Chapter 11 - Substance Use Disorders Flashcards
What percent of people have a substance use disorder in a given year?
16.5%
What percent of people have alcohol use disorder in a given year?
10.6%
What percent of Americans abstain from alcohol?
35%
What percent of people binge drink monthly?
21.5%
How many overdose deaths are there annually?
107,000
What percent of overdose deaths are opioid related?
75%
How many US deaths from smoking-related diseases annually?
Over 480,000
What percent of people have cannabis use disorder annually?
6%
What is the lifetime prevalence of cannabis use?
45%
What is the percent of people who use caffeine daily?
90%
What is a substance?
- any natural or synthesized product that has psychoactive effects
- changes perceptions, thoughts, emotions, and behaviors
What is addictive behavior?
behavior based on the pathological need for substance or activity
What classifies substance abuse?
- the pathological use of a substance resulting in potentially hazardous behavior and continued use despite a persistent social, psychological, occupational, or health problem
What is the DSM-5 criteria for substance use disorder?
- Two or more of the following occurs during 12 months, leading to significant impairment or distress:
- Failure to fulfill important obligations at work, home, or school as a result of substance abuse
- Repeated use of the substance in situations which it is physically hazardous to do so
- Repeated relationship problems
- Continued use of the substance despite repeated social or legal problems as a result of use
- Tolerance, as defined by either: the need for markedly increased amounts of the substance to achieve intoxication or desired effect; markedly diminished effect with continued use of the same amount
- Withdrawal, as manifested by either: the characteristic withdrawal syndrome; the same or closely related substance is taken to relieve or avoid withdrawal symptoms
- The substance is often taken in larger amounts or over a longer period than was intended
- There is a persistent desire or unsuccessful efforts to cut back
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
- Important social, occupational, or recreational activities are given up or reduced because of substance use
- The substance use is continued
What are the factors that influence the development of dependence?
- route of administration (the quicker, the most addictive)
- rate of action
- length of action (longer lasting, less addictive)
What are the methods of taking substances and time to reach the brain?
Fastest to slowest, faster = more addictive:
Inhaling - snorting - injection - oral ingestion - other routes
What are depressants?
- slow the activity of the central nervous system (CNS)
- reduce tension and inhibitions
- may interfere with judgment, motor activity, and concentration
What are the most used depressants?
Alcohol, sedative-hypnotic drugs, opioids
How many people in the world drink alcohol?
2 billion
How many Americans drink alcohol?
Over half
What is a binge-drinking episode?
Consuming 5 or more drinks on a single occasion
What is ethyl alcohol?
- in all alcoholic beverages
- absorbed into the blood through the stomach lining
- takes effect in bloodstream and CNS
- effect of ethyl alcohol and level of impairment is determined by its concentration in the blood
- intoxication = 0.09 percent (.08 legally)
When do the effects of alcohol go away?
After it is metabolized by the liver
What does alcohol do in the brain?
- increases the activity of the neurotransmitter GABA at key sites in the brain to shut down neurons
- decreases activity in glutamate system
- increases dopamine activity
What do women have less of that means they get more intoxicated than men easier?
the stomach enzyme called alcohol dehydrogenase
What are the personal and social impacts of alcoholism?
- plays a role in suicides, homicides, assaults, rapes, and accidents
- long-term excessive drinking can seriously damage physical health and major nutritional problems (Korsakoff’s syndrome)
- the 30 million children of alcoholics are likely to experience a wide range of social and psychological struggles, fetal alcohol syndrome (FAS) and miscarriage risk
What is the clinical picture of alcohol use disorder?
- regular consumption and reliance affect cognition, social life, and work behaviors
- individual alcoholism patterns vary
What are tolerance and withdrawals like in alcoholics?
- tolerance increases consumption levels
- variety of negative withdrawal symptoms like delirium tremens (DTs)
How does alcohol damage the brain?
- complex and often contradictory effects on the brain
- alcohol abuse kills brain cells
- associations between alcohol consumption and gray and white matter volumes (Daviet et al.)
What are sedative-hypnotic (anxiolytic) drugs?
Drugs that produce feelings of relaxation and drowsiness
What are sedative-hypnotic drugs like at low doses?
calming or sedative effect
What are sedative-hypnotic drugs like at high doses?
sleep inducers or hypnotics
What are some sedative-hypnotic drugs?
- barbituates (widely prescribed for the first half of the twentieth century)
- benzodiazepines (safer and less likely to lead to intoxication, tolerance effects, and withdrawal reactions, increase GABA activity)
What are the opioids?
Include natural (opium, heroin, morphine, codeine) and synthetic (methadone) compounds, known collectively as narcotics
When were opium-derived drugs deemed addictive and illegal?
By 1917
How do opioids cause CNS depression?
they attach to endorphin-related brain receptors
What are the dangers of opioid use?
Overdose, ignorance of tolerance, getting impure drugs, infection from dirty needles and other equipment
What are the medical opioids?
Morphine, codeine, and oxycodone
How are opioids injested?
Smoked, inhaled, snorted, injected, or swallowed
What is skin-popping?
Injecting opioid just beneath the skin
What is mainlining?
Injecting opioid deep into a muscle or vein
What is a rush?
Right after injection, spasm of warmth and ecstasy sometimes compared with an orgasm followed by several hours of a high/nod
What is tolerance and withdrawal like for heroin use?
- tolerance for the drug quickly builds
- withdrawal occurs when drug ingestion stops
- increased doses required to avoid withdrawal
What are the withdrawal symptoms for heroin?
- early withdrawal symptoms include anxiety and restlessness
- later symptoms include twitching, aches, fever, vomiting, diarrhea, and weight loss from dehydration
What are stimulants?
- substances that increase the activity of the central nervous system
- cause increases in blood pressure, heart rate, and alertness
- cause rapid behavior and thinking
What are the most common stimulants?
cocaine, amphetamines, caffeine
What is stimulant use disorder?
- when stimulant dominates individual’s life
- leads to poor functioning in social relationships and at work
- tolerance and withdrawal reactions tied to increased doses
What is the most powerful known natural stimulant?
Cocaine
What does cocaine feel like?
a euphoric rush of well-being, orgasmic
What does cocaine do in the brain?
increases the supply of dopamine at key neurons throughout brain as well as norepinephrine and serotonin levels
What are the effects of high doses of cocaine?
cocaine intoxication, cocaine-induced psychotic disorder, depression-like letdown (crashing)
What are the more powerful and cheaper versions of coke?
Crack and freebasing
What are the physical dangers of cocaine?
overdose (greatest risk), excessive doses depress the brain’s respiratory function and stop breathing, heart failure, increased likelihood of miscarriage and of having children with abnormalities
What are the symptoms of cocaine intoxication?
poor muscle coordination, grandiosity, bad judgment, anger, aggression, compulsive behavior, anxiety, and confusion
What are amphetamines?
- Lab-manufactured stimulants like amphetamine, dextroamphetamine, methamphetamine
- Most often taken in pill or capsule form
What are the effects of amphetamines?
- Small doses: increased energy and alertness and reduced appetite
- High doses: produce a rush, intoxication, psychosis
- Cause emotional letdown as they leave body
What amphetamine has become more popular recently?
Methamphetamine
What are the dangers of meth?
serious negative effects on physical, mental, and social life; linked to increased ER visits; may cause neurotoxicity
What are hallucinogens?
substances that produce delusions, hallucinations, and other sensory perception changes, cause trips
What are the natural hallucinogens?
lysergic acid diethylamide (LSD), mescaline (peyote), psilocybin, MDMA (ecstasy)
What is LSD (lysergic acid diethylamide)?
- one of the most powerful hallucinogens derived from ergot alkaloids
- brings on a state of hallucinogen intoxication (hallucinosis)
What are the effects of taking LSD?
- increased and altered sensory perception
- psychological changes
- physical symptoms
- hallucinations and/or synesthesia
- wear off in about 6 hours
What does LSD do in brain?
- binds to serotonin receptors
- these neurons help control visual information and emotions, thereby causing the various effects
What are LSD tolerance and withdrawals like?
These are rare
What are the dangers of LSD?
self-injury, bad trips, flashbacks
What is MDMA? (ecstasy/molly)
- a stimulant and hallucinogen
- provides an energy boost and strong feelings of connectedness
What are the dangers of MDMA?
immediate psychological problems, cognitive impairment, unpleasant and potentially dangerous physical symptoms
What does MDMA do in the brain?
- causes neurotransmitters serotonin and dopamine to be released all at once throughout the brain
- interferes with brain’s ability to produce new serotonin
What is cannabis sativa?
A hemp plant
What is hashish?
solidified resin of the cannabis plant
What is marijuana?
mixture of buds, crushed leaves, and flowering tops
What is the major active ingredient in marijuana?
tetrahydrocannbinol (THC)
What are the effects of cannabis intoxication?
- a mixture of hallucinogenic, depressant, and stimulant effects
- lasting 2-6 hours (12 when eaten)
what are the dangers of cannabis?
tolerance and withdrawal symptoms, occasional panic reactions, automobile accidents, and decreased memory while high, long-term health problems, reproduction problems, motivational syndrome, depression, increased risk of psychosis and risk of addiction to other substances
what is cannabis use disorder influenced by?
regular use
what is marijuana’s role in history?
- historically, replaced by more effective drugs in the medical field and then outlawed
- THC-related research opened cannabis use for new medical applications and legalization
- medical use now allowed in 29 states & recreational in 8
What is polysubstance use?
taking more than one drug at a time
what is a synergistic effect?
the effects of taking multiple drugs at once when they multiply each other’s effects
is it more dangerous to mix drugs with similar or opposite actions?
mixing drugs with similar actions can be deadly
what are antagonistic effects in drugs?
combining drugs with opposite actions
According to sociocultural views, what causes substance use disorders?
- living in stressful socioeconomic conditions
- having families that value or tolerate drug use
- being confronted regularly by other kinds of stress
According to psychodynamic views, what causes substance use disorders?
- having powerful early-year dependency needs
- displaying substance abuse personality
According to cognitive-behavioral views, what causes substance use disorders?
- operant conditioned by tension-reduction
- rewarding effects of drugs (self-medication)
- have rewards-produced expectancy that substances will be rewarding
- influenced by classical conditioning when cues or objects are present during drug use
According to biological views, what causes substance use disorders?
- genetic predisposition
- similarity of alcohol preferences
among alcohol-preferring animals
and their offspring - abnormal form of dopamine-2
receptor gene in people with
substance abuse disorders
- similarity of alcohol preferences
- neurotransmitters
- drug tolerance and withdrawal
symptoms are caused by cutbacks
in the brain’s production of
particular neurotransmitters
during excessive and chronic drug
use - lower GABA production (alcohol
& benzos) - lower endorphin production
(cocaine & amphetamines) - reduced anandamide production
(marijuana) - dopamine is key NT
- drug tolerance and withdrawal
- brain circuits
- reward circuit (reward center)
- pleasure pathway
- drugs stimulate structures directly
and indirectly
- the dopamine reward system
- incentive-sensitization theory
- when substances repeatedly
stimulate the reward center, the
center develops a hypersensitivity
to the substance
- reward-deficiency syndrome (inability to derive reward from ordinary, everyday activities)
According to the developmental psychopathology view, what causes substance use disorders?
- externalizing or internalizing temperament
- numerous stressors throughout childhood
- inadequate parenting
- rewarding substance use experiences
- relationships with peers who use drugs
What are psychodynamic therapies used to treat substance use disorders?
Clients are helped to become aware of and correct underlying needs and conflicts related to drug use
What are cognitive-behavioral therapies used to treat substance use disorders?
- aversion therapy
- contingency management
- relapse-prevention training
- acceptance and commitment therapy
What are biological therapies used to treat substance use disorders?
- help people withdraw, abstain, or maintain level of use without further increases
- detoxification
- Antagonist drugs
- Drug maintenance therapy
(methadone/peyote maintenance programs are designed to provide a safe, legal, and medically supervised substitute for heroin)
What is detoxification?
- systematic and medically supervised withdrawal from a drug
- outpatient or inpatient
- gradual withdrawal or induced withdrawal
What are antagonist drugs?
intended to help the person resist falling back into a pattern of substance abuse or dependence
- opioid antagonist drugs (naloxone)
- partial antagonists
- rapid detoxification
what is aversion therapy?
repeat pairing an unwanted behavior with discomfort (ex: electric shock)
what is contingency management?
when individuals are ‘reinforced’, or rewarded, for evidence of positive behavioral change)
what are the sociocultural therapies used for substance use disorders?
- believe psychological problems emerge in a social setting and are best treated in a social context
- self-help and residential treatment programs
- culture and gender sensitive programs
- community prevention programs
what are other addictive disorders (not drug-related)?
- gambling disorder
- internet gaming disorder is under possible inclusion in future DSM edition
what are the causes of gambling disorder?
- genetic predisposition
- heightened dopamine activity and dysfunction when gambling
- impulsive, novelty-seeking personality style
- repeated and cognitive mistakes
what are the treatments for gambling disorder?
- cognitive-behavioral approaches (relapse-prevention training)
- biological approaches (opioid antagonists)
- self-help programs (Gamblers Anonymous)
