Audrey - Substance use, misuse and abuse Flashcards
Continuum of use
- Experimentation (may never use again)
- Recreational/social use
- Regular use/bingeing
- ⚠️Problematic use: mild to severe
⭐️Broad range is using; it’s not always those in alleyways who do drugs girrrl- don’t be so ignorant!
Tolerance
⭐️Describes certain changes in the way the body reacts to the drug. A person who develops tolerance needs more and more of the drug to at the same effect as before. In essence, it takes a higher does to get the effect- also applies to alcohol.
Withdrawal symptoms
⭐️Are compensatory reactions in the body that oppose the primary effects of the drug. They are therefore the OPPOSITE of the effects of the drug. Eg one effect of heroin is euphoria which is replaced with dysphoria on withdrawal of the drug.
Craving
⭐️A PSYCHOLOGICAL urge to administer a discontinued medication or recreational drug.
It’s the way a person thinks about the drug and their need for it.
When taken in excess all drugs…
Therefore applies to the group of people at the extreme end of the continuum who take in excess
- ➡️direct activation of the brain reward system which ➡️reinforcement of drug taking behaviours (😥 demonstrates the huge impact of drugs and how difficult it is to stop using; this effect has also been observed in rats who chose drugs repeatedly until it killed them)
- Produce intense activation of reward system such that normal activities may be neglected
- Typically produce feelings of pleasure “high”
- ⬇️inhibitory control
Addiction vs Dependence
❗️Required to compare and contrast: how are they the same/how are they different?
⭐️Drug dependence: means that a person NEEDS a drug to FUNCTION NORMALLY. Dependence can be a normal body response to a substance. Eg alcoholism/alcohol dependence: dependent on alcohol.
❗️Can be physically dependent and not addicted (eg seen in those who receive morphine for cancer treatment but who don’t compulsively use it and get addicted to it)
⭐️Drug addiction: the compulsive USE of a substance DESPITE its negative or dangerous EFFECTS.
DSM-5 criteria characteristics
😥Impaired CONTROL use beyond intention; inability to reduce usage even if they want to stop; time taken to obtain, use and recover and cravings)
😥SOCIAL impairment (failure to fulfil obligations, use continues despite problems, withdrawal from people/activities to use substance) - sort of becomes no. 1 priority; important aspects of the person’s life are sacrificed for it
😥RISKY USE (use in physically hazardous situations, valued activities are abandoned or ⬇️)
😥PHARMACOLOGICAL (tolerance, withdrawal)
Is addiction under-recognised? Personal and Professional Attitudes
✖️Less than 1/3 of substance use is recorded, why?
-You have to be prepared to stop using and most people don’t want to
-Stigma
-Failure to acknowledge that you have a problem; clinicians may not identify a problem; individual may even deny they had a problem
✖️Clinicians simply don’t suspect a problem
✖️Lack of skills/knowledge for diagnosis amongst clinicians
✖️Fear on the part of clinicians of negative consequences for patient thus preventing diagnosis (eg across work, legal and insurance domains)
✖️Pessimism about recovery may lead to a ⬇️reporting of problem
✖️Embarrassment or fear of offending patient
✖️OVERSHADOWING: frequently comorbid depression, anxiety, psychosis may overshadow or be more readily recognised and diagnosed leading to an overshadowing/ overlooking of effects of substance use
Theories of addiction
- Biological: dopamine hypothesis: drug ➡️⬆️dopamine➡️⬆️reward seeking➡️⬆️drug taking = ♻️
- Personality:
Compulsive personality: compulsive seeking ➡️⬆️drug-taking - Family causation👨👩👧
- Genetics
- Modelling/Social Learning (what we observe)
- Codependency and enabling (being with someone who uses) - Socio-cultural influence
- Biopsychosocial model
- Disease Theory: drug use changes way brain responds to the substance therefore making one more likely to use the substance again.
⭐️Our conceptualisation of drug and alcohol use disorders determines the course of action taken to combat against it and how it’s viewed in society. - Disease as susceptibility
- Disease as damage: Exposure model
- Incentive-sensitization:
Liking vs. wanting - Positive reinforcement (🏆heightening positive experiences)
- Family interaction model
3 main types of learning
- Operant conditioning
- Classical conditioning
- Social learning
⭐️Almost all of our behaviours are to some degree influenced by these 3 learning principles
Biopsychosocial (complex) Model of Drug Use
❗️Must be able to describe this
⭐️Considers the aetiology to be a multi factorial phenomenon consisting of biological, psychological and social components. ⭐️The emergence of substance use depends on the amount of exposure and social pressure to consume as well as upon the degree of personal vulnerability (peer group, genetics, personality, previous learning/past experiences)
⭐️Looks at the whole individual and the interaction of multiple factors in DETERMINING PROGRESSION (ie why some vs others go on to develop a disorder)
⭐️Drug use is COMPLEX, MULTIFACTORIAL phenomenon; most therapists therefore utilise multiple approaches to intervention and treatment because most single approaches used in isolation do not work and address all influences at play.
Evidence of biopsychosocial in context of drug use:
- Humans are born with the drive- we experiment early in life
- Receive rewards and punishment for trying various ways (eg climbing as a kid and falling may stop us from climbing again)
- Develop preferred methods and tend to persist in attempts
- Shaped by psycho-social processes (desires, availability norms, etc.)
- Set and setting shape experience (can be positive and valuable)
A multi-sourced model of addiction (Kovac)
❗️Must be able to answer what this model is
⭐️Premise: our past experiences have a direct influence on what we do and the decisions we make in the future; current choices or even seemingly irrelevant choices are also influential (eg peer group).
✔️This model provides different avenues to start treating an individual (current choices may be an avenue for intervention- may try to alter decisions made by individual to hang out at bars where they may score their next hit and stop them from hanging out there)
Long-term effects of large amounts and prolonged use on the body
😥⬆️blood pressure➡️enlargement of heart and irregular heart rate 😥Liver: -cancer -cirrhosis -hepatitis 😥Stomach -bleeding -ulcers 😥Brain -brain damage -memory loss
Standard drink
⭐️Any drink containing 10 GRAMS of alcohol regardless of container size or alcohol type (ie beer, wine, or spirit).
Generally takes about 1 hour for the body to clear 1 standard drink, although this varies from person to person (depending on liver size, body mass and composition and alcohol tolerance)
Binge Drinking
⭐️Drinking too much on a single occasion of drinking. It means drinking more than the recommended level for adults (ie drinking more than 4 standard drinks at any one time).
⭐️Can also refer to drinking continuously for a number of days or weeks, occasional or irregular bouts of heavy drinking/drinking to deliberately get drunk.
Binge Drinking:
Associated risks
- memory loss
- injury to yourself and others
- dizziness
- loss of coordination
- diarrhoea
- vomiting
- lack of judgement
- alcohol poisoning
😥Alcohol is the LEADING CAUSE of hospitalisation and ambulance attendance
😥3rd major cause of death for teens, injury and homicide and suicide
Indigenous Australians and alcohol use
⭐️Across the board worse than non-indigenous Australians
😥Burden of disease associated with alcohol use by indigenous Australians is almost DOUBLE that of the general Australian population.
NHMRC alcohol guidelines
- No more than 2 standard drinks on any day reduces the lifetime risk (of harm from drinking)
- No more than 4 standard drinks on any one occasion reduces risk of injury
- Not drinking alcohol before 15
Side note: average onset of drinking is now 12 years!!!! This age group is HR as their PFC (responsible for controlling impulses and allowing us to judge the usefulness of our actions) is still developing) - No drinking while pregnant or breastfeeding (foetal alcohol syndrome)
Rationale for Guidelines:
- Risk of disease conditions
- Risk of delinquent behaviour
- Risk of hospitalisation
⚠️Withdrawal Syndrome and Alcohol Withdrawal Seizures
Withdrawal Syndrome
- Begins within 24 hours
- Lasts up to 5 days
Alcohol Withdrawal Seizures
- Occur in about 5% of people- rare and severe withdrawal symptoms
- Usually within 7-24 hours of last drink
- Considered a medical emergency ⚠️
Cannabis
The delta-9 THC part of of the plant gives the high and consists of:
- Marijuana (dried flowers and leaves)
- Hashish (resin)
- Hash oil (oil from hashish)
😥There are 4 cannabis-related ambulance attendances everyday in Victoria.
Prevalence is greater in Australia than anywhere else.
Treatment of Addiction:
Barriers and Characteristics
⭐️They are developed around how he conceptualise what causes drug use
⭐️Each require MOTIVATION
Harm Reduction Programs interestingly recognise that total abstination is not possible, but still wish to recognise those who do present with an issue and collaborate with them to at least reduce/minimise the harm inflicted by the substance.
⭐️It’s important to consider what the decision-making is for the individual; what the reward is in terms of the drug; why they continue to use the substance, as well as what their thinking around the use of the drug is.
⭐️Just getting help is one of the most important factors in treating addiction; the precise type of treatment received is not as important- as what is more crucial is MOTIVATION and that want to make a change.
✔️Use of Motivational Enhancement Therapy
