lecture 9+ch7/8 Flashcards
state and describe the 4 levels of substance involvement
substance use (ingestion of psychoactive substance in moderate amounts, does NOT significantly interfere w functioning)
intoxication (excessive substance use resulting in impaired judgement, mood changes, lower motor ability)
substance abuse (pattern of excessive or harmful use that significantly interferes w functioning)
substance dependence aka addiction (compulsive drug seeking behaviour, loss of control over usage, -ve emotional state when drug is not available. psychological + physiological dependence)
which level of substance involvement is most problematic
substance dependence
state (dont describe) the 4 reasons why substance dependence is so difficult to overcome
- people become dependent
- you get trapped in the IRISA cycle (Impaired Response Inhibition and Salience Attribution)
- substances alter your neurochemistry
- reinforcement
list and describe the two ways in which addicts become dependent on their substances
physiological dependence
- brain depends on drug to function now
- there are two forms: tolerance (require more of the drug to feel it) and withdrawal (bad physical and psychological symptoms after reducing usage)
psychological dependence
- repeated use of the drug that they cannot control (lose self control)
- cravings to ingest more of the drug
- increased likelihood of relapse
Describe the IRISA cycle
- ingest enough to be intoxicated and lose your self awareness
- lose ability to stop taking the substance (i.e. binge)
- withdrawal if there is no access to the drug (amotivation and anhedonia .. explained in later flashcard)
- cravings, so they seek out the substance
then the cycle repeats!
what does IRISA stand for
impaired response inhibition and salience attribution
VERY GENERALLY, how do drugs alter neurochemistry?
they act on reward centers of the brain and cause dysfunction, by increasing dopamine release
hence, the brain thinks the substance is a reward!
what are reward centers of the brain responsible for?
assigning rewards
producing +ve affect
learning and association
(all of these functions contribute to +ve reinforcement)
what is the main reward center in the brain?
mesolimbic dopamine system (MDS)
true or false: only some structures in the mesolimbic dopamine system make dopamine.
FALSE, all the structures in here make dopamine!
what two brain areas do drugs increase dopamine release in?
ventral tegmental area (VTA)
nucleus accumbens (NA)
explain the relationship between NICOTINE and dopamine brain areas
nic increases dopamine released by the VTA
explain the relationship between OPIATES (their secondary action) and dopamine brain areas
mimic dopamine action in the NA, so brain acts like there is increased dopamine in NA
explain the relationship between ALCOHOL + OPIATES and dopamine brain areas
binds to inhibitory neurons in VTA –> less inhibition in VTA –> more dopamine produced
explain the relationship between COCAINE and dopamine brain areas
stimulates the release of dopamine from VTA and blocks reuptake of dopamine
explain the relationship between OTHER DRUGS (not listed) and dopamine brain areas
alter NA and VTA responses to GLUTAMATE
this heightens memories of past drug experiences, leading to cravings
explain prefrontal cortex (PFC) dysfunction (how drugs alter its neurochemistry)
the PFC no longer properly regulates dopamine, leading to cravings and compulsive use
explain how reinforcement contributes to why addiction is hard to overcome
positive reinforcement
- pleasure, we continue to engage in it bc it feels good
- endorphins and dopamine create pleasure
negative reinforcement
- we use this to avoid withdrawal or reduce withdrawal symptoms
DSM-5 criteria for substance use disorder
at least two symptoms (from the slides) within a 12 month period. examples are:
- strong cravings
- tolerance develops or withdrawal is present
causes significant impairment or distress
true or false: under the DSM-5, clinicians can specify the type of substance for substance use disorders.
TRUE, an example is alcohol use disorder
what drugs are considered depressants?
alcohol
opiates/opioids
sedatives, hypnotics and anxiolytics
differentiate between heavy drinking and binge drinking for men and women.
heavy:
>1/day for women, >2/day for men
binge: >=4 for women, >=5 for men
how does alcohol impact our brain and body
it impacts every major organ once in our bloodstream
for the brain, it has stimulant and depressant effects (involves dopamine, GABA, serotonin, opioids, and glutamate)
what do opiates/opioids make you feel?
drowsy, euphoric, analgesic (numb to pain I think)
how do opiates/opioids impact our brain and us generally?
increase dopamine and bind to endorphin sites
leads to quick tolerance, frequent withdrawal symptoms, cravings, accidental overdoses, and more risk for bloodborne illnesses
what is the relationship bw benzodiazepines and alcohol
combining them can be dangerous since alcohol compounds depressant effect of benzos (a lot of ppl OD from this combo)
what drugs fall under stimulants
caffeine
amphetamine
cocaine
describe the effect of caffiene as a stimulant
impacts serotonin and adenosine
describe the effect of amphetamines as a stimulant
produce euphoria, changes in sociability, anger, anxiety, tension, poor judgement
enhance norepinephrine and dopamine activity
describe the effect of cocaine as a stimulant
euphoria, increased blood pressure and heart rate, insomnia, paranoia, less appetite
what % of the US population uses tobacco products? what about Canada?
26.7% for USA
18% for CAN
what category does nicotine/tobacco fall under, stimulant or depressant?
BOTH! has multiple effects
stimulant: releases dopamine, acetylcholine and epinephrine
depressant: act like opiates and releases endorphines
effect of hallucinogens
vivid sensory experiences
less addictive, so no compulsive drug seeking behaviours
we dont know how it impacts the brain much, but LSD might increase serotonin and dopamine
effect of dissociatives anesthetics
dream like detachment
cough medicine can be misused (turn into lean/sizzurp)
effect of inhalants
brief effects like impaired coordination and judgement, euphoria, dizziness
first time use can even cause stroke or heart failure… spooky!
what age group use inhalants most?`
younger ppl
designer drug examples+ effects
ecstasy, bath salts, “club drugs”
a high followed by a crash
ecstasy use can accelerate physiological dependence development
effects of cannabis and hashish
THC produces euphoria, tranquility and passiveness, with mild perceptual and sensory distortions
unique effect: lack of concern regarding consequences
biological causes of substance disorders: GENES
several genetic factors, such as genes that influence alcohol breakdown in liver
epigenetic and environmental factors as well tho
biological causes of substance disorders: BRAIN FUNCTION
altered reward circuit
low lvls of dopamine
psychological causes of substance disorders (list them)
behavioural (operant/classical conditioning)
cognitive (expectancy effect .. find out wtf this is)
coping w life stress
behavioural issues (risk taking, impulsive)
social/cultural causes of substance disorders (list)
childhood maltreatment
victimization
social norms/advertisements
passive family/friend attitudes
2 main steps to treatment for substance disorders
remove drug from system
increase understanding of factors related to the addiction and develop a future plan
antagonist treatment for substance disorders
provide drug that blocks action of addictive drug (ex; naltrexone)
aversive treatment for substance disorder
provide drug that produces unpleasant effect when addictive drug used (ex; disulfiram)
agonist substitution treatment for substance disorder
provide safer drug that has chemical makeup similar to addictive drug (ex; methadone)
psychological treatment for substance disorders (list)
12 step program (AA)
controlled use
self control strategy
component treatment
social skills training
cue exposure training
relapse prevention
under self control strategies for substance disorder treatment, state the ABCs
Antecedents
Behaviours
Consequences
what is a component treatment?
combines meds and psycho treatment
list other addictive / impulse control disorders (there are 4!)
gambling disorder
kleptomania (stealing)
pyromania(starting fires)
internet gaming disorder
list the feeding disorders
pica
rumination
avoidant/restrictive food intake disorder
pica
eating non nutritive or non edible substances
rumination disorder
repeated regurgitation of food
avoidant/restrictive food intake disorder
lack of interest in certain food , leading to weight loss or nutrition deficiency
treatment for feeding disorders
first, treat nutritional deficiencies
then, psychotherapy:
for avoidant/restrictive: behavioural therapy (learn +ve association bw eating and foods that they wouldn’t typically choose)
for pica: aversive therapy (put bitter tasting thing on their tongue and then put the non nutritive substance in their mouth so that they form an association)
anorexia nervosa + age onset
low body weight and fear of being obese
body image issues and distortion
adolesence (13-20)
subtypes of anorexia
restricting: weight loss through severe dieting or exercising
binge eating/purging: self induced vomiting to control weight after a binge
physical complications of anorexia
high death rate by suicide, substance use, and the effects of starvation
bulimia nervosa
episodes of rapid consumption of large amounts of food, with loss of control over eating
this is followed by a purge, excessive exercise or fasting
they realize this is not normal and hide it from others
eating tends to be their coping mechanism for bad thoughts or stress
what is more common: anorexia or bulimia?
bulimia
health concerns of bulimia nervosa
the vomiting can damage your teeth enamel as well as your gastrointestinal tract
binge eating disorder
bingeing and feeling loss of control combined with distress, which is usually triggered by poor mood or cravings
unlike bulimia or binge eating disorder, there is no purging after the binge. hence, often overweight
MUST HAVE a history of binge episodes at least once a week, for 3 months
MUST HAVE 3 symptoms from the list (i’ll just give 3 random ones here):
- eating large amounts of food when not hungry
- eating alone due to embarrassment about quantity
- feeling guilty after bingeing
how to differentiate between the different eating disorders
look at the AMOUNT of food eaten, if very little, then likely a form of anorexia (binge/purge, restrictive)
look at the WEIGHT of the person (anorexic=underweight, bulimic are normal, and binge eating are overweight)
look at AGE of onset (anorexia = adolescence, bulimia and binge eating disorder =
**note: atypical anorexia is an exception, as they are normal weight.
biological cause of eating disorders
genes:
- runs in family
- genes that influence availability of dopamine and regulation of serotonin
pubertal weight gain
dysregulation of hormones that control hunger and satiety
brain anomalies:
- sometimes restricting or binging causes release in endogenous opiods (neurotransmitters that nmake u feel good), so an association can be formed
psychological causes of eating disorders
body dissatisfaction
low self esteem
perfectionism
overvaluation of appearance
maladaptive beliefs about food and body
reinforcement
sociocultural cause of eating disorders
societal standards for physical attractiveness
stigma around obesity
treatment for anorexia
FIRST STEP IS ALWAYS weight gain and fixing nutrition deficiency
then, psychological:
- understand + cooperate w nutritional and physical rehab
- identify dysfunctional beliefs
- improve relationships
- address other psych disorders
- family therapy
treatment for bulimia
cbt
treatment for binge eating disorder
focus on factors that trigger bingeing
find strategies to reduce binges
