Chapter 14: Drug Abuse Flashcards
What % of American binge drink?
11 million at least once a week
How many American smoke?
62 million
How many American use smokeless tobacco?
7 million
How many American smoke marijuana?
10 million
How many Americans use psychotropic substances?
3 million
How many Americans use cocaine?
1.5 mllion
What percentage use inhalants and hallucinogens?
1 million each
What are the four symptoms of addiction?
1) Impairment in daily functioning and continued use over the use of the substance
2) Impairment of daily functioning and continued use of substance despite adverse consequences
3) Physical or emotional adaptation of the drug such as in the development of tolerance or a withdrawal syndrome.
4) When a user produces physical withdrawal symptoms in the absence of the drug.
What are the three C’s of addiction?
1) Control regarding use of drug
2) Continued use in the face of adverse consequences
3) Compulsion to use the drug
What % of alcoholics relapse?
80%
What is the definition of a drug?
Any chemical substance that can alter a biological system
What is a psychoactive drug?
The amount of a drug that must be given in order to obtain a particular response
Define drug potency
The amount of a drug that must be given in order to obtain a particular response
The three factors that influence drugs
1) Route of administration
2) How well the drugs interact with receptors in the brain
3) How quickly the body and brain adapt to the drug
What is the blood brain barrier (BBB)?
Composed of specialized cells that prevent particular compounds in the circulatory system from entering the brain.
Ways drugs pass the BBB?
1) Mimic neurotransmitters and interact with neurotransmitter receptors
2) Interferes with the synthesis, production of the neurotransmitter in the nerve cell
3) Affect the release of the neurotransmitter or block the receptor on the postsynaptic neuron.
4) Many drugs act by disrupting the reuptake or breakdown process.
5) Other can inhibit the enzymes that are responsible for eliminating excess neurotransmitters.
- In both cases, the end result is an over-activation of the neurotransmitter system
1) Define “neuroadaptation” and 2) how it is involved with addiction.
1) The complex biological changes that occur in the brain with repeated or chronic exposure to a drug
2) Homeostatic or self-corrective mechanisms, the nervous system attempts to compensate for the effects of the drug. Tolerance is one such form of this adaptation.
Have stable characteristics of an addictive personality been found?
No.
Explain the psychodynamic views of addiction.
1) Compensation for defective ego functions.
Used to reduce painful emotional states or as a defense mechanism in relation to an internal conflict.
2) Disruption of early life development, particularly regarding relationships to others, may increase vulnerability
3) Lack of gratifying relationship with others
4) The use of drugs to cope with anxiety associated with intimacy, especially during adolescence, has been noted by several theorists.
Genetic explanations of addiction
Adoption method: even when children of alcoholics are adopted, the children are still 4x more likely to develop alcoholism
How does the opponent-process theory explain addiction?
Exposure leads to craving.
Define “effective pleasure.”
-Pharmacological effect of drugs following initial use results in a hedonic state
Define “affective tolerance”
Higher doses as the exposure increases
Define “affective contrast”
- With continuing drug exposure, the negative, unpleasant state comes to dominate and contrasts sharply with the memory of the positive ones.
- Despite that little pleasure is now derived from the drug, the cycle of addictive behavior continues in order to achieve at least a steady-state or neutral level.
How does “negative reinforcement” explain addiction?
People take drugs to ward off the feelings of withdrawal.
How does “positive reinforcement” explain addiction?
Pleasures, euphoric feelings from drugs.
What is “nucleus accumbens?”
1) Pleasure including laughter, reward, and reinforcement learning, as well as fear, aggression, impulsivity, addiction, and the placebo effect.
2) Dopamine production
3) GABA is the main neurotransmitter within this region.
What are some neurochemical systems that play a role in addiction?
Endogenous opioids:
- Morphine-like substances
- enkaphalin, endorphines, dynorphins
What are some conditioning and learning models associated with addiction?
Drugs bring pleasure and relieve negative feelings that are produced by withdrawal
>This causes “Drug Cues,” which illicit bodily and emotional responses to people about their positive feelings with drug use.
Age of onset of alcoholism
10-24
What race is more likely to have drinking problem?
Whites
Neurochemicals affected by alcohol
1) Serotonin
2) Dopamine
3) GABA
4) Norepinephrine
5) Endogenous opioids
What is metabolic tolerance of alcohol?
The liver is able to break down alcohol faster
What accompanies mild symptoms of alcohol withdrawal?
1) Nausea
2) Weakness
3) Anxiety
4) Tremors
What accompanies severe symptoms of alcohol withdrawal?
1) Hallucinations
2) Disorientation
3) Confusion
4) Agitation
What are the worst symptoms of alcohol withdrawal?
1) Tremors
2) Seizures
3) Severe delirium
4) Delirium Tremens
Criteria of alcoholism
The individual has…
1) Been drinking over an extended period of time
2) Consequently suffered from major multiple life problems
3) Compulsive drinking and an inability to stop despite repeated efforts
4) High consumption, being able to exceed a fifth of liquor or its equivalent in wine or beer
Highest comorbidty disorder with alcoholism?
1) Conduct/antisocial personality disorder
2) Stress
3) Anxiety
Criteria for a Type I Alcoholic:
1) 25 years of age
2) Associated with personality traits characteristics of persons with passive-dependent personalities:
- High reward dependence, high harm avoidance and low novelty-seeking
- Emotionally dependent, sensitive to social cues, apprehensive and inhibited and not likely to engage in dangerous or disordered behavior.
3) Can abstain from drinking but loss of control once resumed and feel guilty about their dependence
4) Marked by:
i) Genetic predisposition
ii) family environment
iii) heavy recreational drinking
Criteria of a Type II alcoholic:
1) Before age of 25
2) Drinks heavily
3) Cannot abstain
4) Physical conflicts:
i) arrests
ii) auto accidents
iii) fights
Treatment process of alcoholism:
1) Detox
2) Therapy
Objectives of therapy for alcoholism
1) Work on developing coping skills
2) Self-esteem building
3) Behavior change
4) Finding strategies to cope with the possibility of relapse
Objectives of CBT in alcoholism treatment
1) Skill Training:
- Teaching patient to identify and cope effectively with high risk situations in which the loss of control or threat of relapse increases
2) Self-control
What are some vulnerable mental/emotional states one might find themselves in to risk relapsing with alcohol?
1) Episodic depression
2) Social pressure
3) Interpersonal conflict
What is “cognitive restructuring in terms of alcoholism treatment?
- Changing the individual’s perception of violation of abstinence or a slip.
- See “slip” as an isolated incident rather than an irrevocable disaster
Drug treatments of alcoholism
1) Disulfiram
- Makes person sick when they drink alcohol
- Only decreases episodes. Does not increase abstinence
2) Naltroxene
- Reduces cravings
3) Lithium, SSRI
- Only in the case of depression
George Vaillant’s stats on alcoholism recovery
- 1/3 of alcoholics recover, 1/3 abstinent and/or drinking socially, 1/3 still trying to quit
- 40-70% of those who receive treatment for drinking return to drinking within a year
George Vaillant’s factors on recovery
1) Experiencing a strongly adversive experience related to drinking
2) Finding a substitute dependency to compete with alcohol use
3) Obtaining new social support
4) Joining an inspirational group
Amount of alcohol-related deaths per year in the U.S.
100,000
Amount of damage from alcohol-related incidences
$100,000,000
Rate of presence of alcohol intoxication in suicides and homicides
1/2
What percentage of hospital visitations are accounted for by alcohol?
40%
Side-effects of alcoholism
1) Liver damage
2) Cirrhosis
3) Damage to the nervous system
4) Damage/stress to/on the heart
5) Damage/stress to/on the digestive system,
6) Cancer
7) Fetal alcohol syndrome
Aside from caffeine, what are the most abused stimulants?
1) Non-presecription drugs
2) Nasal decongestants
3) Bronchodilators
4) Appetite suppressants
5) Energy pills
What was amphetamine originally used for?
Asthma
What does amphetamine used to treat in a medically supervised environment and guidance?
Obesity and ADHD
Effects of amphetamine when used to treat ADHD and obesity
Causes feelings of alertness, decreased appetite, physical activity, euphoria, exhilaration
Side-effects of amphetamine when used to treat ADHD and obesity.
1) Insomnia
2) Hyperthermia
3) Paranoia
4) Depression
5) Anxiety
6) Elevated blood pressure
Long-term side-effects of amphetamine use.
1) Heart failure
2) Stroke
3) Brain damage
4) Schizophrenia-like symptoms of behavior:
i) visual hallucinations
ii) repetitive behavior patterns
iii) anger and paranoia
iv) homicidal and suicidal thoughts
What % does amphetamine abuse account for in the Midwest?
90%
How long has cocaine been used for and by whom?
Incas for more than 5,000 years
When was cocaine use most prevalent, and what was the rate of increase during this time?
1976-86, rose from 5 to 22 million.
Who uses cocaine the most now?
Teenage boys
What is the physiological mechanism behind cocaine?
Vasoconstrictor
- Increases heart rate
- Blood pressure,
- Sometimes cardiac arrhythmia
Increases dopamine production
Changes in emotional state when using cocaine
1) Stimulation
2) Well-being
3) Vigor,
4) Euphoria
5) Enhanced alertness
6) Increased sexuality
7) Heightened energy
8) Deepening of emotions
Chronic use of cocaine
1) Hyper-aggressiveness
2) Insomnia
3) Irritability
4) Impulsiveness
5) Panic.
6) In extreme cases: paranoid psychosis and violent behavior
Cocaine toxicity
1) Cerebral hemorrhage
2) Sudden death
Abstinence pattern of cocaine:
1) Crash
2) Withdrawal
3) Extinction
Characteristics of the cocaine crash
- Sharp decrease in mood, energy, agitations, anxiety, depression and cravings.
- Extreme need for sleep, culminating into sedative, alcohol or opiate use,
Describe the cocaine withdrawal
- Lasts for many weeks and is characterized by intensely dysphoric syndrome in which the person experiences depression and anhedonia.
- Thoughts and memories of the great high and euphoria leads to reuse.
Describe extinction of cocaine withdrawal
If person continues to abstain, they usually return to normal, though sometimes getting cravings anywhere from a couple of months to years.
Treatment of cocaine addiction
1) Antidepressants
2) Dopamine blocking drugs
3) CBT and GT
Heroin use is most prevalent amongst which demographic?
Middle class suburban whites
Effects of heroin
1) Calmness
2) Well-being
3) Sleepy dream-like states
4) Reduction of anxiety, hostility and aggression. 5) “Whole-body orgasm.”
Physiological effects of heroin
1) Shut down of pain receptors
2) Nausea
3) Vomiting
4) Constipation
5) Lower blood pressure
6) Decreased sexual drive and function
Main neurotransmitters involved with heroin use
1) Enkephalins
2) Endorphines
Heroin withdrawal
1) 8-12 hours:
- Restless sleep, dilated pupils, irritability, loss of appetite, tremor
2) 48-72 hours:
- insomnia, violent yawning, excessive tearing and sneezing.
- Muscle weakness and depression
- Goosebumps (piloerection)
- Gastrointestinal distress, characterized by cramps and diarrhea.
- All of these symptoms can be reversed with the administration of a hit
3) 7-10 days:
- Weakening of all of these symptoms.
- Withdrawal is not life-threatening.
Treatments of heroin addiction
1) Substitution treatment (methadone, naltroxene) or drug-prescribed treatments (weaning).
2) Social and family support
3) After-care
4) Social reintegration
5) Follow-up services
Main receptors stimulated in hallucinogens
Serotonin, norepinephrine and dopamine, with a huge reduction in serotonin
Which part of the brain is most affected by LSD?
Limbic system
Effects of PCP and MDMA
Feelings of intoxication, warmth, tingling, numbness in the extremities
Effects of MDMA and PCP with increasing dosages
Body dysmorphia, feelings of extreme depersonalization, confusion, excited intoxication may develop or there may be a stupor coma.
Extreme cases of PCP and MDMA
Schizophrenia-like psychosis leading to violence, aggression and suicide
Withdrawal symptoms of THC
Irritability, restlessness, weight loss, insomnia, tremor, increased body temperature
Which parts of the brain does THC interact with?
Nucleus accumbens and regions in the limbic system that plays a role in pleasurable sensations.
What kind of anticholenergic effect does THC have on the brain?
1) Reduction in acetylcholine, which is responsible for memory.
2) Disrupts activity in the hippocampus, the area related to explicit memory
3) Immune system response suppressant.
Relapse rate of people trying to quit smoking
70%
Withdrawal of nicotine
Irritability, anxiety, restlessness, impaired concentration, strong cravings for tobacco, headaches, drowsiness, gastrointestinal problems, vigilance, attention psychomotor performance and hostility
Theories of Dependence for all drugs
1) Social factors
i) peer pressure
ii) parental modeling
iii) experimentation.
2) Positive reinforcement: Nicotine affects... i) Mood ii) Emotion iii) Cognitive functions.
3) Coping model
i) Stress reduction
- Skin conductance has proven this
Societal costs of smoking
$70 billion in annual smoking-related costs to society, including health care costs and lost productivity
Diseases related to smoking:
1) Lung cancer
2) Coronary heart disease
3) Hypertension
4) Chronic lung disease.
% of deaths related to smoking
30% of cancer deaths and 30% of all deaths due to cardiovascular disease
Treatment of nicotine addiction
Barbiturates and benzodiazepines:
-Anxiety-relieving effects
Side-effects of barbiturates
1) Difficulty thinking
2) Slurred speech
3) Poor…
i) comprehension
ii) Memory
iii) Emotionality
4) Aggressive behavior.
5) Loss of consciousness
6) Slowness of breathing
