Midterm 1 Lecture Flashcards
What are a few of the social determinants of health
- Income
- Education
- Housing
- Indigenous status
- Gender
- Race
- Disability
The lower your income, the ______ your health
lower
What are the indirect impacts of SUDs on social costs (dollars lost due to SUDs)
- loss of wages due to death
- disability
- being absent from work
- being present at work but not able to function
Which drug has the highest social cost ($)
Alcohol
What are the top 4 substances that have the highest social cost ($)
- Alcohol
- Tobacco
- Opioids
- Cannabis
Are most healthcare providers prepared to work with patients who have SUD?
No, many lack the training and often patients aren’t asked about their drug habits
What is often implicated in many suicides
Alcohol and other drugs
> either SUDs or substances in their systems
Do most people with an addiction receive treatment?
Not, most do not
Why do words and labels matter?
Language can stigmatize and impact behaviour
Stigma
Negative attitudes and beliefs about a person that creates prejudice, and leads to negative actions
Self stigma
Internalization of negative beliefs and attitudes, and applying them to the self
5 levels of the substance use continuum
Level 0: Total abstinence Level Rare to social use Heavy social use Heavy problem use/early addiction Middle to late stage addiction
“Addiction” is used to refer to which end of the continuum of substance use?
The extreme end
4 criteria for having an Addiction
- Loss of control over the use of a substance
- Use substance under risky circumstances
- Experience social impairment due to substance use
- Developed physical dependence on the substance as evidenced by tolerance and withdrawal
T/F Many people who could be categorized at experiencing an Alcohol Use Disorder recovered on their own without treatment within 4 years (according to one study)
True
What is the most common drug of abuse
Alcohol
Are people stuck at one stage on the addiction continuum?
No, it is fluid and you can move between stages
Screening
determining who needs further assessment
Who gets screened?
ppl we think are at higher risk for a disease than the general population
Assessment
Defines the nature and the severity of the problem
> Do they meet diagnostic criteria
What are the 4 things you are aiming to do in the first contact with a client
- Build relationship
- Increase person’s motivation for change
- Assess the person’s strengths
- Identify supports to help the person through the change process
5 characteristics of screening tools
- short
- quick to administer and score
- quickly detect possibility of a problem
- can be used in a variety of settings
- not precise
What types of questions should be asked in screenings?
Open-ended questions
TWEAK screening acronym
Tolerance Worried Eye-opener Amnesia Kut down
What are benefits and draw backs of using online or paper screening tools
- inexpensive
- less threatening than face to face
- Vulnerable to deception
- require literacy
- must be valid on pop of interest
6 steps to a diagnostic assessment
- Referral question
- Clinical interview
- Substance use evaluation
- MSE, Mental Status Exam
- Formal testing
- Summary and diagnosis
During a diagnostic assessment, what things do you want to pay attention to while they are speaking
- The “what” of the speech (content)
2. The “how” of the speech (speed, body language)
Referral question
- how the client finds their why to the practitioner
- what is the question the practitioner is being expected to be answered
What is the first thing you do in a clinical interview
Getting informed consent
What is a semi-structured interview
There is certain info we try to gather from everybody, but you want to have flexibility to pursue the necessary leads
6 general areas that the MSE screens for
- Appearance, behaviour and attitude
- speech and communication
- mood and affect
- ideation and thought content, hallucination
- orientation and memory
- intelligence, judgement and insight
Phase 1 in the substance use evaluation
- Extent and severity of use
- type, amount, frequency, tolerance, family history - Problems associated with substance use (life problems)
- social, family, work, consequences, legal - Past military service
- Treatment
Phase 2 in the substance use evaluation
- Determine the appropriate level of care
- Client treatment goals
- Treatment readiness and motivation
- Client’s strength
- Recovery capital
3 types of tests in formal testing
Objective tests (MMPI) Projective tests (TAT) Intelligence tests (WAIS)
Validity
How well the test accurately measures the construct of interest
Reliability
The test’s ability to measure the construct of interest consistently and in a stable manner
______ make a decision based on one piece of data /souce
NEVER
What has been shown to increase increase the accuracy of the information that the client gives
- Alcohol free
- given assurance of confidentiality
- in a clinical or research setting
4 key concepts in DSM5 diagnosing
Disability
Distress
Impairment
Functioning
2 of the following 11 criteria need to be met for 12 months to be diagnosed with an Alcohol Use Disorder (AUD)
- Alcohol taken in larger amounts or over a longer period then intended
- Persistent desire or unsuccessful efforts to cut down or control use
- Spend lots of time getting, using, or recovering from alcohol’s effects
- Craving or strong urge to use
- Recurrent use results in failure to fulfill major role fulfillment
- Continued use despite continued problems
- Important activities given up or reduced because of alcohol use
- Recurrent use in situations where it’s physically hazardous
- Continued use despite knowledge of a problem what was caused or exacerbated by alcohol
- Tolerance (behavioural tolerance = practiced at masking impairment)
- Withdrawal or alcohol or benzo taken to avoid withdrawal symptoms
Number of criteria met and corresponding severity for an alcohol use disorder
2 -3 mild
4-5 moderate
6+ severe
What other drug is very often taken with alcohol use?
Smoking cigarettes
Issues you need to be aware of when people are using multiple substances
- Cross tolerance
- Pharmocological synergism
- Cigarette use
Pharmocological synergism
Interactions that amplifies both effects
What two psychological illnesses often go hand in hand with SUD
Anxiety and depression
Bi-directional model of dial diagnosis
the SUD and psychiatric illness both cause each other
Common factor model of dial diagnosis
Overlapping diathesis for SUD and psychiatric conditions
What is a major problem when people have a psychiatric illness as well as a SUD
the SUD may mask the mental illness symptoms or be misdiagnosed as an MI symptom
Can most people with an SUD benefit from treatment?
Yes, regardless of the severity
ASAM levels of care
Level 0.5: Early intervention
Level 1: Outpatient treatment
Level 2: Intensive outpatient treatment/partial hospitalization
Level 3: Residential/inpatient treatment
Level 4: Medically managed intensive inpatient treatment
Client-treatment matching
Matching the level of treatment with the severity of the problem. The least intensive treatment possible
Transtheoretical model of change 6 stages
Pre-contemplation Contemplation Preparation Action Maintenance Relapse
Recovery capital
Any resource in the person’s world that can be tapped to initiate and sustain recovery from alcohol and other drug problems
What are ways that drugs are classified?
Grouped by similarity:
- Therapeutic use
- Mechanism of action
- Mode of action
- Chemical structure
Psychoactive
Substances that act on the mind and impacts mental status
Three main categories of drugs
Stimulants
Depressants and opioids/narcotics
Hallucinogens
Addictive drugs hijack the ________ centre in the brain
reward/pleasure
Physiological effects of stimulants
Increased: heart rate, blood pressure, bod temp, metabolic rate, pupils
Decreased: appetite, salavation
NT that are effected by stimulants
Norepinephrine
Dopamine
Serotonin
Some examples of stimulants (5)
Cocaine Amphetamines Methylphenidate Tobacco Caffeine
What does it mean to say that stimulants are sympatho mimetic
They mimic the effects of the sympathetic nervous system
Do people overdose from stimulants?
Not really
How do people die when taking stimulants
heart attacks
Desired effects of stimulants (4)
- More awake
- Elevated mood
- More dopamine activity
- Behavioural excitement
Undesired effects of stimulants (4)
- Anxiety
- Reduced self control
- Irritability
- Psychosis at high doses
What are bath salts? What makes them so deadly?
Mixture of drugs (cocaine and amphetamine-like)
>lethal because we don’t know what is in it
Symptoms of bath salts (7)
- Shortness of breath
- blurred vision
- tremors
- seizures
- convulsion
- psychosis
- high BP
What is psychoactive in tobaco
Nicotine
How quickly does nicotine hit the blood?
Very quickly, within ~20 seconds
What is dangerous in cigarettes?
The tar in it, not the nicotine
What does nicotine do for you?
Increases: psychomotor performance and alertness
Decreases: stress
Why is smoking more reinforcing than wearing a nicotine patch?
Because nicotine enters the blood stream faster when inhaled than through the skin, so there is a more instantaneous reward
What is the “gentle stimulant”?
Caffeine
Symptoms of caffeine (3)
- Elevates mood
- Decreases fatigue
- Inhibits sleep
Amphetamines are ______ that lead to a ______
Uppers
Down (crash)
Symptoms of amphetamines (3)
Reduced:
- appetite
- weight
- fatigue
Symptoms of cocaine (3)
- Increases alertness
- Increases blood pressure
- Causes insomnia
Why is cocaine dangerous
Increases blood pressure and constricts arteries so it can result in respiratory and cardiovascular collapse
What can cause death with depressants
Because they are a CNS inhibitor, they can slow down respiration and heart rate too much and cause death
What do sedative hypnotics do? (what are the effects)
Sedative = calming (anxiolytic) Hypnotic = sleep inducing
When are you are particularly high risk for over dose with sedative hypnotics?
When combined with alcohol
Drugs that end with “al” are usually what type?
Barbiturates
What are the long term effects of sedative hypnotics
Cross tolerance
Withdrawal
- shakes, anxiety, insomnia
What are minor tranquilizers and what are the major tranquilizers
Minor: benzodiazepines
Major: anti-psychotics
How long can you safely take benzodiazepines? Why?
Short period (like a week)
Why: because they are quite addictive and can cause death when mixed with alcohol
What are the effects of date rape drugs?
- Weaken resistance of individual, resulting in apparent consent
- Inhibits memory formation after
What are the effects of benzodiazepines?
- Increase mood
- Increase sociability
- reduce anxiety and depression
What receptor cites to depressants work on?
GABA
What do Hallucinogens/Psychedelics do
Act on NT to produce visual hallucinations and out of body experiences
What is the primary psycho-biological action of hallucinogens
Marked alterations in cortical functioning including cognition, perception and mood
“psychotomimetic”
Mimics psychotic states
3 types of hallucinogens drugs
LSD
Psilocybin
Cannabis
hallucinogens stimulate which part of the autonomic nervous system
sympathetic
Hallucinogens can cause synesthesia, what is that?
a cross in sensation modalities (like hearing colours)
Is there a risk of over dose or withdrawal with hallucinogens?
No
How can there be no withdrawal with hallucinogens
because it does not activate the dopamine system
Reverse tolerance
When there are more effects after repeated use
–> sensitization
Different effects of THC and CBD
THC is the psychoactive part
CBD has no psychoactive properties
What drug does reverse tolerance happen with
Cannabis
Overdose risk with cannabis?
Not really but behaviours while impaired can cause personal harm
Opioids are under which drug class
Depressants
Opioids are analgesics/narcotics, what do they do?
Reduce pain and induce sleep
Characteristics of opioids (4)
- Pain killers
- Mimic analgesic actions of endorphins
- Inhibit release of pain-inducing NT
- Highly addictive
What are the physiological effects of opiates, what body system are implicated
CNS and PNS are depressed
What are the fatal effects of opioids
Respiratory and cardiac depression
Tolerance and withdrawal of opioids severity
Rapid and dramatic tolerance
Severe flu like symptoms of withdrawal
Drug effects are influences by 3 things:
- Baseline state (genetics, gender, weight)
- Pharmacokinetics: how time impacts a drug moving through your body
- Routes of administration
A drug’s primary intended and side effects are affected by the:
method of administration
What are enteral forms of administration
through the gastrointestinal tract
2 types of enteral administration
Orally
Rectally
What route of administration is both the easiest but also the slowest
Orally
What is the advantage of slow release drugs?
If you are having an adverse reaction, there is time to intervene
Draw back of oral route of administration
The acidic environment of the stomach. Can interfere with the drug or cause build up of drug and cause upset stomach
Why are most drugs absorbed through the small intestine
Because then the blood is then filtered through the liver
What can be a danger of the slow release of oral drugs
It takes a while for people to feel the effects so they take another does
Parenteral forms of administration
Injecting drugs using a needle
what is the advantage with injection drugs (2)
Rapid absorption and effects
Bypasses absorption barriers
3 types of injection administration
Intravenous (IV)
Intramuscular (IM)
Subcutaneous (SC)
Disadvantages of parenteral drug administration (4)
- possibility of infection
- Drug levels peaks almost instantly
- Rapid onset or “rush” increases addiction potential
- skin and veins scar after repeated injection
3 types of transdermal drug administration
Intranasal (snorting)
Sublingual - under the tongue
Transdermal
Advantages of transdermal administration
- Ease of administration
- Rapid absorption (bypasses gut)
-
Disadvantages of transdermal administration
- Tissue damage at site of administration
- Not many drugs can be administrated this way
What method is the fastest route of administration
>Why
Inhalation
> Because lung tissue has a rich blood supply
The faster the rate of drug effect onset, the _____ addictive the substance
More
What is a disadvantage when volatilization is achieved for inhaling by burning (like cigarrettes)
There are carcinogenic by-products
Why is vaping safer?
Because there is no burning that results in carcinogens
Therapeutic window
MeaA ratio of the effective does and lethal dose
Is a high or low therapeutic window better?
High, because then there is more of a range where the drug works before there are bad side effects
Adulterants
Substances that are used to “cut” other drugs
> fentanyl used to cut cocaine
Alcohol is subject to what when it goes through the liver
First pass metabolism
What has an impact on rate of absorption for alcohol
- Food in stomach
What has an impact on rate of absorption for alcohol
Food in stomach
Why is alcohol called a “dity” drug for the mechanism of action?
Because it affects many different systems
How does alcohol being “dirty’ effect with prescribed medication
Since alcohol has an effect on a regular basis, chances are that it will interact with your medication
Biotransformation of alcohol
- Some of the alcohol is absorbed straight through the mouth tissue
- Then it is metabolized by ADH in the stomach and liver
One of the ingredients in making ADH (alcohol enzyme) is testosterone. What gender effects does that result in?
Men have more testosterone, so they have more ADH and can metabolize alcohol better
Alcohol-flush reaction. What is it, what causes it?
Red face, dizziness, heart palpitations from drinking alcohol
Caused by a build up of a toxic metabolite of alcohol
How long does it take to metabolize one serving of alcohol?
One hour
Concentration of alcohol in your blood is _______ to the amount of alcohol in your exhales breath
proportional, the same
What do you use to treat delirium tremens? Why?
Benzodiazepines
They are in the same drug class (cross tolerance)
of drinks for binge drinking for men and women
women: more than 4
men: more than 5
3 high risk drinking issues
- Alcohol induced blackouts (assault, risky sex, injury)
- Pre-drinking
- Drinking to cope
Low risk drinking guide lines for men and women
Women: 2/day, 10/week
men: 3/day, 15/week
What is a working definition of social drinking
They do not experience negative side effects/consequences that heavy drinkers do
What is straight edge culture?
A punk subculture who take a “vow” to substance abstinence, safe sex, and commitment to anti-racism
The framework from which you practice in a clinical setting drives what?
Treatment
What was the moral model (old) of addiction (4)
- Addiction was a sin
- It was a character flaw
- It was self inflicted
- Thought that people should be punished
Criticisms of the moral model of addiction
Only punitive and no theoretical foundation that helps people
The traditional disease model of addiction (4)
- People are considered sick
- It is beyond people’s control
- No continuum, addiction is either present or it is not
- There is no cure, only remission through total abstinence
Which of the early perspectives of addiction is de-stigmatizing
traditional disease model
How does Jellinek frame addiction?
Framed it as a disease like cancer
Advantages of the disease model of addiction (4)
- Addiction becomes a health rather than a moral issue
- Provides an explanation that is easy to understand
- Offers a treatment approach that works for some people
- De-stigmatizes
Disadvantages of the disease model of addiction
- removes responsibility from the user
- only 1 course of treatment
Not supported by research
What is the view of the cause of addiction today?
Equifinality = there are many potential causes
What is the bio-psycho-social plus model
It sees that biology, psychology, social plus cultural and spiritual factors all work together and interact to create a problem
In the neuroscience perspective, what are the 3 main factors that contribute to addiction
- Genetics
- Environment
- Human development
In the biological approach to the bio-psycho-social model, what is the focus
the brain is the centre of addiction
The architecture of the brain develops in interaction with what?
The environment
What happens to brain development during trauma
Brain circuits don’t develop in a healthy, optimal way
What NT is released when a drug is taken that is a reinforcer?
Dopamine
Learning and dopamine in addiction
When you do something rewarding, dopamine is released to notify the brain that it was a good thing to do and increases memory of the event so they will do it again
The social learning model of addiction
Addiction is a learned behaviour that results from conditioning
> when something is pleasurable we do it more
> stop doing something when the costs outweigh the benefits
Cognitive perspective of addiction
Thoughts and beliefs shape our behaviours and emotions
Our causal attributions influence behaviour
Negative cognitive triad
Pessimistic view of the self, the world, and the future
What is the relationship between ACE and substance use
People who score high on the ACE scale due to trauma and abuse are more likely to suffer from SUDs
When thinking of the social/cultural aspects of the bio-psycho-social model, what should we think of?
The social determinants of mental health
What is a very important macro-level social factor of substance use?
Social-economic disadvantage: poverty
What is the spiritual aspect of the bio psycho social model?
It is a focus on self-awareness and its relationship with self-determination and responsibility for one’s own choices
Whats is the role of spirituality and religion in addiction
See there is something bigger than ourselves and is life affirming, part of a community
