Exam 3 - Alcohol Abuse Flashcards
Addiction
chronic relapsing disease characterized by compulsive drug-seeking and abuse and by long lasting structural and functional changes in the brain
What was the Pure Food and Drug Act (1906), and the Harrison Narcotic Act (1914)?
- prohibited the sell of alcohol
- had to have a license to market or sell drugs
What are the different schedules of drugs?
Schedule 1 - high risk for abuse and no therapeutic use
Schedule 2 - high risk for abuse and some therapeutic use
Schedule 3 - lower risk for abuse
Schedule 4 - even lower risk for abuse
Schedule 5 - lowest change of abuse
What 4 things usually occur in substance abuse?
- failure to fulfill major role obligations and work, school, or home
- recurrent use in situations that are physically hazardous (drinking and driving)
- recurrent substance-related legal problems
- continued substance use despite persistent or recurrent social or interpersonal or exacerbated by substance (getting in fights with friends and family)
Substance dependence is characterized by? (DSM-5)
- tolerance
- withdrawal symptoms
- greater intake of substance
- persistent desire or unsuccessful attempts to cut down
- significant time spent using, obtaining, or recovering
- giving up or reducing important social activities
- continued use despite knowledge of its negative effects
Who is substance dependence common in?
- young (18-25 yo) men
What are the 3 personality dimensions that could influence alcohol dependence?
- risk taking and sensation or novelty seeking behavior
- lack of emotional control
- interpersonal relatedness (attachment style,)
- mental health
What family factors contribute to alcohol dependence?
- parental substance abuse/dependence
- parental personality/psychopathology
- parent-offspring relationship
- sibling influences
What are the developmental factors that could contribute to alcohol dependence?
- peer influences, may seek out friends that do that, or fall victim to peer pressure
- marital partner relations and occupational status (single/divorced) and occupational status
- educational status
What contextual influence could contribute to alcohol dependence?
- low socioeconomic status (residence in impoverished and stressful neighborhoods, drug-salient milieu, social disorganization)
What is the physical dependence model of addiction?
- initial drug use -> repeated drug use -> physical dependence -> attempts at abstinence -> withdrawal symptoms -> relapse
- once physically dependent, attempts at abstinence lead to withdrawal symptoms
- negative reinforcement - continued use to avoid withdrawal
What is the positive reinforcement model of addiction?
- initial use -> positive reinforcement -> repeated drug use -> attempts at abstinence -> compulsive desire for euphoria -> relapse
- support for this model comes from the self-administration paradigm
What is the incentive sensitization model?
- initial use -> positive reinforcement -> repeated use -> sensitization of drug wanting but not liking -> attempts at abstinence -> compulsive desire for the drug due to a sensitized incentive salience system -> relapse
- repeated exposure can change brain cells and circuits that normally regulate the attribution of incentive salience to stimuli
Opponent-process model of addiction
- initial use -> positive reinforcement -> repeated use -> sensitization of drug-induced hedonic response but loweing of the hedonic set point -> attempts at abstinence -> compulsive desire for the drug due to dysphoria and sensitized drug salience -> relapse
- the longer you’re on a drug, the less of a high you get, and you get more wtihdrawal
Disease model of addiction, susceptibility models
- inherited susceptibility to uncontrolled drug use/initial drug use -> repeated drug use -> loss of control
- addiction models - addiction comes from an inherited susceptibility
Disease model of addiction, exposure models
- initial use ->repeated/chronic use -> altered brain function -> loss of control
Who is the highest prevalence of binge and heavy drinking in?
young adults - 18-25
What is the first phase of alcoholism?
- pre-alcoholic phase:
- drinking for social reasons
- anticipated stress reduction and relief from psychological pain/tension
- individual seeks out drinking occasions, increases consumption
- becomes part of daily living
- begin to develop tolerance
What is the second phase of alcoholism?
- prodromal phase:
- develops feeling of guilt about drinking
- need for increased intake (tolerance)
- physiological dependency is established (withdrawal)
- may also experience black outs, and begin to lose control
What is the third phase of alcoholism?
- crucial phase
- solitary drinking
- may restrict consumption, but this is temporary
- reverse tolerance (need less drinks to get desired effect)
- may have nervous or GI disorders, cirrhosis, malnutrition
- personality deterioration
What is reverse tolerance indicative of?
liver damage
What is the fourth phase of alcoholism?
- chronic phase
- develops after years of excessive intake
- medical complication may require institutionalization or death may occur
What stages of alcoholism could an alcoholic enter remission?
stage 2 or 3
What are the sites of action of alcohol?
- decrease amplitude of AP, decreasing NTs released
- depressant of the CNS, capable of entering every cell in the body
- alter cell membrane anatomy by entering internal structure
Pharmacokinetics of alcohol: absorption
- passes from the stomach to the small intestine for rapid absorption
- rate is affected by: variability among individuals, and stomach content
What is the distribution of alcohol affected by?
- can cross BBB, and blood distributes alcohol to all body tissues
- LD 50 of alcohol is about 25 drinks
BAC, what factors affect it?
- blood alcohol concentration
- amount of alcohol in the bloodstream, % of weight of alcohol per 100 units of blood volume
- total body mass, differences in the rate of metabolism
What is the process of breaking down alcohol?
- alcohol dehydrogenase + alcohol = acetaldehyde + acetaldehyde dehydrogenase = acetic acid
- cytochrome P450 family of enzymes from liver also aid
Chronic use of alcohol increases what enzymes? What happens because of this?
- alcohol dehydrogenase and P450
- reduces BAC, increases metabolism
What are the phases of dependence?
Phase 1: occurs after a few hours after drinking (agitation, nausea, vomiting)
Phase 2: onset is w/n 24 hours of after drinking (risk for seizures)
Phase 3: about >30 hours after drinking, may last 3-4 days, commonly called delirium tremens
What is alcohol withdrawal syndrome?
- fever, hallucinations, hypertension, incapable of thinking, cardiovascular collapse
What are the acute affects of alcohol?
- inhibits secretion of antidiuretic
- reduces amount of fat that is oxidized (beer belly)
- disrupts sleep patterns
- impairs memory
- causes slight respiratory depression
What are the sensorimotor affects of alcohol?
- vision acuity decreases, taste and smell are not as sensitive
- reaction time slows
- impairs psychomotor skills
- impairs driving abilities
What are the psychological effects of alcohol?
- alters emotion and mood (low doses increase mood, high doses decrease mood)
- correlated with aggression
Can alcohol damage the brain?
yes, it can cause overall atrophy
What can alcohol do to the liver?
- fatty liver
- cirrhosis
- alcohol hepatitis
Fetal alcohol syndrome
- children have physical deformities
- also show low-normal to sever impairments of intellectual functioning
What are the specific effects of alcohol on neuronal membranes?
- acts at a NT
- modifies gating mechanism inside channel
- stimulates Gs which is linked to adenylyl cyclase
- direct interaction with channel protein
What are the nonspecific effects of alcohol on neuronal membranes?
- disturbs the relationship of protein in membrane
- interacts with polar heads of phospholipids
- alters lipid composition
What NTs does alcohol act on?
- Glutamate: inhibits, reducing effects of NMDA receptor (cause for amnesia)
- GABA: modulates function, withdrawal can cause seizures
- Dopamine: increases transmission in mesolimbic pathway (reward pathway)
What system is highly sensitive to alcohol? Explain.
- opioid system
- causes release, which is why you don’t feel as much pain
Modern treatment for alcoholism is considered in 3 stages, what are they?
- detoxification (ridding the body of alcohol, drying it out)
- medical care for health problems
- changing long term behavior (psychotherapy, family therapy, AA)
What 3 main drugs are used in alcoholic treatments?
- disulfiram (antabuse - interferes w/ metabolism, makes them sick)
- naltrexone - anticraving
- benzodiazepines (valiums, helps with seizures, anxiety, and anger)
- antidepressants
