L7: SUBSTANCE USE DISORDER

Question 1

DSM-4

Answer 1

distinction between substance abuse and substance dependence

Question 1

DEPENDENCE

Answer 1

implied emphasis on bio adaptations (tolerance and withdrawal)- fell out of favour as bio is only a small part of the disorder

Question 2

DSM-5

Answer 2

abuse and dependence combined to single diagnoses of substance use disorder

Question 3

DIAGNOSTIC CRITERIA FOR ALCOHOL AND DRUG USE

Answer 3

.Alcohol taken in larger amounts or over a longer period than intended.
2.Persistent desire or unsuccessful attempts to cut down alcohol use.
3.Great deal of time spent in activities to obtain or use alcohol, or recover.
4.Craving.
5.Recurrent alcohol use resulting in failure to fulfill major role obligations.
6.Continued alcohol use despite social problems caused by it.
7.Important social, occupational or recreational activities sacrificed in favour of drinking.
8.Recurrent alcohol use in situations where it is hazardous.
9.Continued alcohol use despite knowledge of damage to health.
10.Tolerance (either increased amounts used or diminished effect of same dose).
11.Withdrawal (either presence of withdrawal syndrome, or alcohol is used to avoid withdrawal effects).

Question 4

HOW MANY CRITERIA DO YOU HAVE TO MEET

Answer 4

any 2, 2036 diff combinations

Question 5

severity

Answer 5

mild, mod severe

Question 6

alcohol use in women

Answer 6

highest in russia, eastern euthro, north america

Question 7

alcohol use in men

Answer 7

russia, china uk

Question 8

drug use in women

Answer 8

south america, middle east, USA and UK and Spain

Question 9

drug use in men

Answer 9

USA AND SA

Question 10

tobacco smoking women

Answer 10

europe and chile

Question 11

tobacco smoking men

Answer 11

russia, europe, asia

Question 12

number of 16-7 yr olds

Answer 12

lowered in recent years

Question 13

number of 8-12 year olds

Answer 13

ever consumed alcohol in UK- decreased dramatically

Question 14

risk factor- comorbidity

Answer 14

High prevalence of other mental disorders and drug use disorders and smoking
Smoking- no mental health problems smoking= 20%, bipolar disorder= 70%
SUDs more common with Bipolar, MDD, GAD

Question 15

heritability

Answer 15

Agrawal and Lynskey 2008
Twin studies
Estimates of heritability range between 30%-70%

Question 16

risk factor: traumatic life events

Answer 16

SA in childhood particularly

Question 17

people take … to get high

Answer 17

heroin, cocaine, MDMA and alcohol

Question 18

people take… increase alertness and fatigue

Answer 18

nicotine and caffeine

Question 19

people take .. for social facilitation

Answer 19

alcohol, MDMA

Question 20

people take … to alleviate stress

Answer 20

alcohol, heroin, nicotine

Question 21

operant behaviour

Answer 21

voluntary and not a reflex, and maintained by its consequences
Mouse press lever for drug injected into brain, keep doing it as enjoy the consequence

Question 22

problem with explaining via OB

Answer 22

a defining characteristic is that people use drugs even though they wish they could stop as the positive effects have diminished (high) but negative effects have increased (marital breakdown, withdrawal, prison), so why do they continue?

Question 23

compulsive drug use

Answer 23

Compulsion is evoked to explain addictive behaviour even when behaviour created negative consequences are outweighed by positives
Compelled to continue use
Dominant view is that its as its a brain disease

Question 24

brain disease

Answer 24

New england journal of medicine
Diff areas of brain that are affected by prolonged drug use
E.g. amygdala involved in withdrawal, stress, change in mood, anterior cingulate involved in craving and thalamus involved in binge patterns

Question 25

how to treat brain disease

Answer 25

via medication

Question 26

Meta-analysis by Yan et al (2023

Answer 26

addicted brains are hypoactive and less grey matter in prefrontal region inc anterior cingulate cortex/medial prefrontal cortex, striatum and other brain areas

Question 27

brain different due to;

Answer 27

drug alter brain structure or neurotransmitter, inherited brain structure (genetic predisposition- some children with parent who are addicted show slight brain diff similar to drug users), environment

Question 28

long term drug use leads to brain damage

Answer 28

Changes in PC, amygdala and hippocampus
Changes behaviour- increased risk taking, anxiety, cocaine sensitisation and risk of drug abuse

Question 29

abnormal brain function precedes addiction in later life

Answer 29

genetic predisposition- some children with parent who are addicted show slight brain diff similar to drug users before they themselves have taken drugs
Some of those changes mirror those seen when highly rewarding behaviours are repeated
activation in ventral tegmental area when looking at image of current romantic partner

Question 30

habits

Answer 30

Stimulus - anticipated outcome (e.g. getting high), response (doing something to get the outcome)
Direct link between stimuli and response, strengthens, lead to a point when stimulus immediately evokes response even if outcome isn’t there
Evidence for shift from SOR to SR
Lab animals good evidence that drug seeking becomes habitual- rats pressing lever to get drug, persists despite negative consequences (devalue drug), if trained for habitual response, don’t care that its been devalued
Habit in addiction is disputed (heather et al, 2017), more evidence against than for

Question 31

dual process theory

Answer 31

When start drug have controlled cog processes (outcome expectancies and intentions to use) leads to substance use
Automatic cog processes- attentional biases, spontaneous memory associations- see cue, automatic approach tendencies- drawn towards cue, see cues associate drug, activates rewards system
Happens when use drug for a long period of time
Say want to stop using controlled process but automatic processes override

Question 32

evidence for dual procces theory

Answer 32

Addiction characterised by automatic cog processing biases
Retraining of these cog processing treatment e.g. cog bias modification, train to have a diff motor response when see cue, computer and joystick; if see alcohol need to push away and pull anything unrelated towards you for thousands of trial which strengthens their associations, better clinical outcomes

Question 33

does choice play an important role in addiction

Answer 33

Motivation to change is one of the best predictors of recovery
Motivational interviewing, increases motivation to change and shows their ambivalence towards drug use (e.g. they want to stop) and is effective
Drug use is sensitive to economic factors e.g. change in price
Contingency management, receive small incentives if they have not used drugs, is the most effective treatment- doesn’t show addiction is somewhat voluntary and is sensitive to consequence

Question 34

remission more likely

Answer 34

as people gro older

Question 35

CBT

Answer 35

improves coping skills

Question 36

MI

Answer 36

changes motivational balances and increases client change talk (could to can to will change)

Question 37

self help groups

Answer 37

peer led, pair members with a sponsor - effective as increase self-efficacy and changes in social networks

Question 38

residential rehab

Answer 38

private and expensive- adopts AA 12 step principles

Question 39

pharmacotherapy

Answer 39

drug treatments available but no cure and nothing that addresses brain reward system

Question 40

nicotine replacement therapy

Answer 40

e-cigarettes, vaping, harm reduction, varenicline (alleviates withdrawal)

Question 41

heroin

Answer 41

methadone (sub), buprenorphine (longer act sub that blocks effect of heroin, makes it pointless)