Exam #1 Flashcards
Substance addiction (define)
repetitive, pathological intake of a drug or food
- May involve exogenous ligand
Behavioral addiction (process addiction) (define):
Repetitive, pathological engagement in behaviors that do not involve ingestion.
- May alter endogenous ligand function
What drugs are we referring to?
They cross the blood-brain barrier
- Antibiotics? (NOO!!)
Defining an Addiction: Specifics
- “Rush” effect, appetitive effect
-Not a consistent, slower deliberate tempo
-May involve any number of behaviors (not just drugs)
-Changes arousal levels, affect, or cognition; different experience of self in the moment
-Interferes with reflective processing - Time-intensive repetition to achieve satiation
-Temporary period where things are fine
-Engagement may or may not be context-appropriate (studying for finals buzz) - Intense behavioral or cognitive preoccupation (“I need myxxx!”)
-Often not step-by-step, deliberate processing - Loss of control
-Given demands of a context (pushes and pulls)
-Pushes-stress
-Pulls-seduction - Negative consequences (e.g.: social complaints)
-Ignoring longer-term gains decisions
-Tendency to try to minimize negative consequences
Drug use
metabolism
- Administration/absorption (from intake to bloodstream (oral, smoking/inhalation, injection, skin surfaces))
- Distribution from bloodstream to brain receptors (if small molecule size, molecular structure fit, fat solubility, weak PH, blood flow)
-Distribution half life=half of reach to site of action
–Nicotine and marijuana — 9 minutes - Metabolism (brain action and breakdown)
- Elimination (excretion of drug metabolites from the body - sweat, waste products, hair)
-Elimination half life = half metabolized and ready for excretion
-Nicotine—2 hours
-Marijuana – 28 to 56 hours on a single dose
what is potentiating effect (Drug interaction Effects)
Potentiating (0 + 1 = 3)
– [antihistamine and narcotic or
alcohol effects]
-Example: Prof. Sussman took drugs/medicine->didnt feel an effect->drank vodka->uncontrollably threw up
How many categories in Sussman/Ames (2001, 2008, 2017) behavioral
scheme?
8 categories
Depressants example (category #1 in Sussman/Ames (2001, 2008, 2017) behavioral
scheme
DXM (dextromethorphan - for coughs)
Inhalants example (category #1 in Sussman/Ames (2001, 2008, 2017) behavioral
scheme
4 types: solvents (glue), aerosols (gasoline), amyl/butyl/isobutyl nitrites (poppers), anesthetics (nitrous oxide)
Stimulants example (category #1 in Sussman/Ames (2001, 2008, 2017) behavioral
scheme
MDMA (3,4-methylenedioxymethamphetamine)
Opiates example (category #1 in Sussman/Ames (2001, 2008, 2017) behavioral
scheme
fentanyl
Hallucinogens example (category #1 in Sussman/Ames (2001, 2008, 2017) behavioral
scheme
a) serotonin-like = LSD
b) catecholamine-like = mescaline
c) anticholinergic antagonists = belladonna
Cannabis is a category in Sussman/Ames (2001, 2008, 2017) behavioral
scheme (T/F)
True
Other drug example (category #1 in Sussman/Ames (2001, 2008, 2017) behavioral
scheme
- GHB [ Gamma-hydroxybutyrate]
- ketamine[dissociative anesthesia]
DA:
DA-novelty impact
The single addictions (Patterns of Addictions)
43% of population in a 12-month period
Concurrent Additions (Patterns of Addictions)
23% of those addicted
(E.g.: “speed ball” (cocaine with heroin/morphine), smoking with drinking, drinking with eating or gambling, love with sex)
Substitute (Replacement) (Patterns of Addictions)
(Quit alcohol, then smoke; quit heroin, then use marijuana
-Almost no research on this topic)
Marijuana: (World prevalence of addictions)
2.5%(note that 20-30% of world tries it)
Add on overeaters, gambling, sex, love, internet, shopping, workaholism, exercise): find that (BLANK) of the U.S. adult population has a serious problem with one of 11 addictions in a 12-month period
46%
Other drugs: (World prevalence of addictions)
1.7%
Stimulants: (World prevalence of addictions)
0.5%
Opioids/Cocaine: (World prevalence of addictions)
0.3% [0.5% when legal]
Alcohol: (World prevalence of addictions)
10%
Tobacco as sole drug-of-choice (DOC): (World prevalence of addictions)
15%
Tobacco, Alcohol, or Other Drug Use (controlling for overlap)
(World prevalence of addictions)
30%
Drug Misuse
and the Harm
Dysfunction
(HD)
Perspective
MAYBE WE SHOULD GIVE DRUG MISUSE A MORE STRICT-RESTRICTIVE DEFINITION
- Harm-damage to self or others (social, legal, danger, role)
- Dysfunction-Inability to function normally without drug (physiological), with craving
(psychological)
– Using HD criteria lowers alcoholism prevalence from 10% to 5% of U.S. adult
population
* May control for “emerging adults” who grow out of it
– Can the HD Perspective apply to other behaviors?
Drug Misuse (define)
Definition involves NOT using a drug as:
-appropriate (e.g., alcohol binge),
-directed (e.g., over the counter meds (OTC)
-or prescribed (e.g., Oxy fun)
How many ER visits are due to ATOD misuse?
25-40% alcohol plus other drugs (such as pills)
How many fatally impaired drivers-alcohol (Fatal Car Accidents and relapse)
48%/50%
What is the relapse rate for a single attempt at abstinence from ATOD misuse?
65% to 80%
Only about (blank-blank%) of costs of drug abuse are adjudication-related
20-25%
How much violence is drug-related?
35-50%
How many accidents are drug-related?
40-50%
Universal Negative “Consequences” of Substance and Behavioral Addictions!
(Applies to most/all addictions)
- Unusual thinking (e.g.: psychotic reactions with drugs)
-Withdrawal-like (craving, irritability, concentrations)
Addiction-specific Consequences
(i.e., applies to some addictions, not others)
- Financial (e.g., gambling, shopping)
[Loses a round while gambling, losing money, but continues because they are convinced they will win the money back]
-Accidents (ATOD)
What was the first drug?
(History of drug use and abuse)
mead (honey wine) and palm wine
1900 cocaine/heroin legal: 0.5% of U.S. addicted; now it is 0.3%; 40% reduction but impacts many more people (T/F)
True
Dependence (graph)
Lethality
all categories in Sussman/Ames (2001, 2008, 2017) behavioral
scheme
Depressants, PCP, Inhalants, Stimulants, Opiates, Hallucinogens, Cannabis, Other drugs
Schedule #1: Drug Enforcement Administration (DEA)-schedules
(based on “accepted” medical use and potential for abuse)
drug has no current accepted medical use, high potential for abuse
- GHB
-LSD
-Marijuana
Schedule #2: Drug Enforcement Administration (DEA)-schedules
(based on “accepted” medical use and potential for abuse)
drug has current accepted medical use, high potential for abuse
-methamphetamine (speed)
Schedule #3: Drug Enforcement Administration (DEA)-schedules
(based on “accepted” medical use and potential for abuse)
drug has current accepted medical use, medium potential for abuse
-Marinol
Schedule #4: Drug Enforcement Administration (DEA)-schedules
(based on “accepted” medical use and potential for abuse)
drug has current accepted medical use, low potential for abuse
- Rohypnol
Schedule #5: Drug Enforcement Administration (DEA)-schedules
(based on “accepted” medical use and potential for abuse)
drug has current accepted medical use, lowest potential for abuse
-Robitussin AC
Substance abuse: (DSM-IV (1994-2013): Drug use-to-dependence continuum)
a DSM-IV disorder involving recurrent drug use over a 12-month
period and involving 1 or more of 4 criteria
- Failure to fulfill role obligations
- Hazardous use (physical danger)
- Legal problems (dropped in DSM-V)
- Social problems
Substance dependence (DSM-IV (1994-2013): Drug use-to-dependence continuum)
a more “severe” DSM-IV disorder involving 3 or more of 7 criteria:
- Tolerance
- Withdrawal
- Use more than intended
- Desire, but inability, to quit or cut down
- Consumes life (takes up a lot of time)
- Other activities are neglected or given up
- Use results in negative consequences, but still u
DSM-V: created one disorder with 11 criteria; deleted legal consequences as a
criterion; added cravings as a criterion (T/F)
True
DSM-V Substance Use Disorders-2013
Legal consequences is out, craving is in SAD and SDD are combined (is “prevalence” going up due to newer criteria?) (Highlighted)
- Use more than intended
- Desire, but inability, to quit or cut down
- Consumes life (takes up a lot of time)
- Craving, a strong desire to use
- Failure to fulfill role obligations
- Continued use despite related social problems
- Other activities are neglected or given up
- Hazardous use (physical danger)
- Continued use despite related pychological or physical problems
- Tolerance
- Withdrawal
DSM-V Gambling Disorder-2013
4 or more of the following, recurrent behavior, last 12
months
1. More money gambled to get desired excitement
2. Restless or irritable when try to quit or cut down
3. Repeated unsuccessful efforts to control, cut
back or stop
4. Preoccupied with gambling
5. Often gambles when feeling distressed
6. “Chases” losses (highlighted)
7. Lies to conceal extent of involvement (highlighted)
8. Jeopardized or lost relationship, job, opportunity because of gambling
9. Relies on others to provide money to relieve related debt (highlighted)
WHO (ICD) Diagnostic Scheme
1) Harmful use – physical or mental
2.) Dependence syndrome
The 12-Step Focus
- 12-step programs are not focused on
DSM-like consequences so much, or ICD
physical/mental harm - AA/NA focuses more on what precedes
the first drink or drug - Implicit cognition that may lead to
drinking (“stinking thinking”)
What are street drugs? (Terms used to describe dangerous drugs (it’s complicated)
know the context of their
use
Two hallmark symptoms (even in behavioral addiction: (withdrawal symptoms)
- Difficulty concentrating
- Irritability
Dual diagnosis: (define)
co-occurring drug and psychiatric
problems (conditional probabilities)
If drug problem, then (BLANK) have a mental health problem
20%
If mental health problem, then (BLANK) have a drug problem
40%
(Substance abuse: teens versus adults)
- High-risk situations differ (not a parent)
- Rates of dual diagnosis higher among teens
Should marijuana be illegal?
Health risks such as addiction and lung lining damage (smoked)
Should marijuana be legal?
- Demand for marijuana is (somewhat) inelastic as a function of law
– Can be regulated and harm-reduced
– Most marijuana users don’t move on to harder drugs
– Government tax revenue source
– Source of revenue to aspiring business people
– Decreases enforcement costs
– Alcohol is legal
– Free will
– Encourages research on medical effects and harms (May be useful for chronic pain, nausea, sleep disorders, anxiety)
– Maybe a means of harm reduction (less alcohol, opiate, and meth use but more tobacco use
Disease (Basic Outcomes Concepts)
pathological response of bodily structure/system to internal or external factors;
somatic phenomena; alteration of the normal state that impairs performance of vital
functions; generally, not due to an external immediate injury (e.g., heart disease, flu)
-Acute-chronic; infectious-noninfectious: addiction as chronic noninfectio
Disorder (Basic Outcomes Concepts)
Disruption to regular bodily structure and function, which may reflect a disease,
but less restrictive in intent, less definitive (e.g., Substance Use Disorder).
Syndrome (Basic Outcomes Concepts)
Collection of signs and symptoms associated with a cause, that may suggest a
disease (e.g., Down’s Syndrome)
Condition (Basic Outcomes Concepts)
Abnormal state of health that interferes with activities/feelings of wellbeing/least
specific, morbidity (e.g., acne, acidity, allergy, sickly
Highlighted:
-Intentional definitions (rule-based, causal story-based): Poison or flu -> fever
– Extensional definitions (listing-type, social constructivism): the DSM-V criteria
Addicts have been considered immoral or weak-willed (even in DSM-I [1952]) (Is Drug Abuse a Disease?)
– Addicts used to be the domain of courts or religion (T/F)
True
Does AA believe drug abuse is a disease (abstinence goal)? (Is Drug Abuse a Disease?)
yes
Most professional organizations: (Is drug abuse a disease?)
brain disease
Relapse rates during first attempt at quitting are: (Is Drug Abuse a Disease?)
75-80%
Is addiction voluntary? (Is Drug Abuse a Disease?)
No
May genetics be involved? (Is Drug Abuse a Disease?)
Yes
Does drug abuse impair functioning? (Is Drug Abuse a Disease?)
Yes
Is this an argument to “is drug abuse a disease?”: Insurance payment justification
Yes
Cons viewing drug abuse as a disease
- Difficult to distinguish factors (causes of disease) from symptoms
(e.g., high temperature—poison
-Context/culturally defined in part (e.g., being drunk at a funeral
-May limit treatment options (moderation? self-help?)
-Stigma is reduced very little
HIGHLIGHTED:
Review: Extensional definition (listing the set; member of set, family
resemblance)
– DSM-V criteria utilize the extensional definition, which may include different entities
within one net.
- Intentional definition (rule-based: exposure, mediation, outcome
Six Main Types of Assessment
- Mental Status Exam
- Structured Clinical Interview for the Diagnostic Statistical Manual V (SCID-V)-decision trees, clinical exploration (formal diagnosis)
Key “Screeners” of Alcohol or Drug Abuse
CAGE; CRAFT test ((car, relax, alone, forget, family or friends complain, trouble), derived from RAFFT)
Describe CRAFFT
Part A: During the PAST 12 MONTHS, did you: No Yes
1. Drink any alcohol (more than a few sips)? (Do not count sips of alcohol taken during family or
religious events.)
2. Smoke any marijuana or hashish?
3. Use anything else to get high?
(“anything else” includes illegal drugs, over the counter and prescription drugs, and things that you sniff or “huff”)
Part B: CRAFFT No Yes
1. Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been
using alcohol or drugs?
2. Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
3. Do you ever use alcohol or drugs while you are by yourself, or ALONE?
4. Do you ever FORGET things you did while using alcohol or drugs?
5. Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
6. Have you ever gotten into TROUBLE while you were using alcohol or drugs?
Structured assessments of adult drug
Chemical Dependency Assessment Profile (CDAP)
Chemical Dependency Assessment Profile (CDAP)
235-item (true/false) self-report questionnaire; substance use, dependence problems, and treatment needs among adolescents and adults; quantity/frequency of use; physiological symptoms; situational stressors;
antisocial behaviors; interpersonal problems; affective dysfunction
Other popular assessments used with adults
- Michigan Alcohol Screening Test (MAST)
- Alcohol Use Inventory (AUI)
- MacAndrew Alcoholism Scale (MAC-R)
- Addiction Severity Index (ASI)
- Drug Use Screening Inventory (DUSI)
Michigan Alcohol Screening Test (MAST)
25-item self-report of early, middle, or
late-stage impairment. A 10-item Brief MAST exists.
Alcohol Use Inventory (AUI)
228-item multiple-choice self-report; 24 subscales with 17 primary scales grouped via (1) benefits from drinking, (2) drinking styles,
(3) drinking consequences, and (4) concerns about a drinking problem
-Three general profiles: low impairment (later onset, social, married, work, lower level of use),
medium impairment, high impairment
MacAndrew Alcoholism Scale (MAC-R)
49 item self-report from MMPI. Not good
for type of use, gender differences. Not developed specifically as a measure of
drug abuse
Addiction Severity Index (ASI)
Structured interview of problem areas due to drug use (medical, legal, alcohol use, drug use, employment, family, mental health
Drug Use Screening Inventory (DUSI)
Self-report of problem areas (drug use,
mental and physical health, behavior, family, peers, work, school, social skills,
leisure
Likelihood of becoming a controlled
drinker as a function of MAST score: 9+ score=
0% (Neglect obligations, DTs)
Structured assessments of teen drug use
Personal Experience Inventory (PEI)
Personal Experience Inventory (PEI)
276-item self-report questionnaire designed to detect problem consequences and potential risk factors believed to predispose youth to substance use
Level of involvement with a variety of drugs; severity of problems in personal, family & psychosocial domains
Problem Consequences Subscale of the
Personal Experience Inventory (PEI-PCS)
In the last 12 months:
1.Have you taken or sold things that weren’t yours to get or pay for alcohol or other drugs?
* Yes No
2.Have you done personal favors for people to get or pay for alcohol or other drugs?
* Yes No
3.Have you had an accident or been injured due to using alcohol or other drugs?
* Yes No
4.Have you had trouble with a teacher, principal, boss, or coworkers due to using alcohol or other drugs?
* Yes No
5.Have you had trouble at school or work due to alcohol or other drugs?
* Yes No
6.Have you committed a crime while under the influence of alcohol or other drugs?
* Yes No
7.Have you gotten into fights or tried to hurt someone when you were using alcohol or other drugs?
* Yes No
8.Have you sold personal things like your clothes or jewelry to get or pay for alcohol or other drugs?
* Yes No
9.Have you done illegal things other than selling drugs to get or pay for alcohol or other drugs?
* Yes No
10.Have you gotten into fights with friends due to using alcohol or other drugs?
* Yes No
11.Have you missed school or work or gotten to school or work late due to alcohol or other drug use?
* Yes No
Immunoassays example (Biochemical Assessments)
E.g., from saliva–inexpensive
Other terms: false positives and negatives, retention time (e.g., cocaine 1-3 days,
marijuana 1-6 weeks for chronic users)
- Type and amount of drug
- Frequency of use
- Method of use
- Metabolic rates and excretion (genes-related)
- Diet
- Acidity of urine
- Fluid intake
- Time of day
Signal Detection Theory and Compliance Measurement
Opiate urine tests 300 ng/ml cut-off; one bagel=250 ng/ml reading; Note: F+s in 5% to 10% of drug tests [ate 1 teaspoon of poppy seeds]; F-s in 10% to 15% of cases)
2 Poppy seed bagels=false positive
