Chapter 7 - Midterm 2 - Substance-Related and Addictive Disorders Flashcards
What is a substance abuse disorder
Patterns of maladaptive behavior involving the use of a psychoactive substance
Substance-induced disorder
Disorders induced by the use of psychoactive substances, including intoxication, withdrawal syndromes, mood disorders, delirium, and amnesia
Tachycardia
Abnormally fast heartbeat
Delirium tremens
Withdrawal syndrome that often occurs following a sudden decrease of cessation of drinking in chronic alcoholics that is characterized by extreme restlessness, sweating, disorientation, and hallucinations
Delirium
State of mental confusion, disorientation, and extreme difficulty in focusing attention
-Hallmarks of Disordered Substance use
-Tachycardia
-Delirium tremens
¬-Disorientation
-Physiological dependence (addiction)
-Tolerance
-Withdrawal
-Psychological Dependence
DSM-5: substance use disorder (eg., Alcohol)
A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following: – a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
– The characteristic withdrawal syndrome for alcohol
– Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
• Specifiers:
– Mild: Presence of 2-3 symptoms.
– Moderate: Presence of 4-5 symptoms.
– Severe: Presence of 6 or more symptoms.
– In early remission (3 to 12 months)
– In sustained remission (12 months or longer)
– In a controlled environment
-Top 3 commonly used drugs in North America
-Tobacco (about 25% of pop.)
Alcohol (about 15% of pop.)
-Marijuana (about 5% of population)
-Pathways to Drug Dependence
- Experimentation
- most often in a social context, feels like they can stop any time
- no loss of control
- Routine use
- Alternations to lifestyle and personal values
- Borrowing, pawning, theft, lying, manipulation
- May still believe they have control
- Addictions or Dependence
- Efforts centre on avoiding withdrawal symptoms
- life is centred on getting the drug
-Depressants – Depress CNS activity
- Alcohol
- Barbiturates
- Opiates
-Stimulates – Heighten CNS activity
- Amphetamines
- Cocaine
- Nicotine
-Hallucinogens – distort sensory perceptions (synesthesia, colors, sounds, textures)
- LSD
- Phencyclidine (PCP)
- Marijuana
-Inhalants
GABA effects
Tolerance text def
Is a state of physical habituation to a drug that with frequent use, more of the drug is needed to (higher dose) get the same effect
-Risk Factors for Alcoholism
- Gender
- rates about equal, but women start later and progress faster
- alcohol seems to go to women’s head faster
- Age
- Antisocial personality disorder
- Family History
- both heritable and modeling effects
- the best predictor of alcohol abuse
- inherit a predisposition
- Sociodemographic factors
- Lower SES and education, Aboriginal > non-Aboriginal
- The damaging effects of alcohol abuse vary across ethnic groups in Canada, likely because of different cultural constraints and biological tolerance of alcohol
• Alcohol-induced Persisting Amnestic Disorder (aka Korsakoff’s Syndrome)
– Confusion, disorientation, recent memory loss
– Malnutrition
– FASD –
alcohol is a teratogen which can affect cell development in the fetus
Addiction
Impaired control over the use of a chemical substance accompanied by physiological dependence
Physiological dependence
State of physical dependence on a drug in which the user’s body comes to depend on a steady supply
Psychological dependence
Reliance as one a substance although one may not be physiological dependent
What is a depressant ?
Drug that lowers the level of activity of the CNS
Psychological effects of alcohol
- may prevent good judgement
- makes people more relaxed and open, may saying something they will later regret
- perceiving events around them and their own behaviour
- can dampen sexual arousal, or ability to perform
- coordination, motor ability, speech
Physical health and alcohol
Affects virtually every organ in the body (heavy use)
- cancer
- clearly damages the liver
Alcohol induced persisting amnestic disorder (Korsakoff’s disorder)
Form of brain damage associated with chronic thiamine deficiency. The syndrome is associated with chronic alcoholism and characterized by memory loss, disorientation and the tendency to invent memories to replace lost ones (confabulation)
Weekly intake of alcohol limits
14 drinks for men and 9 for women
Barbiturates
Type of depressant drugs that are sometimes used to relieve anxiety or induce sleep but are highly addictive
Sedatives
Type of depressant drugs that reduce states of tension and restlessness and induce sleep
- mostly among middle aged adults
- synergistic effect with alcohol (approx. 4x)
- requires medically supervised withdrawal
Opiates
Types of depressant drugs with strong addictive properties that are derived from the opium poppy; provide a feeling of euphoria and relief form pain
-intense rush to feelings of satisfaction and lesser anxiety
Narcotics
Drugs, such as opiates, that are used for pain relief and treatment of insomnia, but which have a strong addictive potential
Analgesia
State of relief from pain without the loss of consciousness
Endorphins
Natural substance that function as neurotransmitters in the brain and are similar in their effects to morphine
Amphetamines
Types of synthetic stimulants such as Dexedrine and Benzedrine. Abuse can trigger amphetamine psychosis that mimics acute episodes of schizophrenia
Amphetamine psychosis
Psychotic state induced by the ingestion of amphetamines. Mimics features of schizophrenia
Cocaine
Stimulant derived from coca leaves
Freebasing
Method of ingesting cocaine by means of eating the drug with ether to separate its comments and then smoking the extract
hallucinogens
Substances that give revise to sensory distortions or hallucinations
Psychedelics
Class of drugs that induce sensory distortions or hallucinations
LSD
Lysergic acid diethylamide
Mechanisms of Overdose
1. Effective vs Toxic Dose (Primarily Physiological)
a. Tolerance to intoxicating effects to a drug and the lethal dose both increase over time
b. Tolerance builds more quickly
i. Over time the amount of drug necessary to produce the high gets closer and closer to the lethal dose level
ii. Neuroadaptation: brain changes that take place over time to compensate for presence of foreign chemicals
Mechanisms of Overdose
2. Compensatory Conditioning (Primarily Psychological)
a. Over the course of conditioning, a CS may elicit physiological CRs that oppose the US (compensatory CRs). These CSs include contextual cues present during conditioning
b. This contributes to withdrawal symptoms as well as tolerance
c. Siegal et al. (1982) suggested that a failure to elicit such responses might play a part in drug overdose
i. Phase 1 – Conditioning Trials
1. Three groups of rats were heroin addicted over 30 days. Three conditions: same room, different room, and control
2. Same and different room groups got heroin every 2nd day, and a saline infusion on odd days. Saline and heroin were given in different rooms
ii. Phase 2 – Test Day
1. Same room group: got a double dose of heroin in the room where heroin was usually delivered
2. Different room Group: got a double dose of heroin in the room where they usually got saline.
3. Control group: never had heroin before, but got a double dose
iii. Results
1. Same room – 32% mortality
2. Different room – 64% mortality
3. Control – 100% mortality
iv. Note: CSs (cues) for drug use will also frequently trigger cravings and withdrawal symptoms
-Factors that play a role in smoking in Canada
- the prevalence of smoking among adults is higher among Aboriginal than non, regardless of whether they live in rural or urban environments
- Smoking is becoming increasingly concentrated among the poorer and less well-educated segments of the population
Phencyclidine (PCP)
Also known as Angel Dust.
-classified as a Deliriant
Marijuana
Minor hallucinogen, THC,
Hashish
Drug derived from the resin of the marijuana plant
Inhalants
Substances that produce chemical vapors that are inhales for their psychoactive effect
-reinforcing through their effects on GABA and dopamine neurotransmitter systems
Biological Perspectives
- Neurotransmitters - domaine and the pleasure causing effects of drugs.
- Serotonin plays a role in activating the brain’s pleasure system
- endorphins
- Brain’s reward centres (mesolimbic pathways, nucleus acumbens)
Genetic Factors - alcoholism runs in families, about 3 to 4 times more likely to develop
- men are a mix of genetic and environmental and women is only environmental but not completely sure why
- genes that determine the structures of dopamine receptors in the brain can be inherited
- ability to rapidly metabolize alcohol
- can influence the degree of reinforcement obtained from consuming drugs/alcohol
Learning Perspective
- believe they are largely learned and can be unlearned
- Operant Conditioning - drug and alcohol use is reinforced such as social, approval, combat depression, anxiety and tension. It is learned, and can be unlearned
- relief from tension (alcohol- negative reinforcement)
- stimulants can be used to”self medicate” as they temporality alleviate feelings of depression and heighten mood
- based on negative reinforcement and so is withdrawal
- Cues may cause cravings (classical conditioning)
- stimulus smokers
- modeling (observational learning)
Cognitive Perspectives
- outcome expectancies, decisions making and substance abuse
- positive attitudes towards to drug increases the use in frequency and quantity
- weight the positive and negative outcomes when deciding
- self-efficacy expectancies
- thinking that it can help to accomplish a task, reduce stress, use in challenging situations
- shunts criticism
- does one slip cause people with substance abuse or dependence to go on binges?
- abstinence violation effect (attribution to stable internal factors)
- What you believe is what you get - self-fulfilling prophecy
- Amount consumed is influenced by expectation of alcohol
- actual alcohol content didn’t matter
Psychodynamic Perspectives
- oral-dependent personality since it is a oral behavior pattern, dependence, depression, all stem from oral fixation
- smoking is the same
Sociocultural Perspectives
- Cultural and religious factors play a role in drug and alcohol consumption
- church attendance
- social settings, peers
Pre-contemplation
No intention on changing behavior
Contemplation
Aware a problem exists but no commitment to action
Preparation
Intent on taking action to address the problem
Action
Active modification of behavior
Maintenance
Sustained change; new behavior replaces old
Relapse
Fall back into old patterns of behavior
Treatment - Biological Approaches
- Detox - process of ridding the system of alcohol/drugs under supervised conditions in which withdrawal symptoms can be monitored
- Disulfiram - discourages alcohol consumption because it produced the strong aversive effects of a hangover right away
- Antidepressants - shown promise in reduction of craving of cocaine following withdrawal but fail to be consistent for relapse. Disulfiram (Antabuse) has demonstrated the most consistent effect
- reduction of serotonin may underlie alcohol desires. Use serotonin re-uptake inhibitors show increases in alcohol use.
- Nicotine replacement Therapy - the patch
- methadne therapies - synthetic opiate, helps treat heroin addiction to avoid abstinence syndrome. Swapping one drug for another basically
- Naloxone and naltrexone - blocks the high from heroin and alcohol/opiates but has poor long-term compliance
Nonprofessional support groups
AA, NA, CA. Promote abstinence and provide members with an opportunity to discuss their feelings and experiences in a supportive group setting
Residential approaches
Stay in hospital or therapeutic residence
Psychodynamic approaches to treatment
- problems are rooted in childhood experiences
- until underlying conflicts are resolved, the problems will continue
Cognitive-Behavioral Treatment
- self-control strategies - focuses on helping the users develop skills they can use to change their abusive behavior. Cues or stimuli (antecedent), the behaviors and the consequences (ABC)
- Social skills training - develop skills to help in social situations that prompt substance use, fend off social pressure
- cue exposure training
- motivational enhancement therapy - help them realize that treatment is in their best interest, motivate them
Relapse-Prevention Training
• Pattern/high risk factor recognition • Predictability • Behaviours/thoughts/feelings • Chains of behavior/thoughts and feelings • Specific coping strategies • Escape/avoidance • Weekly “bring-backs” • SUDs • Abstinence Violation Effect -controlled social drinking - controversial, drinking moderate amounts in a social setting rather than total abstinence
Abstinence violation effect
Overreact to a lapse with feelings of guilt and a sense of resignation that may then trigger a full blown relapse
Harm Reduction
• Whereas most interventions aim to reduce or eliminate substance use entirely, the Harm Reduction approach attempts to mitigate the harmful consequences.
– Needle exchange programs
– Methadone programs
– Designated drivers
– Restrict use to weekends or other non-workdays
Other Addictive Disorders
problem gambling behaviour was considered an impulse control disorder in former editions of the DSM. In DSM-5, gambling disorder is classified with other substance sue disorders, Gambling disorder has commonalities in expression, causes, comorbidity, and treatment with substance use disorders
- The broader category, though not formally mentioned in DSM is process addictions
- partial exception is Internet Gaming Disorder (conditions for further study: in Appendix 3)
