Lecture 7 - Substance Use

Question 1

Why consider substance use?

Answer 1

• the rule rather than the exception
• poorer prognosis: more likely to become chronic and disabled
• higher utilisation of services
• face greater stigma (most stigmatised against > people think they are to blame)
• illness burden

Question 2

Define substance abuse

Answer 2

• use of substances is causing problems in life
• failure to fulfil role obligations
• impaired functioning in some way

Question 3

Define withdrawal symptoms

Answer 3

• compensatory reactions in the body that oppose the primary effects of the drug (the opposite effects of the drug)
• eg. heroin = euphoria, withdrawal = dysphoria

Question 4

Define craving and tolerance

Answer 4

• craving: psychological urge to use a discontinued substance/drug
• tolerance: need more and more of a drug to get the same effects

Question 5

Explain the continuum of substance use

Answer 5

• experimental (short-term, curiosity, social)
• social-recreational (friends, acquaintances wanting to share a pleasurable experience)
• circumstantial-situational (motivated by the desire to achieve effects of drug to cope with a specific situation or event)
• intensified (long-term use, motivated by desire to relieve problems/stress)
• compulsive (frequent, intense, produce some degree of psych dependence and possible physical dependence)

Question 6

What is a substance use disorder, according to the DSM? What are the specifiers?

Answer 6

• continues using substance despite sig substance-related problems
• cognitive, behavioural + physiological sx
• IMPAIRED CONTROL (craving, consume more over longer time than intended; persistent desire to cut down/regulate substance use; great deal of time obtaining substance/consuming/recovering)
• SOCIAL IMPAIRMENT (work/school/home role; social/interpersonal problems; give up important social activities because of use)
• RISKY USE (in physically hazardous situations, continue despite problems caused/exacerbated by substance)
• PHARMACOLOGICAL (tolerance, withdrawal)
• severity: mild, moderate, severe
• specifiers: early remission, sustained remission, in controlled environment

Question 7

What is a substance induced disorder, according to the DSM?

Answer 7

INTOXICATION

• reversible, substance-specific syndrome due to the recent ingestion of a substance
• clinically sig problematic behaviour or psych change associated with intoxication (attributable to the substance’s effects on the CNS), develop shortly after use of a substance

WITHDRAWAL

• substance-specific problematic behavioural change (with psychological and cognitive concomitants) that is due to the cessation of/reduction in heavy and prolonged substance use
• distress or impairment

Question 8

What are substance/medication induced mental disorders?

Answer 8

• in the section of the DSM specific to each disorder, not in the substance section
• delirium, dementia, amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, sleep disorder

Question 9

What is the prev rate of substance-related disorders? What is the burden of it?

Answer 9

5.1% (men 2x) substance-use disorder

• alcohol and cigarette smoking 2 highest causes of preventable deaths
• drug dependence = single largest contributor to disease burden in Aus

Question 10

What are the drugs that most commonly lead to dependence?

Answer 10

• nicotine: 32%
• heroin: 23%
• crack cocaine: 20%
• alcohol: 15%

Question 11

Why might substance use be under-recognised?

Answer 11

• clinicians do not suspect a problem
• denial/considered too hard > have to do something about it
• lack skills/knowledge for diagnosis
• fear -ve consequences for client (work, legal, insurance etc.)
• pessimism about recovery
• embarrassment/fear of offending client
• overshadowing (comorbid depression, anxiety, psychosis)

Question 12

Who uses drugs?

Answer 12

• 18-25yrs
• males
• urban
• minorities (black, indigenous)
• psychiatric patients
• diffs in gender and ethnic groups in terms of alcohol metabolism
• SES: moving from recreational use to abuse more likely in impoverished populations

Question 13

What is the comorbidity in substance use?

Answer 13

• antisocial PD
• schizophrenia
• affect
• anxiety

Question 14

Why is there higher comorbidity with substance use?

Answer 14

• direct or indirect causal rship??
• common factors that increase risk of both disorders < probably
• shared factors: social + environmental, biological (genetic, personality, neurotransmitters etc.)

Question 15

Explain the conditioning theories of drug dependence

Answer 15

OPERANT

• • or - reinforcement > use again
• physiological or social reinforcement

CLASSICAL
- pair alcohol with positive outcome

Question 16

Explain the disease model of drug dependence

Answer 16

• drug use abnormal (outside medical setting)
• use of psychoactive drugs for pleasure > indicates something ‘wrong’
• use is ‘caused’ by some pathology and ‘causes’ further problems
• user is sick > needs treatment (but what treatment??)
• what has led to AA: alcoholism unique, progressive, diff from normality
• loss of control
• irreversible (no cure, but arrest through total abstinence)
• brought to accept diagnosis
• peer support focus

Question 17

Explain the educational model of drug dependence

Answer 17

• alcohol problems evolve from lack of knowledge and accurate info
• when armed with correct info about dangerous effects of alcohol/drugs, people are presumed to be less likely to use alcohol in hazardous ways
• treatment: educate clients about dangers of drinking and use of drugs

Question 18

Explain the general/social influences of drug dependence model

Answer 18

• parenting/familial influence (permissive)
• environment (exposure)
• SES (influence which drugs are popular)
• cultural factors (eg. religion)
• peers
• socialisation and social skills (normative behaviour eg. beer at BBQ)

Question 19

Explain the temperance model of drug dependence

Answer 19

• emphasis on the drug itself > alcohol has great potential to inflict harm, seen as extraordinarily dangerous, nobody can use safely or in moderation
• individual-level intervention: teach people to practice temperance or abstinence
• policy level: legislation to control the cost and availability of the drug

Question 20

Explain the biological models of drug dependence

Answer 20

• genetics: 4-8x more likely if family hx
• DA reward system + ongoing use of a number of substances (nicotine, alcohol, heroin, cocaine, marijuana etc.)
• role of 5HT and endorphins

Question 21

Explain the personality-based model of drug dependence

Answer 21

• moral weakness
• ‘addictive personality’
• novelty + sensation-seeking
• impulsivity (temporal discounting, loss of control, cravings)
• future time orientation/consideration of future consequences (people become immersed in present time, narrow focus on stimuli that are immediately present)
• harm avoidance + reward dependence (use drugs to avoid -ve states, )

Question 22

Explain the biopsychosocial model of drug dependence

Answer 22

• multifactorial phenomenon (bio, psycho, social factors)
• look at whole person and the interaction of multiple factors in determining progression
• rejects reductionism view + empahsises that it is the result of several forces
• a primary, chronic disease with genetic, psychosocial and environmental factors influencing the development and manifestation. often progressive and fatal.
• drug use is universal; born with drive (early experimentation)
• we receive rewards/punishments for trying various ways
• develop preferred methods and tend to persist in attempts
• shaped by psychosocial processes (desires, availability, norms etc.)
• set and setting shape experience (can be positive and valuable)

Question 23

What are the 5 key aspects of the multi-sourced model of addiction?

Answer 23

• pre-dispositions (genetics, personality)
• past actions/current choices (temporal discounting, patterns of previous consumption, no future consequences considered)
• social, historical and cultural environment (specific stimulating arrangements)
• neurobiology (DA, pleasure centre)
• underlying processes (habitual, form associative links b/w cues + stimuli + others’ responses)

^ provides a number of avenues to intervene!

Question 24

What 4 things do assessment and treatment aim to identify?

Answer 24

• predisposing
• precipitating
• perpetuating
• protective

Question 25

Explain the types of gambling in Australia

Answer 25

• 70-80% gamble once per year
• lottery most common (60%), then scratchies (35%)
• EGM most common continuous gambling (but it’s decreasing)
• EGMs: attract all demographics (women, all ages) - but highest in 18-25 still
• only minority on sports/racing/casino

Question 26

Explain the prev of problem gambling in Australia

Answer 26

• 0.5-2% of adult population
• certain demographics (male, 18-35, Aboriginal, not in stable rship, lower SES)
• started young; big win early on; fam hx of gambling

YOUNG MALES more likely to gamble, having gambling-related problems, have family members with gambling problems, higher prob of involvement in other risky behaviours

Question 27

What are the different ways drugs are classified?

Answer 27

• CNS action (depressant, stimulant)
• subjective effects (hallucinogens)
• context of use (party drugs)
• mode of admin (inhalants)
• source (prescription drugs, illicit vs. licit)

Question 28

Gambling Disorder in the DSM. What are the specifiers?

Answer 28

• persistent + recurrent, distress or impairment, 12+mths
• restless/irritable when stopping
• gamble when distressed
• preoccupied with gambling
• gamble increasingly more money to get excited
• unsuccessful attempts to stop/decrease
• after loss, gamble again to ‘get even’
• lies to conceal extent of gambling
• jeopardised/lost rship, job etc.
• relies on others for $$ to relieve desperate financial situations
• specifiers: episodic v. persistent; early v. remission, mild/mod/severe