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Pmcol 305 > Recovery + Harm Reduction > Flashcards

Recovery + Harm Reduction Flashcards

1
Q

cycle of addiction

A

initial drug use
acute drug experience
drug withdrawal
chronic drug experience

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2
Q

initial drug use

A

genetics - impulsivity
mood
environment

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3
Q

acute drug experience

A

euphoria
analgesia
anxiolytic
antidepressant

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4
Q

drug withdrawal

A

opposite of acute effects - dysphoria, pain, anxiety
unpleasant symptoms drive craving and relapse

certain drug withdrawals have lethal symptoms ex. alcohol

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5
Q

chronic drug experience

A

neurological adaptations (molecular, cellular, behavioural)
tolerance to positive effects of drug + natural rewards
loss of prefrontal cortical control of drug behaviours → compulsive drug seeking

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6
Q

biopsychosocial disease

A

biological factors can increase likelihood of developing an addiction and can promote continued use
also highly correlated with environmental factors

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7
Q

biological factors

A

Mu opioid receptors
neuroadaptations
concurrent mental illness

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8
Q

psychological + social factors

A

psychological:
- support services

social:
- interpersonal relationships
- treatment + drug-use settings
- SES

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9
Q

behavioural interventions

A

CBT
contingency management interventions/motivational incentives
counselling/therapeutic communities

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10
Q

CBT

A

psychosocial intervention administered by psychologist
develop non-drug coping strategies to triggers

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11
Q

contingency management
motivational incentives

A

individuals are rewarded for evidence of positive behavioural change
ex. get money for clean urine drug screens

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12
Q

counselling communities

A

alcoholics/narcotics anonymous

pros:
- connects people to community
- de-stigmatizes drug use
- free

cons:
- no medical interventions
- religious undertones
- abstinence only

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13
Q

systematic reviews and meta-analysis

A

reduce biases and random errors - combine results of many primary studies
highest quality of evidence
data expressed in forest plots

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14
Q

pharmacological interventions

A
  1. block positive effects of drug
  2. make withdrawal easier
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15
Q

drug withdrawal treatment

A

help maintain abstinence; safely + effectively stop drug use
involves treatment with a drug that targets the same receptor as the drug of abuse but has safer therapeutic profile

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16
Q

nicotine replacement therapy

A

provides nicotine by other means than tobacco
alleviates side effects of withdrawal; reduced cravings
increases success of quitting by 55%

side effects are similar to tobacco - dry mouth, headaches
long term use is better than tobacco but minimal studies

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17
Q

alcohol withdrawal

A

alcohol - PAM of GABAa receptor (inhibition)
chronic use upregulates excitatory glutamate signaling to balance excessive inhibition

cessation of alcohol use leads to over excitation - inhibitory balance is removed → can be lethal

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18
Q

alcohol withdrawal treatments

A

drugs that promote GABA signaling to restore inhibition
- benzodiazepines

19
Q

benzodiazepines

A

PAMs at GABAa receptors (like alcohol)
→ enhance GABA activity by binding to allosteric site
have no effects in absence of GABA
short term use

20
Q

opioid withdrawal

A

opposite symptoms of acute use
- anxiety, pain, dysphoria
symptoms last long term = vulnerable to relapse even years after use

21
Q

agonist replacement therapy

A

opioid withdrawal treatment
includes maintenance on opioid agonist + CBT
blunts symptoms of withdrawal
replacement agonists have longer half-lives to avoid repeated high/crash cycle
safe for long term use

methadone
buprenorphine

22
Q

methadone

A

half life = 24-42 hours
long acting full agonist of mu opioid receptor

overdose is still possible because it is a full agonist

23
Q

buprenorphine

A

partial agonist at mu opioid receptor
24 hr half-life

safer agonist profile
suboxone → combine buprenorphine with naloxone to prevent abuse

24
Q

advantages of agonist replacement therapy

A

reduces drug cravings
better participation in addiction treatment - no withdrawal symptoms
improved social functioning
reduce harms of illicit drug use

25
Q

treatments to block drug effects

A

block positive effects of drugs of abuse
removes reinforcing effects of drugs so it is no longer rewarding

disulfiram
naltrexone
drug vaccines
partial dopamine agonists

26
Q

disulfiram

A

inhibits acetaldehyde dehydrogenase - ingestion of alcohol results in accumulation of acetaldehyde
enhances the unpleasant effects of alcohol - tachycardia, nausea, vomiting

must be taken daily to be effective; does not treat cravings

27
Q

naltrexone

A

antagonist at mu opioid receptor
blocks reinforcing properties of drugs of abuse - alcohol + opioids
reduced drug craving and relapse rates
requires daily dosing

28
Q

drug vaccines

A

cocaine analog is conjugated to an antigenic protein
evokes immune response to cocaine = antibodies will bind to cocaine and block transport into brain
early phase II clinical trials

29
Q

pros of drug vaccines

A

adherence is not an issue - no daily dosing
vaccines don’t enter brain - can be used in combination with other interventions

30
Q

cons of drug vaccines

A

length of effect is unknown
high doses might overcome immune response
high drug specificity - only work against cocaine
ethical concerns

31
Q

partial dopamine agonist

A

full DA agonists and antagonist carry lots of side effects - tremors, ataxia, psychosis

some evidence for partial dopamine agonists
aripiprazole

32
Q

aripiprazaole

A

partial DA agonist at D2 receptor
good evidence to treat cocaine addiction; some evidence to treat opioid addiction
less activation - competitive

acts as antagonist to dopamine
when DA absent - agonist → ease withdrawal phases

33
Q

harm reduction

A

policies, programs, and practices that aim to minimize the negative health, social, and legal impacts associated with drug use, policies, and laws

includes laws, resources, treatments

34
Q

goals of harm reduction

A

keep people alive
minimize harms of drug use
improve laws, policies, and enforcement practices
offer evidence-based interventions

35
Q

alcohol prohibition

A

1920-1933
reduced alcohol use; less public intoxication
over time, increased use

36
Q

iron law of prohibition

A

potency of prohibited substances increases as law enforcement becomes more intense

37
Q

war on drugs

A

aim of reducing drug abuse and illegal drug trade

had little effect on drug use overall
incarceration of users is expensive
does not treat underlying addiction

38
Q

decriminalization

A

harm reduction strategy
non-criminal penalties are available for designated activities - fines

39
Q

legalization

A

removes all penalties for possession and personal use of a drug
regulations are maintained

pros - drugs can be regulated
cons - amplification of negative effects if larger population of users

40
Q

drug education

A

provides information on risks and harms of drug use
focused on abstinence

effective drug education presents evidence-based information on risks and ways to mitigate those risks

41
Q

supervised consumption sites

A

safe place to take drugs to reduce harm or overdose
individuals bring own drug
given clean needles; medical supervision
free access

42
Q

safe supply

A

legal and regulated supply of drugs
programs check for contaminants

43
Q

injectable opioid therapy

A

referral program
must have failed all other addiction treatment
prescribed specific doses of injectable opioids - self-administration at clinic
monitored for adverse reactions

44
Q

acute intoxication treatment

A

Narcan (naloxone)
reverses overdose
non-selective competitive opioid receptor antagonist
works within minutes
lasts about 30 min

Pmcol 305 (18 decks)

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