Ch 5 -- Substance use and addictive disorders Flashcards
Defining addition (four DSM-V substance use disorder criteria)
1) Impaired control over use criteria
2) Social impairment criteria
3) Risky use criteria
4) Pharmacological criteria
Impaired control over use criteria (4 points)
- Substance use of greater amounts/longer period than intended.
- Persistent desire or unsuccessful attempts to control/cut down use
- considerable time spent in activities to obtain substance, use of substance, or recovering from effects
- craving or strong desire/urge to use substance
Social impairment criteria (3 points)
- recurrent use results in failure to fulfill obligations at work, home, or school
- persistent use despite social/personal problems caused/ exacerbated by substance use
- progressive neglect of alternative social, occupational, or recreational activities
Risky use criteria (2 points)
- recurrent use in circumstances where use is physically hazardous (e.g. while driving)
- persist with substance use despite knowledge of physical/psychological problems caused or exacerbated by substance
Pharmacological criteria (2 points)
- tolerance (increased dose or decreased effect)
- withdrawal syndrome or use of drug to alleviate/avoid withdrawal symptoms (ex: keeps alcohol in the house to consume when in withdrawal to avoid those effects)
How many of the points/effects in the DSM-V substance use disorder criteria are considered moderate? How many are considered a severe substance use disorder?
4-5 = moderate
>6 = severe substance use disorder
Key concepts/changes of substance use disorders (2)
1) Loss or impairment of control
2) Addiction is a chronic relapsing disorder
Loss or impairment of control
- difficult to discern when use is controlled versus not controlled
- “harm” as index of loss of control
- craving:
- intense preoccupation, strong desire to use drug
- subjective state, requires self-report
- correlation between craving and drug use is poor; used as “after the fact” explanation of relapse
Addiction is a chronic relapsing disorder
Fundamentally altered nervous system. No cure, only remission of symptoms
The first non-substance related disorder?
Gambling
What criteria does gambling show?
loss of control, compulsive drive for reward, tolerance, withdrawal, preoccupied with thoughts of past gambling, planning for future gambling, sacrifice relationships, employment, education, finances to gamble
Models of addiction (4)
1) Disease Model (susceptibility and exposure)
2) Physical Dependence Model
3) Psychological Dependence Model
4) Reinforcement Model
Disease Model of Addiction history (3 points)
Addiction is a disease. American Association for the cure of Inebriates (1870) declares inebriety is a disease; objective-define as a disease, not sin; treatment rather than punishment
“Addiction” = term for excessive drug use by medical profession
1960 - Jellinek authored “The Disease Concept of Alcoholism”
Assumptions of the disease model of addiction
Addiction is a disease (predisposition version) - the approach is rehab/treatment:
- predisposition (genetic, biological); considered a permanent condition; not caused by drug
- loss of control over use; drugs produce uncontrollable cravings (one drink = one drunk)
- progression through stages
The Disease Model of Addition (susceptibility) summary
Both initial drug use and inherited susceptibility to uncontrolled drug use lead to repeated drug use. Repeated drug use leads to a loss of control.
Strengths of the Disease Model (susceptibility) (2)
1) Drug abuse is not “normal”; product of a disease process
2) predisposition explains why some people become addicted when exposed to drugs, but others do not
Weaknesses of the Disease Model susceptibility model
1) Predisposition yet to be isolated; metabolic/neuro factors influence a person’s response to drug.
Evidence for this: addicts have some control over consumption. Recovered alcoholics have been able to control consumption (e.g., in social situations, can drink a controlled amount) - This doesn’t fit with the “loss of control” part of the model”
2) no progression through stages
Assumptions of the addiction is a disease (drug exposure version)
- no predisposition
- brain changes with repeat exposure
- altered brain leads to los of control over us
Disease model - exposure summary
initial drug use leads to repeated drug use which leads to altered brain function and then loss of control
Summation of Disease model (why it’s not helpful - 3)
- whether addiction is or isn’t a disease depends on how disease is defied
- there is little to be gained scientifically by claiming addiction is a disease (social/political value - treat not stigmatize addict)
- high cost to society (War on Drugs - the price increase was not successful, people still paid)
Physical dependence model
Compulsive use of drugs is based on avoidance of withdrawal
Physical dependence model summary
initial drug use leads to repeated drug use, then physical dependence, then attempts at abstinence, then withdrawal symptoms, then relapse. Relapse then leads to attempts at abstinence again.
