Lecture 7 - Substance Use Flashcards
1
Q
Why consider substance use?
A
- 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
2
Q
Define substance abuse
A
- use of substances is causing problems in life
- failure to fulfil role obligations
- impaired functioning in some way
3
Q
Define withdrawal symptoms
A
- compensatory reactions in the body that oppose the primary effects of the drug (the opposite effects of the drug)
- eg. heroin = euphoria, withdrawal = dysphoria
4
Q
Define craving and tolerance
A
- craving: psychological urge to use a discontinued substance/drug
- tolerance: need more and more of a drug to get the same effects
5
Q
Explain the continuum of substance use
A
- 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)
6
Q
What is a substance use disorder, according to the DSM? What are the specifiers?
A
- 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
7
Q
What is a substance induced disorder, according to the DSM?
A
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
8
Q
What are substance/medication induced mental disorders?
A
- 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
9
Q
What is the prev rate of substance-related disorders? What is the burden of it?
A
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
10
Q
What are the drugs that most commonly lead to dependence?
A
- nicotine: 32%
- heroin: 23%
- crack cocaine: 20%
- alcohol: 15%
11
Q
Why might substance use be under-recognised?
A
- 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)
12
Q
Who uses drugs?
A
- 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
13
Q
What is the comorbidity in substance use?
A
- antisocial PD
- schizophrenia
- affect
- anxiety
14
Q
Why is there higher comorbidity with substance use?
A
- direct or indirect causal rship??
- common factors that increase risk of both disorders < probably
- shared factors: social + environmental, biological (genetic, personality, neurotransmitters etc.)
15
Q
Explain the conditioning theories of drug dependence
A
OPERANT
- or - reinforcement > use again
- physiological or social reinforcement
CLASSICAL
- pair alcohol with positive outcome
16
Q
Explain the disease model of drug dependence
A
- 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
17
Q
Explain the educational model of drug dependence
A
- 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
18
Q
Explain the general/social influences of drug dependence model
A
- 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)
19
Q
Explain the temperance model of drug dependence
A
- 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
20
Q
Explain the biological models of drug dependence
A
- 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
21
Q
Explain the personality-based model of drug dependence
A
- 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, )
22
Q
Explain the biopsychosocial model of drug dependence
A
- 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)
23
Q
What are the 5 key aspects of the multi-sourced model of addiction?
A
- 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!
24
Q
What 4 things do assessment and treatment aim to identify?
A
- predisposing
- precipitating
- perpetuating
- protective
25
Q
Explain the types of gambling in Australia
A
- 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
26
Q
Explain the prev of problem gambling in Australia
A
- 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
27
Q
What are the different ways drugs are classified?
A
- CNS action (depressant, stimulant)
- subjective effects (hallucinogens)
- context of use (party drugs)
- mode of admin (inhalants)
- source (prescription drugs, illicit vs. licit)
28
Q
Gambling Disorder in the DSM. What are the specifiers?
A
- 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
