CP: Lecture 9 Substance Use Disorders Flashcards
what is too much? medical approach
women > 7 units,
men > 14 units
+ physical consequences
sociological approach
problems or personal consequences
psychiatric approach
substance use disorder
typical addiction symptoms
loss of control
pre-occupation
craving
tolerance
withdrawal
in welke 3 domeinen kunnen deze symptomen opkomen
behaviour
cognition
physical
(ze kunnen allemaal in alle 3 de domeinen komen!)
dsm 5 substance abuse disorder
at least 2, during 12 months:
- The substance is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control use of the substance.
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
- Craving, or a strong desire or urge to use the substance.
- Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
- Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
- Recurrent use of the substance in situations in which it is physically hazardous.
- 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.
- 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. - 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).
dus dsm 5 kort SUD
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
dsm 5 gradaties van sud
2-3 symptoms: mild sud
4-5 symptoms: moderate sud
6+ symptoms: severe sud
12 month prevalence of alcohol addiction in usa vs china
usa = 7,7
china = 2,3
nl was heel laag, onder de 1
waardoor differences across countries in alcohol gebruik?
cultural differences: rituals, popularity, early vs late onset, definition of problems/function/distress
genetic differences: tolerance, dopamine reward
sad often comorbidity with…
anxiety and depression
voorbeeld ritual
carnaval
the earlier ppl drink…
the later on they will kep on drinking. dus earlier is meer in later life (maar niet altijd! denk aan usa vs nl)
vrouwen alcohol leeftijd in nl
hoe ouder, hoe meer drinken
door pensioen? meer geld? meer tijd?
history’s models of addiction
1850: moral
1920: pharmacological
1940: symptomatic
1950: illness
1975: learning (behaviouristic)
Late 70’s: social
1980: biopsychosocial
1990: brain disease
whether you become an addict depends on genetic predisposition -> disease of the brain or of choice?
weten we nog niet.
effects of calling it a disease..
- haalt blame weg, wat fijn is
- maar kan ook demotiverend zijn voor getting clean (want toch niet jouw schuld)
hoe lang moeten de symptomen present zijn voor dsm voor sud
12 month period
incentive sensitisation theory
- drugs/alcohol stimulate the reward system -> dopamine
- produces rewarding or desirable feeling
- dopamine system -> makes people more sensitive to the drug and drug related cues
- incentive salience to cues
- cue sensitivity: wanting the drug, often without really liking it
- wanting is increased, vs liking is decreased
dus welke theory bij addiction
the incentive sensation theory -> reward system that makes cues wanted (instead of liking)
what psycho process leads to motivation for use of substances
emotion regulation -> i feel bad and i want to feel better.
= emotion regulation, coping
tabel voor emotion regulation: internal en positive outcome
enhance positive mood
positive reinforcement
tabel voor emotion regulation: external and positive outcome
social rewards
positive reinforcement
tabel voor emotion regulation: internal and negative outcome
coping, reduce negative affect
negative reinforcement
tabel voor emotion regulation: external and negative outcome
avoid social rejection
negative reinforcement
check tabel in schrift
oke
addicts hebben vaak… wat voor soort motivation
coping! dus internal en negative outcome.
je hebt niet vaak enhancement drinkers (dus niet enhance positive mood, maar reduce the negative mood)
predictors of sud onset qua personaliteit
negative emotionality
neuroticism
desire for increased arousal and positive affect -> sensation seeking
low constraint (= impulsivity, low control)
sociocultural factors voor sud onset
hoe meer aanwezig, hoe meer gebruik (maar ook niet altijd, nl wiet)
advertising and media (countries than ban ads -> 16% minder consumption)
family factors for onset sud
parental alcohol use
marital discord
lack of emotional support
lack of parental monitoring
treatment gaat vooral over…
motivatie
wanneer is motivatie of hoe ontstaat het
door realising other things are more important, or major life event (scheiden als diegene niet stopt)
motivational interventions
- curb heavy drinking in college
- motivate for treatment
cognitive and behavioural treatments
- Contingency-Management (vouchers): reinforcing behaviours inconsistent with drinking/drug use.
- Relapse prevention
alcoholic anonymous
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
2 types of medications against alcohol abuse
- Nausea & vomiting if alcohol is consumed
* Antabuse (disulfiram) - Anti-craving / replacement
* Naltrexone: opiate antagonist
* Acamprosate
* Methadone: replaces craving for heroin
take home messages
- Many reasons for use and causes for addiction
- Dopamine very important
- Motivation is a precondition for change
- But motivation is not equal to control!
evt nog videos kijken van de slides?
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
