L7: SUBSTANCE USE DISORDER Flashcards
DSM-4
distinction between substance abuse and substance dependence
DEPENDENCE
implied emphasis on bio adaptations (tolerance and withdrawal)- fell out of favour as bio is only a small part of the disorder
DSM-5
abuse and dependence combined to single diagnoses of substance use disorder
DIAGNOSTIC CRITERIA FOR ALCOHOL AND DRUG USE
.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).
HOW MANY CRITERIA DO YOU HAVE TO MEET
any 2, 2036 diff combinations
severity
mild, mod severe
alcohol use in women
highest in russia, eastern euthro, north america
alcohol use in men
russia, china uk
drug use in women
south america, middle east, USA and UK and Spain
drug use in men
USA AND SA
tobacco smoking women
europe and chile
tobacco smoking men
russia, europe, asia
number of 16-7 yr olds
lowered in recent years
number of 8-12 year olds
ever consumed alcohol in UK- decreased dramatically
risk factor- comorbidity
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
heritability
Agrawal and Lynskey 2008
Twin studies
Estimates of heritability range between 30%-70%
risk factor: traumatic life events
SA in childhood particularly
people take … to get high
heroin, cocaine, MDMA and alcohol
people take… increase alertness and fatigue
nicotine and caffeine
people take .. for social facilitation
alcohol, MDMA
people take … to alleviate stress
alcohol, heroin, nicotine
operant behaviour
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
problem with explaining via OB
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?
compulsive drug use
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
brain disease
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
how to treat brain disease
via medication
Meta-analysis by Yan et al (2023
addicted brains are hypoactive and less grey matter in prefrontal region inc anterior cingulate cortex/medial prefrontal cortex, striatum and other brain areas
brain different due to;
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
long term drug use leads to brain damage
Changes in PC, amygdala and hippocampus
Changes behaviour- increased risk taking, anxiety, cocaine sensitisation and risk of drug abuse
abnormal brain function precedes addiction in later life
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
habits
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
dual process theory
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
evidence for dual procces theory
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
does choice play an important role in addiction
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
remission more likely
as people gro older
CBT
improves coping skills
MI
changes motivational balances and increases client change talk (could to can to will change)
self help groups
peer led, pair members with a sponsor - effective as increase self-efficacy and changes in social networks
residential rehab
private and expensive- adopts AA 12 step principles
pharmacotherapy
drug treatments available but no cure and nothing that addresses brain reward system
nicotine replacement therapy
e-cigarettes, vaping, harm reduction, varenicline (alleviates withdrawal)
heroin
methadone (sub), buprenorphine (longer act sub that blocks effect of heroin, makes it pointless)
