Chapter 11: Substance Related and Addictive Disorders

Question 1

Substance use disorders

Answer 1

Recurrent substance use that results in significant adverse consequences in social or occupational functioning, or use of a substance that impairs one’s performance in hazardous situations, for example drinking and driving.

Question 1

Substances of abuse are divided into 10 classes

Answer 1

alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants; tobacco; and other or unknown substances. An individual can receive a diagnosis for one or more of these classes (e.g., alcohol use disorder, opioid use disorder).

Question 2

Four general impairments

Answer 2

impairment of control over use, social impairment, risky use, and pharmacological criteria

Question 3

Impairment of control

Answer 3

includes taking the substance in greater amounts or for longer than intended. For example, an individual may plan to stop for a quick drink at the neighbourhood pub on the way home for dinner but end up spending a few hours drinking

Question 4

Social Impairment

Answer 4

indicators refer to a failure to fulfill major role obligations at work, home, or school; continued use despite clear negative consequences on relationships; and the reduction of other involvements to give priority to using the substance. For example, a person might stay away from an otherwise desirable party if smoking is not allowed.

Question 5

Risky use

Answer 5

ndicators refer to substance use in situations in which it might be hazardous, such as driving or operating machinery, and continued use despite the clear indication that use is causing or exacerbating physical or psychological problems (e.g., headaches, depression).

Question 6

Pharmacological dependence

Answer 6

indicators are tolerance and withdrawal.

Question 7

Tolerance

Answer 7

means that the person needs increased amounts of the substance to achieve the same effect.

Question 8

Withdrawal

Answer 8

experience unpleasant and sometimes dangerous symptoms, such as nausea, headache, or tremors, when the addictive substance is removed from the body

Question 9

Substance-induced disorder (SUDs)

Answer 9

re associated with each of the 10 drug classes, including intoxication, withdrawal, and other substance- or medication-induced mental disorders (e.g., psychotic, bipolar, depressive, anxiety, and sleep disorders). As the name implies, these disorders are sets of symptoms that are caused by the heavy use of specific substances and they generally resolve when the person stops using the substance.

Question 10

Cross tolerance

Answer 10

This happens when the two substances affect the body and brain similarly. People who have increased tolerance to alcohol will also have increased tolerance to sedatives, hypnotics, and anxiolytics. A person with an alcohol use disorder who is prescribed pain medications post-surgery, therefore, may need larger amounts for effective pain relief.

Question 11

Drug potentiation

Answer 11

The interaction between two (or more) substances that causes the total effect of the substances to be larger than the sum of the independent effects of each substance.

Question 12

Reason for drug potentiation

Answer 12

is that the body metabolizes these drugs through the same mechanisms, and essentially cannot keep up.

Question 13

Gambling Disorder

Answer 13

generate short-lived pleasurable feelings and provide relief from negative feelings, and both ultimately create cravings to repeat the behaviour. Both have the ability to alter mood and level of arousal and, arguably, to induce an altered state of perception.

-Certain individuals are unable to control the frequency or amount of the behaviour, much like individuals with substance use disorders

Question 14

Gambling disorder

Answer 14

Persistent and recurrent gambling despite harmful negative consequences or a desire to stop.

Question 15

General Theory of Addiction and three phased in the development of addictions

Answer 15

Phase 1: an individual learns that a substance or behaviour can reduce negative moods; Phase 2: continued positive reinforcement leads to learned behaviours associated with continued use; and Phase 3: despite harms associated with use, an individual continues to use the substance or behaviour in order to avoid the negative mood state that it alleviated initially.

Question 16

Syndrome model

Answer 16

which suggests that people can inherit or encounter different life experiences that can interact to increase the likelihood of developing an addiction

Question 17

Genetic factors

Answer 17

addictive disorders run in families; the children of parents with an addictive disorder are more likely to develop a problem themselves, compared to children of parents without addictive disorders.

Question 18

Genes that are associated

Answer 18

Genes associated with the GABAergic, dopaminergic, glutamatergic, serotonergic, opioid, and cholinergic systems have been implicated in the susceptibility to alcohol dependence

-Fewer studies have examined genetic influences on gambling disorder, but the dopamine and serotonergic systems have been implicated

Question 19

Neurobiological influences

Answer 19

-behavioural addictions are characterized by differences in brain areas and neurotransmitter systems. All classes of drugs of abuse have been linked to changes in the dopamine neurotransmitter system and brain regions involved in reward

-GABA (gamma-aminobutyric acid), beta-endorphin, and serotonin are other potential markers for addictive disorders. For example, low levels of serotonin have been associated with alcohol-related characteristics such as impulsivity, aggression, antisocial behaviour, reward processing, and alcohol craving in both animals and humans (Hayes & Greenshaw, 2011). Changes in the serotonin system are also implicated in the development and maintenance of addiction to multiple substances, including cocaine, amphetamine, ecstasy, heroin, cannabis, and nicotine

Question 20

Behavioural disinhibition and disorders

Answer 20

A personality trait describing an inability to inhibit behavioural impulses, rebelliousness, aggressiveness, and risk taking that are associated with the development of alcohol problems.

Question 21

Negative emotionality

Answer 21

Negative emotionality is the tendency to experience psychological distress, anxiety, and depression. Research shows that individuals with substance use problems are more likely to have this tendency than are non-affected individuals

Question 22

Self medication hypothesis

Answer 22

suggests that individuals use substances in order to relieve symptoms of other mental disorders, such as anxiety or depression

Question 23

Alcohol Expectancy Theory

Answer 23

proposes that drinking behaviour is largely determined by the reinforcement that an individual expects to receive from it. Among the expectancies identified by a group of social drinkers were that alcohol positively transforms experiences, enhances both social and physical pleasure and sexual performance and experience, increases power and aggression, alters personal characteristics and improves social skill, and reduces tension

Question 24

Behavioural tolerance

Answer 24

Through the principles of classical conditioning, cues in the environment can become conditioned stimuli to the effects of drug use. These cues cause the individual to anticipate the drug effects so that when the drug is actually administered the effects are diminished. Tolerance, or the need for a greater amount of drug for the same effect, is greatest when the conditioned environmental cues are present.

Question 25

Social learning theory

Answer 25

suggests that individuals learn behaviours that are observed and reinforced. Individuals who are introduced to drinking as a rite of passage in an environment in which excessive drinking is socially accepted (and, indeed, encouraged by peer pressure) face an increased risk of developing alcohol problems.

Question 26

Acculturation

Answer 26

refers to the process and degree of adapting to the dominant culture among individuals who have immigrated. Increased acculturation can increase a particular behaviour.

Question 27

Groups of alcohol

Answer 27

The largest groups of drinkers are classified as light infrequent drinkers (less than weekly and fewer than five drinks per occasion) at 36%, and light frequent drinkers (more than weekly and fewer than five drinks per occasion) at 32%. About 5% are heavy infrequent drinkers (less than weekly and five or more drinks per occasion) and 4% are heavy frequent drinkers (more than weekly and five or more drinks per occasion).

Question 28

Low risk drinking guidelines

Answer 28

have been established by the canadian centre on Substance Use and Addiction (CCSA) and endorsed by many professional organizations

Question 29

Guidelines example

Answer 29

Guideline 1= reduce your long term health risks by drinking no more than:
10 drinks a week for women, with no more than 2 drinks a day most days

Question 30

Ethyl alcohol

Answer 30

Is the effective chemical compound in alcoholic beverages. It reduces anxiety, produces euphoria, and creates a sense of well being. It also reduces inhibitions, which adds to the perception that alcohol enhances social and physical pleasre, sexual performance, power and social assertiveness

Question 31

Ethanol is water soluble

Answer 31

So it can pass directly into the blood from the stomach. The bloodstream quickly carries it to the CNS

Question 32

Blood alcohol level (BAL)

Answer 32

is 0.08%

Question 33

Alcohol Dehydrogenase

Answer 33

An enzyme that helps break down alcohol in the stomach. Women have significantly less of this enzyme than men.

Question 34

Biphasic effect

Answer 34

At lower doses, the effect of alcohol is stimulating, resulting in pleasant feelings. At higher doses, alcohol acts as a depressant, and many may experience dysphoria. High doses can also produce unconsciousness and death

Question 35

Blackouts

Answer 35

An interval of time for which the person cannot recall key details or entire events

Question 36

Alcohol and sleep

Answer 36

alcohol is often considered a good way to get a good night’s sleep

Question 37

Chronic alcohol consumption

Answer 37

is related to many disease. Alcohol travels through the body in the bloodstream, it comes in contact with every organ, directly or indirectly affecting every part of the body

Question 38

Heavy alcohol is associated with

Answer 38

Damage to the heart muscle, high blood pressure and strokes

Question 39

Fetal alcohol spectrum disorder (FASD)

Answer 39

Prenatal and postnatal growth retardation and central nervous system dysfunction due to alcohol consumption during pregnancy.

Question 40

Depressants

Answer 40

Inhibit neurotransmitter activity in the CNS

Drugs that inhibit neurotransmitter activity in the central nervous system. Examples are alcohol, barbiturates (“downers”), and benzodiazepines.

sedative, hypnotic, or anxiolytic drugs based upon their typical prescribed use as sedatives (also called tranquilizers), sleeping medications, and anti-anxiety medications.

Question 41

Barbiturates are commonly known as “downers,” or according to the colour of their brand name versions

Question 42

Benozdiazepines

Answer 42

(e.g., Valium, Librium, Xanax, Ativan) are more frequently prescribed for sleep and anxiety problems

Question 43

Barbiturates and benzodiazephines are

Answer 43

odourless, white, crystalline compounds usually taken as tablets or capsules. Long-acting forms are available for prolonged sedation. Shorter-acting versions, used to treat insomnia, are thought to be more addicting.

Question 44

Barbiturates and benzodiazepines effects

Answer 44

In small doses, these drugs cause mild euphoria. With larger doses, slurred speech, poor motor coordination, and impairment of judgment and concentration occur. Initially, users may be combative and argumentative, but the larger dosages eventually induce sleep.

Question 45

Chronic use of these drugs

Answer 45

Chronic use of barbiturates or benzodiazepines can cause what appears to be a constant state of alcohol intoxication. Long-term use causes depression, chronic fatigue, mood swings, and paranoia. It may also result in dramatic personality changes and serious impairments of memory and judgment.

Question 46

Tolerance to barbiturates develops rapidly

Answer 46

With regular use, increasingly higher doses are needed to achieve sedative effects. Tolerance to the benzodiazepines typically develops much more slowly than tolerance to barbiturates.

Question 47

Nicotine use (form of cigarettes, snuff, chewing, tobacco, cigars, and pipes)

Answer 47

Nicotine comes from the tobacco plant Nicotiniana tabacum, which is a member of the nightshade family

Nicotine is a CNS stimulant related to the amphetamines. Stimulants are a class of drugs that have a stimulating or arousing effect on the CNS and create their effects by influencing the rate of uptake of the neurotransmitters dopamine, norepinephrine, and serotonin at receptor sites in the brain. The increased availability of these neurotransmitters affects the nucleus accumbens, which is a primary reward centre in the brain.

Question 48

Nicotine dependence develops quickly, and although extremely large doses are required

Answer 48

to produce intoxication, its behavioural effects are severe enough to classify many tobacco users as having a substance use disorder according to DSM-5 criteria. Smokers become addicted not only because of nicotine’s mood-enhancing abilities but to prevent the effects of withdrawal, which can be quite severe.

Question 49

Addicted to nicotine showcases

Answer 49

they often need a cigarette to start their day, they frequently smoke more than they anticipate, and they often spend a great deal of time looking for more cigarettes. Some smokers change their social plans to have continuous access to cigarettes.

Question 50

Amphetamines

Answer 50

Drugs that have effects on the body similar to those of the naturally occurring hormone adrenaline. Originally developed as a nasal decongestant and asthma treatment in the 1930s. In addition to shrinking mucous membranes and constricting blood vessels, they increase alertness and concentration. Chronic amphetamine use is associated with feelings of fatigue and sadness, as well as periods of social withdrawal and intense anger.

Question 51

Two of the most commonly abused forms of amphatmine are

Answer 51

methamphetamine (with street names such as “speed” when injected, and “ice” or “crystal” when smoked in a purified form) and dextroamphetamine (a legally prescribed medication sold under the name Dexedrine)

Question 52

Low does, amphetamines

Answer 52

increase alertness and allow the user to focus attention effectively, offering improved performance on cognitive tasks. Amphetamines also suppress appetite. At higher doses, they induce feelings of exhilaration, extraversion, and confidence, and at very high doses, restlessness and anxiety can occur.

Question 53

Chronic amphetamine

Answer 53

associated with feelings of fatigue and sadness, as well as periods of social withdrawal and intense anger. Repeated high doses can cause hallucinations, delirium, and paranoia, a condition known as toxic psychosis

Question 54

To combat undesirable effects such as sleeplessness, many amphetamine users also become dependent

Answer 54

many amphetamine users also become dependent upon depressant drugs such as tranquilizers, barbiturates, and alcohol to induce sleep. This can lead to a roller coaster–like vicious circle of drug use

Question 55

Physical effects of amphetamines

Answer 55

increased or irregular heartbeat, fluctuations in blood pressure, hot or cold flashes, nausea, weakness, and dilation of pupils. Prolonged use usually leads to weight loss.

At very high doses, amphetamines can induce seizures, confusion, and coma. The periods of intense anger associated with prolonged amphetamine use might also contribute to the prevalence of violent death in Canada such as suicides, homicides, and violent accidents

Question 56

Effects of Amphetamines

Answer 56

experience a post-high “crash” marked by feelings of fatigue, irritability, sadness, and craving. Withdrawal from amphetamines also often causes periods of apathy and prolonged sleeping.

Question 57

Cocaine

Answer 57

This powder is often snorted, but can also be rubbed into the skin or mixed with water and injected. Another method of cocaine ingestion is called “freebasing” and involves purifying cocaine by heating it and smoking the residue.

Crack is made by dissolving powdered cocaine in a solvent, combining it with baking soda, and heating it until it forms a crystallized substance (a “rock”), which is then smoked

Question 58

Small amounts= cocaine produces

Answer 58

feelings of euphoria, well being, and confidence

-Users become more alert, and talkative, experiencing reduced appetite and increased excitement and energy due to the stimulation of the higher centres of the CNS

Question 59

Feelings of cocaine are due to

Answer 59

increasing the availability of dopamine at important neuronal sites in the brain. With high doses, the CNS is overstimulated, leading to poor muscle control, confusion, anxiety, anger, and aggression.

-Continuous results in mood swings, loss of interest in sex, weight loss, and insomnia

Question 60

Physical symptoms of cocaine use include

Answer 60

increased blood pressure and body temperature, as well as irregular heartbeat. Users may also experience chest pain, nausea, blurred vision, fever, muscle spasms, convulsions, and coma.

Question 61

Cocaine and dependency

Answer 61

produces intense psychological dependence and results in severe withdrawal symptoms. Cocaine users often feel a crash as the drug begins to wear off, which results in intense craving, depression, and paranoia, followed by fatigue

Question 62

Opoids are a class of

Answer 62

CNS depressants—drugs whose main effects are the reduction of pain and sleep inducement.

Question 63

Natural opiates are refined

Answer 63

directly from opium

Question 64

Semi synthetic opiates (heroin, oxycodone)

Answer 64

are derived from natural opiates.

Question 65

Synthetic opiates

Answer 65

(e.g., methadone, Demerol, Percocet) are drugs manufactured to have similar effects to those of the other opiates.

Question 66

Opiods can be taken as

Answer 66

tablets, capsules, suppositories, syrups, or in the form of an injection. In pure form, heroin appears as a white, odourless, bitter-tasting powder that can also be snorted. Most heroin users, however, prefer to mix heroin with water and inject it to produce a more intense high. This is known as “mainlining.”

Question 67

Fentanyl

Answer 67

synthetic opioid that is up to 100 times more potent than morphine.

Heroin users may acquire fentanyl-laced heroin, “fake oxy” tablets that are manufactured to resemble oxycodone, or purposefully seek out fentanyl (Jafari, Buxton, & Joe, 2015). The introduction of a more potent form of fentanyl, called carfentanil, into the drug supply is also thought to have contributed to a spike in overdose deaths in 2016

Question 68

Nalaxone (Narcan)

Answer 68

is a drug that blocks the effects of opioids, including depressed respiration and loss of consciousness, and is used to treat narcotic overdoses in emergency situations.

Question 69

Harm reduction approaches

Answer 69

focus on reducing the consequences of the use. Injection is often the preferred method of drug taking, and many harm reduction approaches have focused on reducing consequences of this route of administration.

Question 70

Opioids mimic the effects of

Answer 70

endogenous opiates, the body’s natural painkillers

Question 71

Exogenous opiates

Answer 71

narcotics affect receptor sites located throughout the body, including the brain, spinal cord, and bloodstream. The narcotics bind to receptor sites at these locations and, in turn, reduce the body’s production of endogenous opiates.

Question 72

Heroin is perhaps the most addicting of all opiates

Answer 72

in part due to the sensations associated with using the drug.

Question 73

About one minute after injecting heroin

Answer 73

the user experiences an intense pleasurable rush. After this subsides, a euphoria characterized by dulled sensations and dreamlike sedation is produced, and the user may appear drunk. Heroin also acts as an appetite suppressant, and even small doses can cause restlessness, nausea, and vomiting

Question 74

Heroin has extremely dangerous effects

Answer 74

pupils constrict, the skin may turn blue and feel cold and clammy, breathing slows, and coma and respiratory depression causing death can occur.

Question 75

Endocarditis

Answer 75

an infection of the lining of the heart, occurs as a result of the use of unsterilized needles. The use of unsterilized injection equipment can also cause abscesses, cellulitis, liver disease, and brain damage

Question 76

Withdrawal symptoms associated with heroin and other opiods

Answer 76

are extremely severe and begin about eight hours after the last dose.

dysphoria, a dulling of the senses, anxiety, increased bodily secretions (runny eyes and nose), pupil dilation, fever, sweating, and muscle pain. Thirty-six hours after a dose, muscle-twitching, cramps, hot flashes, and changes in heart rate and blood pressure can occur, in addition to sleeplessness, vomiting, and diarrhea. These symptoms gradually diminish over a five to 10-day period.

Question 77

Cannabis- Marijuana

Answer 77

hemp plant was originally (and still is) cultivated for its strong fibres, which can be processed into cloth and rope.

Marijuana consists of the leaves and flowers of this plant, which are dried and crushed. Hashish, made from the resin produced by the plant, is a much stronger form of cannabis. Although both forms are most often smoked in cigarette form (called a “joint”) or in a pipe, they can also be chewed, added to baked goods, or prepared in a tea. Other names for marijuana and hashish are “pot,” “weed,” “grass,” “dope,” “reefer,” and “bud.”

Question 78

Marijuana generally has depressant effects, yet it increases the user’s

Answer 78

heart rate like a stimulant. It can also produce hallucinations when consumed in large doses, but this is not a usual effect.

Question 79

Psychoactive effects of cannabis are caused primarily by

Answer 79

the chemical delta-9-tetrahydrocannabinol (THC).

Question 80

THC

Answer 80

Acts upon specific cannabinoid receptors in the body and mimics the effects of naturally occurring substances, including the endogenous opiates

Question 81

Cannabis and the changes to the body

Answer 81

Involves mild changes in perception along with enhancement of physical experiences

-small does: many users report feeling mildly euphoric and sociable. A sense of well being and relaxation usually begins with minutes of ingesting the drug and lasts for two to the hours

Question 82

Some other effects

Answer 82

Find the drug stimulating and occasionally panic or anxiety is also experienced.

Question 83

High does of Cannabis

Answer 83

Hallucination, although it seems that this most often occurs when the user has a pre-existing mental disorder. Individuals under the influence of marijuana show deficits in complex motor skills, STM, reaction time, and attention

Question 84

Physical symptoms

Answer 84

Itchy, red eyes, increased blood pressure, and increased appetite

Question 85

Amotivational syndrome-Long term users

Answer 85

a continuing pattern of apathy, profound self-absorption, detachment from friends and family, and abandonment of career and educational goals. Reduced motivation for goal-directed behaviour in cannabis users appears to be related to repeated doses of THC, supporting the hypothesis that THC can disrupt reward-based learning

Question 86

Regular use

Answer 86

Increase the onset of psychosis

Question 87

Cannabis and treatment

Answer 87

Used to treat several diseases, including cancer, AIDS, and glaucoma

THC can help alleviate nausea and encourage eating in cancer and AIDS patients

Question 88

Dependency and marijuana

Answer 88

Irritability, nervousness, and anxiety, loss of appetite, restlessness, sleep disturbances, and anger/aggression

Question 89

Hallucinogens

Answer 89

are drugs that change a person’s mental state by inducing perceptual and sensory distortions or hallucinations. They are also called psychedelics, which comes from the Greek words for “soul” and “to make manifest.”

Question 90

Common well known hallucinogens

Answer 90

lysergic acid diethylamide (LSD or “acid”), mescaline, and psilocybin (magic mushrooms). Methylene-dioxymethamphetamine (MDMA) or ecstasy (described under “Amphetamines and Designer Drugs” earlier in this chapter) is sometimes included in this category as well.

Question 91

Hallucinogens can be injested

Answer 91

in capsule or tablet form, or as a liquid applied to small pieces of paper (e.g., stamps or stickers) and then placed on the tongue. The effects of hallucinogens usually begin within an hour of ingestion or sooner and last between six and 12 hours

Question 92

Types of Hallucinogens

Answer 92

Mescaline is found in the head of the peyote cactus and is chewed or mixed with food or water. Psilocybin is also chewed or swallowed with water. Phencyclidine (PCP or “angel dust”) is a dissociative anaesthetic that is typically smoked for its hallucinogenic properties. Ketamine (K or Special K), a close analogue to PCP, is used as a veterinary anaesthetic. Recreationally, ketamine is injected, snorted, or taken orally. Salvia (Salvia divinorum) is a plant native to southern Mexico containing powerful psychoactive chemical properties that lead to hallucinations. Salvia was traditionally ingested by chewing the plant leaves but is more commonly smoked.

Question 93

Experiences of hallucinogens

Answer 93

Report a number of sensory experiences, including vivid visual hallucinations

-Objects may waver, shimmer, or become disorted (limbs may become very long)

-People commonly see colourful “halos” around objects; moving objects leave visible trails

Question 94

Hallucinogens can result in synesthesia

Answer 94

A transference of stimuli from one sense to another, such as “hearing” colours or “feeling soundsd”

Question 95

Hall have an excitatory effect on the CNS

Answer 95

Mimic the effects of serotonin by acting upon serotonin receptors in the brain stem and cerebral cortex

Question 96

Hallucinogens experience flashbacks

Answer 96

These are unpredictable recurrences of some of the physical or perceptual disortions experienced

Question 97

Hallucinogen persisting perception disorder

Answer 97

Is applied if flashbacks cause significant distress or interfere with social or occupational functioning

Question 98

Hallucinogens and dependency

Answer 98

They do not appear to cause noticeable withdrawal effects, even after long term use

Question 99

Gambling

Answer 99

Lottery games appear to be the most popular form of gambling, followed by instant win tickets and gambling at a casino