CP: Lecture 9 Substance Use Disorders

Question 1

what is too much? medical approach

Answer 1

women > 7 units,
men > 14 units

+ physical consequences

Question 2

sociological approach

Answer 2

problems or personal consequences

Question 3

psychiatric approach

Answer 3

substance use disorder

Question 4

typical addiction symptoms

Answer 4

loss of control
pre-occupation
craving
tolerance
withdrawal

Question 5

in welke 3 domeinen kunnen deze symptomen opkomen

Answer 5

behaviour
cognition
physical

(ze kunnen allemaal in alle 3 de domeinen komen!)

Question 6

dsm 5 substance abuse disorder

Answer 6

at least 2, during 12 months:

1. The substance 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 use of the substance.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
8. Recurrent use of the substance in situations in which it is physically hazardous.
9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
    a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
    b. A markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal, as manifested by either of the following:
    a. The characteristic withdrawal syndrome for other (or unknown) substance (refer to Criteria A and B of the criteria sets for other [or unknown] substance withdrawal).

Question 7

dus dsm 5 kort SUD

Answer 7

at least 2, during 12 months:

larger amounts or longer period of time than intended
persistent desire or unsucessful effort to quit
spent a lot of time in activities related to
craving
problems at work/school/home
continued use even after social/interpersonal problems
social/work/recreational activities are reduced due to substance
recurrent use in situations where it is not safe
use is continued even though there is a physical/psychological problem
tolerance: more needed or less effect of dosis
withdrawal: withdrawal syndrome or substance is taken to relief symptoms of withdrawal

Question 8

dsm 5 gradaties van sud

Answer 8

2-3 symptoms: mild sud
4-5 symptoms: moderate sud
6+ symptoms: severe sud

Question 9

12 month prevalence of alcohol addiction in usa vs china

Answer 9

usa = 7,7
china = 2,3

nl was heel laag, onder de 1

Question 10

waardoor differences across countries in alcohol gebruik?

Answer 10

cultural differences: rituals, popularity, early vs late onset, definition of problems/function/distress

genetic differences: tolerance, dopamine reward

Question 11

sad often comorbidity with…

Answer 11

anxiety and depression

Question 12

voorbeeld ritual

Answer 12

carnaval

Question 13

the earlier ppl drink…

Answer 13

the later on they will kep on drinking. dus earlier is meer in later life (maar niet altijd! denk aan usa vs nl)

Question 14

vrouwen alcohol leeftijd in nl

Answer 14

hoe ouder, hoe meer drinken

door pensioen? meer geld? meer tijd?

Question 15

history’s models of addiction

Answer 15

1850: moral
1920: pharmacological
1940: symptomatic
1950: illness
1975: learning (behaviouristic)
Late 70’s: social
1980: biopsychosocial
1990: brain disease

Question 16

whether you become an addict depends on genetic predisposition -> disease of the brain or of choice?

Answer 16

weten we nog niet.

Question 17

effects of calling it a disease..

Answer 17

• haalt blame weg, wat fijn is
• maar kan ook demotiverend zijn voor getting clean (want toch niet jouw schuld)

Question 18

hoe lang moeten de symptomen present zijn voor dsm voor sud

Answer 18

12 month period

Question 19

incentive sensitisation theory

Answer 19

1. drugs/alcohol stimulate the reward system -> dopamine
2. produces rewarding or desirable feeling
3. dopamine system -> makes people more sensitive to the drug and drug related cues
4. incentive salience to cues
5. cue sensitivity: wanting the drug, often without really liking it
6. wanting is increased, vs liking is decreased

Question 20

dus welke theory bij addiction

Answer 20

the incentive sensation theory -> reward system that makes cues wanted (instead of liking)

Question 21

what psycho process leads to motivation for use of substances

Answer 21

emotion regulation -> i feel bad and i want to feel better.

= emotion regulation, coping

Question 22

tabel voor emotion regulation: internal en positive outcome

Answer 22

enhance positive mood
positive reinforcement

Question 23

tabel voor emotion regulation: external and positive outcome

Answer 23

social rewards
positive reinforcement

Question 24

tabel voor emotion regulation: internal and negative outcome

Answer 24

coping, reduce negative affect
negative reinforcement

Question 25

tabel voor emotion regulation: external and negative outcome

Answer 25

avoid social rejection negative reinforcement

Question 26

check tabel in schrift

Answer 26

oke

Question 27

addicts hebben vaak... wat voor soort motivation

Answer 27

coping! dus internal en negative outcome. je hebt niet vaak enhancement drinkers (dus niet enhance positive mood, maar reduce the negative mood)

Question 28

predictors of sud onset qua personaliteit

Answer 28

negative emotionality neuroticism desire for increased arousal and positive affect -> sensation seeking low constraint (= impulsivity, low control)

Question 29

sociocultural factors voor sud onset

Answer 29

hoe meer aanwezig, hoe meer gebruik (maar ook niet altijd, nl wiet) advertising and media (countries than ban ads -> 16% minder consumption)

Question 30

family factors for onset sud

Answer 30

parental alcohol use marital discord lack of emotional support lack of parental monitoring

Question 31

treatment gaat vooral over...

Answer 31

motivatie

Question 32

wanneer is motivatie of hoe ontstaat het

Answer 32

door realising other things are more important, or major life event (scheiden als diegene niet stopt)

Question 33

motivational interventions

Answer 33

- curb heavy drinking in college - motivate for treatment

Question 34

cognitive and behavioural treatments

Answer 34

* Contingency-Management (vouchers): reinforcing behaviours inconsistent with drinking/drug use. * Relapse prevention

Question 35

alcoholic anonymous

Answer 35

Largest self-help group * Regular meetings provide support, understanding, and acceptance * 12 step program: e.g., admit powerless over alcohol, inventory and admitting wrongdoings, ask God for help. * Complete abstinence

Question 36

2 types of medications against alcohol abuse

Answer 36

1. Nausea & vomiting if alcohol is consumed * Antabuse (disulfiram) 2. Anti-craving / replacement * Naltrexone: opiate antagonist * Acamprosate * Methadone: replaces craving for heroin

Question 37

take home messages

Answer 37

* Many reasons for use and causes for addiction * Dopamine very important * Motivation is a precondition for change * But motivation is not equal to control!

Question 38

evt nog videos kijken van de slides?

Answer 38

is misschien wel handig!!! * Dr. Nora Volkow, disease model: https://www.youtube.com/watch?v=JH7zq0_VA9U * Critics on disease mode: Heyman: https://www.youtube.com/watch?v=jh0ZAUxuQSo * Stories of addiction: * Katie: https://www.youtube.com/watch?v=y0X1N6KNEyk * Sam: https://www.youtube.com/watch?v=i0lrZY_N2vg * Heroin withdrawal: https://www.youtube.com/watch?v=NaMgdlUcsko