Problem 9 Flashcards
Name the 4 substance-related conditions that appear in the DSM-4.
- Substance intoxication
- Substance withdrawal
- Substance abuse
- Substance dependence
Name the 4 groups of substances that most often lead to substance disorders.
- CNS depressants (Psycho-leptics)
- -> alcohol, inhalants, benzodiazepines - CNS stimulants (Psycho-analeptics)
- -> cocaine, nicotine, caffeine - Opioids (Psycho-leptics)
- -> heroin, morphine - Hallucinogens (Psycho-disleptics)
- -> Cannabis
=> withdrawal, abuse + dependence may occur with most of them
Substance intoxication
Refers to a set of behavioral + psychological changes that occur as a result of the physiological changes of the CNS
–> that is due to the substance
What are the symptoms of intoxication ?
The specific symptoms depend on what substance is taken
–> decline as the amount of substance in the blood declines, may last for hours
AND: users
a) expectation of the symptoms
b) environment
may influence them
Substance withdrawal
Refers to a set of physiological + behavioral symptoms that occur when people who have been heavily using a substance for a long time stop/reduce their use
What is required for a person to be diagnosed with substance withdrawal ?
Significant distress or impairment in a persons everyday functioning
–> e.g.: caffeine withdrawal is not significant
Substance abuse
Is diagnosed when a persons recurrent use of a substance results in significant harmful consequences
What is required for a person to be diagnosed with substance abuse ?
The occurrence of at least one of the following 4 categories of harmful consequences
- Failing to fulfill important obligations
- Repeatedly using the substance in situations in which it is physically dangerous/dumb
- Repeatedly having legal problems as a result
- Continuing to use the substance despite repeated social or legal problems
=> have to occur within 1 year period
Substance dependence
Refers to a maladaptive patterns of substance abuse, thus showing tolerance or withdrawal from it
–> closest to drug addiction definition
Tolerance
Experiencing less effects from the same dose of a substance
–> needing more to achieve intoxication
What is required for a person to be diagnosed with substance dependence ?
Compulsively (not able to stop at own will) using the substance
–> despite
a) social
b) psychological
c) medical problems
BUT:
a) physiological dependence is not required for diagnose
b) cannot be diagnosed with SA and SD simultaneously
Which substance will most likely lead to substance abuse or dependence ?
Substances that
- can be absorbed rapidly + efficiently
- -> injection, smoking, snorting - Act more rapidly on the CNS, thus faster intoxication
- whose effects wear off quickly
Substance-use disorder
Refers to the combined diagnosis of substance abuse + dependence
–> includes the criteria “craving”, removes “legal problems”
=> proposed by the DSM 5
Depressants
Are substances that
- slow the CNS
- relax
- reduce concentration
- impair motor skills + thinking
–> alcohol, benzodiazepines, inhalants
Alcohols effects on the brain occur in 2 distinct phases.
Name them.
- Low doses
- -> self-confidence, relaxed, euphoric - High doses
- -> depression, fatigue, motor impairment
=> DEPRESSANT
Alcohol-use disorder
Refers to the combination of alcohol abuse + alcohol dependence (alcoholism), that requires at least 2 symptoms to be diagnosed
–> proposed in DSM-5
The withdrawal symptoms of alcohol manifest in 3 stages.
Name them.
- Tremulousness (shaking), weakness, anxiety, vomiting
- Convulsive seizures
- -> after 12h - Delirium tremens (DTs)
- -> auditory, visual, tactile hallucinations, fatal in 10%
Alcohol-induced persisting amnesic disorder
Refers to a permanent cognitive disorder cause by damage to the CNS, consists of 2 syndromes
- Wernickes encephalopathy
- -> mental confusion, sometimes coma - Korsakoffs syndrome
- -> memory loss for recent events + difficulty recalling distant ones
Gender differences in substance abuse ?
In general more men than women
–> women are less likely to have personality traits associated with substance-use disorder + more sensitive to its risks
Name 3 other groups of depressants (than alcohol).
- Benzodiazepines + Barbiturates
–> decrease blood pressure + respiratory rate, sold by prescription usually used for treatment in anxiety or insomnia
- Inhalants
- -> produce chemical vapors which are inhaled
e. g.: gazoline, spray paints, laughing gas
BUT: both of these groups can cause serious permanent damage
Stimulants
Activate the CNS, to cause feelings of
- energy
- happiness
- power
- decreased desire for sleep
- diminished appetite
–> cocaine, amphetamines, caffeine, nicotine
Why is cocaine so highly addictive ?
Because its effects wear off quickly, so a frequent intake is required to maintain the high
–> tolerance can also develop and be the cause
Amphetamines
Stimulants
Refer to stimulants prescribed for the treatment of
a) attention problems
b) narcolepsy
c) chronic fatigue
–> can be taken as pill, snorted or smoked
e.g.: “speed”, “meth”, “chalk”
How do the CNS stimulants produce their effects ? Which brain mechanisms does it activate ?
By activating the brain areas involved in pleasure + reward
- release neurotransmitters involved (dopamine, norepinephrine, serotonin)
- block the re-uptake of these NTs into the transmitting neurons which causes them to accumulate in the synapse to maintain the pleasurable feeling
BUT: a) may produce perceptual distortions
b) nicotine works on both CNS + PNS
Can heavy coffee drinks be called “caffeine addicts” ?
No,
because the dependence on the drug doesn’t seem to cause significant social + occupational problems
Opioids
Relieve pain, starting by sense of warmth until passing out into a state of drowsiness + slurred speech
–> also naturally produced by our bodies, can be snorted smoked or injected
e.g.: morphine, heroin, codeine
Hallucinogens
Refer to a mixed group of substances including LSD
–> results in sensory distortions + hallucinations
Ecstasy
Has the stimulant effects of amphetamine + occasional hallucinogenic properties
–> short-term use can have long-term negative effects on health + cognition
How do Opioids produce their effects ? Which brain mechanisms do they activate ?
- Inhibit GABA
- GABA stops inhibiting dopamine
- Dopamine is available to reward center
=> indirect
Which brain areas are included in the Control network of substance use ?
- Orbitofrontal cortex
- DLPFC
- inferior frontal gyrus
–> if the reward network overpowers this one, one will be more likely to abuse substances
Biological theory of substance use
Genetic variation in the dopamine transporter gene + receptor gene will influence how the brain processes dopamine
–> affects individual reward sensitivity, thus genetics play substantial role
Social learning theory
Suggests that children + adolescents may learn substance-use behaviors from the modeling of their parents
–> usually bad male role models
Behavioral under control
Refers to the tendency to be impulsive and prone to antisocial behavior
–> are more likely to be diagnosed with substance abuse or dependence
Sociocultural theory of substance abuse
People who are
- chronically stressed
- poor
- female in abusive relationships
- constantly witnessing fights
are more prone to engage in substance abuse as this may be a way of fleeing
Methadone maintenance program
Controversial
Involves the use of the opioid methadone with which gradual withdrawal from heroin can be achieved, as it has less long-lasting effects than heroin
–> reduces extreme negative heroin symptoms
BUT: although goal is to eventually withdraw patients from methadone, some take is for years under physicians care
Aversive classical conditioning
Behavioral treatment
Involves developing conditioned responses to the substance
e.g.: vomiting in alcohol abuse
–> usually in combination with biological or other psychosocial therapies
Cognitive treatment of substance abuse
Involve challenging the patients expectations of the substance by reviewing its negative effects on the patients behaviors
Motivational interviewing
Designed to elicit + solidify the clients motivation + commitment to changing their substance use
–> because w/o motivation no treatment will be effective
What was the aim of Alcohol induced place conditioning ?
Finding out whether
- non-dependent drinkers show a place preference for a location paired with alcohol
- the fact that they spent time at this place is related to the subjective alcohol effects
What was the result of the alcohol induced place conditioning test ?
Non-dependant consumers develop a preference for locations paired with alcohol consumption
- More so for those with sedative effects from alcohol
- -> sedation might be considered rewarding in terms of relaxation - Conditioning happened without explicit knowledge of the drug cue contingencies
- -> behavior is influenced by the drug before we are even aware of it
Disease model
- Binge + intoxication
- -> a) repeated experience of reward becomes associated with environmental stimuli that precede them
b) dopamine cells stop firing in response to reward itself and start firing in an anticipatory response
- Withdrawal + negative affect
- -> drug consumption triggers much
a) smaller increases in dopamine levels, less sensitive to + non-drug related give less rewards
b) adaption in the circuit of the extended amygdala which results in increased reactivity to stress emergence of negative emotions
Push: Escape distress
Pull: want to feel euphoria
- Preoccupation + anticipation
- -> prefrontal region changes, thus impaired executive functioning, which leads to weakened ability to resist strong urges + follow through on decision to stop taking the drug
CONCLUSION: Addiction is a brain disease
Dual process model alcohol dependence
Suggests that alcohol dependence results from the imbalance of 2 system
- Reflective system
- -> cognitive evaluation (PFC), impaired - Affective system
- -> emotional evaluation (Limbic system), over activated
Continuum hypothesis of binge drinking
Assumes that there are similar deficits across different alcohol related disorders
–> binge drinkers would show qualitatively similar but quantitatively less impairments than alcohol-dependent people
Do binge drinkers show impairments in the affective or reflective system ?
Reflective system, due to reduced cortical thickness + executive impairments
How does the dual process model explain substance abuse?
The affective system overrules the reflective system due to an over-activation of it
The choice model
Heymann
Suggests that addiction is a choice as one bargains between immediate taking + not taking it
a) immediate present (locally)
b) anticipated future (globally)
c) something in between
–> immediate reward self is stronger than anticipated future
Louis comment on choice model + brain disease model
It is a choice but not as easy as suggested
–> should still take into account brain differences
