Recovery + Harm Reduction Flashcards
cycle of addiction
initial drug use
acute drug experience
drug withdrawal
chronic drug experience
initial drug use
genetics - impulsivity
mood
environment
acute drug experience
euphoria
analgesia
anxiolytic
antidepressant
drug withdrawal
opposite of acute effects - dysphoria, pain, anxiety
unpleasant symptoms drive craving and relapse
certain drug withdrawals have lethal symptoms ex. alcohol
chronic drug experience
neurological adaptations (molecular, cellular, behavioural)
tolerance to positive effects of drug + natural rewards
loss of prefrontal cortical control of drug behaviours → compulsive drug seeking
biopsychosocial disease
biological factors can increase likelihood of developing an addiction and can promote continued use
also highly correlated with environmental factors
biological factors
Mu opioid receptors
neuroadaptations
concurrent mental illness
psychological + social factors
psychological:
- support services
social:
- interpersonal relationships
- treatment + drug-use settings
- SES
behavioural interventions
CBT
contingency management interventions/motivational incentives
counselling/therapeutic communities
CBT
psychosocial intervention administered by psychologist
develop non-drug coping strategies to triggers
contingency management
motivational incentives
individuals are rewarded for evidence of positive behavioural change
ex. get money for clean urine drug screens
counselling communities
alcoholics/narcotics anonymous
pros:
- connects people to community
- de-stigmatizes drug use
- free
cons:
- no medical interventions
- religious undertones
- abstinence only
systematic reviews and meta-analysis
reduce biases and random errors - combine results of many primary studies
highest quality of evidence
data expressed in forest plots
pharmacological interventions
- block positive effects of drug
- make withdrawal easier
drug withdrawal treatment
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
nicotine replacement therapy
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
alcohol withdrawal
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
alcohol withdrawal treatments
drugs that promote GABA signaling to restore inhibition
- benzodiazepines
benzodiazepines
PAMs at GABAa receptors (like alcohol)
→ enhance GABA activity by binding to allosteric site
have no effects in absence of GABA
short term use
opioid withdrawal
opposite symptoms of acute use
- anxiety, pain, dysphoria
symptoms last long term = vulnerable to relapse even years after use
agonist replacement therapy
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
methadone
half life = 24-42 hours
long acting full agonist of mu opioid receptor
overdose is still possible because it is a full agonist
buprenorphine
partial agonist at mu opioid receptor
24 hr half-life
safer agonist profile
suboxone → combine buprenorphine with naloxone to prevent abuse
advantages of agonist replacement therapy
reduces drug cravings
better participation in addiction treatment - no withdrawal symptoms
improved social functioning
reduce harms of illicit drug use
treatments to block drug effects
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
disulfiram
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
naltrexone
antagonist at mu opioid receptor
blocks reinforcing properties of drugs of abuse - alcohol + opioids
reduced drug craving and relapse rates
requires daily dosing
drug vaccines
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
pros of drug vaccines
adherence is not an issue - no daily dosing
vaccines don’t enter brain - can be used in combination with other interventions
cons of drug vaccines
length of effect is unknown
high doses might overcome immune response
high drug specificity - only work against cocaine
ethical concerns
partial dopamine agonist
full DA agonists and antagonist carry lots of side effects - tremors, ataxia, psychosis
some evidence for partial dopamine agonists
aripiprazole
aripiprazaole
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
harm reduction
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
goals of harm reduction
keep people alive
minimize harms of drug use
improve laws, policies, and enforcement practices
offer evidence-based interventions
alcohol prohibition
1920-1933
reduced alcohol use; less public intoxication
over time, increased use
iron law of prohibition
potency of prohibited substances increases as law enforcement becomes more intense
war on drugs
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
decriminalization
harm reduction strategy
non-criminal penalties are available for designated activities - fines
legalization
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
drug education
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
supervised consumption sites
safe place to take drugs to reduce harm or overdose
individuals bring own drug
given clean needles; medical supervision
free access
safe supply
legal and regulated supply of drugs
programs check for contaminants
injectable opioid therapy
referral program
must have failed all other addiction treatment
prescribed specific doses of injectable opioids - self-administration at clinic
monitored for adverse reactions
acute intoxication treatment
Narcan (naloxone)
reverses overdose
non-selective competitive opioid receptor antagonist
works within minutes
lasts about 30 min
