Lecture 5 - Alcohol and Substance Use Disorders Flashcards
What does it mean by Substance Use?
Not just illegal drugs
- Alcohol
- Misuse of prescribed meds (sedatives, diazepam, nitrazepam - used as downers to offset stimulants)
- Steroid misuse, solvents
What are some physical health effects of substance use?
- Direct = liver, lung, cancer
Breast cancer increased due to alcohol consumption - Indirect = injury, self neglect, harm from risky behaviours
What are other consequences of substance use?
- Financial effects = drugs are expensive, also not turning up to work due to after effects means less money
- Social and Interpersonal = conflict with others (family members), exclusion, stigma, homelessness
What are some impacts of substance use on mental health?
- Transient psychosis - cannabis induced psychosis
- Alcohol can cause psychotic symptoms, depression, anxiety (acts as a depressant)
- Established mental health issues can get worse - poorer functioning, relapses, suicide
How many hospital admissions relating to drug related disorders were there in 2019/20
7,027 - primary diagnosis of drug-related mental health and behaviour disorders
(135 people per week)
21% higher than 2009/10
What are the statistics of the societal and economic burden of drug and alcohol abuse?
NHS costs and welfare costs
358,000 admissions to hospital in 2018/19 from drinking too much alcohol
(1,000 per day)
6% higher than 2017/18
19% higher than 2008/9
How common is Substance Use Disorder?
- Varies due to setting and geographical locations e.g more in London compared to Rural areas
What percentage of 16-59 year olds had taken drugs at some point in their lifetime?
- 35%
- 9% had taken an illicit drug in the last year
- 21% young adults (16-24) had taken an illicit drug in the last year
- 4.3% classed as frequent drug users (monthly)
Is drug use rising?
Yes - it fell 1995-2013 but is now rising. Large increase of class A drugs in 16-24 year olds
What are the NHS states on alcohol use: How many men had drunk alcohol in the past week? (2020 study)
65%
What are the NHS stats on alcohol use: How many women had drunk alcohol in the past week? (2020 study)
50%
How many men aged 55-64 were drinking above safe limits? (14 units +)
38%
How many women aged 55-64 were drinking above safe limits? (14 units +)
19%
What areas are drug related hospital admissions more likely?
Deprived areas - 5 X more likely
Why is it hard to help someone with mental health problems who also have substance use disorders?
MH needs to be sorted before substance use can but MH services can’t help when someone is using drugs
What is Comorbidity?
When 2 disorders or illnesses occur simultaneously (substance use and MH problems)
What is Dual Diagnosis?
Used to describe people with severe mental illness (psychosis) and problematic drug and alcohol use
How much more likely are you to have a drug diagnosis if you have Schizophrenia?
6 X more likely
How much more likely are you to have a drug diagnosis if you have Bipolar Disorder?
8.3 X more likely
What percentage of people with psychosis use substances?
50%
What percentage of people with psychosis smoke cigarettes?
85%
What are the outcomes for substance users with psychosis?
More symptoms
More relapses
More hospitalisation
Poor functioning
Increased suicidality
What is Psychosis?
- Loss of contact with reality
- False beliefs about what is taking place (delusions)
- Seeing or hearing things that aren’t there (hallucinations)
- Disorganised speech
- Catatonic behaviour
- Negative symptoms
- Social and occupational dysfunction
- Lasting 6 months
- 2 symptoms = Schizophrenia diagnosis
What are the proposed causes of comorbidity (SUD and Psychosis)
- Substance use causes psychosis
- Substance use as a consequence of psychosis - coping / self medicating / reducing symptoms
- Common origin (genetic)
- Bidirectional - psychosis and substance use interact and maintain each other
What is the relationship between heroin and psychosis?
Heroin masks symptoms of psychosis
When withdrawing = become way more psychotic
What drugs can induce psychosis?
Amphetamine, cocaine, cannabis
What does THC (psychoactive ingredient of cannabis) produce?
- Schizophrenia-like positive symptoms in healthy individuals
- Transiently increases symptoms in people with Schizophrenia
- People with Sz more vulnerable to the effects of THC
- Develop or worsen psychotic symptoms 20 mins after taking cannabis
What evidence suggests that substance use precedes psychotic symptoms? (longitudinal cohort studies)
- Andreasson et al. 1987
- 50+ cannabis users used before age of 18. 6 X greater likelihood of hospitalisation for SZ at age 33
- Soldiers after army - those that used cannabis more than 50 times had 6 X greater likelihood of being hospitalised for Sz
What has a birth cohort study found (1970s) about the link between psychosis and cannabis?
- Users of cannabis before age 15 had more Sz symptoms at 26
- Genetic predisposition moderated risk
- People with psychosis report using substances to self medicate (reduce symptoms)
What is evidence for genetic factors predisposing individuals to mental health and substance use? - Dunedin cohort study
Adults with COMT polymorphism (val allele) 10 X MORE LIKELY to have SZ disorder at age 26
What is the DSM criteria for Substance Use Disorder?
- Large amounts / long period
- Persistent desire / unsuccessful efforts to cut down or control
- Loads of time spent obtaining the substance, including using or recovering from use
- Cravings and desires
- Social / interpersonal problems but still continue using
- Give up activities
- Failure in job / work / school
- Physical or psychological problems
- Dangerous situations - driving while using
- Increased tolerance / diminished effect
- Withdrawal
What is the minimum amount of criteria for SUD
2-3 (mild SUD)
4-5 (moderate SUD)
6-7 (severe SUD)
What does the DSM focus on?
Impact rather than amount
