcohol abuse. Other religions are like use as much as you want and say sorry on sunda)
(what are the attitudes and use patterns in your cultlure. Culture can be larger culture and sub culture. Is there a tradition of aggression? If you look at among people if you lok at people from certain countries are those countries with more aggressive cultures or passive aggressive Scotland alcohol and likelihhod of aggression is a little different than england’s aggression. England’s aggression is more bitchy or passive aggressive. People who are heavy drinkers from scotland, they are gonna be more likely to fight you when aggressive. The thinky mean people in England are less likely to engage in things physically. )
Family
* Parent use/guidance
* Family/marital problems
* Older siblings
Exposure and learning
Availability of substance (generally how available it is. High availabiliy makes it much more likely that you’re gonna use. Social influences. If you’re around people that are like lets get wasted, you are more likely to.)
Peer/social influences (you can get medications that make you less likely to crave alcohol. )
Media
What is the bio treatment of alcohol and substance abuse?
Medications:
- Black desire to drink (Antabuse, Naltrexone)
lower side effects of withdrawal (valium)
What is the psychological treatment of susbtance and drug abuse disorders?
Transtheoretical Model (TTM) - this applies to a lot of things. Basically behaviour you want ot change.
Stages of Change:
1. Pre-contemplation (means I’m just going all in and I’m not even thinking about it. ) no mention of changing behaviour
- Contemplation (start ot prepare and be like maybe I should do somethign to not do this etc. )
aware a problem exists but committed to change
- Preparation
(intends to take action to change)
- Action (actually making changes and starting to do new stuff)
(is sustaining changes and developing new behaviour)
- Maintenance (I’m regularly doing stuff I ‘m supposed to be doing.)
(return to old ways)
- relapse. (return to old ways)
you don’t want to discount all of the progress they have made with one mistake
often if people just do something once you call it a lapse because you don’t want them to go full swing into it again.
relapse is somethign you want to plan for and expect.
What stage is this person in?
Sarah
16-year-old girl who has been using speed for about two years. She uses speed intravenously, having originally
snorted it for the first 12 months. On assessment, Sarah tells you that she has been trying to cut down on her
speed use and has even had a period of two weeks where she didn’t use it. She appears to be ‘speeding’ when
you meet with her.
action and maybe a little relapse
Jian
14-year-old boy who smokes cannabis and tobacco. On assessment of his cannabis use, he states that he can ‘take
it or leave it’. He tends to smoke with friends on the weekend. Jian smokes cigarettes whenever he can afford
them. He also drinks alcohol to the point where he ‘blacks-out’ about once a month.
pre-contemplation
Shae
17-year-old female who is involved in a Drug Court program. She has a history of poly-drug use and has worked as
a sex worker. Shae has been trying to stay off cocaine and speed. She continues to drink heavily a couple of
times a week and also takes street benzos as she says this helps her to sleep. Shae’s latest urinalysis reveals
cannabis, benzodiazepines and amphetamines. She is pretty worried that she will be taken off the Drug Court
Program and she states she really wants to stay out of trouble.
she’s in the action phase but just a little
Luis
18-year-old male who has been using heroin for about three years. He smokes heroin on a daily basis and also
takes Valium or Normison if he can’t get any heroin. Luis has been caught breaking and entering on a number
of occasions. His family is very worried about his drug use and the trouble he is i
FIGURE IT OUT
Psychological treamtent substance use and alcohol abuse?
CBT and Behavioural
- Aversion conditioning (classical conditioning )
- Skills training (how do you deal with the problems without using. The reason you are using is usually for a lot of different factors)
- Self-control (will power is not gonna get you out of anything.)
- Motivational
enhancement
(see Motivational Interviewing link)
Controlled drinking vs. abstinence
(do you lose everything because you are like I can never go near alcohol again or do you say you can drink once a week.)
What is the social treatment for substance abuse and alcohol abuse?
Group therapy
* Forced to confront problem
Alcoholics Anonymous (AA)
Environmental intervention
* Halfway houses
(theres like requirements like you can’t have substances where you live and if you do you get kicked out.)
What is the treatment efficacy for substance and alcohol abuse?
Wide range
looking at people who are in a lot of different circumstances, situations, etc.
Depends on:
* Severity of substance abuse
* Type of treatment
However…
1 Study compared:
* 12-step program
* CBT
* Motivational enhancement therapy
Results: All equally effective
Is this abuse or dependence?
Aliyah engages in binge drinking on weekends with her
friends.
Her drinking does not really interfere with work, but her
partner has complained that she drinks too much at times.
She has frequently driven home from a club when her BAC
is over the limit, and she lost her license for 1 year for this
reason.
She often feels terrible the day after partying with friends
and needs most of the day to recover.
abuse
