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Psych 354 > Chapter 11 - substance related dxs > Flashcards

Chapter 11 - substance related dxs Flashcards

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1
Q

Psychological dependence def? aka?

A

The urge to take psychoactive substances for reasons like…
- alleviating negative moods
- avoiding withdrawal symptoms
- preparing for an activity

aka craving

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2
Q

Physiological dependence def?

A
  • tolerance & withdrawal are signs of physiological dependence
  • characterized by tolerance to withdrawal symptoms
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3
Q

Tolerance def?

A

Nervous system becomes less sensitive to the physiological effects of the chemical over time

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4
Q

3 mechanisms of tolerance?

A
  • metabolic
  • pharmacodynamic (aka down regulation)
  • behavioral conditioning
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5
Q

metabolic tolerance?

A
  • repeated exposure causes your liver to produce more enzymes that metabolize it
  • metabolize faster –> consume more to experience the same high
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6
Q

pharmacodynamic tolerance?

A
  • receptors in the brain adapt to continued presence of the drug
  • receptors are less sensitive to drug
  • need more drug to get same high
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7
Q

behavioral conditioning mechanisms for tolerance?

A
  • cues associated with drug elicit response opposite in direction of natural effect of drug
  • competes with drug response
  • need more of drug
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8
Q

Withdrawal def? ex?

A
  • Physiological symptoms a person experiences when drug use is stopped

ex.
- tremors, sweating, nausea, anxiety, insomnia, convulsions, hallucinations

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9
Q

Alcohol withdrawal derilium?

A
  • severe cases, heavy use long term
  • try to stop cold turkey
  • agitated, confused, psychotic symptoms, temporary or permanent cognitive problems
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10
Q

Drug of abuse / psychoactive substance def?

A

A chemical substance that alters mood, changes perception, or changes brain functioning

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11
Q

Addictive potential def?

A
  • likelihood that a person who has used the substance will become addicted to / dependent on the substance
  • factors specific to a drug
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12
Q

3 factors considered for addictive potential?

A
  • How the drug works
  • Dosage to achieve desired effect and its route of administration
  • Potential for harm:
    → how difficult is it to stop
    → likelihood of developing problems
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13
Q

4 symptom categories? (divide the symptom criteria in DSM5)

A

A. impaired control
B. social impairment
C. risky use
D. pharmacological criteria

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14
Q

9 substance types

A

Alcohol
Tobacco
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedatives
Stimulants

Can have abuse disorder for everything except caffeine

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15
Q

Meth: type of drug? how addicting? what’s the high like?

A
  • stimulant
  • highly addicting
    → possibly more than cocaine
  • quick, long-lasting high
    → Coming down: feel weak, lethargic, depressed
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16
Q

Meth: long term use? treatment?

A

Long term:
- structural changes in brain
- Psychiatric problems associated
- Problems with learning and memory
- Mental health problems like paranoid thinking and hallucinations

Highly resistant to treatment:
- 1/3 use again 6 month later
- 1/2 use again 2 yr later

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17
Q

Stimulants and cocaine: activate ____?

A

sympathetic nervous system

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18
Q

Stimulants and cocaine: one important risk of long term use? withdrawal? reactions?

A
  • risk of psychotic break (mostly for users who are predisposed)
  • DON’T typically experience much withdrawal symptoms
  • most common reaction is depression
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19
Q

Opioids: what are they? what’s the high like?

A
  • Synthetic versions of opiates
  • Dream-like euphoria, pleasure rush (very short lasting)
  • Long term negative changes in mood/emotion
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20
Q

Opioids: relationship to heroin use?

A
  • 4-6% of people who misuse prescription painkillers go to heroin
  • 80% of people who use heroin first abused prescription painkillers
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21
Q

What counties prescribe/ receive the most opioids?

A
  • Smaller cities or larger towns
    –> Not the most urban areas
  • White residents
  • More dentists and physicians
  • More uninsured / unemployed
  • More residents who have diabetes, arthritis, or a disability
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22
Q

Fentanyl: what is it? origin? why’s it a problem?

A
  • synthetic opioid drug
  • FDA approved analgesic & anesthetic
  • more potent than heroin & morphine
    –>100x stronger than morphine
  • involved in ~85% of overdose deaths
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23
Q

Over ___% of overdose deaths had at least one potential opportunity for intervention

A

3/5 (60%)

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24
Q

Sedatives/hypnotics/anxiolytics: Drug families aka? What are they used for? What’s the “high” like?

A
  • barbiturates & benzos
  • Anxiolytic = tranquilizers
    → used to decrease anxiety
  • hypnotics → sleep
  • sedative → calm, reduce excitement
  • acute effects similar to alcohol intoxication
  • can produce “rage reaction” (hostile/aggressive behavior)
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25
Q

Sedatives/hypnotics/anxiolytics: long term problems / withdrawal?

A
  • discontinuance syndrome:
    → original anxiety symptoms return and worsen

possible withdrawal symptoms:
- irritability, sleep problems, paranoia, restlessness, etc
- withdrawal LESS likely if discontinued GRADUALLY

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26
Q

Cannabis: acute effects of high? long term?

A

short:
- well-being & happiness
- temporal disintegration
→ trouble retaining & organizing information

long:
- cognitive / neuropsychological functioning decline
- attention, learning, decision making problems

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27
Q

Cannabis: tolerance/withdrawal?

A

tolerance:
- controversial, not a lot of evidence
- anecdotal evidence for reverse tolerance

withdrawal:
- unlikely for occasional use / low dose
- possible for continuous, high dose
- symptoms: irritability, restlessness, insomnia

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28
Q

Hallucinogens: acute effects? chemical properties?

A
  • hallucinate
  • positive mood
  • sometimes bad trip
  • resemble serotonin molecules
29
Q

Hallucinogens: toxicity/risk? tolerance/withdrawal?

A
  • most relatively non-toxic, usually don’t overdose
  • PCP very dangerous in high doses
  • risk of persistent psychotic behavior –> psychotic break
  • almost no tolerance, don’t increase frequency or amount of drug
  • no withdrawal symptoms
30
Q

DSM 4: substance abuse? characterized by…? types of symptoms?

A
  • less severe than dependence
  • Maladaptive and recurrent use
  • Impaired functioning / distress
  • NO tolerance, withdrawal, or compulsive use
  • need 1 or more symptoms
  • social impairment / risky use symptoms
31
Q

DSM 4: substance dependence? characterized by…? types of symptoms?

A
  • drug use that results in tolerance, withdrawal, or compulsive behavior
  • commonly called addiction
  • need 3 or more symptoms
  • all 4 categories
    (impaired control, social impairment, risky use, tolerance/withdrawal)
32
Q

DSM 5: alcohol use disorder? criteria? specifiers? remission?

A
  • impairment or distress
  • 2 or more symptoms (of 11)
  • specify severity
    → mild
    → moderate
    → severe
  • 2 eras of remission
    → early (3+ months)
    → sustained (12+ months)
33
Q

4 Impaired control symptoms?

A
  • longer / larger amounts than intended
  • desire / failed efforts to reduce
  • craving
  • lots of time spent obtaining, using, or recovering
34
Q

3 social impairment symptoms?

A
  • failure to fulfill role obligations
  • use despite interpersonal/social problems
  • social/occupational activities given up/reduced due to drug use
35
Q

2 risky use symptoms?

A
  • use in situations where physically hazardous (DUI)
  • use despite knowledge of persistent physical or psychological problem due to drug (ex. health problems)
36
Q

Alcohol: physiological effects
higher vs lower levels?

A

higher: depresses brain functioning (lower inhibition)

lower: stimulates certain brain cells, activates “pleasure areas”

37
Q

Alcohol: acute effects?

A
  • impaired speech & vision
  • interference in thought
  • poor coordination
  • loss of balance
  • depression & withdrawal
38
Q

Alcohol: 2 possible chemical processes / how they affect reward pathways?

A
  1. decrease activity of GABA neurons (normally inhibit dopamine)
  2. excessive activation of endogenous opioid system (endorphins, affect emotion, stress, & reward)
39
Q

Alcohol: course? age of onset? consistent element…?

A
  • both vary a lot from person to person
  • people ALTERNATE between periods of heavy use and relative abstinence
40
Q

Alcohol: city/harvard study? age of onset?

A
  • more city men had AUD
  • age of onset EARLIER for city men
  • city men MORE likely to achieve abstinence
41
Q

Factor that makes someone more likely to remain abstinent?

A

the longer you’ve been abstinent, the more likely you are to remain abstinent

42
Q

Alcohol: long term physical effects

A
  • Malnutrition –> loss of appetite
  • Cirrhosis of liver
  • Stomach pains
43
Q

Alcohol: long term psychological effects

A
  • chronic fatigue
  • oversensitivity
  • depression
  • poor judgement
  • loss of pride
44
Q

Korsakoff syndrome?

A
  • severe syndrome following MANY years of heavy use
  • memory disorder
  • problems with NEW information
  • can’t remember conversation
  • confabulation (fill in info)
  • hallucinations
45
Q

Lifetime prevalence of AUD? any drug use disorder?

A

AUD = 29.1%
Any drug = 9.9%

46
Q

Gender divisions: who has higher rates of substance use disorders?

A
  • MEN have higher rates of AUD and most drug use disorders
  • men are more likely to use drugs/alc in general
47
Q

Comorbidities: mental disorders & drug use?

A

higher prevalence of mental disorders among patients with drug use disorders

48
Q

AUD comorbidities substances:
~___% have had another lifetime substance use disorder

__ times more likely to smoke

A

40-50%
3 times

49
Q

AUD & MDD:
- prevalence of AUD in those w/lifetime MDD = ___%

  • Prevalence of MDD in people with current AUD = ___%
A
  • prevalence of AUD in those w/lifetime MDD = ~30%
  • Prevalence of MDD in people with current AUD = 4-22%
50
Q

Odds ratio of comorbidity between AUD and anxiety disorder? meaning??

A

2.1-3.3
- someone with AUD is 2.1 to 3.3 times more likely to have anxiety than someone without AUD

51
Q

Other common comorbidities?

A

ptsd & adhd
* early onset adhd is risk factor for / associated with AUD

52
Q

Etiology: drug COMMON factors?

A
  • Affect dopamine pathways
  • Functions: reward, pleasure, motor function
53
Q

Etiology: drug SPECIFIC factors? (that increase risk for drug abuse)

A
  • Method of administration
    → injection = higher risk
  • Speed of delivery
    → faster = higher risk
  • Drug metabolism
    → faster = higher risk
  • Higher tolerance = higher risk
54
Q

Etiology: Genetic factors account for ___% of the variability for developing AUD?

A

2/3 (66%)

55
Q

Etiology: 3 Psychological dimensions?

A
  1. Classical conditioning
  2. Operant conditioning
  3. Opponent process theory
56
Q

Etiology: 2 social / environmental factors?

A
  • environmental cues can trigger cravings (ex. vape while driving)
  • manner of consumption (ie. binge drinking)
  • culture or religion influences how early & context around exposure to alcohol
    → AUD higher among Christians than Jews
57
Q

Risk factors for adolescents:

A
  1. Academics & times of transition
  2. Home & parents*
  3. Siblings & peers*
  4. Expectancy effects
    → positive beliefs ab effects = higher risk for AUD
  5. age of exposure

*modeling of behavior

58
Q

Acute vs long-term treatment goals?

A

Acute:
- detox
- readiness to change

Long-term:
- abstinence
- harm reduction

59
Q

Only ___% of people who with AUD diagnosis ever receive treatment

A

24%

60
Q

Treatment is least successful for people who…?

A

have comorbid conditions

61
Q

Detox?

A
  • usually have to do slowly
  • can stop stimulants abruptly
  • often inpatient, in hospital
  • can be helped with meds
62
Q

CBT Motivational interviewing: why/when is it used?
short/long?
focus on what?

A
  • when a person is ambivalent ab their problem / changing
  • increase motivation to change

short-term

focus on:
- empathy, open questions
- affirmations
- reflection

63
Q

CBT long term: philosophy? main goal? focuses on? learn…?

A
  • philosophy: abuse is learned maladaptive coping strategy
  • factors that initiate & maintain drug use
  • learn how to anticipate problems & increase self-control

goal: strategies to cope with cravings, avoid risky situations, prevent relapse

64
Q

Harm reduction:
goal? focus? strategies?

A
  • alternative to complete abstinence
  • accepts where they’re at
  • focus on minimizing harmful effects / risk

strategies:
- safer use
- managed use
- increase functioning
- overdose prevention

65
Q

Alcoholics Anonymous?

A
  • group “therapy” effective, lets them acknowledge severity of problems
  • drop out is high
  • success among those who do stay is high
  • studies show equally or more effective than CBT & motivation therapy
66
Q

Important treatment considerations?

A
  • role of denial
  • compliance issues
  • improvements in overall health, social & occupational functioning
67
Q

treatment efficacy? remission?

A
  • longer treatment duration is more effective for remission
  • longer abstinence predicts sustained remission
  • relapse is very common
68
Q

abstinence violation effect?

A
  • when a person relapses, they blame themselves
  • feel like one mistake is a sign that they’ve totally lost control, and any attempts to fix it would be useless
  • can cause them to give up on treatment, even with just one mistake
69
Q

Long term outcome for AUD is best predicted by…? NOT by…?

A

Predicted by coping resources
- social skills
- available social support
- level of stress in environment

NOT predicted by specific treatment type

Psych 354 (10 decks)

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