Chapter 7: Substance Related and Addictive Disorder Flashcards
Substance Use Disorders
patterns of maladaptive behavior involving the use of a psychoactive substance
Substance-Induced Disorders
disorders induced by the use of psychoactive substances, including intoxication, withdrawal symptoms, mood disorders, delirium, and amnesia
Psychoactive
describing chemical substances or drugs that have psychological effects
Intoxication
substance-induced disorder characterized by clinically significant problematic behavioral or psychological changes caused by the recent ingestion of a substance (state of drunkenness or “being high”)
Withdrawal Syndrome
characteristic cluster of withdrawal symptoms following the sudden reduction or abrupt cessation of use of a psychoactive substance after psychological dependence has developed
Tachycardia
abnormally rapid heartbeat
Delirium Tremens (DT)
withdrawal symptom that often occurs following a sudden decrease or cessation of drinking in chronic alcoholics that is characterized by extreme restlessness, sweating, dissociation, and hallucinations
Delirium
(1) a state of mental confusion, disorientation, and extreme difficulty in focusing attention
(2) a syndrome occurring among the elderly that typically involves confusion, problems with concentration, and cognitive dysfunction
Disorientation
state of mental confusion or lack of awareness with respect to time, place, or the identity of oneself or others
Addicition
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 on a substance, although one may not be physiologically dependent
Depressant
drug that lowers the level of activity of the central nervous system
Korsakoff’s Syndrome
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)
also called alcohol-induced persisting amnestic disorder
Barbiturates
types of depressant drugs that are sometimes used to relieve anxiety or induce sleep but that are highly addictive
Sedatives
types of depressant drugs that reduce states of tension and restlessness and induce sleep
Opiates
types of depressant drugs with strong addictive properties that are derived from the opium poppy
provide feelings of euphoria and relief from pain
Narcotics
drugs, such as opiates, that are used for pain relief and treatment of insomnia, but have strong addictive potential
Analgesia
state of relief from pain without loss of consciousness
Endorphins
natural substances 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 an amphetamine psychosis that mimics acute episodes of schizophrenia
Amphetamine Psychosis
psychotic state induced by ingestion of amphetamines
Cocaine
stimulant derived from coca leaves
Crack
hardened, smokable form of cocaine
Freebasing
method of ingesting cocaine by means of heating the drug with ether to separate its most potent component (“free base”) and then smoking the extract
Hallucinogens
substances that give rise to sensory distortions or hallucinations
Psychedelics
class of drugs that induce sensory distortions or hallucinations
also called hallucinogens
Lysergic Acid Diethylamide (LSD)
a powerful hallucinogenic drug
Flashbacks
(1) vivid re-experiencing of a past event, which may be difficult to distinguish from current reality
(2) experiences of sensory distortions or hallucinations occurring days or weeks after use of LSD or another hallucinogenic drug that mimic the drugs effects
Marijuana
a mild or minor hallucinogen derived from the Cannabis sativa plant
Delta-9-tetrahydrocannabinoid (THC)
major active ingredient in marijuana
Hashish
drug derived from the resin of the marijuana plant, Cannabis sativa
Inhalents
substances that produce chemical vapors that are inhaled for their psychoactive effect
Detoxification
process of ridding the system of alcohol or drugs under supervised conditions in which withdrawal symptoms can be monitored and controlled
Methadone
artificial narcotic that lacks the rush associated with heroin and is used to help people addicted to heroin abstain without incurring and abstinence disorder
Naloxone
drug that prevents users from becoming high if they subsequently take heroin
some people are placed on naloxone after being withdrawn from heroin to prevent return to heroin
Naltrexone
chemical cousin of naloxone that blocks the high from alcohol as well as opiates and is now approved for the use in treating alcoholism
Al-Anon
organization sponsoring support groups of family members of people with alcoholism
Cue-Exposure Training
treatment used for people with substance-related disorders
it involves exposure to cues associated with ingestion of drugs or alcoholic beverages in a controlled situation in which the person is prevented from using the drug
Relapse
recurrence of a problem behavior or disorder
Relapse-Prevention Training
cognitive-behavioral technique used in the treatment of addictive behaviors that involves the use of behavioral and cognitive strategies to resist temptations and prevent lapses from becoming relapses
Abstinence-Violation Effect (AVE)
tendency in people trying to maintain abstinence from a substance, such as alcohol or cigarettes, to overreact to a lapse with feelings of guilt and a sense of resignation that may then trigger a full-blown relapse
Controlled Social Drinking
controversial approach to treating problem drinkers in which the goal of treatment is the maintenance of controlled social drinking in moderate amounts, rather than total abstinence
What are substance use disorders?
patterns of maladaptive behavior involving the use of a psychoactive substances
substance-use disorders include substance-abuse disorders and substance dependence disorders
deals with the use itself
What are substance-induced disorders?
disorders induced by the use of psychoactive substances, including intoxication, withdrawal syndromes, mood disorders, delirium, and amnesia
What is gambling disorder?
problem gambling behavior was considered an impulse control disorder in former editions of the DSM
in DSM-5, gambling disorder is classified with other substance use 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 Gambling Disorder
legal problems: person being sued by credit card, “the reason I couldn’t pay is a diagnostic disease”, can be used as legal arguments
What are the hallmarks of disordered substance use?
tachycardia
delirium tremens (shaking, sweating, hypertension, hallucinations, give benzos as treatment)
delirium (alcohol poisoning)
disorientation
physiological dependence (addiction): tolerance, withdrawal
psychological dependence
“wet-brain”: intoxicated even though no recent alcohol consumption
What are the characteristics of substance use disorder (specifically alcohol) that are outlined in the DSM-5?
alcohol is often taken in larger amounts than intended
unsuccessful efforts to cut down or control use
a great deal of time is spent on activities related to alcohol
cravings
failure to fulfill major role obligations
persistent or recurrent social or interpersonal problems
activities are given up or reduced
physically hazardous
use is continued despite knowledge that it is harmful
tolerance
withdrawal
What is tolerance?
a need for markedly increased amounts of alcohol to achieve intoxication or desired effect
a markedly diminished effect with continued use of the same amount of alcohol
What is withdrawal?
the characteristic withdrawal syndrome for alcohol
alcohol (or a closely related substance, such as benzodiazepine) is taken to relieve or avoid withdrawal symptoms
What are the specifiers of substance use disorder?
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 a sustained remission (12 months or longer)
in a controlled environment (if they were in rehab we don’t know that they will keep sober in the real world)
What are the top three commonly used drugs in North America?
tobacco (about 25% of population)
alcohol (about 15% of population)
marijuana (about 5% of population)
What are the pathways to drug dependence?
experimentation: most often in a social context, no loss of control
routine use: alterations to lifestyle and personal values, borrowing, pawning, theft, lying, and manipulation, may still believe they have control
addiction or dependence: efforts center on avoiding withdrawal symptoms, life is centered on getting the drug
What are depessants?
“depress” CNS activity
alcohol
barbiturates
opiates
What are stimulants?
heighten CNS activity
amphetamines
cocaine
nicotine
What are hallucinogens?
distort sensory perceptions (e.g. synesthesia, colors, sounds, textures)
LSD
Phencyclidine (PCP)
marijuana
What are inhalants?
GABA effects
inhibitory, relaxation
What are the risk factors of alcoholism?
gender: rates about equal, but women start later and progress faster
age (starting before 40)
antisocial personality disorder
family history: both heritable and modeling effects
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
What is alcohol-induced persisting amnestic disorder (Korsakoff’s syndrome)?
“wet-brain”
confusion, disorientation, recent memory loss
malnutrition (inflammation of digestive tract)
FASD (fetal alcohol spectrum disorder)
Is there a health benefit to moderate drinking?
increases HDL
decreases clotting risk
</= 14 per week for men
</= 9 per week for women
now they are saying no more than 2/day either gender
What kinds of deaths are related to alcohol use?
snowmobile accidents: about 77% of cases
homicides: over 50% of cases
traffic accidents: over 40% of cases
boating accidents: about 40% of cases
suicides: over 20% of cases
What are barbiturates?
sedatives
mostly among middle ages adults
synergistic effect with alcohol (4x, two shots = eight shots)
requires medically supervised withdrawal, lethal withdrawal effects, high probability of relapse
What are opiates?
intense rush
narcotics
analgesics
endorphins
What are stimulants?
cocaine
amphetamines
What is cocaine?
snorted or injected
often consumed in binges
crack: for smoking, fast, concentrated rush
freebasing: heated with ether
What are the effects of cocaine?
birth defects: child will be addicted and have withdrawals
auditory information processing
sexual dysfunction (mostly males)
increased body temperature, respiratory distress, appetite suppression
What are the mechanisms of overdose?
effective vs toxic doses (primarily physiological)
compensatory conditioning (primarily psychological)
How do effective and toxic doses cause overdoses?
tolerance to intoxicating effects to a drug and the lethal dose
tolerance builds more quickly
over time, the amount of drug necessary to produce the high gets closer and closer to the lethal dose level
neuroadaption: brain changes that take place over time to compensate for presence of foreign chemicals, don’t react the same to the same dose
more you use, less likely to get high, but the lethal dose remains the same
How does compensatory conditioning cause overdoses?
over the course of conditioning, a CS may elicit physiological CRs that oppose the US (compensatory CRs)
these CSs may include contextual cues present during conditioning
e.g. cytochrome P450, the body wants to speed up metabolism to get rid of toxic materials
this contributed to withdrawal symptoms as well as tolerance, the body will produce enzymes in the area of regular drug use
compensatory conditioning: organism will compensate for something coming their way
How did the Siegel et al. (1982) study suggest that a failure to elicit such responses might play a part in drug overdose?
Phase 1 (conditioning trails): two groups of rats were heroin addicted over 30 days, conditions: same room, different rooms, same and different room groups got heroin every second day, and a saline infusion on odd days, saline and heroin were given in different rooms
Phase 2 (test day): same room group got a double dose of heroin in the room were heroin was usually delivered, different where they usually got saline, control group: never had heroin before but got a double dose
same room: 32% mortality
different room: 64% mortality
controls: 100% mortality
What are factors that play a role in cigarette smoking in Canada?
the prevalence of smoking among adults is higher among Aboriginal than non-Aboriginal people, 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
What are hallucinogens?
phencyclidine (PCP): angel dust, can become dangerous
marijuana: delta-9-terahydrocannabinol (THC), hashish, is more powerful in modern times because of selective breeding
inhalants: DA and GABA effects, sense of relaxation, solvents, gasoline, glue
What are the biological perspectives on substance use disorder?
neurotransmitters: dopamine, brain’s reward centers (mesolimbic pathway, nucleus), pleasure associated with the surroundings and behaviors that took place
genetic factors: addictions tend to run in families, addictive personality types
alcohol dehydrogenase: ability to metabolize alcohol, flushing, nausea, intoxication at lower doses
What are the learning perspectives on substance use disorder?
operant conditioning: alcohol and tension reduction, negative reinforcement and withdrawal, drinking alcohol takes away withdrawal symptoms which leads to negative reinforcement
the conditioning model of cravings, cues for substance use
observational learning: children pretend to drink after observing parents drink
What are the cognitive perspectives on substance use disorder?
outcome experiences, decision making and substance
self-efficacy expectancies
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: amount consumed is influenced by expectation of alcohol, actual alcohol content didn’t matter
What are the psychodynamic perspectives on substance use disorder?
oral fixation
What are the sociocultural perspectives on substance use disorder?
both cultural and subcultural (e.g. religion)
some religions ban alcohol
North American cultures glamorize alcohol
What are the states of change associated with recovery from substance abuse?
- pre-contemplation: no intention in changing behavior, don’t understand there is a problem
- contemplation: aware a problem exists but with no commitment to action
- preparation: intent on taking action to address the problem, know they need help, gather info on what to do
- action: active modification of behavior, therapy, meeting
- maintenance: sustained change, new behavior replaces old
- relapse: fall back into old patterns of behavior, not all or nothing
What are the biological approaches to the treatment of substance use disorder?
detoxification: medically supervised, need to be sober before other treatment can occur
disulfiram (Antabuse): take this, if they drink alcohol they get violently sick, get around the treatment by not taking the pills
antidepressants: SSRIs reduce impulsivity
nicotine replacement therapy: gum, inhalable, patches
methadone maintenance programs: safer, lesser of two evils
naloxone and naltrexone: block the high from opiates, poor long-term compliance
What are some general treatment approaches for substance use disorder?
nonprofessional support groups: Al-Anon, accountability, sometimes get a sponsor
residential approaches: lack generalization
psychodynamic approaches: don’t do anything
What are some behavioral approaches for the treatment of substance use disorder?
self-control strategies: control-breaking, learn to drink small amounts
aversive conditioning: don’t go to places associated with use
social skills training: electric shocks, noxious odor therapy, aversive conditioning, punishment, resisting peer pressure
What is relapse-prevention training?
involves dissecting behavior patterns and coming up with coping strategies (avoidance or escape strategies)
pattern/high risk factor recognition
predictability: build behavior chains into our life
weekly “bring-backs”
SUDs: seemingly unimportant decisions
abstinence violation effect
Is controlled drinking a viable treatment option?
can people with alcoholism be taught to engage in controlled social drinking?
original research done in the 70’s: not encouraging, improper control procedures were used
the contention that people with alcoholism can learn to drink moderately remains controversial, self-fulfilling prophecies
controlled drinking programs may represent one pathway to abstinence for people who would not otherwise enter abstinence-only treatment programs
What is the harm reduction model of treatment?
accept that there will be people who use, need to help reduce harmful effects to others
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
