Chapter 11: Substance Abuse Disorders Flashcards
1
Q
What is substance intoxication?
A
- reversible and temporary condition due to the recent ingestion of a substance
2
Q
What is disordered substance use?
A
- used to describe a recurrent substance use that results in significant adverse consequences in social or occupational functioning
→ interpersonal functioning may deteriorate and the substance may be used in dangerous situations - also refers to lack of control over substance use
3
Q
What is drug tolerance?
A
- neuroadaptation caused by decreased sensitivity to a drug as a consequence of exposure to it
→ decrease in response
→ increase in amount needed
→ shift dose-response curve (exponential increase in dose:response ratio)
4
Q
What are the characteristics of addiction?
A
- abuse
- reinforcement
- dependence
- rebound
- tolerance
5
Q
What is drug abuse?
A
- use of a drug that causes culturally determined conflict
6
Q
What is drug reinforcement?
A
- the reward obtained by performing the addictive behavior
7
Q
What is drug dependence?
A
- neuroadaptation to the addictive substance, promoting craving and withdrawal symptoms
8
Q
What is drug withdrawal?
A
- feelings of restlessness and irritability
- time will be spent obtaining or using the substance.
- usually involves opposite effect of drug
→ e.g., extreme sensitivity following prolonged exposure to opiods
9
Q
What is polysubstance use disorder?
A
- simultaneous misuse or dependence upon two or more substances
- dangerous since the effects are often synergistic
- the drug that presents the most significant health problems is focus of treatment
10
Q
What doe “synergistic” mean?
A
- combined effects of drugs exceeds or are significantly different from the sum of its effects
11
Q
What is the societal cost of substance abuse?
A
- in Canada, alcohol and illicit drugs costs 14 billion dollars a year
- there are 86,000 admissions to Canadian hospitals each year for
alcohol‐related health reasons - alcohol is associated with more than half of traffic deaths and
homicides and 30% of all suicides. - in 2002, 19.3% of all deaths in Canada were attributed to alcohol,
tobacco, or illicit drugs
12
Q
What are the major classes of abused drugs?
A
- amphetamines
- ecstasy
- LSD
- heroin
- prescription medications
- alcohol
13
Q
What are the effects of amphetamines?
A
- feelings of euphoria and alertness
- cause high body temperature
→ heart problems and seizures
14
Q
What are the effects of ecstasy?
A
- produces both stimulant and mind‐altering effects
- neurotoxic effects, increased metabolic activity and stress
15
Q
What are the effects of LSD?
A
- one of the most potent hallucinogenic, or perception‐altering, drugs
- unpredictable hallucinations, many somatic side effects
16
Q
What are the effects of heroin?
A
- powerful opiate drug that produces euphoria, slows respiration
- other opioid drugs include morphine, OxyContin, Vicodin, and Percodan
17
Q
What are common prescription medications that are abused?
A
- painkillers
- sedatives
- stimulants
18
Q
What is the limit on daily/weekly alcohol intake?
A
- daily → 2 drinks
- weekly → 14 drinks for men, 9 for women
19
Q
What is the Alochol Use Disorders Identification Test (AUDIT)?
A
- screening tool indicating relationship between individual’s consumption and risk of alcoholism
20
Q
What are the short-term effects of alcohol?
A
- vary with level of concentration in bloodstream
→ biphasic effect - drowsiness, deficits in eye‐hand coordination, and decrease in steadiness
- decreased sensitivity to taste, smell, and pain.
- slowed reaction time
- drinking large amounts of alcohol quickly can cause memory blackouts
21
Q
Why do people get thirsty when hungover?
A
- related to alcohol’s ability to cause the fluid inside the body’s cells to move outside the cells
22
Q
What are the long-term effects of alcohol abuse?
A
- low‐grade hypertension
- alcohol‐induced persisting amnesic disorder
- Wernicke’s encephalopathy
- Korsakoff’s psychosis
- alcohol‐induced dementia
- deficits in memory, abstract thinking, problem solving; paranoia
- fetal alcohol syndrome
23
Q
What is Wernicke’s encephalopathy?
A
- presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine (vitamin B1)
- characterised by the triad:
→ ophthalmoplegia (weakness/paralysis of muscles involved in eye movement)
→ ataxia (lack of voluntary coordination of muscle movements)
→ confusion
24
Q
What is Korsakoff’s psychosis?
A
- neurological disorder caused by a lack of thiamine (vitamin B1) in the brain
- characterized by: → anterograde amnesia → retrograde amnesia → confabulation (invented memories which are then taken as true due to gaps in memory sometimes associated with blackouts) → minimal content in conversation → lack of insight → apathy
25
What is Fetal Alcohol Syndrome?
- prenatal and postnatal growth retardation and CNS dysfunction due to alcohol consumption during pregnancy
26
What is the genetic etiology of alcohol abuse?
- genes involved in sensitivity of a number of receptor sites for a number of neurotransmitters that form part of the reward system of the brain
- may also be involved in differences in the ability to metabolize alcohol, which affects alcohol consumption
- low monoamine oxidase activity in alcoholics
27
What are benzodiazepenes and barbiturates?
- depressants
| - inhibit CNS neurotransmitter activity
28
What are two common patterns of abuse of B&Bs?
1 - adolescents using them for recreational purposes
2 - people (particularly women and older people) using initially under physician’s care but then increasing doses as tolerance develops
29
What are barbiturates?
- "downers"
| - widely prescribed until the 1940s, when their addictive potential became known
30
What are benzodiazepenes?
- Valium, Xanax, and Ativan
- enhances response to the inhibitory neurotransmitter GABA, by opening GABA‐activated chloride channels
→ allows chloride ions to enter the neuron, making the neuron negatively charged and resistant to excitation
- legally manufactured and sold by prescription, usually for the treatment of anxiety and insomnia
31
What are the effects of B&Bs?
- small doses: mild euphoria
- large doses: slurred speech, poor motor coordination, and impaired judgment & concentration
- chronic use: symptoms similar to a constant state of alcohol intoxication
- long‐term use: depression, chronic fatigue, mood swings, and paranoia
32
What is the rate of dependency of B&Bs?
- tolerance to barbiturates develops rapidly
- tolerance to benzodiazepines develops slower
- user with high tolerance to either type of drug experiences extreme withdrawal symptoms if the drug is stopped abruptly
33
How are B&Bs treated?
- administering progressively smaller doses of the drug to minimize withdrawal symptoms
- psychological and educational programs
34
Who uses inhalants?
- prepubescent and younger teenage boys; Canada’s
| Aboriginal youth
35
What are the chronic effects of inhalants?
chronic users may have a variety of respiratory irritations and rashes
36
What damage do inhalants do to the body?
- CNS
- organ failure
→ death
37
What are the stimulants?
- drug causing arousing effect on the CNS
→ influence the rate of uptake of dopamine, norepinephrine, and serotonin.
- most commonly used and addictive drugs
- includes nicotine, cocaine, amphetamines, caffeine
38
How is nicotine treated?
- public pre-emptive treatment through smoking bans
- cognitive/behavioural psychological treatments
- biological treatments reduce craving and withdrawal symptoms by maintaining steady level of nicotine in the system
39
What are the symptoms of cocaine use?
- behavioural changes
- physiological responses
- weight‐loss, nausea, vomiting
- muscular weakness
- slowed breathing, chest pain, confusion
- seizures, coma
40
What are amphetamines?
- stimulants used to combat depression or fatigue or boost energy and self‐confidence; also in diet drugs
- cause release of dopamine and norepinephrine and block their reuptake
41
What are the effects of amphetamines?
- low doses: increase alertness and attention.
- higher doses: they induce feelings of exhilaration, extraversion, and confidence
→ restlessness and anxiety
- very high doses: seizures, confusion, and coma
- chronic use: may result in fatigue and sadness, social withdrawal, and anger
→ repeated high doses may cause hallucinations, delirium, and paranoia (toxic psychosis)
42
What are the physical effects of amphetamine use?
- irregular or increased heart rate
- fluctuations in blood pressure
- nausea
- hot or cold flashes
- weakness
- dilation of pupils
43
How does caffeine work?
- stimulates the central nervous system increasing levels of dopamine, norepinephrine, and serotonin
44
What are examples of opioids derived from the opiate poppy?
* Morphine
* Heroin
* Codeine
* Methadone
45
What are examples of opioids derived naturally from the body?
* endorphins
| * enkaphalins
46
What are the intoxication symptoms of opioids?
- Behavioural changes
- Constriction of pupils
- Drowsiness or coma
- Slurred speech
- Hallucinations/illusions
- Attention and memory problems
47
What are the withdrawal symptoms of opioids?
- Dysphoric mood
- Nausea or vomiting
- Muscle aches
- Tearing/nasal mucus discharge
- Dilation
of pupils
- Goose bumps, sweating
- Diarrhea, yawning, fever, insomnia
48
What are substances classified as hallucinogens?
- LSD
- MDMA
- peyote
49
What is PCP?
- "angel dust"
| - manufactured as a powder to be snorted or smoked
50
What are the intoxication symptoms of hallucinogens and PCP?
- behavioural changes (e.g., marked anxiety or depression, paranoia, belligerence)
- perceptual changes while awake
- intensification of senses
- dilation of pupils
- rapid heartbeat
- blurring of vision
- tremors
51
What are the withdrawal symptoms of hallucinogens and PCP?
- flashbacks
| - dehydration
52
What are the intoxication symptoms of cannabis?
- begins with feeling “high,” being relaxed, and tranquil; may become more aware of their environment, sleepy, grandiose or lethargic
- cognition is
impaired
- moderate to high does may induce hallucinations, feelings of depersonalization, and paranoia
53
What is problem gambling?
- pattern of gambling behaviour that causes harm to an individual’s personal or family life, work, finances, or health
- included under "behavioural addictions" in DSM-V
54
How is alcohol a form of depression?
- behavioural disinhibition is associated with alcohol problems
- also negative emotionality
55
What are the behavioural and cognitive theories of alcohol abuse?
- children and adolescents learn alcohol‐related behaviours from the modelling of their parents and important others in their culture
- people who expect alcohol to reduce their distress and who do not have other, more adaptive means of coping available to them are more likely than others to drink alcohol when they are upset
56
What are predisposing personality traits to alcoholism?
– anxiety sensitivity, introversion, impulsivity, and behavioural under‐control
57
What is the tension-reduction/anxiety relief hypothesis of alcohol abuse?
- suggests that drinking is reinforced by its ability to reduce negative emotions
- alcohol expectancy theory suggests that drinking behaviour is largely determined by the reinforcement that an individual expects
to receive
→ alcoholics and non‐problem drinkers have both been found to drink more when told that their drinks contain alcohol
58
What is the behavioural tolerance effect?
- classical conditioning may play role in alcoholism
- environment becomes associated with drug use and predicts its occurrence
→ leads to tolerance in that same environment, but not in novel environments
→ possibly leads to a fatal overdose
59
How is the striatum related to drug abuse?
- decrease in dopamine released by striatum in abstinent alcoholics shows reward system may be different for those who abuse alcohol
60
What are biological treatments of drug abuse?
– Antidepressants and antianxiety agents to help with withdrawal syndromes;
– Antagonists to block the reinforcing effects of the drug;
– Disulfiram (Antabuse) for aversive conditioning with alcohol;
– Bupropion (Zyban) for smoking cessation;
– Methadone maintenance programs to help with withdrawal from heroin
61
What is the Minnesota model?
- most common treatment for alcohol use and dependence
- views alcoholism as a disease
- treatment usually begins in a hospital or detoxification clinic, followed by treatment for psychological dependence, which involves education, individual counselling, and group therapy
- abstinence is the goal, and participants are encouraged to attend Alcoholics Anonymous
62
What medications are used to assist in treating alcoholism?
- benzodiazepines are used to assist in detoxification
- Naltrexone, an antagonist drug, is prescribed to reduce the immediate gratification associated with drinking
- Acamprosate, an agonist drug has been used to reduce craving for alcohol and to reduce the distress during early abstinence
- Antabuse has been used to make drinking extremely aversive
63
What is alcohol dehydrogenase?
- enzyme that helps break down alcohol in the stomach
| - women have significantly less of it than men
