Chapter 11: Substance Related and Addictive Disorders Flashcards
Substance use disorders
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.
Substances of abuse are divided into 10 classes
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).
Four general impairments
impairment of control over use, social impairment, risky use, and pharmacological criteria
Impairment of control
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
Social Impairment
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.
Risky use
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).
Pharmacological dependence
indicators are tolerance and withdrawal.
Tolerance
means that the person needs increased amounts of the substance to achieve the same effect.
Withdrawal
experience unpleasant and sometimes dangerous symptoms, such as nausea, headache, or tremors, when the addictive substance is removed from the body
Substance-induced disorder (SUDs)
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.
Cross tolerance
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.
Drug potentiation
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.
Reason for drug potentiation
is that the body metabolizes these drugs through the same mechanisms, and essentially cannot keep up.
Gambling Disorder
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
Gambling disorder
Persistent and recurrent gambling despite harmful negative consequences or a desire to stop.
General Theory of Addiction and three phased in the development of addictions
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.
Syndrome model
which suggests that people can inherit or encounter different life experiences that can interact to increase the likelihood of developing an addiction
Genetic factors
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.
Genes that are associated
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
Neurobiological influences
-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
Behavioural disinhibition and disorders
A personality trait describing an inability to inhibit behavioural impulses, rebelliousness, aggressiveness, and risk taking that are associated with the development of alcohol problems.
Negative emotionality
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
Self medication hypothesis
suggests that individuals use substances in order to relieve symptoms of other mental disorders, such as anxiety or depression
Alcohol Expectancy Theory
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
Behavioural tolerance
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.
Social learning theory
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.
Acculturation
refers to the process and degree of adapting to the dominant culture among individuals who have immigrated. Increased acculturation can increase a particular behaviour.
Groups of alcohol
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).
Low risk drinking guidelines
have been established by the canadian centre on Substance Use and Addiction (CCSA) and endorsed by many professional organizations
Guidelines example
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
Ethyl alcohol
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
Ethanol is water soluble
So it can pass directly into the blood from the stomach. The bloodstream quickly carries it to the CNS
Blood alcohol level (BAL)
is 0.08%
Alcohol Dehydrogenase
An enzyme that helps break down alcohol in the stomach. Women have significantly less of this enzyme than men.
Biphasic effect
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
Blackouts
An interval of time for which the person cannot recall key details or entire events
Alcohol and sleep
alcohol is often considered a good way to get a good night’s sleep
Chronic alcohol consumption
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
Heavy alcohol is associated with
Damage to the heart muscle, high blood pressure and strokes
Fetal alcohol spectrum disorder (FASD)
Prenatal and postnatal growth retardation and central nervous system dysfunction due to alcohol consumption during pregnancy.
Depressants
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.
Barbiturates are commonly known as “downers,” or according to the colour of their brand name versions
Benozdiazepines
(e.g., Valium, Librium, Xanax, Ativan) are more frequently prescribed for sleep and anxiety problems
Barbiturates and benzodiazephines are
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.
Barbiturates and benzodiazepines effects
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.
Chronic use of these drugs
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.
Tolerance to barbiturates develops rapidly
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.
Nicotine use (form of cigarettes, snuff, chewing, tobacco, cigars, and pipes)
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.
Nicotine dependence develops quickly, and although extremely large doses are required
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.
Addicted to nicotine showcases
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.
Amphetamines
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.
Two of the most commonly abused forms of amphatmine are
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)
Low does, amphetamines
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.
Chronic amphetamine
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
To combat undesirable effects such as sleeplessness, many amphetamine users also become dependent
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
Physical effects of amphetamines
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
Effects of Amphetamines
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.
Cocaine
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
Small amounts= cocaine produces
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
Feelings of cocaine are due to
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
Physical symptoms of cocaine use include
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.
Cocaine and dependency
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
Opoids are a class of
CNS depressants—drugs whose main effects are the reduction of pain and sleep inducement.
Natural opiates are refined
directly from opium
Semi synthetic opiates (heroin, oxycodone)
are derived from natural opiates.
Synthetic opiates
(e.g., methadone, Demerol, Percocet) are drugs manufactured to have similar effects to those of the other opiates.
Opiods can be taken as
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.”
Fentanyl
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
Nalaxone (Narcan)
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.
Harm reduction approaches
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.
Opioids mimic the effects of
endogenous opiates, the body’s natural painkillers
Exogenous opiates
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.
Heroin is perhaps the most addicting of all opiates
in part due to the sensations associated with using the drug.
About one minute after injecting heroin
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
Heroin has extremely dangerous effects
pupils constrict, the skin may turn blue and feel cold and clammy, breathing slows, and coma and respiratory depression causing death can occur.
Endocarditis
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
Withdrawal symptoms associated with heroin and other opiods
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.
Cannabis- Marijuana
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.”
Marijuana generally has depressant effects, yet it increases the user’s
heart rate like a stimulant. It can also produce hallucinations when consumed in large doses, but this is not a usual effect.
Psychoactive effects of cannabis are caused primarily by
the chemical delta-9-tetrahydrocannabinol (THC).
THC
Acts upon specific cannabinoid receptors in the body and mimics the effects of naturally occurring substances, including the endogenous opiates
Cannabis and the changes to the body
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
Some other effects
Find the drug stimulating and occasionally panic or anxiety is also experienced.
High does of Cannabis
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
Physical symptoms
Itchy, red eyes, increased blood pressure, and increased appetite
Amotivational syndrome-Long term users
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
Regular use
Increase the onset of psychosis
Cannabis and treatment
Used to treat several diseases, including cancer, AIDS, and glaucoma
THC can help alleviate nausea and encourage eating in cancer and AIDS patients
Dependency and marijuana
Irritability, nervousness, and anxiety, loss of appetite, restlessness, sleep disturbances, and anger/aggression
Hallucinogens
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.”
Common well known hallucinogens
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.
Hallucinogens can be injested
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
Types of Hallucinogens
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.
Experiences of hallucinogens
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
Hallucinogens can result in synesthesia
A transference of stimuli from one sense to another, such as “hearing” colours or “feeling soundsd”
Hall have an excitatory effect on the CNS
Mimic the effects of serotonin by acting upon serotonin receptors in the brain stem and cerebral cortex
Hallucinogens experience flashbacks
These are unpredictable recurrences of some of the physical or perceptual disortions experienced
Hallucinogen persisting perception disorder
Is applied if flashbacks cause significant distress or interfere with social or occupational functioning
Hallucinogens and dependency
They do not appear to cause noticeable withdrawal effects, even after long term use
Gambling
Lottery games appear to be the most popular form of gambling, followed by instant win tickets and gambling at a casino
