PATHOPHYSIOLOGY OF SUBSTANCE USE DISORDER Flashcards
What is drug abuse
the harmful or hazardous use of psycho- active substances, including alcohol and illicit drugs
What is drug misuse
the use of a drug for a purpose not consistent with legal or medical guidelines
what is drug dependence
Drug dependence refers to the inability of the individual to function normally in the absence of the drug. Dependence can be both physical and psychological
What is substance use disorder
a complex condition in which there is uncontrolled use of a substance despite harmful consequences.
What is addiction
is a state of habitual drug use associated with
significant harm that is driven by the complex interaction of
behavioral, biological, cultural, financial, moral, and social factors
is a chronic, relapsing disorder of the brain characterized by compulsive drug seeking and use despite adverse consequences.
what is tolerance
is the body’s ability to adapt or acclimate to the effect(s) of a drug over time. A larger dose of the drug is required to achieve the desired effect of the drug due to a progressively decreased responsiveness to the drug
What is withdrawal
is a constellation of symptoms that occur as a result of the abrupt discontinuation of a drug.
describe the general trends in drug overdose death overtime
deaths have been trending upward over time and continue to increase
What are the key DSM-5 criteria for diagnosis of abuse
have to have greater than or equal to one of the following criteria
Hazardous use, social/interpersonal problems related to use, neglected major roles to use, and legal problems
what are the key DSM-5 criteria for diagnosis of dependence
> 3 for diagnosis
withdrawal, tolerance, used larger amounts/longer, repeated attempts to quit/control use, much time spent using, physical/physiological problems related to use, activities given up to use
what are the key DSM-5 criteria for diagnosis of Substance use disorders
> 2 criteria
Hazardous use, social/interpersonal problems related to use, neglected major roles to use
withdrawal, tolerance, used larger amounts/longer, repeated attempts to quit/control use, much time spent using, physical/physiological problems related to use, activities given up to use
craving
Describe the potential role of the mesolimbic dopamine system in sustaining drug use
Dopaminergic projections from the VTA that go into nucleus accumbens which is a site of reward, and the prefrontal cortex which have to do with planning and judgement
and many drugs of abuse interact with this system and increase dompaminergic activity
describe the potential role of glutamate in sustaining drug use
Glutamate can increase dopamin activity in the NAcc, glutamate projection to VTA, destruction of this pathway reduces cocaine/morphine reward
NMDA antagonists blocks acquisition of reinforcement learning
Intra NAcc AMPA injection causes relapse
dopamine controls glutamate activity in the amygdala
list 4 short-comings of the dopamine-reward hypothesis for drug addiction
- Lack of relationship btwn dopamine release and addiction liability
- lack of ability of dopamine modulators to treat addiction
- While dopamine reward is operational for all who use drugs recreationally, few become addicted
4.Addictive behavior observed with drugs not observed with euphoria
What is rhinitis medicamentosa
people who are addicted to nasal sprays
What are the theories on drivers of drug use
self-medication hypothesis
brain disease model
acculturation model
social contagion model
development or learning model
What is the self-medication Hypothesis
Feelings of distress–> drug experimentation–> feelings of Relief/Comfort–> continued use Driven by relief Obtained
