Psych - Substance Abuse + Addiction Flashcards
What drugs can cause substance addiction?
• Alcohol • Nicotine • Cannabis • Stimulants – Amphetamine – Cocaine • Crack – Ecstasy • Opioids (prescribed, OTC) – Heroin, fentanyl – DF118 • Ketamine • Solvents • GHB, GBL • Benzodiazepines • Psychedelics – LSD, Magic mushrooms • Nitrous oxide • Khat • ‘Novel psychoactive substances’ – ~950 synthetic (UNODC); – new: ~1/wk – Categories: • Depressant, stimulant, hallucinogenic. cannabinoid
Why do people take recreational drugs?
- reduce anxiety
- get high
- boredom
- stay awake
- to fit in
- rebel
- escapism
- like it
- to get to sleep
- why not
- feel better
- everyone does
- curious
What is positive reinforcement?
action taken to gain a positive state
What are examples of positive reinforcement that fuel addiction?
- escapism
- get high
- stay awake
- like it
What is negative reinforcement?
action taken to overcome adverse states
What are examples of negative reinforcement that fuel addiction?
- boredom
- to get to sleep
- reduce anxiety
- feel better
What is the course of addiction or drug abuse? *
• "LIKE" : Experimental/‘recreational’ use, causes no/limited difficulties - (majority of population) • "WANT" : Increasingly regular use (fewer people) • "NEED" : Spiralling, dependence (smaller number)
What is the definition of harmful substance use?
Actual damage should have been caused to the mental or physical health of the user in the absence of diagnosis of dependence syndrome
What is the progression from “like” to “want” to “need called?
neuroadaptations
What is the prevalence of alcohol dependence?
– 595, 000 estimated prevalence
– 103,471 in treatment
– approx. 82% of adults in need of specialist treatment for alcohol not receiving it.
What is the prevalence of opiate dependence?
– 257,476 estimated prevalence
– 170,032 in treatment
– ~46% of adults in need of specialist treatment for opiates not receiving it
– Death rates rising from opiates and from cocaine
What is the definition of addiction?
compulsive drug use despite harmful consequences, characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, (depending on the drug) tolerance and withdrawal
What is dependence?
refers to a physical adaptation to a substance
– Tolerance/withdrawal
so can be dependent and not addicted
What are some examples of behavioural addictions?
– internet gaming disorder
– gambling disorder
Why was gambling reclassified as a behavioural addiction from ‘impulse control disorder’ previously?
Many similarities in aetiology, neurobiology and treatment
approaches, as well as comorbidity, with substance dependence
What is hazardous substance use?
likely to cause harm if it continues at this level
Phil drinks four pints of Stella most evenings. Says his drinking doesn’t cause problems. What issue may he have?
Hazardous Use:
– quantity + frequency is too high
Jenny drinks a bottle of wine most evenings, more at the weekends. Occasionally misses work
because of hangovers. What issue may she have?
Harmful Use:
– negative consequences
– Physical, Psychological, Social impact
– Eg Missing work due to hangovers
Tom drinks cider first thing each morning to stop himself shaking. Regards drink as a medicine,
believes he wouldn’t get by without it. Doesn’t tend to get drunk. What is the issue?
Dependence / Addiction:
– Tolerance and morning drinking to relieve
– withdrawal are signs of dependence.
Katie broke her ankle 6 months ago which healed well and is back to playing football. Is still taking her
opioid painkillers which are on repeat prescription. Is there an issue?
Likely biologically dependent as has been taking opioids for many months; no evidence of taking more than is
prescribed (ie suggesting ‘abuse’) however need to ask if this
is the case and why it is on repeat – has it just happened through error/lack of review or has she requested it?
