Module 8 - Substance Abuse

Question 1

Substances of abuse are divided into what 10 classes?

Answer 1

alcohol; caffeine; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants; tobacco; and other or unknown substances.

Question 2

What is substance use disorder?

Answer 2

Recurrent use of one of these specific substances that leads to adverse consequences. The disorder ranges in severity from mild to moderate to severe, depending on the number of problem indicators. The 11 indicators apply to most classes of substances.

Question 3

What are the 4 general groupings of indicators of substance use disorder?

Answer 3

1) Impairment of control over use

2) Social impairment

3) Risky use

4) Pharmacological criteria - indicators (10 and 11) are tolerance and withdrawal.

Question 4

What is a substance-induced disorder?

Answer 4

These disorders are sets of symptoms that are caused by the heavy use of specific substances and they generally resolve when the person stops using the substance.

Question 5

What is Polysubstance abuse?

Answer 5

The simultaneous misuse or dependence upon two or more substances.

Question 6

Combining drugs is physically dangerous because they are often synergistic. What does this mean?

Answer 6

The combined effects of the drugs exceed or are significantly different from the sum of their individual effects.

(Ie: mixing alcohol and barbiturates or opioids can depress central nervous system (CNS) functioning to a much greater degree than any of these substances alone.)

Question 7

What has been called the “world’s number one psychoactive substance”?

Answer 7

Alcohol.

Question 8

What is the effective chemical compound in alcoholic beverages? And what does it do?

Answer 8

Ethyl alcohol.

It has a biphasic effect: At lower doses, the effect of alcohol is stimulating, resulting in pleasant feelings. At higher doses, alcohol acts as a depressant, and many may experience dysphoria.

Question 9

True or False?

Women have significantly less of the enzyme alcohol dehydrogenase (which breaks down alcohol in the stomach).

Answer 9

True.

Question 10

True or False?

There is consistent evidence that moderate alcohol consumption is related to a lower incidence of coronary heart disease.

Answer 10

True.

Consuming 1-2 drinks of alcohol per day may raise HDL cholesterol (“good cholesterol”), which in turn increases blood flow through the coronary vessels. BUT heavy alcohol use = damage to the heart muscle (cardiomyopathy), high blood pressure, and strokes.

Question 11

Research has demonstrated that the brains of individuals who abuse alcohol demonstrate tissue reduction, particularly in the hypothalamus and thalamus. What is one result of this?

Hint: It’s the name of a syndrome.

Answer 11

Wernicke-Korsakoff syndrome

(an inability to form new memories and a loss of contact with reality.)

Question 12

What are some factors in the etiology of alcohol disorders?

Answer 12

Genetic + Neurobiological- Genes associated with the GABAergic, dopaminergic, glutamatergic, serotonergic, opioid, and cholinergic systems have been implicated in the susceptibility to alcohol dependence. AND ability to metabolize alcohol can be genetic.

Psychological Factors - strongest association is with the trait of behavioural disinhibition. Also, negative emotionality or neuroticism is associated with alcoholism.

Socio-Cultural - people who are introduced to drinking as a rite of passage in an environment in which excessive drinking is socially accepted are an increased risk of developing alcohol problems.

Question 13

What is the alcohol expectancy theory?

Answer 13

Proposes that drinking behaviour is largely determined by the reinforcement that an individual expects to receive from it.

Question 14

What is the term for this phenomenon?

Our bodies learn to anticipate and adjust to drug effects based on the cues in our surroundings.

Answer 14

Behavioural tolerance.

Question 15

What are the treatments for alcohol use disorders?

Answer 15

1) Minnesota Model - 12 step philosophy. Abstinence is the goal.

2) Drugs - benzodiazepines to make detox more tolerable. Naltrexone (an opioid antagonist drug) blocks pleasurable effects of alcohol. Acamprosate (agonist for GABA) reduces cravings. Antabuse (to buildup of acetaldehyde) is used to make person throw up etc.

3) Mutual Support Groups - AA does not use professionally trained staff; it is a self-help group. Goal is abstinence. Don’t believe in cure but believe that they are powerless to control their drinking and must rely on a “Higher Power” to help them.

4) Psyc Treatments - pairing alcohol with an unpleasant stimulus. Contingency management. Marital and Family Therapy (among the approaches with the strongest empirical support).

5) Brief Intervention - 1-3 sessions with doctor for advice.

Question 16

Define Relapse.

Answer 16

A failure of a person’s cognitive and behavioural coping skills to cope with life’s problems.

Question 17

In the DSM-5, the depressant drugs other than alcohol are grouped together as what 3 categories?

Answer 17

sedative, hypnotic, or anxiolytic drugs

Question 18

___________ produced in 1903, was one of the first drugs developed as a treatment for anxiety and tension and later for sleep.

Answer 18

Barbituric acid.

Question 19

What are barbiturates more commonly known as?

Answer 19

“Downers” or the colour of their brand name version (blues, yellow jackets, red birds etc)

Question 20

What are some example brand names of the sedative-hypnotic class called benzodiazepines?

Answer 20

Valium, Librium, Xanax, Ativan.

Question 21

What are some side-effect of benzos and barbituates?

Answer 21

They depress CNS function - which and cause lower respiration, blood pressure, and heart rate to dangerous levels. Suffication/Coma. Chronic use = can look like a constant state of being drunk, lead to depression, paranoia, impaired memory etc.

Question 22

How do stimulants work?

Answer 22

Stimulants are a class of drugs that have a stimulating or arousing effect on the CNS and create their effects by influencing the rate of uptake of the neurotransmitters dopamine, norepinephrine, and serotonin at receptor sites in the brain.

Question 23

As a group, what are the most commonly used and abused drugs?

Answer 23

Stimulants.

(Tobacco, amphetamines, cocaine, and caffeine. Medications such as Ritalin and Adderal)

Question 24

__________ use constitutes one of the leading public health concerns in Canada.

Answer 24

Tobacco.

Question 25

True or False?

Dependence produced by nicotine is thought to be even greater than that produced by other addictive substances, including alcohol, cocaine, and caffeine.

Answer 25

True.

Dependence develops quickly and withdrawal effects can be severe.

Question 26

What are the two most commonly abused forms of amphetamines?

Answer 26

1) Methamphetamine (“speed” when injected, and “ice” or “crystal” when smoked in a purified form)

2) Dextroamphetamine (a legally prescribed medication sold under the name Dexedrine. Called “bennies”, “uppers”, “glass”.

Question 27

What drugs are referred to as designer drugs and have both stimulant and hallucinogenic properties?

Answer 27

Methylated amphetamines.

(Ie MDMA, MDA, PMA)

Question 28

What were amphetamines originally developed to treat in the 1930s?

Answer 28

As a nasal decongestant and asthma treatment.

(To shrink mucous membranes and constrict blood vessels)

Question 29

How is crack made?

Answer 29

By dissolving powdered cocaine in a solvent, combining it with baking soda, and heating it until it forms a crystallized substance (a “rock”), which is then smoked.

Question 30

What are some side-effects of cocaine use?

Answer 30

With high doses, the CNS is overstimulated, leading to poor muscle control, confusion, anxiety, anger, and aggression. Continuous use may result in mood swings, loss of interest in sex, weight loss, and insomnia. Toxic psychosis.

Question 31

What are the treatment reccs for amphetamine and cocaine abuse?

Answer 31

Psychological Treatments - Intervention programs based on 12 step. Cognitive-behavioural interventions. Community outpatient contingency management programs (rewarded with money and social outings if they remain drug-free.)

Bio Treatments - Antidepressants to combat depression that occurs with withdrawal. most beneficial when added to psyc treatment.

Question 32

What are opioids?

Answer 32

(also known as narcotics) - are a class of CNS depressants—drugs whose main effects are the reduction of pain and sleep inducement.

Question 33

What is the most commonly abused opioid?

Answer 33

Heroin.

Question 34

List examples of natural opiates, semi-synthetic opiates and synthetic opiates.

Answer 34

Natural opiates (refined directly from opium): Morphine & Codeine

Semi-synthetic opiates (derived from natural opiates): Heroin & Oxycodone

Synthetic opiates (manufactured): Methadone, Demerol, Percocet

Question 35

How do opioids work?

Answer 35

They mimic the effects of endogenous opiates (the body’s natural painkillers). Known as exogenous opiates, narcotics affect receptor sites located throughout the body, including the brain, spinal cord, and bloodstream. The narcotics bind to receptor sites at these locations and, in turn, reduce the body’s production of endogenous opiates.

Question 36

What are the treatment reccs for opioid abuse?

Answer 36

Medication - Naltrexone acts as opioid antagonists and help to alleviate initial symptoms of withdrawal. Methadone, a heroin replacement, or a newer medication, buprenorphine/naloxone, are often used to reduce the craving after initial withdrawal symptoms have abated.

(Meds are best in conjunction with individual and group psychological programs and peer support.)

Question 37

What are the treatment reccs for cannabis use?

Answer 37

A combination of motivational enhancement and cognitive-behavioural therapy has the greatest evidence of success.

Question 38

What are hallucinogens?

Answer 38

Drugs that change a person’s mental state by inducing perceptual and sensory distortions or hallucinations.

The most well-known are lysergic acid diethylamide (LSD or “acid”), mescaline, and psilocybin (magic mushrooms).

Question 39

True or False?

People’s expectations regarding the effects of hallucinogens appear to play a large role in determining their reaction.

Answer 39

True.

Question 40

How do hallucinogens work?

Answer 40

They have an excitatory effect on the CNS and mimic the effects of serotonin by acting upon serotonin receptors in the brain stem and cerebral cortex.

Question 41

True or False?

Cannabis is not addictive.

Answer 41

It has long been believed that cannabis is not addictive, but there is recent recognition that regular use results in both tolerance and withdrawal symptoms, although withdrawal is milder than with other addictive substances. Symptoms include irritability, nervousness and anxiety, loss of appetite, restlessness, sleep disturbances, and anger/aggression.