Lecture 13

Question 1

Acrophobia is the fear of ____, and trypanophobia is the fear of ______

Answer 1

• heights
• needles

Question 2

What does the word “addiction mean to you?

Answer 2

• surge of dopamine
• frequent cravings
• feeling relieved
• withdrawal symptoms

Question 3

What has drug trade contributed to?

Answer 3

• contributed to tremendous wealth and political influence of societies (commodities)

Question 4

define adiction

Answer 4

• repetitive consumption of a substance, or repetitive engagement in an activity that is considered to be problematic
• this definition has evolved, but the core concept is that the behaviour associated with the substance use is harmful for the individual and/or the people/community around that individual (both health and social problems)

Question 5

define psychoactive drugs

Answer 5

• defined as a substance capable of influencing brain systems linked to mood/emotion/perception, as well as reward and pleasure

Question 6

define PWUD

Answer 6

• people who use drugs
• person-first, descriptive, neutral

Question 7

define PWID

Answer 7

• people who inject drugs
• injection as mode of administration

Question 8

define “addict”

Answer 8

• lacks precision and clarity, can be pejorative and stigmatizing

Question 9

define “drug use”

Answer 9

• transparent, neutral, and free of judgement

Question 10

define illicit drugs

Answer 10

• controlled/prohibited substances (heroin, cocaine, etc.) and diverted pharmaceuticals (prescription opioids)

Question 11

define harmful use or problematic use (sometimes termed drug misuse)

Answer 11

• consumption that causes social, psychological or health problems/harms for individual or society

Question 12

define drug dependence

Answer 12

• psychobiological syndrome involving impaired control of use, increased tolerance, continued use despite negative consequences, and withdrawal symptoms

Question 13

what has replaced “drug addiction” in the ICD

Answer 13

• drug dependence

Question 14

define substance use vs. substance abuse

Answer 14

• subjective distinctions and value judgements based on particular understandings of physiology, psychology, law, and history

Question 15

What do some argue about terms like substance “abuse” and “abuser”

Answer 15

argue that those terms are stigmatizing

Question 16

What things began the process of medicalization of addiction to a wide variety of substances, and later to behaviours?

Answer 16

• in the 18th century, a distinction was made between “normal” drinking and “abnormal” drinking
  — normal drinking included drunkenness
• late 19th century : “inebriety” was a concept that likened abnormal drinking to a physical illness, and referred to “a disease of the nervous system characterized by morbid craving” for alcohol
• 1940s : term “alcoholism” used to refer to problem drinking and physiological dependence

Question 17

What are 2 parallel models of addiction developed in the 19th century

Answer 17

• disease model
• addiction related to the characteristics of the substance itself

Question 18

explain disease model

Answer 18

• addiction stemmed from physiological or psychological predispositions in some individuals
• this model contributed to theory of individual degeneracy (as inheritable) and solutions such as institutionalization and sterilization

Question 19

explain addiction related to the characteristics of the substance itself

Answer 19

• this model was associated with the “temperance movement” which identified the substance (alcohol) as the source of the problem and advocated for severe restrictions or prohibitions (laws making production and sales illegal) on the availability of alcohol

Question 20

review this about terminology and conceptualization

Answer 20

• the tension between a disease model focusing on the person with addiction and a focus on dangerous substances influenced our current responses to addiction
• if we see addiction as a disease, we are likely to favour medical responses to addiction
• if we see addiction as bad behaviour (moral view), we are likely to favour criminal justice responses to addiction as punishment and deterrent
• if we consider social determinants of health, we might look at systemic or social drivers (causes) of addiction

Question 21

The disease model may bring a more humane approach, but what are the consequences related to medicalization?

Answer 21

• arguably reduces individual responsibility and imperative to improve/reform
• decreases emphasis on social, economic, and cultural contexts in shaping substance use and outcomes, with a larger focus on biology and medications
• less attention to systemic and underlying issues, if we view it solely as medical problem; medical solutions are somewhat narrow

Question 22

define public health

Answer 22

• more focus on populations but also individuals in context and the role of socio-cultural influences in shaping behaviour and outcomes

Question 23

what affects public health

Answer 23

• social determinants of health and systemic factors
• ethnicity, neighbourhood characteristics, gender, sexual orientation, income (socioeconomic status), education: all influence mental health
• environment is centrally important and structures issues related to addiction

Question 24

give some related substances of the drug class opioids and its pharmacological effects

Answer 24

• heroin, opium, morphine, oxycodone, codeine, fentanyl, methadone, pethidine
• acts on nervous system (slows it dow) to relieve pain; have the capacity to produce high euphoria and induce respiratory depression, drowsiness, and impaired judgement

Question 25

give some related substances of the drug class cannabis and its pharmacological effects

Answer 25

• hashish, THC, marijuana, bhang, ganja, hash oil
• intoxication produces feelings of euphoria, lightness of limbs, increased appetite, tachycardia, and impaired judgement

Question 26

give some related substances of the drug class cocaine and its pharmacological effects

Answer 26

• crack
• feelings of elation (joy), exaggerated feelings of confidence. Acute toxic reactions include hypertension, cardiac arrhythmias, auditory and visual hallucinations, seizures

Question 27

give some related substances of the drug class amphetamines/other stimulants and its pharmacological effects

Answer 27

• dexamphetamine, methamphetamine, methylphenidate, phenmetrazine, diethylpropion
• effects include euphoria, anorexia, nausea, vomiting, insomnia and abnormal behaviour such as aggression, grandiosity, hypervigilance, agitation, and impaired judgement

Question 28

give some related substances of the drug class hypnotics/sedatives and its pharmacological effects

Answer 28

• benzodiazepines, barbiturates, buspirone, methaqualone, Rohypnol
• induce muscle relaxation, calmness, and sleep. Impair concentration, memory, and coordination. Other effects include slurred speech, drowsiness, unsteady gait

Question 29

give some related substances of the drug class hallucinogens and its pharmacological effects

Answer 29

• lysergic acid diethylamide (LSD), dimethyltryptamine (DMT), psilocybin, mescaline, MDMA, phencyclidine (PCP)
• produce feelings of euphoria/dysphoria, mood changes, altered perceptions, and visual illusions. Adverse effects include panic reactions, flashbacks, and mood disorders

Question 30

give some related substances of the drug class psychoactive inhalants and its pharmacological effects

Answer 30

• industrial solvents, glue, aerosol, paints, lacquer thinners, gasoline, cleaning fluids, amyl nitrite, nitrous oxide
• signs of intoxication include belligerences, hallucinations, lethargy, psychomotor impairment, euphoria, impaired judgement, dizziness, nystagmus, slurred speech, tremors, muscle weakness, unsteady gate, stupor, coma

Question 31

Who was the term “addiction” abandoned by and why?

Answer 31

• abandoned by WHO in 1964
• due to imprecision
  — adopted dependence
• physiological syndrome involving tolerance and withdrawal as key components

Question 32

define tolerance

Answer 32

• more of a substance is required to achieve same effect

Question 33

define withdrawal

Answer 33

• unpleasant symptoms accompany cessation or reduction of consumption

Question 34

review about medical models of addiction

Answer 34

• DSM-5 uses the term “addiction” and includes nonchemical, behavioural addictions in the relevant sections
• Section was to be titles “Addiction and related disorders” but became “Substance Use and Addictive Disorders”

Question 35

Including non-chemical, what do behavioural addictions emphasize?

Answer 35

• emphasizes psychological aspects of dependence, rather than just physical/biological (substances)

Question 36

What is the implication of the emphasis of non-chemical and behavioural addictions?

Answer 36

• this can lead to inclusion of “addictions” that do not involve physiological dependence (as substances do), but some biologically/brain focused researchers would say these problem behaviours similarly alter brain function/chemistry

Question 37

Viewing behavioural addictions (ex. sex, shopping addictions, etc.) as similar to substance use disorders is founded upon view of addiction as involving what?

Answer 37

• compulsion
• loss of control
• continued use/behvaiour despite negative consequences

Question 38

what do advocates for this model (behavioural addiction) point to?

Answer 38

• point to neurological research into the reward systems of the brain
• what was rewarding or pleasurable, becomes compulsive/addiction due to neurological changes in the brain (common between chemical and non-chemical dependencies)
  — also known as the “hijacked” brain model of addiction

Question 39

some addictive behaviours are now thought to operate what?

Answer 39

• thought to operate psychologically and physiologically like substance dependence
• there are similar neurochemical changes in the brain when the behaviour is engaged in related to the reward system in the brain

Question 40

What are the implications of this reconceptualization?

Answer 40

• addictions as progressive and fatal diseases
• downplays personal agency and fosters assumptions that those who are addicted will always continue to be
• de-emphasizes social factors shaping behaviour
• there’s a need to re-examine the disease model, (ex. the assumption that addiction is always a chronic, relapsing condition and also progressive and fatal) - recovery happens!

Question 41

What are the 3 criteria ICD-11 focuses on?

Answer 41

Any 2 qualify as a diagnosis of substance dependence

• impaired control over substance use
• substance use becoming an overriding priority in the user’s life
• tolerance to or withdrawal symptoms from the drug
• DSM-V; dependence replaced with substance use disorder, diagnosed on presence of 2/11 criteria related to use…

Question 42

How was “addiction” redefined from DSM-IV to DSM-5

Answer 42

• DSM-IV had 2 different diagnostics (Abuse and Dependence (Abuse+)) // DSM-5 has one diagnostic (Substance Use) and the severity for it
• in the symptoms, “recurrent legal problems due to use” got taken out and in the DSM-5, “craving or strong desire to use” was put in instead

Question 43

For each, Abuse, Dependence (Abuse+), Substance Use, how many do you need of the symptoms?

Answer 43

Abuse: 1 or more of the 4

Dependence (Abuse+): 3 or more of the 11

Substance Use: 2 or more of the 11

Question 44

What are the different severities of addiction in DSM-5?

Answer 44

• mild (2-3 symptoms)
• moderate (4-5 symptoms)
• severe (6 or more symptoms)