Chapter 10 Flashcards
DSM-5 Criteria for Substance Use Disorder
*Problematic pattern of use that impairs functioning. Two or more symptoms within a 1-year period:
Failure to meet obligations
Repeated use in situations where it is physically dangerous
Repeated relationship problems
Continued use despite problems caused by the substance
Tolerance
Withdrawal
Substance taken for longer time or greater amounts than intended
Efforts to reduce or control use do not work
Much time is spent trying to obtain the substance
Social, hobbies, or work activities given up or reduced
Craving to use the substance is strong
DSM-5 Criteria for Substance Use Disorder : time period
Two or more symptoms within a 1-year period
Severity Ratings for Substance Use Disorders in DSM-5
mild: 2-3 criteria
moderate: 4-5 criteria
severe: 6 or more criteria
Two symptoms often a part of severe substance use disorder:
*Tolerance
Larger doses of drug needed to produce desired effect
Effects of drug decrease if usual amount is taken
*Withdrawal
Negative physical and psychological effects from stopping substance use
E.g., muscle pain, twitching, sweats, vomiting, diarrhea, insomnia
What is the time requirement for substance use disorder?
What is the time requirement for substance use disorder?
Within a year! This is different than other disorders
T/F addiction usually starts out as self medicating
true !
*self medicating : addiction usually starts out as self medicating
“Dependent” or addicted
People who develop tolerance or withdrawal
Alcohol withdrawal
*Muscle tremors, elevated pulse, blood pressure, and temperature
*Delirium tremens
Rare withdrawal symptom when alcohol in blood drops suddenly
Delirium, tremulous, hallucinations
Can kill you
Delirium tremens
Rare withdrawal symptom when alcohol in blood drops suddenly
Delirium, tremulous, hallucinations
Can kill you
T/F alcohol withdrawal is really bad but it cant kill you
FALSE
I am pretty sure
administered for the management alcohol withdrawal symptoms.
Benzodiazepine
alcohol abuse disorder is associated with what other drug use
Associated with other drug use
80-85% smoke tobacco
Alcohol use is especially frequent among ____
___ report binge drinking ( def?)
____% report heavy-use drinking (Def?)
Alcohol use is especially frequent among college-age adults
- 39.4% report binge drinking
- 5 drinks in a short period of time
*12.5% report heavy-use drinking
5 drinks on the same occasion 5 or more times in a 30-day period
alcohol : Prevalence
Prevalence varies by gender, race, and education level
More common in men than woman
This gender difference continues to shrink
Rates higher for never married or divorced men and women
Marti is a 24-year-old college student who started drinking heavily when he was 15. Marti drinks a moderate amount every night. In high school, he would become drunk after about four beers; now his tolerance has more than doubled. Marti claims alcohol relieves the pressures of college life. He once attempted to quit drinking, but he had chills, fever, diarrhea, nausea and vomiting, and body aches and pains.
alcohol use disorder
Effects of Marijuana: Long-term Physiological
Damage to lung structure and function in long-term users
Cognitive problems linked to the effects of marijuana on CB1 and CB2 receptors in the brain (e.g., hippocampus)
Cannabanoid 1, cannabanoid 2
Different patterns of connectivity between amygdala and frontal cortex among users compared to non-users
Use can develop tolerance and withdrawal
What NT’s are affected by alcohol and how?
What NT’s are affected by alcohol and how?
Gaba: more
Increased dopamine and serotonin
Less glutamate
Stimulates GABA receptors Reduces tension Increases dopamine and serotonin Produces pleasurable effects Inhibits glutamate receptors Produces cognitive difficulties (e.g., slowed thinking, memory loss)
What receptors does marijuana affect in the brain?
CB1 and CB2 (endocannabanoids)
Lung cancer rates are lower with tobacco use among which ethnic group?
Asian Americans
Short-term Effects of Alcohol
Enters the bloodstream quickly through small intestine
Metabolized by the liver slowly at 1 ounce of 100 proof per hour
Effects vary by concentration
Concentration varies by gender, height, weight, liver efficiency, food in stomach
Size of drink defined by alcohol content
12 oz. glass of beer, 5 oz. glass of wine, and 1.5 oz. of hard liquor are equal in alcohol content
- Interacts with several neurotransmitters
- *Stimulates GABA receptors: Reduces tension
- *Increases dopamine and serotonin: Produces pleasurable effects
- *Inhibits glutamate receptors: Produces cognitive difficulties (e.g., slowed thinking, memory loss)
Short-term Effects of Alcohol and neurotransmitters
Interacts with several neurotransmitters
Stimulates GABA receptors
Reduces tension
Increases dopamine and serotonin
Produces pleasurable effects
Inhibits glutamate receptors
Produces cognitive difficulties (e.g., slowed thinking, memory loss)
Opiate Withdrawal
May begin within 8 hours after high tolerance develops
Muscle pain, sneezing, sweating, tearfulness, yawning
Resembles influenza
Within 36 hours, becomes more severe:
Uncontrollable muscle twitching, cramps, chills, flushing/sweating, elevated heart rate/blood pressure, insomnia, vomiting, diarrhea
Withdrawal persists for about 72 hours – diminishing over 5-10 days
T/F you can die from opiate withdrawal
FALSE but may feel like you want to
Neurobiological Factors
Nearly all drugs stimulate the dopamine system, particularly the mesolimbic pathway
Linked to pleasure and reward
Vulnerability model vs. Toxic effect model
Vulnerability in the dopamine system leads to substance use or substance use leads to dopamine system problems
People also take drugs to avoid the bad feelings
Avoidance of withdrawal symptoms
Explains frequency of relapse
Incentive-sensitization theory
Distinguish wanting (craving for drug) from liking (pleasure obtained by taking the drug)
Dopamine system becomes sensitive to the drug and the cues associated with drug (e.g., needles, rolling papers, etc.)
Over time, liking for drugs decreases, but wanting remains intense
Craving (wanting) is associated with use
Brain imaging studies:
Cues for a drug (needle or a cigarette) activate the reward and pleasure areas of the brain involved in drug use
Reward Pathways in the Brain Affected by Different Drugs
affecting the nucleus accumbens: amphetamines, cocaine, marijuna, opiates, phencyclidine
affecting the ventral tegmental area: alcohol, opiates, barbiturates, benzodiazepines
Reward Pathways in the Brain Affected by Different Drugs: affecting the ventral tegmental area:
affecting the ventral tegmental area: alcohol, opiates, barbiturates, benzodiazepines
Reward Pathways in the Brain Affected by Different Drugs: affecting the nucleus accumbens
affecting the nucleus accumbens: amphetamines, cocaine, marijuna, opiates, phencyclidine
Valuing Short Term Over the Long Term
Immediate (short-term) vs. delayed (long-term) rewards
People dependent on substances discount delayed rewards more steeply than do people not dependent
Valuing immediate vs. delayed rewards recruit different brain regions:
Delayed reward = prefrontal cortex
Immediate reward = amygdala, nucleus accumbens
T/F People dependent on substances discount delayed rewards more steeply than do people not dependent
TRUE
Nearly all drugs stimulate which system?
Nearly all drugs stimulate which system?
Dopamine system
___people with substance use______ discount delayed rewards more steeply than people without a substance use
How do expectations affect alcohol use?
More likely to use that substance : if you expect it to do good
Example: ben franklin quote
______ discount delayed rewards more steeply than people _______
people with substance use disorder discount delayed rewards more steeply than people without a substance use
How do expectations affect alcohol use?
More likely to use that substance : if you expect it to do good
Example: ben franklin quote
How do expectations affect alcohol use?
More likely to use that substance : if you expect it to do good
Example: ben franklin quote
AA firmly states that controlled drinking does not work. What does the research say?
AA firmly states that controlled drinking does not work. What does the research say?
There is some evidence that controlled drinking can work
(probs better for early form )
What medications are used for opiate use?
Naltrexone (and others that I missed!)
What medications are used for opiate use?
naltrexone and buprenorphine (Suboxone)
Treatment of Drug Use Disorders: Medications
Opioid substitutes and Opioid antagonists
Opioid substitutes
Synthetic narcotics, methadone, buprenorphine (Suboxone)
Used to wean off opioids
Person does not experience euphoric high
Dropout is high
Side effects: insomnia, constipation, excessive sweating, diminished sexual functioning
Opioid antagonists
Naltrexone
Person is gradually weaned from heroin or pain medication
Receives increasing dosages of Naltrexone to prevent feeling high should they later take other opioids
addiction is purely psychological
T/F
- addiction: is not just psychological it is also social
- thus addiction should not just be from a psych standpoint (or pharmacoloigcal standpoint)
Tobacco Use Disorder: Prevalence
*More prevalent among people in lower socioeconomic classes
*African American cigarette smokers Less likely to quit More likely to get lung cancer Nicotine is metabolized more slowly More likely to smoke menthol cigarettes Direct advertisement to this community People tend to inhale more deeply and hold the smoke for longer
*Chinese Americans
Metabolize less nicotine from cigarettes than European American or Latino smokers
Lung cancer rates are lower
Marijuana: Prevalence
- gender
- race
Marijuana is considered an illicit drug Legal for all uses in 8 states Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, Washington Has gone up to 15 I think Growing Legal for medical uses in 29 states
*Higher among men than women
No differences across racial and ethnic groups
Rates of daily use are on the rise
May be related to varying degrees of legal status by state
Stimulants: Cocaine
Comes from leaves of coca shrub
Can be snorted, smoked, swallowed, or injected
Used predominantly in urban areas and by men
Used less frequently today
Crack
Form of cocaine developed in the 1980s
Rock crystal that is heated, melted, and smoked
Cheaper than cocaine
Acts rapidly on the brain
Blocks reuptake of dopamine in mesolimbic areas
Induces pleasurable states
Increased sexual desire, self-confidence, stamina
Overdose (OD)
Chills, nausea, insomnia, paranoia, hallucinations, possibly heart attack and death
Not all users develop tolerance
May increase risk of OD
Treatment of Drug Use Disorders
Substance use disorders are typically chronic, and relapse occurs often
Detoxification central to treatment
90% of people who need treatment for substance use disorder do not get it
Treatment of Drug Use Disorders: Psychological Treatments
CBT
Learn how to avoid high-risk situations, recognize triggers, and develop alternatives to use
Contingency management
Vouchers that can be traded for desirable goods are given to users who abstain
Motivational enhancement therapy
CBT plus solution focus therapy effective for alcohol and drug use
Self-help residential homes
Non-drug environment
Group therapy
Guidance and support from former users
Stimulants: Amphetamines
Synthetic stimulants: Dexedrine, Adderall
Trigger release and block reuptake of norepinephrine and dopamine
Taken orally or intravenously
A person becomes alert, euphoric, outgoing, feels boundless energy and self-confidence
High doses can lead to nervousness, agitation, confusion, suspiciousness, hostility
Tolerance can develop after only 6 days of use
Opioids
Includes: Opium, morphine, heroin, codeine
Moderate doses relieve pain
Prescription pain medications among the most abused of all drugs
Vicodin, Zydone, Lortab, Percodan, Tylox, OxyContin
7% of US misused at least once
Among those with schizophrenia who suffer from delusions, a large majority experience
a) delusions of persecution.
b) thought broadcast.
c) delusions of impulses imposed by others.
d) hallucinations with the delusions
a) delusions of persecution.
Carlos has schizophrenia and is living with his parents. One of his symptoms is a difficulty initiating any activity, and once started, he is unable to finish. This is an example of
a) akathisia.
b) anhedonia.
c) avolition.
d) alogia.
c) avolition.
- Which of the following is not one of the sociocultural factors implicated in the etiology of substance use disorders?
a. the media
b. gender
c. availability of a substance
d. social networks
b. gender
Anhedonia as a symptom of schizophrenia refers to lack of
a) emotional expression.
b) interest or pleasure.
c) coherent speech.
d) speech.
b) interest or pleasure.
The symptom alogia refers to lack of
a) intelligence.
b) energy and interest.
c) emotional response.
d) speech.
d) speech.
A major goal of inpatient hospital-based treatment for alcohol abuse is
Question 7 options:
a) to focus upon sobriety as a major criteria for discharge.
b) helping the individual admit there is a problem.
c) increasing nutrition and creating a behavior that inhibits alcohol consumption.
d) detoxification.
d) detoxification.
James is struggling with schizophrenia. He also finds it difficult to experience pleasure from activities that he enjoyed before his symptoms began. This is an example of
a) alogia.
b) anhedonia.
c) avolition.
d) asociality.
b) anhedonia.
Mr. Hart spends long hours sitting in a chair with his arms behind his back and his left leg tucked under. No matter what is going on around him, he remains in this position. This is an example of which symptom of schizophrenia?
a) somatic passivity
b) anhedonia
c) catatonic immobility
d) inappropriate affect
c) catatonic immobility
The term schizophrenia comes from the Greek word schizein meaning to split and phren meaning
a) dissociation.
b) mind.
c) conscience.
d) unconscious state.
b
List four of the therapeutic benefits of marijuana.
pain relief, reduction of nausea, increased appetite, relief from the discomfort from AIDS
The DSM-5 removed the subtype of schizophrenia called
a) paranoid.
b) disorganized.
c) catatonic.
d) all of the above.
d
Match the treatment approach to the type of substance(s). Treatment 1. Suboxone 2. AA 3. couples therapy 4. opiate antagonist 5. antidepressant 6. patch 7. Matrix
Substance
a. alcohol
b. heroin
c. cocaine
d. nicotine
e. methamphetamine
b, a, a, b, a/c/d, d, e
Studies show that, of the schizophrenic symptoms, the ones with the greater genetic component are
a) negative symptoms.
b) delusions.
c) positive symptoms.
d) persecution delusions
a) negative symptoms.
True or False: According to DSM criteria a diagnosis of a substance use disorder requires BOTH tolerance and withdrawal symptoms?
FALSE
Which of the following sociocultural factors is NOT associated with schizophrenia
a) Poverty.
b) Child rearing practices.
c) Urbancity.
d) Migration.
b) Child rearing practices.
Marijuana
- derived from:
- how consumed:
Drug derived from dried and crushed leaves and flowering tops of the hemp plant (Cannabis sativa)
Most often smoked, but it can be chewed, prepared as a tea, or eaten in baked goods
Hashish
Stronger than marijuana
Produced by drying the resin exudate of the tops of the plant
Synthetic marijuana
Spice or K2
alcohol comorbidity
Often comorbid with borderline and antisocial personality disorders, mood disorders, and anxiety disorders
Dissociative Identity Disorder : gender prevelance
more common in women
Hallucinogens
Used more often by men and European Americans
LSD
Popular in 1960s, but regular use has declined
No evidence of withdrawal, but tolerance develops rapidly
Effects serotonin system
Effects take place within 30 minutes, last up to 12 hours
Hallucinations, sense of time, mood swings, expanded consciousness
Flashbacks – visual recurrences of perceptual experiences after effects of drug have worn off
Ecstasy (molly)
Taken in a pill or powder form
Average age of first use: 21
Acts primarily on the serotonin system
Increases feelings of intimacy, insight, positive emotions, self-confidence
Can also cause muscle tension, nausea, anxiety, depression, confusion, depersonalization
PCP (phencyclidine)
PCP (phencyclidine) Angel dust Used more by men Causes severe paranoia and violence Coma and death are possible
- The “pleasure pathways” or internal reward centers in the human brain are primarily made up
of
a. dopamine-sensitive neurons.
b. serotonin-sensitive neurons.
c. both dopamine-sensitive and serotonin-sensitive neurons.
d. none of these
a. dopamine-sensitive neurons.
Alcohol Use Disorders : medications
Medications
Antabuse (disulfiram)
Produces nausea and vomiting if alcohol is consumed
Dropout rates are high (80%)
Other medications: naltrexone and acamprosate
Most effective when combined with CBT
Explain the frequency of relapse
neurobiological factors
People also take drugs to avoid the bad feelings
Avoidance of withdrawal symptoms
Explains frequency of relapse
In a laboratory research study involving “drug addiction” in animals, it was demonstrated that
the positive-reinforcing effect (i.e., pleasure) of drugs
a. is a uniquely human weakness
b. Primarily asocial and cultural phenomenon
c. Existed even without social and cultural influences.
d. biological, social, and cultural.
c. Existed even without social and cultural influences.
Prevention of Substance Use
The measures that hold promise for persuading young people to resist smoking may also be useful in dissuading them from trying other drugs and alcohol
Brief family interventions
Associated with less initiation of alcohol use among teens
Which of the following has been useful in discouraging teens from trying drugs and alcohol?
a) DARE
b) brief family interventions
c) television commercials about the dangers of substance use
d) all of the above
b) brief family interventions
- Which of these symptoms is not a criterion for Substance Use Disorder in the DSM-5?
a. Continued use despite knowing the use causes problems.
b. Efforts to control or stop use are unsuccessful.
c. Craving to use is strong.
d. Withdrawal is experienced when ceasing use.
a. Continued use despite knowing the use causes problems.
- Delirium tremens refers to
a) a symptom of conversion disorder.
b) the symptoms that accompany an overdose of heroin.
c) the symptoms that may accompany withdrawal from alcohol.
d) the hallucinations common in schizophrenia.
c) the symptoms that may accompany withdrawal from alcohol.
Which neurotransmitter has been implicated in alcohol tolerance?
a) serotonin
b) dopamine
c) norepinephrine
d) GABA
d) GABA
alcohol enters the bloodstream _[speed]__ through _____. It is metabolized by the ______ _[speed] at what rate?
Enters the bloodstream quickly through small intestine
Metabolized by the liver slowly at 1 ounce of 100 proof per hour
- Cirrhosis of the liver due to alcohol abuse is characterized by
a) liver cells becoming engorged with fat and protein.
b) an increased efficiency of alcohol absorption with a corresponding decrease in blood cell
reproduction.
c) a decreased efficiency in absorption due to liver atrophy.
d) None of the above.
liver cells becoming engorged with fat and protein.
Alcohol goes into the \_\_\_\_\_\_\_\_\_\_ and is absorbed into the blood, after which it is metabolized by the \_\_\_\_\_\_\_\_\_\_. a) small intestine; kidneys b) small intestine; liver c) stomach; liver d) stomach; kidneys
small intestine; liver
23. Nicotine ultimately stimulates \_\_\_\_\_\_\_\_\_\_, which are implicated in the reinforcing effects of smoking. a) muscarinic receptors b) dopamine receptors c) GABA receptors d) serotonin receptors
b) dopamine receptors
