Recovery and Rehabilitation Flashcards
What is the cycle of addiction?
Initial drug use
Acute drug experience
Drug withdrawal
Chronic drug experience
How does initial drug use occur?
Genetic (impulsivity)
Mood (depression)
Environment (trauma)
What happens during acute drug experience?
Euphoria
Analgesia
Anxiolytic
Antidepressant
What happens during drug withdrawal?
Opposite effects of acute drug use
Unpleasant symptoms can drive craving and relapse
What occurs during chronic drug experience?
Neurological adaptations
Tolerance to positive effects of drug and natural rewards
Loss of prefrontal cortical control of drug behaviors
What is addiction?
A biopsychological disease
What is risky drug use correlated with?
Biological factors
Socioeconomic status
Homelessness
Social isolation
Early life trauma
What is CBT?
A talk-based psychosocial intervention administered by a licensed psychologist
Aim is to develop non-drug coping strategies
What are contingency management interventions?
Individuals are rewarded for evidence of positive behavioural change
What are counseling communities?
AA, NA
How do we know that intervention works?
Systematic reviews and meta-analysis synthesizes the results of multiple primary studies
These reports are the highest quality evidence that an intervention works
What are forest plots?
Used to express data generated from systematic reviews
Provide data on the number of trials, size of each trial, outcomes of trials, and overall summary of trials
What are the pros of AA/NA?
Connects people seeking treatment to a community of non-users
De-stigmatizes drug use
Can connect users with medical interventions
Free
What are the cons of AA/NA?
No medical interventions
Religious undertones can be off-putting
Abstinence only
What are the two types of pharmacological interventions?
Block the positive effects of the drug
Make withdrawal easier
What does treatment of withdrawal symptoms help with?
Maintaining abstinence and may be a necessary step to safely and effectively stop drug use
What does treatment of withdrawal symptoms involve?
Treatment with a drug that targets the same receptor as the drug of abuse, but with a safer therapeutic profile
What are some treatments for nicotine withdrawal?
Nicotine replacement therapy, provides nicotine by means other than tobacco
Alleviates the side effects of nicotine withdrawal and reduces cravings but the side effects of using replacements are similar to tobacco
What type of molecule is alcohol?
A positive allosteric modulator of the GABAa receptor
What does chronic alcohol use do?
Up regulates excitatory glutamate signaling in the brain
What happens when you stop using alcohol?
Increased excitation
What does alcohol withdrawal treatment involve?
Drugs that promote GABA signaling
What does alcohol detoxification involve?
Administration of benzodiazepines
Also positive allosteric modulators at the GABAa receptors
Dangerous to use WITH alcohol but has no effect on GABA receptor in the absence of GABA
Given short-term to blunt withdrawal then tapered off
What is agonist replacement therapy for opioid withdrawal?
A comprehensive treatment approach including maintenance on an opioid agonist and CBT
blunts the symptoms of opioid withdrawal
Longer half-lives so there is no high and crash cycle
What is methadone?
Long-acting full agonist at the mu-opioid receptor
It is a full agonist so overdose is still possible
What is buprenorphine?
A partial agonist at the mu-opioid receptor
Safer agonist profile
Marketed as suboxone (contains naloxone)
How long can patients be on buprenorphine?
Forever, if they want
What are the advantages of agonist replacement therapy?
Reduces drug cravings
Better participation in addiction treatment since withdrawal symptoms aren’t a distraction
Improved social functioning
Reduction in infectious disease/death associated with illicit drug use
What is the purpose of treatments that block drug effects?
Removes the reinforcing effects of drugs so that drug use is no longer rewarding or pleasant
How does disulfiram treat alcohol addiction?
Inhibits acetaldehyde dehydrogenase
Ingestion of alcohol results in an accumulation of acetaldehyde and this will enhance the unpleasant effects of alcohol
Must be taken daily to be effective and does not treat cravings
How does naltrexone block drug effects?
Antagonist at the mu-opioid receptor
Blocks the reinforcing properties of drugs of abuse
Reduces drug cravings and relapse rates
Requires daily dosing, treatment adherence is a challenge
How do drug vaccines work (cocaine)
A cocaine analog is conjugated to an antigenic protein which will evoke an immune response to cocaine
Antibodies will bind to cocaine and block transport into the brain
What are the pros of drug vaccines?
Does not require repeated dosing, adherence not an issue
Can be used in combination with other brain-targeting interventions because they do not enter the brain
What are the cons of drug vaccines?
Uncertain how long the effect will last
Immune response may be surmountable, overcome with high doses
Vaccine has a drug specificity, won’t work for other drugs
Ethical concerns of free will
What does intermittent high-dose drug use lead to?
Sensitization
Increases arousal, drug seeking behaviour, impulsivity
True for psychostimulants
What does chronic repetitive use of drugs lead to?
Desensitization
Hypodopaminergia
True for opioid agonists
What is hyperdopaminergia associated with?
Depression, can persist for a long time and contribute to risk of relapse
Why have full dopamine agonists and antagonists been ineffective in treating drug addiction?
They carry a lot of side effects that make them undesirable drug targets
What is aripiprazole?
A partial dopamine agonist at the D2 receptor
Good evidence to treat cocaine and opioid addiction
How does aripiprazole act?
As an antagonist to dopamine (because partial agonist) which will block the effects of cocaine
Acts as a gentle dopamine agonist when dopamine is absent during withdrawal phases
Avoids the side of effects of full dopamine agonists
What treatments for substance use disorder are most effective?
Those with both behavioural and pharmacological interventions
What must drug treatments be to be effective?
Voluntary
Mandatory drug treatments are not effective and increase harms
The risk of relapse is 2-20x higher for those with forced abstinence than those without forced abstinence
