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iBSC Abnormal Psychology > Session Seventeen (Addiction) > Flashcards

Session Seventeen (Addiction) Flashcards

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1
Q

What are some crucial facts to remember about an addiction presentation?

A
  • Addiction exists at every strata of society
  • The causes/ responses/ effects/ appearance of addiction are different at every strata
  • Addiction never exists in isolation, plethora of surrounding factors
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2
Q

What terms are used clinically to speak about addiction?

A
  • Clinically, we use dependence or addiction disorders more
  • Addiction is not a clinical term
  • Difficult to define
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3
Q

What methods are used to identify individuals with dependency issues?

A
  • Self report measures (but naturally have issues around under-reporting)
  • Biomarkers can be used e.g. urine dip, breathalysers, hair sample, blood (N.B. give an idea of drug USE but can’t tell us about drug DEPENDENCE, which is a significantly more subjective term

Best method = Clinical assessment using structured diagnostic interviews

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4
Q

Outline the DSM-5 ICD-10 features of addiction disorders?

A
  • Physical symptoms (e.g. tolerance, withdrawal) +
  • Psychological symptoms (e.g. loss of control, craving, compulsion to use, neglect of other areas of life, unsuccessful attempts to quit, problems in social/familial/work life

Also describe:

  • Chronic and Relapsing nature of the condition
  • Spectrum of addiction (risky use, harmful use, abuse, dependence)
  • CRUCIALLY: They describe both chemical addictions such as coke, alcohol, opioids AND behavioural addictions
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5
Q

Give 3 examples of behavioural addictions recognised by ICD-11?

A
  • Gambling
  • Compulsive Sexual Behaviour
  • Internet Gaming Disorder

(DSM-5 only recognises gambling)

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6
Q

Outside of those officially recognised in ICD, state some proposed behavioural addiction disorders?

A
  • Workaholism
  • Excessive exercise
  • Compulsive shopping
  • Orthorexia (healthy eating)
  • Kleptomania
  • Trichotillomania
  • Social media?
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7
Q

Why is it difficult to accurately portray prevalence of addiction disorders?

A
  • For many substances (alcohol, tobacco, opioid painkillers) the line between normal use and addiction is very thin
  • Almost all people under-report
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8
Q

How do men and women differ in terms of substance consumption?

A
  • Women consume less than men of almost all potentially addictive drugs generally
  • Therefore threshold for addiction is lower

HOWEVER:

  • The reverse is probably true for Painkillers and Benzos
  • Female addict consumes more than Male addict
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9
Q

Summarise the various theories of addiction, as described by West and Hardy, 2006?

A

Addiction = a rational choice:

  • Self-medication model
  • Becker and Murphy’s Theory of rational addiction

Addiction = an irrational choice:

  • Expectancy theories
  • Skog’s Choice theory
  • Gateway drug theory
  • Cognitive bias theory
  • Behavioural economics theory

Addiction = a disorder of impulse and/or self-control:

  • Addictive personality theory
  • Self-regulation theory
  • Cognitive model of drug urges
  • Self-efficacy theory

Addiction = a learning disorder:

  • Classical or Operant conditioning
  • SLT
  • Dopamine reward theory
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10
Q

What is the disease model of addiction?

A

Addiction = a disease that afflicts people, same as any other. Started with AA and alcoholism

Pros:

  • Can be extremely beneficial in helping people conceptualise and overcome their addiction, reduces stigma.
  • Biological, genetic factors support
  • Comes with physical symptoms (addiction, withdrawal)
  • Comorbidity with mental health problems supports conceptualisation as a disease
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11
Q

Outline the 4 Biological risk factors associated with alcoholism?

A

Genes:

  • Women and men heritability equal, around 50%
  • 100 genes gave been implicated, small effect sizes, none necessary or sufficient.

Sex Hormones:

  • Mainly affecting women
  • Oestrogen increases drug seeking behaviour
  • Progesterone reduces it
  • Therefore differences in addiction behaviour depending on point in menstrual cycle

Metabolism:

  • Women’s alcohol metabolism less efficient
  • Differences in cannabis metabolism
  • COCP increases metabolism of tobacco

Neuroscience:

  • Becker et al, 2012
  • Sex differences in brain function might explain different pathways to addiction
  • Men appear to take drugs for euphoric effects
  • Women take drugs for dysphoric effect
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12
Q

Is there such a thing as an addictive personality?

A

Not really.

The model of certain people being massively prone to addiction has been widely disproven, however it remains true that certain personality TRAITS e.g. Impulsivity are associated with addiction

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13
Q

How does the learning model suggest addiction develops?

A

Addiction = a collection of learned behaviour patters, which once started are extremely difficult to break out of.

E.g. its Friday, therefore I must drink

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14
Q

Give some psych risk factors for addiction?

A
  • Depression
  • Anxiety
  • Adverse life events
  • Suicidal ideation
  • Eating disorders
  • PTSD
  • Psychosis
  • Personality disorders (ASBD, BPD)
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15
Q

What issue is there when thinking about psych risk factors for addiction?

A

Cause and effect, impossible to tell which of addiction and mental health problems came first.

  • Many people with mental health issues self-medicate with drugs
  • Drugs worsen and create mental health issues
  • Also interact with anti-depressants
  • Drugs lead to unsafe situations, which lead to adverse life events, worsen mental health
  • Perhaps one common factor underlines both
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16
Q

Name some social factors that affect addiction behaviour?

A
  • Deprivation
  • Life events
  • Divorce, seperation
  • Childhood abuse
  • Domestic violence
  • Norms
  • Stigma
  • Price
  • Availability
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17
Q

Give some BPS consequences of addiction?

A

Bio: Health problems, brain changes, death

Psycho: Mental health, learning and attention abilities

Social: Life events, stigma, crime

18
Q

How is addiction normally treated and why?

A

Predominantly treated as a psychiatric condition, due to the significant mental health components involved in an addiction presentation.

However related harms should still be treated as a mental condition e.g. in alcohol detox.

(this requires a high degree of co-operation between health care practitioners that often makes care difficult)

19
Q

What are the 4 essential stages of treating addiction?

A

1) Detoxification:
2) Combination of Pharm and Psych treatments
3) Aftercare/ Relapse Prevention
4) Recovery

20
Q

What is involved in detoxification?

A
  • Resetting status quo of drug free brain, while keeping patient stable
  • Get them to a point where they are able to engage in treatment
  • Requires protective interventions to prevent sudden chemical imbalances from causing damage
  • Only really necessary for alcohol and opioids
  • Takes 1-4 weeks depending on severity of addiction
  • Normally done in community, only 2% of UK patients go into residential care (rehab)
21
Q

What are some generic symptoms of detox/ withdrawal?

A

Exhaustion, vomiting, insomnia, seizures, muscular pain, debilitating headaches, sweats, nausea, seizures

22
Q

What protective medications are commonly given during detox?

A
  • Benzodiazepines to prevent seizures

- Vitamin B1 (thiamine) given to prevent alcohol related brain damage (normally as Pabrinex)

23
Q

What psychological interventions have good evidence in the treatment of addiction?

A
  • Group work
  • Family therapy
  • One-on-one key working
  • Peer support
  • Couples therapy
  • CBT and Psychotherapy not supported by evidence.

Important to note that most psych treatments are universal and applicable across substances (and behavioural addictions). Target underlying processes not chemical pathways.

24
Q

When should psych interventions be used to treat addiction?

A

Mainstay of treatment for addictions where there are limited pharm intervention options and no substitute therapy e.g. stimulant addiction, cannabis addiction, behavioural addictions.

25
Q

What are substitute drugs in addiction? Give some examples.

A
  • Part of pharm management for chemical addictions
  • Aim is to remove the highs and lows of addiction, flatten out spikes and remove need for illegal acitvity
  • Provide the patient with a controlled, less harmful way of staving off the symptoms of withdrawal without spiralling.

Examples:

  • Methadone and Buprenorphine (for opioids addiction)
  • Nicotine patches, gums, lozenges, e-cigs (tobacco)
26
Q

What pharm interventions are used to manage alcohol dependency and how do they work?

A
  • Disulfiram: makes you sick when you drink
  • Naltrexone: interferes with the pleasure you get from drinking
  • Acamprosate: reduces craving for alcohol
27
Q

Outline what is involved in the “Aftercare/Recovery” stage of addiction management?

A
  • Delivered in residential or community settings
  • Involves a structured day programme
  • Group work, one-on-one sessions
  • Occupational therapy activities
  • Workshops on findings jobs, Support for finding housing, Sorting out benefits
  • May include some pharm treatment mentioned above
  • After 3-6 months reducing in intensity, but may still continue 12-steps style meetings
28
Q

What does “recovery” mean in terms of addiction behaviour?

A

Means different things to different people but essentially it focuses on being at a point where you can live independently, maintain a job and some semblance of a social life.

If a person is still drinking a little, or using methadone to achieve this then that’s still recovery as their life is recovering, don’t have to go tee total although obviously thats the preferred path.

29
Q

What are some potential triggers and risk to relapse?

A
  • coping with new trauma or distress
  • availability
  • lack of support
  • lack of treatment
  • habit
  • neurological changes in the brain
  • severity of underlying dependence
30
Q

What are some common issues seen in alcoholism treatment?

A
  • Stigma in seeking help
  • Services are often too generic and mixed (opioid and alcohol users lumped together, genders lumped together)
  • Issues with parents going (have to find child care + looks bad to social workers)
  • High drop out rates
31
Q

Why is alcohol addiction so hard to spot and treat?

A
  • Alcoholism exists on a scale that almost all people find themselves on
  • People with alcohol issues are often belligerent and aggressive
32
Q

How is alcohol withdrawal managed?

A
  • Benzodiazepines are the mainstay of treatment for alcohol withdrawal in the UK
  • Prevent potentially life-threatening complications e.g. seizures and delirium tremens
  • Reducing dosage regimens over a couple of days/weeks
  • Issue: Cross-tolerance between alcohol and benzos makes it difficult to dose benzos effectively
33
Q

What tool can be used to work out benzodiazepines dosage in someone about to detox from alcohol?

A

CIWA (Clinical Institute Withdrawal Assessment of Alcohol)

34
Q

Where do most alcohol addicts detox and what precautions must be taken?

A

98% detox in the community.

Therefore those living alone or with a history of seizures, or with a substantial physical or mental health co-morbidity are admitted for planned detoxification.

35
Q

What should all individuals in alcohol withdrawal be assessed for and how would you prevent it?

A
  • Wernicke-Korsakoff syndrome
  • Caused by sudden profound thiamine deficiency
  • Leads to irreversible brain damage
  • Presents with a triad of ataxia, ophthalmoplegia and confusion
  • Prevention = Pabrinex, IM or IV
  • If symptoms develop give Pabrinex 3x a day for 5 days
36
Q

What two drugs are used to treat opioid addiction and what are their respective benefits?

A

Methadone = Full agonist but with a longer half life (thereby protecting against the aversive effects of withdrawal, also less reinforcing)

Buprenorphine = Partial agonist

  • Methadone is associated with increased risk of death during initiation
  • Therefore buprenorphine is preferred
  • However can only give buprenorphine once fully detoxed, absolutely cannot have an agonist on board
  • Therefore timing is an issue, patients want to get on BN but struggle to be in withdrawal enough to be eligible for it.
37
Q

How doe OSTs reduce harm in opioid addicts?

A

Opioid Substitution Treatment is beneficial as it reduces:

  • opiate related death
  • street heroin use
  • adverse health outcomes
  • HIC, Hep C
38
Q

What is involved in opioid detoxification?

A
  • Normally done on patients on OST
  • Gradual reduction in OST over the course of weeks

+ Adjunctive measures:

  • Loperomide for Diarrhoea
  • Buscopan for stomach cramps
  • Lofexidine can be helpful towards the end of therapy as it reduces noradrenaline transmission
39
Q

What measures have been put in place to prevent heroin overdoses?

A

Take-home Naloxone.

  • Naloxone = an opioid receptor antagonist
  • Injected IM
  • Prevents death by respiratory failure, puts patient into withdrawal
  • Used in hospitals but recently been given out to friends and family of users
  • Has helped reduce deaths from overdose in Scotland
40
Q

What can be done to prevent relapse in an opioid addict?

A

Naltrexone (orally, long-acting injection). Reduces risk of relapse

41
Q

What treatments have been used to treat behavioural addictions?

A

Pharm:
- Naltrexone
- Nalmefene
(same as used for chemical addictions)

Psychological:

  • Individual psych support
  • Behavioural couples therapy
  • Support groups
  • Psych reviews
  • Aftercare
  • Medication for problem gambling

iBSC Abnormal Psychology (19 decks)

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