Chapter 11 - substance related dxs Flashcards
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
2
Q
Physiological dependence def?
A
- tolerance & withdrawal are signs of physiological dependence
- characterized by tolerance to withdrawal symptoms
3
Q
Tolerance def?
A
Nervous system becomes less sensitive to the physiological effects of the chemical over time
4
Q
3 mechanisms of tolerance?
A
- metabolic
- pharmacodynamic (aka down regulation)
- behavioral conditioning
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
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
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
8
Q
Withdrawal def? ex?
A
- Physiological symptoms a person experiences when drug use is stopped
ex.
- tremors, sweating, nausea, anxiety, insomnia, convulsions, hallucinations
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
10
Q
Drug of abuse / psychoactive substance def?
A
A chemical substance that alters mood, changes perception, or changes brain functioning
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
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
13
Q
4 symptom categories? (divide the symptom criteria in DSM5)
A
A. impaired control
B. social impairment
C. risky use
D. pharmacological criteria
14
Q
9 substance types
A
Alcohol
Tobacco
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedatives
Stimulants
Can have abuse disorder for everything except caffeine
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
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
17
Q
Stimulants and cocaine: activate ____?
A
sympathetic nervous system
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
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
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
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
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
23
Q
Over ___% of overdose deaths had at least one potential opportunity for intervention
A
3/5 (60%)
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)
25
Sedatives/hypnotics/anxiolytics: long term problems / withdrawal?
- discontinuance syndrome:
→ original anxiety symptoms return and worsen
possible withdrawal symptoms:
- irritability, sleep problems, paranoia, restlessness, etc
- withdrawal LESS likely if discontinued GRADUALLY
26
Cannabis: acute effects of high? long term?
short:
- well-being & happiness
- temporal disintegration
→ trouble retaining & organizing information
long:
- cognitive / neuropsychological functioning decline
- attention, learning, decision making problems
27
Cannabis: tolerance/withdrawal?
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
28
Hallucinogens: acute effects? chemical properties?
- hallucinate
- positive mood
- sometimes bad trip
- resemble serotonin molecules
29
Hallucinogens: toxicity/risk? tolerance/withdrawal?
- 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
DSM 4: substance abuse? characterized by...? types of symptoms?
- 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
DSM 4: substance dependence? characterized by...? types of symptoms?
- 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
DSM 5: alcohol use disorder? criteria? specifiers? remission?
- 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
4 Impaired control symptoms?
- longer / larger amounts than intended
- desire / failed efforts to reduce
- craving
- lots of time spent obtaining, using, or recovering
34
3 social impairment symptoms?
- failure to fulfill role obligations
- use despite interpersonal/social problems
- social/occupational activities given up/reduced due to drug use
35
2 risky use symptoms?
- use in situations where physically hazardous (DUI)
- use despite knowledge of persistent physical or psychological problem due to drug (ex. health problems)
36
Alcohol: physiological effects
higher vs lower levels?
higher: depresses brain functioning (lower inhibition)
lower: stimulates certain brain cells, activates "pleasure areas"
37
Alcohol: acute effects?
- impaired speech & vision
- interference in thought
- poor coordination
- loss of balance
- depression & withdrawal
38
Alcohol: 2 possible chemical processes / how they affect reward pathways?
1. decrease activity of GABA neurons (normally inhibit dopamine)
2. excessive activation of endogenous opioid system (endorphins, affect emotion, stress, & reward)
39
Alcohol: course? age of onset? consistent element...?
- both vary a lot from person to person
- people ALTERNATE between periods of heavy use and relative abstinence
40
Alcohol: city/harvard study? age of onset?
- more city men had AUD
- age of onset EARLIER for city men
- city men MORE likely to achieve _abstinence_
41
Factor that makes someone more likely to remain abstinent?
the longer you've been abstinent, the more likely you are to remain abstinent
42
Alcohol: long term physical effects
- Malnutrition --> loss of appetite
- Cirrhosis of liver
- Stomach pains
43
Alcohol: long term psychological effects
- chronic fatigue
- oversensitivity
- depression
- poor judgement
- loss of pride
44
Korsakoff syndrome?
- severe syndrome following MANY years of heavy use
- memory disorder
- problems with NEW information
- can't remember conversation
- confabulation (fill in info)
- hallucinations
45
Lifetime prevalence of AUD? any drug use disorder?
AUD = 29.1%
Any drug = 9.9%
46
Gender divisions: who has higher rates of substance use disorders?
- MEN have higher rates of AUD and most drug use disorders
- men are more likely to use drugs/alc in general
47
Comorbidities: mental disorders & drug use?
higher prevalence of mental disorders among patients with drug use disorders
48
AUD comorbidities substances:
~___% have had another lifetime substance use disorder
__ times more likely to smoke
40-50%
3 times
49
AUD & MDD:
- prevalence of AUD in those w/lifetime MDD = ___%
- Prevalence of MDD in people with current AUD = ___%
- prevalence of AUD in those w/lifetime MDD = ~30%
- Prevalence of MDD in people with current AUD = 4-22%
50
Odds ratio of comorbidity between AUD and anxiety disorder? meaning??
2.1-3.3
- someone with AUD is 2.1 to 3.3 times more likely to have anxiety than someone without AUD
51
Other common comorbidities?
ptsd & adhd
* early onset adhd is risk factor for / associated with AUD
52
Etiology: drug COMMON factors?
- Affect dopamine pathways
- Functions: reward, pleasure, motor function
53
Etiology: drug SPECIFIC factors? (that increase risk for drug abuse)
- Method of administration
→ injection = higher risk
- Speed of delivery
→ faster = higher risk
- Drug metabolism
→ faster = higher risk
- Higher tolerance = higher risk
54
Etiology: Genetic factors account for ___% of the variability for developing AUD?
2/3 (66%)
55
Etiology: 3 Psychological dimensions?
1. Classical conditioning
2. Operant conditioning
3. Opponent process theory
56
Etiology: 2 social / environmental factors?
- 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
Risk factors for adolescents:
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
Acute vs long-term treatment goals?
Acute:
- detox
- readiness to change
Long-term:
- abstinence
- harm reduction
59
Only ___% of people who with AUD diagnosis ever receive treatment
24%
60
Treatment is least successful for people who...?
have comorbid conditions
61
Detox?
- usually have to do slowly
- can stop stimulants abruptly
- often inpatient, in hospital
- can be helped with meds
62
CBT Motivational interviewing: why/when is it used?
short/long?
focus on what?
- when a person is ambivalent ab their problem / changing
- increase motivation to change
short-term
focus on:
- empathy, open questions
- affirmations
- reflection
63
CBT long term: philosophy? main goal? focuses on? learn...?
- 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
Harm reduction:
goal? focus? strategies?
- 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
Alcoholics Anonymous?
- 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
Important treatment considerations?
- role of denial
- compliance issues
- improvements in overall health, social & occupational functioning
67
treatment efficacy? remission?
- longer treatment duration is more effective for remission
- longer abstinence predicts sustained remission
- relapse is very common
68
abstinence violation effect?
- 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
Long term outcome for AUD is best predicted by...? NOT by...?
Predicted by _coping resources_
- social skills
- available social support
- level of stress in environment
NOT predicted by specific _treatment type_
