CH 11 Substance Abuse Disorders Flashcards
11.1 What term do medical and psychological professionals use instead of “alcoholic” or “alcoholism”?
Harmful use of alcohol
11.1 Describe the prevalence and demographics of Alcohol Use Disorder
Approx. 30% of people in the USA meet DSM criteria at some point in their lifetime
Nearly 15% in a given year
(2015) 50% of adults drink, 25% binge drink
Risk of AUD is nearly twice as high in men than women
11.1 Correct the following statement:
Alcohol is a stimulant
Alcohol is both a nervous system stimulant and a depressant
11.1 Correct the following statement:
You can always detect alcohol on the breath of someone who has been drinking
It is NOT always possible to detect
11.1 Correct the following statement:
Alcohol can help a person sleep more soundly
It can interfere with sleep
11.1 Correct the following statement:
Impaired judgment occurs after other obvious signs of intoxication
It can occur long before motor signs become impaired
11.1 Correct the following statement:
Drinking several cups of coffee can counteract the effects of alcohol and allow the drinker to “sober up”
Drinking coffee has no effect on level of intoxication
11.1 Correct the following statement:
Exercise or a cold shower helps speed up the metabolization of alcohol
They do not
11.1 Correct the following statement:
Alcohol is less dangerous/addictive than other substances
Alcohol can be just as addictive and dangerous
11.1 Correct the following statement:
Liver damage shows up before brain damage in heavy drinkers
It can be present in organic brain damage first as well
11.1 Correct the following statement:
Everybody drinks
28% of men and 50% of women abstain from drinking in the USA
11.1 DSM-5 Criteria for Alcohol Use Disorder
A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least 2 of to following, occurring within a 12-month period:
1. Alcohol is often taken in larger
amounts or over a longer period
than was intended
2. There is a persistent desire or
unsuccessful efforts to cut down or
control use
3. A great deal of time is spent in
activities necessary to obtain, use, or
recover from the effects of alcohol
4. Craving/strong desire to use alcohol
5. Recurrent alcohol use resulting in
failure to fulfill major role obligations
(work, school, home)
6. Continued use despite having
persistent or recurrent
social/interpersonal problems
caused/exacerbated by alcohol
7. Important social, occupational, or
recreational activities are given up or
reduced because of alcohol use
8. Recurrent alcohol use in situations in
which it is physically hazardous
9. Alcohol use is continued despite
knowledge of having a persistent or
recurrent physical or psychological
problem that is likely to have been
caused or exacerbated by alcohol
10. Tolerance, as defined by EITHER of
the following
a. Need for markedly increased
amounts to achieve the desired
intoxication
b. Diminished effect with continued
use of the same amount
11. Withdrawal, as manifested by
EITHER of the following:
a. Characteristic withdrawal
syndrome for alcohol
b. Alcohol is taken to relieve
withdrawal symptoms
11.1 List some side effects of excessive alcohol consumption
Fetal Alcohol Syndrome
Malnutrition, gastrointestinal symptoms
Chronic fatigue, oversensitivity, depression
Impaired reasoning, poor judgment, personality deterioration
Coarse/inappropriate behavior
Loss of pride in appearance, neglect of family, irritability, and unwillingness to discuss the issue at hand
Acute psychotic reactions: alcohol-induced psychotic disorders
Alcohol withdrawal delirium
Alcohol amnestic disorder
11.1 Alcohol withdrawal delirium (delirium tremens)
Acute delirium associated with withdrawal from alcohol after prolonged heavy consumption; characterized by intense anxiety, tremors, fever and sweating, and hallucinations.
11.1 Alcohol Amnestic Disorder (Korsakoff’s syndrome)
Caused by Vitamin D (thiamine) deficiency
Severe, memory deficit is sometimes accompanied by falsification of events
Trouble recognizing pictures, faces, rooms, etc.
Can lead to severe brain damage
11.2 Mesocorticolimbic Dopamine Pathway MCLP
Center of psychoactive drug activation in the brain
Involved in the release of dopamine and in mediating the rewarding properties of drugs
11.2 What does MCLP stand for?
Mesocorticolimbic Dopamine Pathway
11.2 Describe the genetic vulnerability associated with alcohol abuse problems
1/3 of those with AUD had at least one parent with an alcohol problem
Having one alcoholic parent increased the rate of AUD from 12.4% to 29.5%
Adoption studies show that children of parents with AUD were nearly 2x as likely to have alcohol problems in their late 20s
11.2 Describe an alcohol-risk personality
An individual who has an inherited predisposition toward alcohol abuse, is impulsive, prefers taking high risks, and is emotionally unstable
11.2 “Alcohol flush reaction”
Common in Asians and Native Americans
(Roughly 50% of Asians)
Flushing of skin, drop in blood pressure, heart palpitations, and nausea following drinking alcohol
Results from a mutant enzyme that fails to break alcohol down
11.2 List some disorders and symptoms that tend to have comorbidity with alcohol or drug abuse and dependencies
Schizophrenia (50% of schizophrenics struggle with dependency/abuse)
Antisocial personality disorder and aggression
Depressive disorders
11.2 Relate stress and alcohol use
Stressful life events, unsupportive relationships, and social expectations are associated with alcohol abuse
11.3 What fraction of those with AUD receive treatment?
Less than 1/3
11.3 What are the goals of alcohol abuse treatment?
Either abstinence from drinking or reduced consumption of alcohol
11.3 What medications block the desire to drink?
Disulfiram (Antabuse) - makes you throw up when you drink
Naltrexone - opiate antagonist reduced craving by blocking pleasure-producing effects of alcohol
Acamprosate
11.3 What medications reduce the side effects of acute withdrawal?
Valium
Benzodiazepines such as diazepam
11.3 What psychological treatments are generally used to treat alcohol abuse?
Group therapy, environmental intervention, Behavioral Therapy, CBT, and Motivational Interviewing
CBT shows only modest effects
11.3 Miller and Colleagues Study (1986)
Controlled drinking was more likely to be successful in persons with less severe alcohol problems
11.3 Alcoholics Anonymous
(Who started it, what is it)
Founded in 1935 by Dr. Bob and Bill W.
Self-help counseling program in which person-to-person AND group relationships are emphasized
Lifts the burden of personal responsibility by helping alcoholics accept their disorder
Affiliated moments like AI-Anon family groups and Alateen are designed to bring family members together
11.3 What does NIAAA stand for?
National Institute of Alcohol Abuse and Alcoholism
11.3 Gordis (1997)
Patients from competently run alcohol use disorder treatment programs will do as well in any of the three treatments studied
11.3 Relapse Prevention Treatment
Clients are taught to recognize the seemingly irrelevant decisions that serve as early warning signals of the possibility of relapse, high-risk situations and vulnerability are assessed and targeted
“Planned relapse”
11.3 “Planned Relapse”
When patients are taught to expect a relapse, they are better able to handle it
11.4 List the 6 psychoactive drugs associated with abuse and dependence in society (following alcohol)
1) Opiates: opium and heroin
2) Stimulants: cocaine, amphetamines, caffeine, & nicotine
3) Sedatives: Barbiturates
4) Hallucinogens: LCD
5) Antianxiety drugs: Benzodiazepines
6) Pain medications: OxyCotin
11.4 Sedatives
Alcohol
Reduce tension, facilitate social interaction, “blot out” feelings or events
Barbiturates, Nembutal, Seconal, Veronal, Tuinal
11.4 Stimulants
Amphetamines, Benzedrine, Dexedrine, Meth, Cocaine
Increased alertness and confidence, decreased fatigue, increased endurance and sex drive
11.4 Opiates
Opium, Morphine, Codeine, Heroin, Methadone
Alleviate physical pain and anxiety, induce relaxation, treatment of heroin dependence
11.4 Hallucinogens
Cannabis, Marijuana, Hashish, Peyote, LSD, PCP, Shrooms
Changes in mood, thought, and behavior
“Expand” the mind
Induce stupor
11.4 Antianxiety drugs (minor tranquilizers)
Librium, Miltown, Valium, Xanax
Alleviate tension and anxiety
Induce relaxation and sleep
11.4 Who uses illicit drugs?
Estimated 27 million Americans aged 12+ in the past year
Approx. 10% of US population
11.5 Opium
A mixture of about 18 chemical substances (alkaloids)
Morphine is most prevalent
11.5 Morphine
Named after Morpheus, the god of sleep
Bitter-tasting powder, powerful sedative/pain reliever
Widely administered to Civil War soldiers
11.5 Heroin
Discovered by Heinrich Dreser
Replaced morphine, more dangerous than morphine
11.5 Harrison Act (1914)
Made unauthorized sale and distribution of certain drugs a federal offense
11.5 Dopamine Theory of Addiction
Addiction results from dysfunction of the dopamine reward pathway or “pleasure pathway”
11.5 Reward Deficiency Syndrome Hypothesis
Addiction is more likely to occur in individuals who have genetic deviations in components of the reward pathway, which leads them to be less satisfied by natural rewards, leading them to turn to overuse of drugs
11.6 Cocaine
Plant product
Used to be in Coca-Cola
Made illegal in early 1900s
Sniffing, swallowing, injecting
Primary Effect: Blocks presynaptic dopamine transporter, high lasts 4-6 hrs
11.6 Amphetamines
1st: Benzedrine, amphetamine sulfate
Dexedrine, Meth
Schedule II controlled substances
Give user energy by pushing them toward greater expenditures of their own resources, often to the point of hazardous fatigue, tolerance builds up rapidly
Consequences: high bp, enlarged pupils, unclear or rapid speech, profuse sweating, tremors, excitability, loss of appetite, confusion, sleeplessness, death, amphetamine psychosis, violence, brain damage
Treatment: Withdrawal is safe, psychological dependence can lead to depression and weariness
11.6 Amphetamine Psychosis
Similar symptoms to paranoid schizophrenia
11.6 Methamphetamine
“Crystal” or “Ice”
Immediate and long-lasting high
VERY DANGEROUS
Function: Increases level of dopamine in the brain but is metabolized more slowly than other drugs such as cocaine and produces a longer high
11.6 Caffeine and Nicotine
Easy to abuse, difficult to quit due to addictive properties AND their place in our social context
11.6 Shiffman and colleagues (2006)
High-dose NRT reduces nicotine withdrawal symptoms
11.7 Describe the effects of sedatives on the brain
Impaired decision-making and problem-solving, sluggishness, slow speech, sudden mood shifts, drowsiness,
Psychological and physiological dependence, brain damage, personality deterioration
11.8 LSD
Odorless, colorless, tasteless
Intoxication with amounts smaller than a grain of salt
Discovered by chemist Albert Hofmann (1938)
Dissolve blotter paper on tongue
8 hours of changes in sensory perception, mood swings, and feelings of depersonalization and detachment, can be traumatic and terrifying
Involuntary flashbacks to trips
This leads to visual issues
Rave culture
11.8 Mescaline and Psilocybin
Mescalin - disk-like growths on peyote cactus
Psilocybin - from sacred Mexican mushrooms (Psilocybe Mexicana)
11.8 Ecstasy
MDMA (Sometimes substitutes)
Originally meant as a diet pill
Triggers release of large amounts of serotonin and blocking reuptake
Intense experience of color and sound, mild hallucinations
Increased risk of hyperthermia after administration, serotonin depletion leads to depression, irritability, and anxiety in the following days
11.8 Marijuana and Hashish
Marijuana - Hemp leaves
Effects vary greatly
Sense of time is distorted, alters internal clock, short-term memory can be affected, pleasure is enhanced, 2-3 hrs of effects
Hashish is stronger, resin exuded by the cannabis plant, is made into gummy powder
11.8 Synthetic Cathinones
Bath salts
Mimic amphetamines and cocaine by activating the monoamine system
11.9 Are there addictive disorders other than alcohol and drugs?
YES!!!
Gambling, shopping, etc.
11.9 DSM-5 Criteria for Gambling Disorder
A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress as indicated by exhibiting 4+ of the following in a 12-month period
1. Need to gable with increasing
amounts of money to achieve
desired excitement
2. Restless or irritable when attempting
to cut down or stop gambling
3. Made repeated unsuccessful
attempts to cut back, control, or stop
4. Often preoccupied with gambling
5. Gambles when feeling distressed
6. After losing $ gambling, returns to
get even often
7. Lies to conceal the extent of it
8. Has jeopardized or lost a significant
job, relationship, or opportunity
because of it
9. Relies on others for money because
of it
B. Gambling behavior is not better explained by a manic episode
