Class 5 Flashcards
Why Do People Abuse Drugs?
Drugs of Abuse Engage Motivation and Pleasure Pathways of the Brain.
Stress Reduction
To Feel Good To have novel: feelings, sensations, experiences AND to share them.
To Feel Better To lessen: anxiety, worries, fears, depression, hopelessness.
Natural rewards ??? DA levels but drugs
elevate, are mon effective
What is Addiction?
Addiction is A Brain Disease
Characterized by:
Compulsive behavior or craving
Continued abuse of drugs despite negative consequences
Persistent changes in the brains structure and function
True or false, addiction can change biology
true
Biologic changes following addiction
Decreased Brain Metabolism
Decreased DA transporters
Induced suppression of brain activity (ROH, cocaine)
– changes in neurotransmitter levels
– decreased dopamine D2 receptors
– low activity in the orbitofrontal cortex (OFC) and the
anterior cingulate gyrus (CG)
– inhibition of the frontal cortex – effects on memory,
decision making, inhibitory control, poor judgement,
planning and behavioural control
Hallmark of addiction
loss of control of the use of substance
compulsive use or craving
continued use despite consequences
Misuse
Use of medication other than as directed, whether
wilful or not.
Similar to abuse but usually applies to drugs prescribed by physicians that are then used improperly.
Abuse
Maladaptive pattern of substance use leading to
clinical impairment or distress.
Use of medication for non medical purposes.
Use of any drug, usually by self administration, in a
manner that deviates from approved social or medical
patterns.
Withdrawal
A substance specific syndrome that occurs after
stopping or reducing the amount of the drug or
substance that has been used regularly over a
prolonged period. This syndrome is characterized
by physiological signs and symptoms in addition to
psychological changes such as disturbances in
thinking, feeling, and behaviour.
Intoxication
A reversible syndrome caused by a specific
substance that affects one or more of the following
mental functions.
DSM 5 Definitions
Substance use disorder
A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by 2 or more of the following (11 symptoms) occurring
within a 12 month period:
- Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
- Recurrent substance use in situations in which it is physically hazardous.
- Continued substance use despite having persistent and recurrent social or interpersonal problems caused or
exacerbated by the effects of the substance. - Tolerance: Need increased amounts to achieve intoxication. Diminished effect with continued use
- Withdrawal
- Substance is often taken in larger amounts or over a longer period than was intended
- Persistent desire or unsuccessful efforts to cut down or control substance use
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
- Important social, occupational, or recreational activities are given up or reduced because of substance use.
- The substance use is continued despite knowledge of having persistent or recurrent physical or physiological problem that is likely to have been caused or exacerbated by the substance.
- Craving or a strong desire to use a specific substance.
Severity: Depends on the number of symptoms Mild: 2 3 Moderate: 4 5 Severe: 6 or more
Specifiers:
In early remission: no criteria for more than 3 months
but less than 12
In sustained remission: no criteria for more than 12
months
In a controlled environment
10 Classes of Substances
Alcohol Caffeine Cannabis Hallucinogens: PCP, others Inhalants Opioids Sedatives, hypnotics, and anxiolytics Stimulants Tobacco Other (Gambling)
Etiology
Bio: Genetics Neurotransmitters Signaling pathways Psycho: Psychodynamic Learning and conditioning: the addiction cycle Social
Major neurotransmitter systems:
Dopamine: activates the reward system/triggers
GABA: indirect activation of reward system
Glutamate: reinforcement, relapse, and drug seeking
Brain reward circuitry
Nucleus accumbens Locus ceruleus Prefrontal cortex Amygdala Hippocampus
Drugs of abuse ????
natural neurotransmitters in the brain
resemble/activate or disrupt
Dopamine Pathways Functions
- attention, arousal
- reward (motivation)
- motor function
- decision making
Serotonin Pathways Functions
- mood
- memory processing
- sleep
- cognition
Psycho : Addiction cycle
emotional pain = craving for relief = preoccupation with substance/ behaviour = substance use/ compulsive behaviour = short term pain relief = negative consequences resulting from behaviour = depression, guilt, shame =more pain
Social : Addiction
Family Peers Societal Cultural Life events Stress Isolation
Predisposing Factors
Biological factors: Genetic, 10% addicts have genetic predisposition. Familial
Psychosocial: Being a male Peer pressure Religion Home conditions Stability of parents’ marriage Cultural practices
Precipitating factors
Exposure to drink or drugs for social and other
reasons
Perpetuating factors
Persistent exposure
Lack of treatment
Lack of social support
Protective Factors
female gender assertiveness high commitment to school high educational aspirations close affective relationships absence of parental problems high religiosity close supportive relationships with positive influencing peers high self esteem self efficiency creativity good temperament high sociability
Indirect stimulation of pleasure pathways: decrease background
PCP, ketamin
Indirect stimulation of pleasure pathways: increase signal intensity
psychadelics
direct interaction with pleasure pathways: primary DA effect
stimulants
direct interaction with pleasure pathways: primary endorphin effect
opioids
direct interaction with pleasure pathways: DA + GABA + endorphins
sedative hypnotics
ROH
only ??? in 10 person with addiction receives treatment
1
Psychosocial therapies
Motivational Cognitive behavioral Community reinforcement Contingency management Behavioral couples family
NIDA: Selected Principles of Effective Treatment (EBPs)
- Addiction is a complex but treatable disease that affects brain function and behavior.
- No single treatment is appropriate for everyone.
- Treatment needs to be readily available.
- Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
- Counselling individual and/or group and other behavioural therapies are the most commonly used forms of drug abuse treatment.
- Many drug addicted individuals also have other mental disorders.
- Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long term drug abuse.
- Treatment does not need to be voluntary to be effective.
- Treatment programs should assess patients for the presence of HIV/ AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.
Scientifically Based Approaches
to Addiction Treatment
Cognitive behavioral interventions Community reinforcement Motivational enhancement therapy 12 step facilitation Contingency management Pharmacological therapies Relapse Prevention
True or false: Relapse Rates Are Similar to
Other Chronic Diseases
True
Management: screening
Clinical assessment: Don t forget, patients usually under report their use or sometimes downright lie about their use CAGE Screening questionnaires: DAST AUDIT
CAGE
Have you ever felt you should c ut down on your drinking?
Have people a nnoyed you by criticising your drinking?
Have you ever felt bad or g uilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get
rid of a hangover ( e ye opener)?
Stages of transtheoretical model of changes:
Precomtemplation Contemplation Decision Action Maintenance Relapse
Precomtemplation
Not a problem
Intervention: raise doubt
Contemplation
a problem that maybe needs to change
Intervention: strengthen the will to change
