module 7 - final Flashcards
substance use
the ingestion with no negative effects
substance intoxication
- experiencing the intended psychological effects of substances
- different depending on the substance, person, situation, amount of substance and method of engaging with the substance
substance abuse
- when use causes distress and/or impairment
- distress to you
- impairing work, school, daily functioning or involve putting yourself in dangerous situations
substance dependence
dependence is physiological and psychological
substance dependence - physiology
- the physiological experience discusses tolerance and/or withdrawal associated with substance use
- increased tolerance: increasing amounts of the substance to experience an effect
- may not necessarily negatively affect you according to users
substance dependence - psychology
- the beliefs and behaviours surrounding the substance
- the sense you are craving the substance
- beliefs you have about needing the substance
- behaviours you engage in; such as, are you engaging in negative behaviours to continue engaging in use?
common misconceptions
- “Illegal drugs have no positive effects”
- “If you use an illegal drug once, you will become addicted”
- cannabis is a “gateway” drug
- prohibition increases drug availability
- only former drug abusers (those with addiction experience) make good drug therapists
rat experiment
- rats in an empty cage were given regular water and water laced with drugs and majority/all of the rats drank themselves to death with laced water
- when rats were in a cage with stimulation (other rats, toys, things to do) none/minimal rats overdosed on the laced water
- proposed to idea that connections and bonding are adaptive and can contribute to a need for drugs
substance abuse disorder criteria
- must meet 2/11 criteria over a 12 months period and experience significant impairment or distress
- the criteria are grouped based on:
- physical dependence
- risky use
- social problems
- impaired control
etiology of general biological factors
- genetics: genetic contribution specific to alcohol, tobacco and opiates
- reward areas in the brain: dopamine reinforces use and is the most related system in the brain to substance use. our opiate systems consist of pain relief and pleasure
treatment of general biological factors
- antagonists (block effects) exist to counteract overdose for some substances
- antagonist examples: naloxone → stop opioid (fentanyl) overdose and valium→ prevent amphetamine (cocaine) overdose
- stomach pumping → prevent alcohol overdose
- medically supervised withdrawal
- replacement medications such as methadone which can be legally prescribed as a replacement for the illicit drug
general psychological etiological factors
- disease model
- parental influence
- expectancy effects
- positive reinforcement
- negative reinforcement
- opponent-process theory
- conditioned place preference/tolerance
general psychological etiology - disease model
- addiction is the same as any other disease
- meaning if someone has access to the substance they cannot control their actions and will engage in said substance
- often taken by 12-step recovery approaches like AA
general psychological etiology - parental influence
- if children grow up witnessing drug use in parents it will normalize it and may teach children that drugs are an appropriate coping mechanism
- on the other hand parents that exert firm behavioural control may stop the effects of negative peer influences
general psychological etiology - expectancy effects
- how beneficial we believe the drug will be, increases our likelihood of using it
- expectancy effects are generally not linked to dependence but can be linked to abuse
general psychological etiology - positive reinforcement
- e.g. the high from substances is positively reinforcing and can encourage more use
- poly-substance use is often an attempt to enhance the effects/the high
- e.g. partying with friends and getting high to have more fun
general psychological etiology - negative reinforcement
- we remove the unpleasant to reinforce the behaviour
- removing either physiological or psychological distress reinforces use
- e.g. having a bad day and knowing smoking weed and feeling that high will make the bad feelings go away; escape bad things
- self medication motivation is less linked to abuse but more linked to dependence
general psychological etiology - opponent-process theory
- we have emotions that are paired as opposites (happiness and sadness; fear and relief; pleasure and pain)
- this means that when you are experiencing one emotion the other is temporarily inhibited, and with repeated stimulus the initial emotion becomes weaker and the opposing emotion intensifies
- drug addiction is the result of an emotional pairing of pleasure and pain (withdrawal symptoms)
- drug users feel intense levels of pleasure but overtime pleasure decreases and withdrawal symptoms increase; meaning now they need more of the substance, more frequently to avoid withdrawal
- accounts for tolerance and reuse to escape withdrawal effects
general psychological etiology - conditioned place preference/tolerance
- individuals develop context associations in reward related behaviours
- reward related behaviours can include both natural rewards and drugs of abuse
- when individuals engage in substances they may created associations with where they are and their use of substances
- e.g. if every time when they walk into their home, it is dark and they feel angry, go to their fridge and crack open a beer, it creates context cues
- your body will begin to ready itself physiologically or develop cravings when exposed to context cues
- can lead to overdose in certain circumstances if someone is consistently engaging in a substance in particular circumstances, their body will not be ready physiologically of you begin using a substance in a new area
general psychological treatments
- 12 step programs
- support groups/community resources
- inpatient programs
- CBT
- motivational interviewing
- harm-reduction
general psychological treatments - 12 step programs
- support disease model
- often a religious component tied to them
- often male dominated
- good for social support
- often not fans of independent research into their efficacy
- efficacy can range from 30-60%
- high drop-out rates
general psychological treatments - support groups/community resources
- can help with things like housing and issues contributing to poor outcomes of addiction
- not effective in treating addiction
general psychological treatments - inpatient programs
not super effective and are good for detox but that’s about it
general psychological treatments - CBT
- more cognitive focussed
- exposure component of CBT is not as useful here
- can treat comorbid symptoms
- CBT typically more focused on controlled use rather then abstinence
general psychological treatments - motivational interviewing
- help individual find their own reasons for addressing their substance use
- used but itself or in conjunction with CBT
- tends to be fairly effective with addictions and teens
general psychological treatments - harm reduction
- focuses on helping the individual reach their goals and be safe about it
- can be use don combination with CBT
- research has shown effectiveness
- e.g. safe injection sites, providing fresh needles
substance related disorders
- alcohol
- tobacco
- cannabis
- amphetamines/cocaine
- opioids
- hallucinogens
- gambling disorder
alcohol intoxication
- initial increase in well-being and decreased inhibitions
- increased use leads to decreased motor control, decreased coordination, impaired reaction times, poor judgment, blackouts
- long term, chronic use can lead to dementia and brain damage
- FASD is a potential side effect of alcohol consumption during pregnancy
alcohol withdrawal
- alcohol withdrawal for those with addiction may experience hand tremors, nausea, anxiety, insomnia, hallucinations and delirium tremens
- alcohol is the only substance where people can die from the withdrawal symptoms
- binge drinking men: 5+ drinks in 2 hours; 4+ drinks in 2 hours
delirium tremens
severe hallucinations and body tremors
alcohol disorder prevalence
- 12mo% = 12% men, 5% women
- higher in teenagers and young adults
- young males are most at risk of alcohol addiction
biological etiology of alcohol disorder
- genetics
- glutamate and GABA
- serotonin, dopamine and opioids
- alcohol dehydrogenase
genetics as an biological etiology of alcohol disorder
- genetic contribution particularly for men toward alcohol dependence
- individuals with a family history of alcohol addiction seem to experience more physiological pleasure from drinking
- heritability of alcoholism may be as high as 70% and its possible it is the same genes that predispose us to be antisocial
glutamate and GABA as biological etiology of alcohol disorder
- decrease glutamate which is a cause of blackouts
- increases GABA which has an anxiolytic effect and slows the firing of neurons
serotonin, dopamine and opioids as biological etiology of alcohol disorder
- increases serotonin but overtime/long term use depletes serotonin in the system
- the effects of serotonin are associated with cravings
- initial increase in dopamine and reinforces use or abuse but, long-term decrease in dopamine results in dependence
- hijacks our pleasure systems
alcohol dehydrogenase as an biological etiology of alcohol disorder
- dehydrogenase is the enzyme in the liver that breaks down alcohol and it is not present in some asian individuals which results in the skin flushing response; present in 30-50% of asians
- asians have lower rates of alcohol abuse
biological treatment of alcohol abuse disorder
- antabuse: causes nausea while drinking, but people often stop taking it if they know they will drink
- naltrexone: stops euphoria associated with alcohol by blocking opioid receptors
psychological etiology of alcohol disorders
- cultural differences
- alcohol myopia
- motivations for use
cultural differences as a psychological etiology for alcohol disorder
- affect perceptions of appropriate amounts of alcohol to drink, or the type of beverages more likely to be consumed
- some cultures and religions completely discourage alcohol use
- certain places such as France and Greece are more comfortable with childhood use of alcohol and actually have lower rates of alcohol abuse
alcohol myopia as a psychological etiology for alcohol disorder
- myopia refers to nearsightedness
- alcohol Myopia is the tendency of alcohol to increase a person’s concentration upon immediate events (what’s happening right now) and reduce awareness of events which are distant (less focus on the future)
- focus on here and now and defines YOLO
motivations for use as a psychological etiology for alcohol disorder
- are the engaging with alcohol for positive reinforcement reasons like the high or euphoria>
- are they using alcohol to medicate, and for negative reinforcement like removing pain?
psychological treatments for alcohol abuse disorder
- alcoholics anonymous
- CBT
- harm reduction
AA as a psychological treatments for alcohol abuse disorder
- support disease model
- “Turn yourself over to a higher power”
- promote complete abstinence
- huge dropout rates
- best features include lack of stigmatization and social support
- little research on efficacy because they tend to prevent research from occurring
CBT as a psychological treatments for alcohol abuse disorder
- focus on controlled drinking rather than complete abstinence
- examine their beliefs around how much they drink, what they think about their drinking, why they think they drink, when do they tend to drink, what triggers drinking, etc
- eeem to be equivalent if not superior to AA
- less dropout then AA but still has a lot of relapse (70-80%)
harm reduction as a psychological treatments for alcohol abuse disorder
- tailored to the individuals
- mitigate risks of their use through acknowledging contexts and environments where abuse occurs
amphetamines/cocaine intoxication
- initial increase in euphoria, alertness, insomnia
- with increased use you may experience hallucinations, anxiety, vomiting, weight loss, seizures, coma
- ages the brain quicker
- long-term negative side effects take a while to develop but sleep disturbances and social isolation tend to be the most prominent
amphetamines/cocaine withdrawal
experience apathy, boredom, depression, increased sleep, irritability
amphetamines/cocaine prevalence
- 12mo% = 0.2%
- use of cocaine is relatively uncommon, with less than 10% of people having ever used cocaine (don’t memorize)
- no difference between men and women but men use cocaine more
biological etiology of amphetamines/cocaine abuse disorder
- increased norepinephrine and dopamine causes hallucinations
- reverse tolerance and sensitization
reverse tolerance/sensitization as a etiology of amphetamines/cocaine abuse disorder
- drug sensitization/reverse tolerance is the opposite of developing a tolerance to the substance, meaning you get increasing effects with the same use
- certain drugs, typically psychoactive substances, used repeatedly can alter the body’s sensitivity so that repeated administration of the drug enhances its effects
biological treatment of amphetamines/cocaine abuse disorder
- propranolol: targets the anxiety associated with cocaine withdrawal
- modafinil & ADHD medication: give attention improving effects they’d usually get from cocaine without having to get high
psychological etiology of amphetamines/cocaine abuse disorder
- apathy and extreme boredom are symptoms of withdrawal which prompts re-use
- impulsivity linked to sensitization
psychological treatment of amphetamines/cocaine abuse disorder
- cocaine anonymous
- CBT – contingency management
- CBT - community reinforcement
- harm reduction
cocaine anon. - psychological treatment of amphetamines/cocaine abuse disorder
- similar to AA model
- support disease model
- “Turn yourself over to a higher power”
- best features include lack of stigmatization and social support
CBT - contingency management -psychological treatment of amphetamines/cocaine abuse disorder
- behaviorism - positive reinforcement
- set up programs for the individual to receive positive rewards when meeting their goals
- e.g. read a paragraph get a gummy bear → but addiction model like 6 month clean chip
CBT - community reinforcement - psychological treatment of amphetamines/cocaine abuse disorder
- non-using social support in an individual’s life being involved in their treatment
- improving relationships
- also helps with finding housing, work, education, recreational activities
harm reduction - psychological treatment of amphetamines/cocaine abuse disorder
- drug checking to screen for amphetamines or cocaine
- promote the use of straws, or cleaner methods to snort cocaine, clean needles or non-sharing methods
tobacco/nicotine intoxication
- experience the immediate relief of stress and mood improvement
- blurred vision, confusion, convulsions
- however, nicotine may improve conditions and may be beneficial in treating those with alzheimers and dementia
tobacco/nicotine withdrawal
experience depressed mood, insomnia, anxiety, difficulty concentrating, restlessness, irritability, increased appetite/weight gain
tobacco/nicotine prevalence
- 12mo% = 15%
- 40% of people have been smokers at some point
- men tend to start sampling younger and rates of smoking in women tend to increase during the first year of university
biological etiology of tobacco/nicotine abuse
- nicotinic acetylcholine receptors: located in the limbic system, in the pleasure systems in the brain and smoking cigarettes enhances the influence of alcohol on dopamine
- genetic predisposition: heritability component of both depression and nicotine addiction
biological treatment of tobacco/nicotine abuse
- nicotine replacement therapy
- wellbutrin/zyban
- champix
- silver acetate
nicotine replacement therapy - biological treatment of tobacco/nicotine abuse
- chew nicotine gum or using nicotine patches
- moderately effective but should be used in combination with therapy
wellbutrin/zyban - biological treatment of tobacco/nicotine abuse
- antidepressant but also helped people quit smoking
- can see positive benefits but can cause hallucinations and delusions
champix - biological treatment of tobacco/nicotine abuse
- tends to decrease cravings and the pleasurable effects of tobacco
- roughly 20-25% effective
silver acetate - biological treatment of tobacco/nicotine abuse
- can be taken in the form of chewing gum or a lozenge
- makes tobacco taste bad
- not very effective
psychological etiology of tobacco/nicotine abuse
- depression/anxiety can prompt relapse if the most immediate effect of smoking is stress relief
- motivations for use
- environmental stimuli/triggers
psychological treatment of tobacco/nicotine abuse
- CBT:
- contingency management
- community reinforcement
- changing environmental stimuli
- psychoeducation
- abstinence is almost always to goal because smoking cigarettes is so dangerous to your health because of links to cancer or heart disease
opioid intoxication
- euphoria, drowsiness, slowed breathing
- death due to depressed respiration
- many people with opioid abuse will die from homicide, suicide or overdose
opioid withdrawal
experience nausea, chills, diarrhea, and insomnia
opioid prevalence
12mo% = 0.1-1%
biological etiology of opioid abuse
- enkephalin and endorphin systems are part of the general opioid system in our bodies which gets hijacked
- removal of pain is often why individuals keep using
biological treatment of opioid abuse
- methadone: switching someone’s addiction to a legal drug
- buprenorphine: partial opioid agonist
- naltrexone: stop the high but rare for people to continue taking
psychological etiology of opioid abuse
- withdrawal symptoms prompt re-use
- sensation seekers vs. emotional copers
- sensation seekers use is motivated by positive reinforcement like the high or euphoria
- emotion copers use is motivated by negative reinforcement like removing pain
psychological treatment of opioid abuse
- narcotics anon.
- CBT
- harm reduction
CBT - psychological treatment of opioid abuse
- contingency management
- community reinforcement
- changing environmental stimuli
- psychoeducation
cannabis intoxication (THC & CBD)
- experiences vary from person to person
- reactions change over time and change depending on type of ingestion
- euphoria, loss of time, heightened sensory experiences, mood swings, anxiety
- with increased use paranoia, hallucinations, dizziness may be experiences
- experience both tolerance and sensitization
- heavy users may report impairment of memory, contraction and motivation
cannabis withdrawal
- irritability, appetite loss, and difficulties sleeping
- experience extreme, colourful, vivid dreams
- withdrawal is rare and cravings are extremely low compared to other substances
cannabis prevalence
- 12mo% = 1-4%
- slightly higher in men compared to women
- 10-25% report trying it at some point
biological etiology of cannabis abuse disorder
- endocannabinoids
- sensitization
endocannabinoids - biological etiology of cannabis abuse disorder
- system throughout our brain and body
- effects of THC are wide ranging because of all the areas in our body with endocannabinoids
- contributed to slow reaction time, disrupt ability to remember recent events, effect judgment, cause anxiety
- effects the parts of the brain that gives you the feel good, euphoria, high feeling
- overtime THC can change how endocannabinoids work, which causes addiction, and long-term effects of memory
biological treatment for cannabis abuse disorder
treat comorbid conditions such as anxiety or depression
psychological etiology of cannabis abuse disorder
- motivations for use
- positive vs. negative reinforcement os use
psychological treatment of cannabis abuse disorder
- CBT – relapse prevention; encourage them to view relapses as deviations/slip-ups and not a full return to abuse
- harm reduction
hallucinogen intoxication
- hallucinations, depersonalization, and distorted sensory perceptions
- increased use can result in increased heart rate and perspiration
- rapid tolerance occurs
hallucinogen withdrawal
none, but “bad trips” may occur
hallucinogen prevalence
- 12mo% = 0.1%
- addiction is slightly higher in men
biological etiology of hallucinogens
- serotonin and norepinephrine (no idea how they are involved)
- there is no treatment
psychological etiology of hallucinogens
motivations for use
psychological treatment of hallucinogens
- rarely seek treatment most of the time they will just stop on their own
- CBT; similar to other addictions
- harm-reduction
gambling disorder
- persistent and recurrent problematic gambling behaviour, as indicated by:
- needs to gamble with increasing amounts to achieve desired level of excitement (tolerance)
- is restless or irritable when attempting to cut down or stop (withdrawal)
- repeated unsuccessful efforts to control, cut down, or stop
gambling disorder criteria
- 4/9 criteria in a 12 month period for a diagnosis
- gambling is characterized as mild, moderate or severe
- gambling can be episodic or persistent
- often gambles when distressed
- after losing money, often returns another day in an attempt to break even
- has jeopardized or lost significant relationships, and educational, or job opportunities
- may lie to others to hide the extent of their gambling involvement
- may rely on others to help them financially
gambling disorder prevalence
- 12mo% = 0.2-5%
- rates tend to be higher in men
- elderly individuals may be particularly at risk
- not super common in teens other than online (sports betting, online poker games)
mild, moderate and severe gambling criteria
- mild = 4-5/11 criteria
- moderate = 6-7/11 criteria
- severe = 8-9/11 criteria
biological etiology of gambling disorder
- dopamine and serotonin systems; initial increase in dopamine and serotonin, however that seems to decrease long-term
- decreased activity in brain areas associated with impulse control
biological treatments of gambling disorder
- opioid antagonists: blocking opioid receptors; some effectiveness in blocking opiates/the high but come with side effects
- SSRIs: not useful long-term but short-term benefits have been seen
- lithium: useful in reducing thoughts about gambling but not actual gambling behaviours
psychological etiology of gambling disorder
- positive and negative reinforcement (flashing lights and colours vs. coping)
- gamblers tend to overestimate their skills
- lack an understanding of “chance” and “random”
subtypes of psychological etiology of gambling disorder
- behaviourally conditioned
- emotionally vulnerable
- antisocial-impulsive
behaviourally conditioned subtype of psychological etiology
succumb to the principles of operant conditioning; positive reinforcement; the wins, lights, sounds, etc
emotionally vulnerable subtype of psychological etiology
emotional copers, the ones that gamble to hide emotional disorders
antisocial-impulsive subtype of psychological etiology
- genes that predispose someone being antisocial are also related to impulsiveness
- these would be the ones that don’t make plans or may steal to pay for their gambling
psychological treatment for gambling disorder
- CBT/harm reduction: eliminate as many risks of gambling as possible while changing beliefs around chance, randomness and skills; also replacing gambling behaviour with a hobby or activity
- gamblers anonymous: rarely effective
