L7 - Substance Use, Misuse and Abuse (McKinlay)

Question 1

Describe the continuum of substance use.

Answer 1

Experimentation -> Recreational/Social use -> Regular Use/Binging -> Problematic Use (mild to severe)

Question 2

What is tolerance?

Answer 2

This describes changes in ways that the body reacts to a drug. When someone develops a tolerance, they need increasing doses to achieve the same effect.

Question 3

What are withdrawal symptoms?

Answer 3

These are compensatory reactions in the body that oppose the primary effects of the drug, and happen in the absence of the drug.

Question 4

What is craving?

Answer 4

This is a PSYCHOLOGICAL urge to administer a discontinued medication or drug.

Question 5

How do drugs become addictive?

Answer 5

Taking the drug activates the BRAIN REWARD SYSTEM.

This REINFORCES drug taking (Brain may change in response to drug taking, and urge to take the drug)

Produces INTENSE activation of the reward system.
–> feeling “high”, reduces inhibitory control!

Question 6

What is the difference between addiction and dependence?

Answer 6

• drug dependence means person needs drug to function normally
• drug addiction - compulsive use of the substance, despite negative/harmful effects
• a person may have physical dependence WITHOUT having an addition

Question 7

What is alcoholism?

Answer 7

ALCOHOL DEPENDENCE.

• intoxication, disorder, withdrawal.
• can be mild, moderate or severe.

Question 8

What are DSM-V characteristics of substance-induced disorders?

Answer 8

• intoxication, disorder, withdrawal
• impaired control
• social impairment (failure to fulfil obligations, withdraw from people)
• risky use (use in hazardous situations)
• pharmacological (tolerance and withdrawal)

Question 9

What are problems in diagnosis of substance use disorders?

Answer 9

• less than 1/3 of substance abuse is recorded
• clinicians don’t suspect a problem because people w/ tolerance may not appear to be having a problem.
• People have to acknowledge they have a problem and stop using, and deal with the stigma
• lack of skills, from the clinician
• embarassment or fear of offending patient
• frequently comorbid depression, anxiety, psychosis - OVERSHADOWS the substance use

Question 10

What are some theories of addiction?

Answer 10

• Dopamine hypothesis
• personality
• family causation
• socio-cultural influence
• bio-psycho-social model
• disease theory
• disease as damage
• family interaction model

Question 11

What is disease theory?

Answer 11

Theorises that drug use changes the way the brain responds to the stimulus, therefore more likely to use again.

(Refer to paper for more!!)

Question 12

What are the 3 main times of learning?

Answer 12

• operant conditioning
• classical conditioning
• social learning

Question 13

What is operant conditioning?

Answer 13

This is learning which occurs through reinforced behaviour being more likely to be repeated.
Behaviours that are not reinforced tends to die out or be extinguished.

Accidental response –> reinforcement –> deliberate response

Question 14

What is classical conditioning?

Answer 14

This occurs through a process of association.

Repeated pairings of UNCONDITIONED STIMULUS with CONDITIONED STIMULUS, will eventually elicit UNCONDITIONED RESPONSE in the absense of CONDITIONED STIMULUS, with only unconditioned stimulus.

Question 15

Describe social learning.

Answer 15

When we learn through observing others. This is the most common way people learn
- observing others use drugs in a bad way…

Question 16

Explain the biopsychosocial model in terms of drug use.

Answer 16

• drug abuse is multifactorial, including biological, psychological and social components.
• emergence of substance abuse depends on the amount of exposure and social pressure, as well as personal vulnerability.
• Explains why some people in a similar situation don’t get affected
• looks at what maintains the addiction…. genetics.. previous learning.. own personality

Question 17

What are some biopsychosocial influences??

Answer 17

Bio - we’re born with a drive… some are high risk, some aren’t

social - we receive rewards and punishment for various things

psychosocial - desires, norms..

develop preferred methods and tend to persist in attempts.

set and setting shape experiences.

Question 18

Why is it so hard for those who are addicted to drop their habits even when they are presented with a direct consequence (eg. heart failure)

Answer 18

Meaning of the drug is highly important..

• social element?
• psychological meaning - they can attach it to their IDENTITY.
• physical dependence - can you tolerate living if you can’t function properly?

Question 19

What are the long term effects of alcohol on the body?

Answer 19

HEART - increase BP, enlarges heart, irregular HR

MUSCLES - shrink

SKIN - redness, sweating more

LIVER - cancer, extreme pain and swelling

BRAIN - damage, memory loss, confusion, hallucinations

LUNGS - increase change of infection

STOMACH - bleeding, ulcers

.. etc

Question 20

How much is a standard drink?

Answer 20

any drink with 10g of alcohol.

Question 21

How long does it take the body to clear one standard drink?

Answer 21

Averages about 1 hour to clear the body from one standard drink, but depends on liver size, body mass and composition and alcohol tolerance.

Question 22

What is binge drinking?

Answer 22

This is drinking too much on a single occasion of drinking. - more than the recommended level for adults.

or continuously drinking for a number of days, weeks or irregular bouts.

Question 23

Risks associated with binge drinking?

Answer 23

• memory loss
• injury to self and others
• dizziness
• loss of coordination
• diarrhoea, vomitting
• lack of judgement
• alcohol poisoning - sometimes fatal

Question 24

What is the problem with indigenous australians and alcohol use?

Answer 24

• burden of disease due to alcohol use is double than that of general aus population
• in 2003, alcohol accounted for 6.2% of overall burden of disease among indig aus.
• higher percentages of risky comsumption and short and long term high risk consumption for indigenous than general aus population

Question 25

What are the national health and medical research council’s alcohol guidelines?

Answer 25

1. no more than 2 standard drinks in 1 day reduces lifetime risk
2. no more than 4 standard drinks on any one occasion reduces risk of injury
3. not drinking alcohol before 15 - more likely to undertake more risky and antisocial behaviour.
4. no drinking while pregnant or breastfeeding.

Question 26

Describe withdrawal syndrome for alcohol.

Answer 26

• begins within 24 hours
• lasts up to 5 days
• happens when theres a regular intake of 6 (f) to 8 (m) drinks.
• alcohol withdrawal seizures
• considered medical emergency

Question 27

What are some treatment options for substance use disorders?

Answer 27

• Support groups
• Beyond 12step groups (for alcohol)
• medication
• smart recovery groups
• harm reduction programs - doesn’t push total abstinence, helps you come to a negotiated agreement!!
• traditional talking therapies
• therapeutic community models

Question 28

Relapse rate over time for heroin, smoking and alcohol?

Answer 28

HIGH RELAPSE.

BUT OBVIOUSLY, THERE IS SOME EFFECT OF TREATMENT..

ABOUT 80% relapse for smoking and heroin and 70% for alcohol.

Question 29

What is the multi-sourced model of addiction?

Answer 29

Takes into consideration that there are many factors that lead to an individual’s actions.

• predispositions - genetic, personality
• past actions / current choices - seemingly irrelevant choices that they make?
• social historial and cultural envrionment - norms in society
• neurobiology
• underlying processes

*read article

this model gives a good way to intervein in current choices etc… for treatment

instead of only considering one factor