Chapter 7: Substance Abuse Flashcards
The DSM uses what 2 major categories of substance-related disorders?
Substance Use disorder
Substance Induced Disorder
Substance use disorder
USE
Patterns of maladaptive behaviour involving the use of a psychoactive substance.
Includes Substance-abuse disorders and Substance dependence disorders
Substance-induced disorder
PRODUCE
Disorders induced by the use of psychoactive substances
i.e. intoxication, withdrawal syndromes, mood disorders, delirium, and amnesia
Substance use disorder is often characterized by what?
Physiological dependence
Hallmarks of Substance Abuse and dependence
Tolerance Withdrawal syndrome tachycardia delirium tremens (hallucinations/ restlessness/ disorientation) Delirium Disorientation Addition Physio dependence psychological dependance
Addiction
Impaired control over the use of a chemical substance accompanied by physiological dependence
Physiological dependence
State of physical dependence on a drug which the user’s body comes to depend on a steady supply
Psychological dependence
reliance on a substance, although one may not be physically dependent
CRAVINGS
Top three commonly used drugs in North American
Tobacco (25% of population)
Alcohol (15% of population)
Marijuana (5% of population)
Pathways to Drug Dependence
Experimentation Routine Use (denial, behaviours and values change, mood swings) Addiction or Dependence (powerless to the drug at tis point)
Depressants
ex. Alcohol
Alcohol risk factors
Gender: females and males (12 and 11%). Men start younger, females catch up
Age: start late adolescence (earlier you start the harder it is to stop)
Antisocial personality disorder
Family history: father who drinks, genetics
Sociodemographic factors: stressors, bad coping mechanisms, lower income/education, first nations
__% of homeless people will suffer from alcohol addition
26%
AA sees alcoholism as what?
As being a disease
Learning theorists see alcoholism as what?
As being a learned behaviour
Psychological effects of alcohol
Euphoria, relaxation, increased confidence
Physical health and alcohol
Alcohol-induced persisting amnestic Korsakoff's syndrome (thiamine deficiency, leads to amnesia, confabulation) higher rates of cancer ulcers hypertension gout
Is there a health benefit to moderate alcohol consumption?
Yes, but no more than 2 drinks a day have a protective impact on the heart (decrease BP, vasodilator)
Alcohol and ethnic diversity
Bad with First Nations
Jewish people have low alcohol related problems (children are exposed to the ritual use of wine in childhood and impose cultural restraints on excessive drinking
Asian people drink less heavily than other Canadians (less biological tolerance of alcohol and therefore have a greater flushing response)
Alcohol plays a role in deaths due to…
Snowmobile accidents (77%) Homicides (>50%) Traffic accidents (>40%) boating accidents (40%) suicides (>20%)
Barbiturates
Sedatives dangerous when mixed with alcohol effect for 3-6 hours very addictive reduce tension treat: epilepsy/high BP most popular street drug 1% Middle age females take it most often to help them sleep 4x more potent than alcohol significant withdrawal is sopped cold turkey
Opiates
Narcotics Analgesia Endorphins produces rush for 5-15 minutes euphoria for 3-5 hours ex. form poppy plant ex. Vicodin, Oxycontin are the most widely abused 0.7% of population abuses them Withdrawal is flu-like symptoms (increased HR and fever)
Stimulants
Amphetamines
Amphetamine Psychosis
Pill, crushed
suicide rates go up when you’re on the way down from the high
can cause withdrawal effects like insomnia, psychotic state like schizophrenia
Cocaine
- crack (more popular with adolescents)
- freebasing (power form)
effects - binge states (12-46 hours),
2-5 days coming down
withdrawal: depression
highly addictive!!!
Nicotine
Nicotine dependence
feel more alert
withdrawal symptoms: depression, weight gain, light headed, increased appetite, can’t concentrate, fever, sweating
20-24 years old
younger you are at the start the harder it is to stop
lots of health impacts: miscarriages, cancer
(90% of lung cancers caused by smoking >leading cause of women’s death (has surpassed breast cancer)
Hallucinogens
Psychedelics, LSD
Flashbacks
sensory deprivation, hallucinations, alter consciousness
withdrawal symptoms: anxiety and depression
unpredictable (can have a good or bad trip)
Factors for cigarette smoking in Canada
the prevalence of smoking among adults is higher among Aboriginals than non-Aborignials (regardless of whether they live in rural or urban environments)
Smoking is more common among the poorer and less educated segments of the population
Phencyclidine (PCP)
Angel Dust Anesthetic hallucinations readily available, inexpensive produces dissociations, delirium, paranoia, agitation, absent state
Marijuana
Delta-9-tetrahydrocannabinol (THC)
Hashish
5-6% of population, more common in males
18-30 year olds
low doses = relaxation
higher doses = more isolation > less ability to recall facts
Inhalants
adhesives, aerosols, cleaning fluids, markers, predice, euphoria unpredictable leads to death is inhale too mush impact memory and learning leads to illness
The proportion of Marijuana users in Canada is…
much higher among young adults than in the population as a whole
Gambling disorder
Impulse control disorder in former DSM editions
in DSM 5 gambling disorer is classified with other substance use disorders
has commonalities in expression, aetiology, comorbidity, and treatment with substance abuse disorders
Aetiology
aka Etiology
the study of causation/origination
Biological perspective
NTS
Brain’s reward centres
genetic factors
nicotine/alcohol/heroin/cocaine/marijuana all increase DA levels - impact brains natural DA production - can lead to psychotic state Cocaine - impacts 5HT levels of brain Heroin - effect endorphin levels
connected to brain’s reward pathway
genetic factors
- family members, alcohol, smoking = you are more likely to use
- monozygotic twins more likely!
Learning Perspective
Operant conditioning (trial and error, social influences) Alcohol and tension reduction (it's a short term solution but a long term problem) Negative reinforcement and withdrawal (keep abusing drugs to avoid withdrawal)
The conditional model of cravings
Observational learning
-what is your social network like?
- what is the environment?
- if you smoke at parties, then you’ll crave drug at parties
- CUES are very IMPORTANT
- treatment involved learning and recognizing the cues
Cognitive Perspective
What you believe is what you get
Outcome expectancies, decision making and substance
self efficacy expectations
does one slip cause people with substance abuse or dependence to go on binges?
Psychodynamic Perspectives
Stuck in oral fixation phase
Sociocultural perspectives
religious beliefs
Biological Approaches
Detoxification
Disulfiram
- no good > doesn’t alter your behaviour
- adverse side effects when taken with alcohol, to prevent alcohol consumption
Antidepressants (reduce cravings for cocaine)
Nicotine replacement therapy (the patch, gum)
Methadone maintenance programs
- methadone (prevents craving)
Naloxene and Naltrexone
- blocks high
- prevents craving
Treatment
Nonprofessional support groups
- AA
Residential approaches
Psychodynamic approaches
Behavioural approaches
Relapse prevention training
Behavioural approaches
Self control strategies
- limit opportunities to see cues
- resopnse prevention
control consequnnces
Aversive conditioning
- behavioural, pair it with an unpleasant thing
social skills training
Relapse prevention training
Relapse
Relapse-prevention training
Abstinence violation effect
Most habit forming drug?
Cocaine
Stages of change
see slide
Pre-contemplation
1: no intention to change, unaware of the problem
2: contemplation (aware the problem exists and serious evaluation of options but not committed to take action)
3: preparation (intends to take action, makes small changes, needs to set goals and priorities)
4: Action (dedicates time and energy, make overt/viable changes, developed strategies to deal with barriers
5: adaptation/maintenance
- works to adapt and adjust to facilitate maintenance of change
what stage is the person in?
not every client is going to be ready for the action stage, some times you just need them to accept their problem and begin to formulate plans
