PSYU3337 - Substance Related and Addictive Disorders

Question 1

Outline the categories of drugs

Answer 1

Depressants: induces behavioural sedation and relaxation (alcohol, sedatives, barbituates, benzos)
Stimulants: increase alertness, mood and activity (amphetamines, crystal meth, cocaine, nicotine, caffeine)
Opiates: produce analgesia and euphoria (heroin, opium, codeine, morphine)
Hallucinogen: alters sensory perception (cannabis, LSD, PCP)

Criticism: these are not mutually exclusive

Question 2

Substance abuse and dependence –> substance use disorder

Answer 2

Pre-DSM-5: substance abuse and substance dependence described different severities of substance use disorder (dependence is worse)

Definition of substance use disorder = at least 2 symptoms in the last year that interfered with life - and can develop even if an individual is not using a drug for intoxicating purposes

Question 3

Illicit drug use in australia

Answer 3

10% of Aus population use cannabis

substance use disorder is the third most common, experienced by 5% of population in Australia.

young people (16-24) are the most likely individuals to experience a substance use disorder

Question 4

Substance use disorder; criteria

Answer 4

11 different criteria
- 2-3 = mild
- 4-5 = moderate
- 6+ = severe

• larger amounts or for longer than intended
• unsuccessful efforts to reduce use
• spending a lot of time
• cravings
• role disruption
• continued use despite it causing interpersonal problems
• continued use despite physical or psychological problems
• reduction in activities
• using in hazardous situations
• tolerance
• withdrawal

Question 5

What drugs can be involved in substance use disorders

Answer 5

NOT caffeine

Other (or unknown) = could be like steroid s
Other XX-induced = medication use disorder (psychotic /anxiety disordres induced by a drug)

Question 6

What other specifiers are used

Answer 6

• in early remission (3-11 months)
• in sustained remission (12 months)
• in a controlled environment
• on maintenance therapy
• severity

Question 7

Substance intoxication

Answer 7

development of a reversible substance specific problematic behaviour due to acute ingestion of a substance (can occur wihtout a substance use disorder)
- can not include tobacco

Question 8

substance withdrawal

Answer 8

• cannot be from hallucinogens or inhalants

Question 9

What are the acute effects of alcohol?

Answer 9

Influences GABA (inhibitory NT) - makes the receptor less receptive to other transmitters - inhibiting the ability to feel anxiety.

Influences Glutamate (excitatory NT) - alcohol suppresses the release of glutamate (important for memory and learning) - resulting in memory loss and blackouts

Serotonin - temporarily boost serotonin - resulting in cravings

Question 10

Long term effects of alcohol use

Answer 10

• withdrawal (delirium tremens)
• liver disease
• pancreatitis
• cardiovascular disorders
• brain damage (dementia and wernicke-korsakoff syndrome)

Question 11

Predictors of alcohol abuse

Answer 11

• drinking at an early age (11 -14)
• low level of response to alcohol
• family history
• increased positive alcohol expectancies
• high impulsivity
• high novelty seeking

Question 12

acute effects of nicotine

Answer 12

• reaches the brain within 7-19 seconds (highly rewarding)
• influences nicotinic acetylcholine receptors (improve energy and mood)
• influences glutamate (enforces us to remember the acute benefits of smoking)

Question 13

Long term effects of nicotine

Answer 13

• withdrawal
• loss of taste and smell
• yellow teeth, tooth decay
• premature aging
• decrease immune response
• respiratory disorder
• cardiovascular disorders
• gastrointestinal disorders
• cancer
• resistance to chemo and radio therapeutic agents

Question 14

Predictors of nicotine dependence

Answer 14

• smoking at early age
• mood disorders
• anxiety disorders
• personality disorders
• illicit substance use disorders
• unmarried
• low education
• low ses

Question 15

acute effects of illicit drugs

Answer 15

Sedatives, hypnotic and anxiolytic drugs:
- act on GABA NT to produce tranqulizing effects

Amphetamines
- acts on onrepinephrine to influence arousal, attention and mood

Opiods:
- acts on enkephalins and endorphins to produce pain relief and induce euphoria

Cannabis
- acts on cannabinid receptors to influence pleasure, memory, thinking, concentration, movement, coordination, sensory and time perception

Question 16

Long term effects of illicit drugs

Answer 16

Sedative, hypnotic, anxiolytic
- memory problems and depression

Amphetamines:
- paranoia, hallucinations, malnutrition, reduced immunity, mood swings, heart and kidney problems

Opiods:
constipation, sleep-disordered breathing, fractures, HPA dysregulation

Cannabis: psychosis, chronic coughing, sputum production, bronchitis

Question 17

Predictors of illicit drug dependence

Answer 17

• severe and chronic early life stress
• using drugs before adulthood
• drinking early
• cigarette use
• depression
• male
• low education attainment
• high neuroticism
• conduct disorder

Question 18

Dopamine reward system

Answer 18

• all drugs increase dopamine in the nucleus accumbens
• helps us learn which stimuli are associated with reward - and increases our reward seeking behaviour

Question 19

Biological cause of substance use disorders

Answer 19

• greater concordance between identical twins than fraternal twins for substance use disorders
• affect the pleasure pathway / reward pathway
• incentive sensitization theory
  –> naive users will get dopamine from drugs
  –> regular users will not get as much dopamine from drug use, but will get a dopamine hit from drug paraphernalia (i.e. drug cues are driving drug use)
• valuing immediate rewards over delayed rewards

Question 20

Psychological causes of substance use disorders

Answer 20

mood alteration
–> drugs can increase positive affect and diminish negative affect
–> increases in negative affect predict drug use

outcome and expectancies influence use
- people use a drug not because it changes their mood, but because they think it does
- balanced placebo designs
- greater positive expectancies predict greater use and greater problems

neuroticism: substance use to reduce negative affect
disinhibitory personality traits - use drug to increase pleasure

Question 21

Sociocultural causes

Answer 21

Alcohol is the most used drug in most countries but it varies:
- Australia, Europe and Argentina have some of the highest rates of alcohol use
- Followed by North and South America
- Africa and Asia have lower rates of alcohol use

Question 22

Treatment of substance use disorders

Answer 22

Agonist substitution: safe drug with a similar chemical composition to the abused drug (nicotine gum)

Antagonist treatment: drugs that block or counteract the positive effects of substances

Aversive treatment

AA may be helpful, and controlled use may be just as helpful as complete abstinence.
Community reinforcement is helpufl.

CBT teaches behaviours that make relapse less likely

Question 23

Prevention of substance use disorders

Answer 23

Universal programs target the whole populatoins - don’t have great effects (particularly DARE) but have significant sicla savings (every $1 spent on prevention saves society up to $20)

Selective programs which target at risk groups are often more costly

Question 24

What is gambling disorder

Answer 24

Similar to substance use disorder criteria, but added ones =
- often gambles when distressed
- after losing money, returns to get even
- lies to conceal the extent of gambling involvement
- relies on others for money to relieve financial situation
- rules out mania

Question 25

Difference in gambling disorder and SUD

Answer 25

• prevalence = 1-2% lifetime (but they need to fulfill 4 criteria to be considered GD, rather than 2 like in SUD)
• diagnostic thresholds:
  –> 4-5 = mild
  –> 6-7 = moderate
  –> 8-9 - severe

Question 26

Causal factors of GUD

Answer 26

Heritability is between 0.50 - 0.60
Heritable risk tends to be nonspecific and shared across all substance and gambling

Environmental contributions account for 38-65% of variance %
- childhood maltreatment
- parental gambling behaviour
- convenience of gambling establishments