Lecture 5a - Substance Use Disorders

Question 1

Which are the two categories of Substance use disorders?

Answer 1

1. Substance abuse

2. Substance dependence

Question 2

What are the main substance use disorders?

Answer 2

 Alcohol
 Amphetamine
 Cannabis
 Cocaine
 Gambling (new to DSM 
 Hallucinogen
 Inhalant
 Opioid
 Phencyclidine
 Sedative/hypnotic/
 Tobacco

Question 3

Criteria for substance use disorder

Answer 3

+Problematic pattern of use that impairs functioning. Two or more symptoms within a 1 year period:
• Failure to meet obligations
• Repeated use in situations where it is physically dangerous
• Repeated relationship problems
• Continued use despite problems caused by the substance
• Tolerance
• Withdrawal
• Substance taken for a longer time or in greater amounts than intended
• Efforts to reduce or control use do not work
• Much time spent trying to obtain the substance
• Social, hobbies, or work activities given up or reduced
• Continued use despite knowing problems caused by substance • Craving to use the substance is strong

Question 4

Severe ratings for substance use disorders

Answer 4

Mild - 2-3 criteria
Moderate - 4-5 criteria
Severe - 6 or more

Question 5

What is Addiction?

Answer 5

\+Severe substance use disorder
Having 6 or more severe symptoms such as:
\+tolerance
\+Withdrawal
\+Using more than intended amounts
\+Trying unsuccessfully to stop
\+Having physical or psychological problems made worse by drug
\+Experience problematic relationships

+With physiological dependence:
Presence of either tolerance or withdrawal
+Without physiological dependence:
Absence of either tolerance or withdrawal

Question 6

What is alcohol use disorder?

Answer 6

When somebody is physiologically dependent in alcohol

Question 7

What is delirium tremens (DTs)

Answer 7

+Can occur when blood alcohol levels drop suddenly Results in:
+Deliriousness Tremulousness Hallucinations
+Primarily visual; may be tactile

Question 8

What is Polydrug abuse?

Answer 8

When somebody abuse multiple substances

Cigarette, cocaine, marijuana, alcohol

Question 9

Prevalence of alcohol abuse

Answer 9

+Lifetime prevalence
+ Binge drinking - 5 drinks in one hour
+Heavy use of drinking - 5 drinks, 5 or more times in a period of 30 days
+Higher prevalence in men
+White and Hispanic adolescents and adults more likely to binge drinking
+ Binge and heavy use drinking lowest among Asian Americans and African Americans
+ Alcohol dependence highest among Native Americans and Hispanics
+Comorbidity with other disorders: personality disorders, mood disorders, schizophrenia, and anxiety disorders

Question 10

Short term effects of alcohol

Answer 10

\+Interacts with several neural systems
\+Stimulates GABA receptors
\+Reduces tension
\+Increases dopamine and serotonin
\+Produces pleasurable effects
\+Inhibits glutamate receptors
\+Produces cognitive difficulties

Question 10

Short term effects of alcohol

Answer 10

1. Interacts with several neural systems
\+Stimulates GABA receptors
\+Reduces tension
\+Increases dopamine and serotonin
\+Produces pleasurable effects
\+Inhibits glutamate receptors
\+Produces cognitive difficulties

2. Effects of ingesting large amounts
   Significant motor impairment
   Poor decision making
   Poor awareness of errors made

Question 11

Long term effects of alcohol

Answer 11

 Malnutrition
• Calories from alcohol lack
nutrients
• Alcohol interferes with digestion and absorption of vitamins from food
 Damage to endocrine glands and pancreas
 Heart failure
 Erectile dysfunction
 Hypertension
 Stroke
 Capillary hemorrhages
• Facial swelling and redness, especially in nose
 Destruction of brain cells
• Especially areas important to memory
                       • Deficiency of B
causes Amnestic syndrome
-
Severe loss of memory for both
complex vitamins

+ Malnutrition
Calories from alcohol lack nutrients
Alcohol interferes with digestion and absorption of vitamins from food
Deficiency of b-complex vitamins causes Amnestic syndrome.
Severe loss of memory for both long and short term information.

+Cirrhosis of the liver
• Liver cells engorged with fat and protein, impeding functioning
• Cells die, triggering scar tissue which obstructs blood flow
• Liver disease and cirrhosis rank 12 in the U.S causes of death

\+Damage to endocrine glands and pancreas
\+Heart failure
\+ Erectile dysfunction
\+Hypertension
\+Stroke
\+Capillary hemorrhages
Facial swelling and redness, especially in nose.
\+Destruction of brain cells
Especially areas important to memory
        -
and
-
short
-
term information

Question 12

What is Fetal alcohol syndrome?

Answer 12

\+Heavy alcohol intake during pregnancy
A leading cause of mental retardation
Fetal growth slowed
Cranial facial and limb anomalies occur
\+Total abstinence by pregnant women recommended

Question 13

Tobacco use disorder

Answer 13

+Nicotine
Addicting agent of tobacco
Stimulates dopamine neurons in mesolimbic area
Involved in reinforcing effect

Question 14

Prevalence and Health consequences of tobacco

Answer 14

+18% prevalence
+Smoking is the single most preventable cause of premature death in the U.S
+Cigarettes kill 1000 people every day
+Lung cancer is most common cancer
+Cigarettes also cause or exacerbate: emphysema, cancers of larynx, esophagus, pancreas, bladder, cervix, stomach, cardiovascular disease
Sudden infant death syndrome and pregnancy complications

Question 15

Prevalence and Health consequences of tobacco

Answer 15

+More prevalent among white and Hispanic youth than African Americans
+More prevalent among men than women
+Second hand smoke

Question 16

What is Marijuana?

Answer 16

Drug derived from dried and ground leaves and stems of the female hemp plant.

Question 17

What is Hashish?

Answer 17

+ Stronger than marijuana
+ Produced by drying the resin exudate of the tops of plants
+ In DSM-5 called Cannabis use disorder

Question 18

Marijuana prevalence

Answer 18

+Most frequently used illicit drug in U.S
+Greater use by men than women
+Rates of daily use are on the rise
+ May be related to varying degrees of legal status by state

Question 19

Effects of Marijuana

Answer 19

1. Psychological
   Major active ingredient - tetrahydrocannabinol
   Feelings of relaxation and sociability
   Rapid shifts of emotion
   Interferes with attention, memory and thinking
   Decline in IQ over time
   • Heavy doses can induce hallucinations and panic
   • Difficult to regulate dosage
   Effects take 30 minutes to appear
   Smoke more than intended waiting for effects
   • Interfere with cognitive functioning

2. Physiological 
• Bloodshot and itchy eyes
• Dry mouth and throat
• Increased appetite
• Reduced pressure within the eye
• Increased BP
• Damage to lung structure
and function in long users
                     

Question 20

Marijuana and the Brain

Answer 20

Two cannabinoid brain receptors
CB1 and CB2
High concentration in hippocampus
Increased blood flow to emotion regions
Amygdala and anterior cingulate
Habitual use leads to tolerance
Withdrawal symptoms also observed

Question 21

Therapeutic effects of Marijuana

Answer 21

+reduces nausea and loss of appetite caused by chemotherapy
+relieves discomfort of AIDS, chronic pain

Supreme court rulings:
+federal law prohibits dispensing marijuana for medicinal purposes
+Medical use can be prohibited by federal government even if states approve