Chapter 12 Substance Use and Impulse Control Flashcards
1
Q
What is a substance?
A
A chemical compound ingested to alter mood or behaviour
2
Q
What is polysubstance use?
A
Using multiple substances
Ex. Alcohol and cigarettes
3
Q
What are psychoactive substances?
A
Substances that alter mood, behaviour, or both Ex, cocaine, heroin but also commonplace drugs
4
Q
What causes more health problems: Commonplace legal drugs or illegal drugs?
A
Legal drugs such as alcohol and nicotine
5
Q
What are substance related and addictive disorders?
A
Range of problems associated with the use and misuse of drugs such as alcohol, cocaine, heroin, and other substances people use to alter the way they think, feel, and behave. These are extremely costly in human and financial terms.
6
Q
What are impulse control disorders?
A
Disorders in which a person acts on an irresistible, but potentially harmful, impulse.
7
Q
What does the first level of involvement of drugs (Use) involve?
A
Ingesting moderate amounts of substance that is not interfering with their life
Ex. coffee, beer after a game etc
8
Q
What is substance intoxication? (Second level of involvement)
A
The substance is having some problematic impacts
9
Q
Are these examples of use, intoxication, or dependence?
A
1) Intoxication
2) Use
3) Dependence
10
Q
Can we define substance use disorder by how much substance is ingested?
A
No, we define it based on how significantly it effects the users life
11
Q
What is the DSM-5 definition of substance use disorder?
A
If substances disrupt your education, job, or relationships with others, and put you in physically dangerous situations (e.g., while driving), you would be considered to have a disorder.
SUD: To meet the criteria for a disorder, a person must have at least two symptoms in the last year that interfered with their life or bothered the person a great deal.
Moderate SUD: When a person has four or five symptoms, they are considered to fall in the moderate range.
Severe SUD: A severe substance use disorder would be someone who has six or more symptoms.
12
Q
The symptoms of SUD involve physiological dependance, this includes what two effects?
A
1) Tolerance
2) Withdrawal
13
Q
True or false: Some drugs have more of a psychological addiction than biological
A
True Ex. cocaine
14
Q
What is substance withdrawal?
A
Negative physical response when the substance is no longer ingested
Withdrawal from many substances can bring on chills, fever, diarrhea, nausea and vomiting, and aches and pains.
15
Q
What are the DSM-5-TR criteria for substance use disorder?
A
Described as an addiction with physiological and psychological dependence (behavioural)
Physiological dependence includes tolerance and withdrawal symptoms.
Psychological involves drug seeking behaviour, repeated drug use, and need to ingest more drugs
16
Q
Can people use drugs without misuse?
A
Yes, as many people who drink do, some people can do this with harder drugs too but its not known who is likely to become dependent with even passing use of a substance.
17
Q
Can drug dependence be present without misuse?
A
Yes (surprisingly). For example, cancer patients who take morphine for pain may become dependent on the drug—build up a tolerance and go through withdrawal if it is stopped
Ex. Birth control, ADHD meds, antidepressants
18
Q
How many symptoms are included in substance use disorders in the DSM-5?
A
11 symptoms, ranging from mild to severe.
19
Q
What is an example of how symptoms of other disorders complicate substance use disorders?
A
It is unclear whether people drink excessively due to depression or if drinking and its consequences cause depression.
20
Q
What percentage of people with alcohol disorders have an additional psychiatric disorder?
A
More than half.
21
Q
What are three possible reasons for the high comorbidity between substance use disorders and mental health disorders?
A
- High prevalence of both disorders in society.
- Drug intoxication and withdrawal can cause psychiatric symptoms.
- Mental health disorders may lead to substance use as a form of self-medication.
22
Q
When screening for substance use disorder its also important to look at?
A
other potential mental health disorders
23
Q
What are the 5 categories of substances?
A
24
Q
What are depressants, and what do they do?
A
Substances that cause behavioral sedation and relaxation, such as alcohol, barbiturates, and benzodiazepines.
25
What are stimulants, and what are some examples?
Substances that increase activity, alertness, and mood, such as amphetamines, cocaine, nicotine, and caffeine.
26
What are opioids, and what are their primary effects?
Substances that reduce pain and induce euphoria, including heroin, opium, kratom, morphine, and oxycodone. Also can cause psychological dependence
27
What are hallucinogens, and what are their effects?
Substances that alter sensory perception and can cause delusions, paranoia, and hallucinations, such as cannabis and LSD.
28
What are some examples of "other drugs" that do not fit into the main categories?
Inhalants (e.g., airplane glue), anabolic steroids, and over-the-counter or prescription drugs (e.g., nitrous oxide).
29
What is the primary effect of depressants on the brain?
Slow down inhibitory centers in the brain reducing our arousal
## Footnote
This can lead to impaired motor coordination and judgment.
30
What is the most common depressant?
Alcohol
31
Diagnostic Criteria for Alcohol Use Disorder:
32
What are the effects of alcohol on the body?
* Impaired motor coordination
* Slower reaction time
* Poor judgment
* Affects vision and hearing
## Footnote
With continued drinking, however, alcohol depresses more areas of the brain, which impedes the ability to function properly.
33
How does alcohol travel through the body after ingestion?
1. Passes through the esophagus into the stomach, where small amounts are absorbed.
2. Moves to the small intestine, where it is easily absorbed into the bloodstream.
3. The circulatory system distributes alcohol to major organs, including the heart.
4. Some alcohol reaches the lungs, where it vaporizes and is exhaled (basis for breath analyzer tests).
5. Passes through the liver, where enzymes break it down into carbon dioxide and water.
34
Does alcohol affect one receptor or multiple?
Multiple but mainly GABA
35
What is delirium tremens (DTs)?
Frightening hallucinations and body tremors related to alcohol withdrawal
## Footnote
DTs can be life-threatening and require medical attention. Looks similar to schizophrenic and manic episodes so hard to differentiate
36
What are some consequences of long term excessive drinking?
Liver disease, pancreatitis, cardiovascular disorders, and brain damage.
37
What are the two types of organic brain syndromes caused by long-term alcohol use?
38
What is Fetal Alcohol Spectrum Syndrome (FASS)?
A group of birth defects caused by alcohol exposure during pregnancy, leading to:
Fetal growth retardation
Cognitive deficits & learning difficulties
Behavioral problems
39
What are the characteristic facial features of FASS?
Skin folds at the corners of the eyes
Low nasal bridge
Short nose
Flattened groove between nose and upper lip
Small head circumference
Small eye openings
Thin upper lip
40
Alcohol use in the general population by country:
50-80% of population uses alcohol
41
What are Canada’s low-risk drinking guidelines (Butt et al., 2011)?
Women: No more than 2 drinks per day, 10 drinks per week
Men: No more than 3 drinks per day, 15 drinks per week
Latest revision: 0–2 drinks per week for everyone (CCSA).
42
How many Canadians exceeded low-risk drinking guidelines in a given week?
21% of drinkers exceeded the limits: 22% of men and 19% of women.
43
How common is binge drinking among Canadian students?
33% of male students and 28% of female students had 5+ drinks in one sitting in the last two weeks.
25% of students did not drink alcohol.
46% had not engaged in heavy drinking.
44
Which age group is most vulnerable to drinking problems?
Males aged 18 to 29.
45
Do men or women drink more?
Men
46
What did a study on health inequalities in Canada find about Indigenous communities and alcohol use?
Heavy drinking was more common among Inuit, Métis, and First Nations people.
Challenges faced: Unemployment, inadequate health services, language barriers, legacy of colonization.
Abstaining from alcohol was more prevalent among Indigenous communities than in the general population
47
Do people with alcohol use disorder always drink heavily?
No, they may fluctuate between heavy drinking, social drinking without negative effects, and abstinence
48
How does early alcohol use relate to later misuse?
Drinking at ages 11–14 predicts later alcohol-related disorders (DeWit et al., 2000).
Drinking at age 11 or earlier increases the risk of chronic and severe alcohol use disorders (Guttmannova et al., 2011).
49
What is the relationship between alcohol and violent behavior?
Alcohol is frequently linked to murder, rape, and assault (Rossow & Bye, 2012).
Alcohol may increase aggression, but behavior depends on multiple factors (Bushman, 1993; Hoaken & Stewart, 2003).
Alcohol can reduce fear of punishment and impair impulse control (Kuypers et al., 2020).
Harmful alcohol use in men predicts intimate partner violence (Woodin et al., 2014).
Alcohol intoxication increases the risk of being a victim of violence (Wekerle & Wall, 2002).
50
What are the 3 most common effects of depressant drugs?
Include calming (sedative), sleep-inducing (hypnotic), and anxiety-reducing (anxiolytic) effects
## Footnote
Examples include barbiturates and benzodiazepines.
51
What are some of the effects that come with the use of barbiturates?
-Relaxation of muscles
-Feeling of well being
52
What is a large concern regarding barbiturates?
There is a high risk of suicide associated with use, and they are a common means of suicide as excessive dosages lead to respiratory depression
53
What develops with repeated use of benzodiazepines?
Tolerance and dependence
54
Sedatives combined with what drug can cause dangerous depression?
Alcohol, often leads to unintentional overdose
55
How many Canadians use sedatives and what is the gender difference here?
12% use sedatives with more women using than men
56
Say someone has been unable to sleep due to the loss of a family member, what may a good prescription be to help with this
benzodiazepine to allow them to sleep
57
What class of substances are the most commonly used in Canada?
Stimulants
Ex. Caffeine, ADHD meds etc
58
What are some of the common effects of stimulants?
-Up and then Down "crash"
-Reduced appetite
-Reduced fatigue
-Sense of euphoria
59
How does MDMA work?
It stimulates the CNS by positively acting on NE and Dopamine receptors
60
What are some concerns of MDMA?
It can lead to hallucinations and delusions
61
What is a risk of ADHD medication?
They are stimulants so increase heart rate which can lead to heart arrhythmias but this is analyzed by a risk:benefit ratio for those prescribed it
Ex. Untreated ADHD may lead to higher risk of problematic substance use without medication
62
What are some of the effects of cocaine?
Increases alertness, BP, causes insomnia
63
Why may cocaine use be so low in Canada?
Its expensive
64
What are the diagnostic criteria for stimulant use disorders according to DSM-5-TR?
Include behavioral and physiological symptoms
## Footnote
Symptoms can vary based on the type of stimulant used.
65
What is one of the main reasons nicotine is so addictive?
It has very fast effects 7-19 seconds after inhalation
66
True or False: Nicotine is more addictive than heroin
True, its harder to kick the habit
67
Nicotine is related with what other mental health problem?
Depression
68
What is the role of positive reinforcement in substance use?
Psychoactive drugs provide a pleasurable experience leading to increased use
## Footnote
This can lead to tolerance and dependence.
69
What are the effects of nicotine on the body?
Produces dependence, tolerance, withdrawal
## Footnote
Nicotine stimulates pleasure pathways in the brain.
70
Does the DSM-5 include a caffeine use disorder?
Yes, it states the disorder as "problematic caffeine use that causes significant impairment and distress"
71
What are the risks with opiate use?
-Laced with fentanyl
-Risks of HIV
-Horrible withdrawal
72
What is the primary effect of opioids?
Sleep-inducing and pain-relieving (analgesic)
## Footnote
Opioids are associated with high mortality rates due to overdose.
73
What are some common hallucinogens?
LSD, DMT, Psilocybin, peyote, PCP
74
What is the diagnostic DSM-5 criteria for hallucinogen related disorders?
1) Perceptual changes: More intense hallucinations, depersonalization
2) Physical symptoms: Dilated pupils, rapid heart rate
75
What effects are cannabis most commonly associated with?
Alters perceptions and mood swings
## Footnote
Cannabis use in Canada was reported at 15% in 2019.
76
How many Canadians use cannabis?
15%
77
What are some of the concerns with cannabis use?
-Increased risk of schizophrenia
-Impairments in memory and concentration
78
What is reverse tolerance with cannabis?
People who have smoked for many years may become more sensitive to bad side effects with continual use
79
Are there concerns with adult cannabis use?
It doesn't show long term brain impairments in adults
80
Inhalants are...
a. not a concern
b. very dangerous to the brain
b
81
Is there a genetic link to addiction?
Yes
82
Psychoactive drugs activate what in the brain?
The reward centre: Dopaminergic system and the opioid releasing neurons
83
Cocaine is very biologically or psychologically addictive?
Psychologically, due to the negative and positive reinforcement-you are avoiding the bad and enhancing the good
84
What is the role of positive and negative reinforcement in addiction?
Positive -> Provides pleasure
Negative -> Removes pain and stress
## Footnote
Remember negative isn't bad, its taking something away
85
What is the opponent process theory?
Experiencing an unpleasant crash after being high
## Footnote
This theory explains the cycle of addiction.
Think "the opposing process to being high is to crash"
86
Do cultural and social influences alter how we experience the effects of certain substances?
Yes, this is known as the expectancy effect -> People expect to experiences when they use drugs influences their reaction
Ex. The social norm of getting in a bar fight will make it more likely that you will when drinking
87
What is alcohol myopia?
The narrowing of attention to immediate cues rather than peripheral info while drinking which can lead to dangerous behaviours Ex. Drunk driving
88
What are some of the social and cultural factors leading to substance use?
Social-> TV, media, friends expose you to substances all the time
Cultural -> Drinking heavily on certain occasions is normalized Ex. Weddings, New years
89
What can be helpful as a way to prevent substance use by your kids as parents?
Frank and open conversations and monitoring their use by being engaged in their life
90
What encompases the integrative model of substance use?
The idea that multiple influences interact to account for substance use disorders
91
The multiple causes of substance use and misuse...
92
What is an agonist substitution in biological treatments?
Chemical makeup similar to addictive drug to reduce withdrawal symptoms
## Footnote
Examples include methadone for opioid dependence.
93
What is the primary function of antagonist treatments?
Block or counteract the effects of psychoactive drugs
## Footnote
Naltrexone is an example used for opioid and alcohol dependence.
94
What kind of therapy for substance use involves analyzing where an individual is at in their motivational cycle Ex. do they want to change?
Motivational enhancement therapy (MET)
95
What is the aim of motivational enhancement therapy (MET)?
Increase motivation to change substance use behavior
## Footnote
MET is often used in conjunction with other treatments.
96
What may be a good MET question to ask someone considering quitting drinking?
What are some negative things that would improve if you stopped?
Ex. Maybe sleep, concentration, etc
97
Treatment principles for drug use:
-Treatment must be long term
-Treatment should include monitoring for drugs during it
98
What are some agonist and antagonist biological treatments for drug use?
Agonist -> When the chemical makeup is similar to the actual drug Ex. Methadone
Antagonist -> Blocks effects of the drug
Ex. Naltrexone
99
What is naltrexone used for?
Opioid dependence and alcohol dependence
## Footnote
Produces immediate withdrawal symptoms.
100
What is aversive treatment?
Prescribed drugs make ingesting abused substances extremely unpleasant
## Footnote
Example: Disulfiram (Antabuse) for alcohol disorder.
101
What is a significant problem associated with aversive treatment?
Noncompliance
## Footnote
Patients may not adhere to the treatment regimen.
102
What is an example of an aversive treatment for smoking?
Silver nitrate in lozenges or gum
## Footnote
Used to create aversion to smoking.
103
What types of medications are used for withdrawal symptoms?
Sedatives, clonidine
## Footnote
Clonidine is developed to treat hypertension and is used for opioid withdrawal.
104
What are some common psychosocial treatments for substance use disorder?
-Inpatient facilities
-AA and its variations
-Controlled use
-Component treatment
-Relapse prevention
105
What is the purpose of inpatient facilities in treatment?
Provide supportive therapy during the initial withdrawal period
## Footnote
They can be expensive.
106
What is Alcoholics Anonymous (AA)?
A support group independent from the established medical community
## Footnote
Operates in more than 170 countries with a 12-step philosophy.
107
What is controlled use in terms of substance treatment?
Controlled use of a substance instead of abstinence, reduction in the amount, dosage, and frequency.
## Footnote
It is not very effective over the long term.
108
What are some component treatments in psychosocial treatment?
Covert sensitization, contingency management, community reinforcement approach
## Footnote
Matching treatment to the needs of the client is essential.
109
What is covert sensitization?
Getting the user to imagine unpleasant scents associated with their drug use
110
What is contingency management?
Ex. getting someone to save the 20$ they would spend on cigs and put it away in savings to remind them of the positive improvements with stopping drug use
## Footnote
Think "contingency fund saves money"
111
What is relapse prevention?
Addressing cognitive and behavioral coping skills regarding drug use. What will they do when triggers come up, list reasons why they quit
## Footnote
Involves helping individuals examine their beliefs about the positive aspects of the drug.
112
What does harm reduction involve?
Controlled drinking, safe injection sites, education-based programs
## Footnote
Success depends on cooperation among various social institutions.
113
What are some drug use prevention methods?
-Education based programs
-Community interventions
114
What is the lifetime prevalence of gambling disorder in Americans?
Approximately 2%
## Footnote
Associated with job loss, bankruptcy, and arrests.
115
What are the characteristics of gambling disorder according to DSM-5-TR?
Urges similar to those experienced in substance-related disorders
## Footnote
Individuals may be in denial and exhibit impulsive behavior. Often they are continually optimistic
116
What is intermittent explosive disorder?
Aggressive outbursts/impulses resulting in serious assaults or property destruction
## Footnote
Lifetime prevalence is 7%.
117
What is kleptomania?
Recurrent failure to resist urges to steal things usually with no need to do so just because they like the rush
## Footnote
Often associated with stigma and is illegal.
118
What is pyromania?
Irresistible urge to set fires
## Footnote
Treatment typically involves cognitive-behavioral strategies.
