Drug Abuse And Dependence Flashcards
The scale of the problem (5)
addiction, alcohol depen., opioid depen. + anxiety disorders = gone up to 150 billion euro/ year === very similar cost to cancer/CVD
worst mental health condition: 200 billion euro/ yr -> depression
alcohol - affects every single organ in your body
highest causes of prevantable death in uk
1= smoking
2= ???
3rd = Alcohol
opioid epidemic globally
What is drug addiction? (4)
A chronic relapsing disorder characterised by:
1) compulsion to seek and take the drug
2) loss of control in limiting intake
3) Emergence of a negative emotional state (dysphoria, anxiety, irritability) (WHEN DRUG IS NOT ON BOARD)
DSM-5 substance use disorder definition
A maladaptive pattern of substance use leading to clinically sig impairment or distress, as manifested by 2 or more of the following, occurring
Scale w/e.g.’s - Cannabis + Nicotine (6)
Cannabis:
-40-50% prevalance with a 3% usage at age 12
-Association with schizophrenia (Odds ratio 10): age/genetic risk
-Increasing consumption due to increased purity (3-20% THC)
E.g. Nicotine
->1 billion people worldwide
-14.4% of population in UK
-Cost of smoking to UK GOV £14billion/year (cost to NHS £2.6Billion a year)
-1 in 10 deaths are smoking related
Drug Harm: Lancet 2010 (4)
Analysed diff. DofA in relation to the harm to users, AND including social harm (harm to others)
= worst is alcohol
2nd: heroin
3rd: Cocaine
Factors Contributing
to Vulnerability to Develop Addiction: (3)
NEEDS A HOLISTIC APPROACH:
use of the drug of abuse essential(100%)
GENETIC - BIGGEST FACTOR (50-60%) - twins, GWAS etc (polymorphisms of several genes which make you addicted), epigenetic mutations (methylation or acetylation)
ENVIRONMENTAL(very high) - social, stress (trigger for relapse- 50% comorbidity of alcoholism + stress-induced disorders), socio-economic (deprived etc.)
DRUG-INDUCED EFFECTS(very high) - changes in the brain
MINORITY of ppl actually get addicted due to these factors + due to the DofA in q
Mental Health disorder comorbidity with Drug Addiction Facts (5)
- Prevalence in drug/alcohol services: 60-80%
- Emotional disorders key predictor of alcohol use
- Social anxiety disorders is severe in 60% of drug abusers seeking help
- It is accompanied by more severe symptoms, longer illness duration, higher service utilization and higher relapse rates
dual diagnosis: substance abuse + mental illness
Stages in addiction cycle Image (4)
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-works through POSITIVE reinforcement
-withdrawal+ protracted withdrawal: self medicate these symptoms
- # relapse: triggered w/ the memory of drug
- relapse: 7/10 heroin after a month + smoking
Stages in addiction cycle EXTRA points (5)
-Biggest hurdle: Maintenance of drug-free state as 70% relapse
-Current pharmacotherapy ineffective at maintaining this
-Physical withdrawal symptoms decrease over time whereas emotional withdrawal symptoms persist for months
-40% co morbidity between opioid addiction and anxiety, depression
-Impairment of social behaviour in heroin abstinent individuals
Tolerance Definition:
When a person’s reaction to a drug decreases such that larger doses are needed to achieve the same effect.
Dependence Definition + explained: (3)
An adaptive state that develops from repeated drug administration, and which results in the emergence of physical and emotional withdrawal symptoms upon cessation of drug use.
Physical, characterised by abstinence syndrome syndrome (LC)
** Sweating, gooseflesh (cold turkey), irritability,
Psychological, craving to avoid withdrawal effects
DIFFERENT TO ADDICTION
Psychiatric perspective on addiction (2)
image -
often described as : transition from positive reinforcement to negative reinforcement
OR
characterised as a transition from Impulse Control Disorder to Compulsive Disorder
Criteria for Substance Dependence
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