LO1 Flashcards
What is a drug?
Any substance, natural or artificial, other than food, which by its chemical nature alters structure or function in the living organism.
What is an illicit drug?
A drug that is unlawful to possess or use. They may be available by prescription, but when manufactured or sold illegally, they are illicit.
What is addiction?
Chronic relapsing condition characterized by compulsive drug seeking and abuse by long-lasting chemical changes in the brain. Continued use of the addictive substance includes adaptive changes in the brain that lead to tolerance, physical dependence, uncontrollable cravings, and relapse.
What is drug misuse?
Use of prescribed drugs in greater amounts than, or for purposes other than, those prescribed by a physician or a dentist. For non-prescription drugs or chemicals such as paints, glues or solvents, misuse might mean any other than the use intended by the manufacturer.
What is drug abuse?
Use of a substance in a manner, amounts, or situations such that the drug use causes problems or greatly increases the chances of problems occurring. The problems may be social, legal, occupational, psychological, or physical.
What is drug dependence?
A state in which the individual uses the drug so frequently and consistently that it appears it would be difficult for the person to get along without using the drug. Stopping is very difficult and may cause severe physical and psychological withdrawal.
What is drug tolerance?
A reduced reaction to a drug following it’s repeated use. Increasing its dosage may re-amplify the drug’s effects. Indicative of drug use but is not necessarily associated with drug dependence or addiction.
What is dopamine signalling?
Dopamine is a key signalling molecule in the brain’s reward system. Repeated exposures to addictive substances can cause the dopamine pathway in the brain to adapt to the effects of these substances, requiring more of the substance to receive the same amount of reward.
What are the psychological factors influencing addiction?
- Thoughts, feelings, and behaviours surrounding and generated by misuse (triggers).
- Early and persistent problem behaviours and learning difficulties.
- Mental illness (anxiety and depression).
- Issues related to trauma, victimization, and extreme stress experiences.
- Motivators to reduce or stop drug use.
What are the social factors of addiction?
- Friends and family
- Performance at work and school
- Neighbourhood risks (violence, gangs, crime rates)
- Early access to drugs and alcohol
- Racial discrimination or prejudice
- Early life exposure to stressful situations
- Association with substance users
What is trauma?
Directly experiencing or witnessing an event that involves actual or threatened death or serious injury. Can also be learning about a family member or close associate who has experienced such an event.
What are the two hypotheses for substance use disorder and trauma?
- Self-medicating to try to numb the pain and feelings
- Using substances can lead to traumatic events
What are the adverse childhood experiences?
- Abuse- physical, emotional, or sexual
- Neglect- physical and emotional
- Household dysfunction - mental illness, incarcerated relative, domestic violence, substance abuse, or divorce
What are the nursing interventions for trauma?
- Introduce yourself and what your role is
- Use non-threatening body positioning
- Explain what needs to be done and what you are doing to the patient
- Ask permission before touching the patient
- Protect the privacy of the patient
What are some signs of adolescent substance use?
- Problems at school- attendance or grades
- Resisting discipline or feedback- ignoring curfew
- Secrecy- locking bedroom, secret phone calls
- Withdrawal from relationships- family or friends
- Frequently asking for money or stealing
- Poor hygiene and eye contact
What are some factors related to geriatric substance abuse?
- Chronic pain/illness
- Slow metabolism
- Poly pharmacy
- Disability/reduced mobility
- Life transitions
- Grief
- Mood disorders
What are some of the risk factors in Black Indigenous People of Colour (BIPOF) Communities?
Systemic racism, not having means to pay for tx, fear of incarceration, lack of nuclear family structure, lack of visible role models, lack of access to tx facilities, lack of leadership and support within the community, lack of representation and support from public health policymakers, and disparities in health care including a lack of cultural awareness from healthcare providers.
What are the criteria for substance related disorders?
2-3 symptoms are mild
4-5 symptoms are moderate
Over 6 symptoms are severe
What is considered binge drinking?
5 or more drinks for men
4 or more drinks for women
Remission
Early remission: no symptoms for the past 3 months or longer
Sustained remission: no symptoms for 12 months or longer
Cravings: may still exist
Limbic system
Brain regulates- temp, emotions, coordination, breathing, etc.
Drugs interact with the limbic system to release the feel good emotion- the brain is rewarding something that brings pleasure.
What is the major feature of dependence?
The loss of control over drug seeking behaviour.
At first glance the lack of control seems to be voluntary.
Neurobiology suggests the compulsion is overwhelming (biochemical causation).
Dopamine and Addiction
The crucial neurotransmitter
Dopamine is involved with movement, motivation, emotional response, and pleasure and pain.
The mesolimbic dopamine system begins in the midbrain and connects to the limbic system in the amygdala and hippocampus and the medial frontal cortex.
Some drugs like cocaine block the reputable increasing the dopamine available in the synaptic cleft.
Other important neurotransmitters
Serotonin- role in emotional disorders, aggression (LSD acts upon).
Norepinephrine- regulates arousal to the environment (hormone) regulator of body functions hr and bp (cocaine indirectly acts upon).
Acetylcholine- excites neurons, muscle contractions (nicotine acts upon).
Endorphins- released during stress, pain (opioids act upon).
Endocannabinoids- a role in mood, pain (marijuana acts upon).
Glutamate- excites neurons (alcohol acts upon).
GABA- inhibits neurons (benzos act upon)
Theories to help explain addiction
Dysregulation of the reward pathway with long time use.
Neuroadaptation- increased or decreased sensitivity to the drug.
Genetic factors or a genetic vulnerability.
Most likely a combination genetic, environmental, and drug exposure (biopsychosocial)
Sensitization and Desensitization- Neuroadaptation
Cells adapt to exposure and can become MORE sensitive to the drugs OR the number of receptors decrease and become LESS sensitive to the drug.
Tolerance and sensitization are the bodies desire for homeostasis.
This process can occur with ONE exposure.
Genetic/Biological
The reward or mesolimbic dopamine system- site of addiction.
Genetic miswiring may be a causative factor in addiction.
Alcohol
Depressant, but creates an initial feeling of euphoria
Decreased inhibitions
Neurotoxin
Abuse often binge drinking (mixing caffeine with drinks increases buzz)
Most widely used and accepted drug
No specific receptor site
Alcohol use disorder- level of severity mild, moderate, severe.
CNS stimulants
Stimulate CNS at many levels
Euphoria and relief from fatigue
Most common: amphetamines, methamphetamine, cocaine
Amphetamine- Stimulant
Legal use for narcolepsy, short-term weight reduction programs
Extended release and medication patches decrease the abuse potential of the drug
Cocaine- Stimulant
Inhaled as a powder, snorted, injected intravenously, or smoked
Cocaine euphoria short acting, starting with 10-20 second rush, then 15-20 minutes of less intense euphoria.
Used for thousands of years for its anti fatigue.
CNS Depressants
Barbiturates: depressants initial response of euphoria
Once widely prescribed for sedative-hypnotic effects
Produce excessive drowsiness, even at therapeutic doses
Tolerance develops rapidly
Benzodiazepines
Replaced barbiturates as preferred tx for anxiety, insomnia, and panic disorder
Safer
Physical and psychological dependence
Withdrawal symptoms when discontinued
Commonly prescribed
Opioids
Derived from opium-active ingredient morphine
Often prescribed as an analgesic
Natural opium derivative is morphine
Semi synthetic and synthetic oxycodone, heroin, codeine, fentanyl, methadone.
Marijuana
Psychoactive ingredient is THC
One of the most common drugs, legalized in 2018
Generally smoked
A more potent form is hashish
Cannabis withdrawal has been added to the DSM V
Club drugs Hallucinogens
Commonly used hallucinations: LSD, peyote, mescaline
Perceptual distortions, not true hallucinations
LSD- very potent mind expanding psychedelic
Club drugs and dissociative anaesthetics
LSD alters perception
Ketamine is a dissociative anaesthetic
Methamphetamine is a stimulant
GHB increases alertness used by body builders
Rohypnol- the date rape drug
Club drugs
Common club drugs
Ecstasy - Often used at raves, Produces euphoria, Anti fatigue effect increases energy, Increases body temperature.
Phencyclidine- ingested or smoked when mixed with other substances.
Euphoric, floating feeling; heightened emotionality, in coordination, and distorted perceptions.
Dissociative anaesthetic- feel little or no pain
Inhalants
A description of many substances that are inhaled for effect: gasoline, paint thinner, glue, spray cans.
Euphoric, mind altering
Low cost, legal to obtain, easy availability.
