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MD3002 > Drug and alcohol dependency > Flashcards

Drug and alcohol dependency Flashcards

1
Q

Define tolerance.

A

– Through habituation an individual develops a tolerance to the effects of a substance
i.e. with repeated administration more of the substance is required in order to achieve the same effects

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2
Q

What are the main kinds of withdrawal ? What are the main characteristics of each ?

A

– Physical withdrawals – can be fatal particularly in alcohol, seizures, death
– Psychological withdrawal state of anhedonia characterised by dysphoria, irritability, emotional distress

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3
Q

Define craving/compulsion.

A

– Powerful desire or urge

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4
Q

How are drugs classified ? Identify examples.

A

Based on their effects, or their chemical structure.
E.g.

Psychedelics (Heightened senses, visual or auditory hallucinations etc.)
Dissociative (Out of body, euphory, relaxed)
Opioids
Cannabinoids

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5
Q

How can we classify the extent of dependency ?

A

Based on DSM-5 criteria:

  • Hazardous use
  • Social/interpersonal problems related to use
  • Neglected major roles to use
  • Withdrawal
  • Tolerance
  • Used larger amounts/longer
  • Much time spent using
  • Physical/psychological problems related to use
  • Activities given up to use
  • Craving

DSM-5 Criteria: 2-3 = mild Substance Use Disorder, 4-5 = moderate SUD, >6 severe SUD

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6
Q

Identify the main models of substance misuse.

A

Mainly unidimensional:

  • Temperance
  • Moral
  • Disease
  • Medical
  • Psychodynamic
  • Socio-cultural
  • Systems and families
  • Learning theory

• Integrated theory

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7
Q

Describe the temperance model of substance misuse.

A
  • The drug is dangerous and causes the problems
  • Moderation is unreliable so the answer is prohibition..
  • ‘Once you start using, can’t stop…’
  • The drug takes control
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8
Q

Describe the moral model of substance misuse.

A

• People decide to use alcohol and other drugs based on social and/or religious norms
– Addiction is the result of weakness and defective character
– Biological basis of addiction is rejected – total responsibility is placed on the person
• So we need to help people make better decisions with education and deterrents
• ‘They can always choose not to use…’
• But social and religious norms change over time

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9
Q

Describe the Jellinek Curve of Addiction.

A

Phase 1: Progression (occasional relief drinking, then constant relief drinking, then increase of alcohol tolerance)
Phase 2: Crucial phase (Urgency of first drinks, feeling of guilt, efforts to control fail repeatedly)
Phase 3: Chronic phase (Impaired thinking, physical deterioration)
Phase 4: Rehabilitation (Honest desire for help, learns addiction is an illness, meets normal and happy former addicts)
Phase 5: Recovery (rebirth of ideals, rationalisations recognised, contentment in sobriety)

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10
Q

Describe the disease model of substance misuse.

A
  • Certain people have a specific physiological process off addiction which leads to a loss of control when the drug is used (i.e. activation of reward pathway by addictive drugs)
  • These people need to be identified and can not drink/use
  • ‘I have a disease…’
  • The individual has the responsibility of managing his/her disease but if use, then loss of control…
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11
Q

Describe the medical model of substance misuse.

A
  • A number of potential physiological medical factors have been considered which put the person at risk/more vulnerable to problems
  • Assess risk and address factors as possible
  • ‘Alcoholism runs in my family’
  • Again control is related to risk management
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12
Q

Describe the psychodynamic model of substance misuse.

A

• Alcohol and other drug problems are primarily related to psychodynamic factors such as early childhood experiences or trauma
– Addictive personality disorder/self medication
• People need psychotherapy to address
underlying issues
• ‘I have an addictive personality’
• Substance misuse as maladaptive coping

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13
Q

Describe the sociocultural model of substance misuse.

A

• A number of sociocultural factors have been identified which increase the risk of problems within a population
• Need to address these factors
• ‘Who wouldn’t have a problem living in my
neighbourhood…’
• Sociocultural factors seen as key

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14
Q

Describe the systems and family model of substance misuse.

A
  • Need to see alcohol and other drug use in relationship to the functioning of family and social systems
  • For people to change, need to consider relationships and change within the system
  • ‘You cant be sober and deal with my family…’
  • Much more difficult for a person to change because of system
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15
Q

Describe the learning model of substance misuse.

A
  • Alcohol and other drug use is learned behaviour
  • If a behaviour is learned it can be unlearned and new behaviour learned in its place
  • ‘I use Valium because I don’t know how else to get to sleep…’
  • The person is responsible for learning and practicing…
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16
Q

Distinguish between Pavlov and Skinner’s Conditioning models.

A

PAVLOV: CLASSICAL CONDITIONING (i.e. associative learning, any learning process in which a new response becomes associated with a particular stimulus such as smell)

SKINNER: OPERANT CONDITIONING (i.e. instrumental learning, reinforcement or punishment are used to either increase or decrease the probability that a behavior will occur again in the future)

17
Q

Describe the main principles of instrumental learning.

A

Reinforcement increases frequency of behavior (may be positive i.e. “ reward for doing something well” or negative i.e. “aversive stimulus (a ‘bad consequence’) is removed after a good behavior is exhibited”)

Punishment decreases frequency of behavior (may be positive, i.e. “adding an aversive consequence after an undesired behavior is emitted to decrease future responses”, or negative i.e. “taking away a certain reinforcing item after the undesired behavior happens in order to decrease future responses”)

18
Q

Identify the main aspects of psychological theories to consider in the context of substance misuse.

A
  • CHOICE – a person often chooses to engage in addictive behaviour as a result of a cost benefit analysis of the alternatives (may be influenced by biases and changing preferences)
  • COMPULSION AND SELF-CONTROL – a person sometimes sincerely chooses to refrain from a behaviour but fails to enact their choice
  • LEARNING MECHANISMS – sometimes behaviour results from a habit with little conscious decision-making, and certain behaviours come to be valued out of proportion to the benefits they bring
19
Q

Describe the integrated theory of substance misuse.

A

• PRIME theory – ‘a synthetic theory of addiction’

Based on a multifaceted theory of motivation
• Takes into account the biological, psychological
and social elements
• Encompasses varying forms of addiction
• Notes that addiction is related to other behaviours where strong desires/ motivation overtake reason

20
Q

Identify the main categories of factors which are involved in substance misuse.

A
  • PRESENTING
  • PREDISPOSING (e.g. ACEs)
  • PRECIPITATING
  • PERPETUATING
  • PROTECTIVE

Examples of the middle three:

  • Family (relationships)
  • Social (financial housing, employment, debts, schooling and upbringing, offending behavior)
  • Legal (forensic implications)
  • Physical (genetic, medical, direct and indirect, psychological)
21
Q

Identify examples of Adverse Childhood Experiences.

A

Abuse (physical, sexual, emotional)
Neglect (physical, emotional)
Household difficulties (mental illness, incarcerated relative, substance abuse, mother treated violently, parental separation)

22
Q

How much more likely are people with 4+ ACEs to be a high risk drinker ?

A

4 times

23
Q

Read this scenario, and identify the main prediposing, precipitating, and perpetuating factors.

• James 34 year old released from prison – opioid dependent
• Father alcohol dependent, violent left when James was 5 years old
• Mother single handed raised James’ younger siblings. Mother suffered with depression and committed suicide 2 years ago
• Disruptive behaviour at school – PRU left aged 14
• Antisocial drinking, multiple offenses initially petty
• Joined gang and was a runner for them and arrested for supply
• Was in RTA – close friend died – from recreational heroin inh started injected
• 3 custodial sentences
• Unable to hold down work was in a 2 year relationship has a 5 year
old but no contact
• Homeless
• Hepatitis C

A

PREDISPOSING
Biological: Genetic – father alcoholism, mother mental health problems
Psychological: Schooling + Upbringing
Social: Schooling + Upbringing

PRECIPITATING
Biological: Drug and Alcohol use
Psychological: Personality difficulties + PTSD
Social: Unemployment + Offending behaviour +
NFA

PERPETUATING
Biological: Hepatitis, active drug use
Psychological: No contact with son
Social: NFA

24
Q

Read this scenario, and describe the a) risk assessment, and management and treatment in the b) short term and c) long term.

• James 34 year old released from prison – opioid dependent
• Father alcohol dependent, violent left when James was 5 years old
• Mother single handed raised James’ younger siblings. Mother suffered with depression and committed suicide 2 years ago
• Disruptive behaviour at school – PRU left aged 14
• Antisocial drinking, multiple offenses initially petty
• Joined gang and was a runner for them and arrested for supply
• Was in RTA – close friend died – from recreational heroin inh started injected
• 3 custodial sentences
• Unable to hold down work was in a 2 year relationship has a 5 year
old but no contact
• Homeless
• Hepatitis C

A

RISK ASSESSMENT
Biological: Harm minimisation (e.g. needle distribution programmes) + Prescribing (e.g. in order to stabilise, and prevent withdrawal, alcohol withdrawal especially bad)
Psychological: Factors leading to relapse
Social: Needs assessment (sometimes, people forced into dependency (e.g. sex workers))

SHORT TERM
Biological: Prescribing in a Recovery context
Psychological: Strength and resilience building + Recovery
Social: Unemployment + Offending behaviour + NFA

LONG TERM
Biological: Hepatitis treatment + Assisted withdrawal (so prescription)
Psychological: No contact with son + mental health management and treatment
Social: Recovery

MD3002 (95 decks)

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