set 7 - substance abuse Flashcards
set 7 - substance abuse
what is substance abuse?
ingestion with no negative effects
- what most people do
substance intoxication
experiencing the intended physiological effects of substances
–vary depending on substance, situation, person, amount
-presentation will look different for each substance
substance abuse
when use causes distress and/or impairment
there is an impairment in functioning, negatively impacting life
substance dependence
physiological: cravings for substance
- tolerance: need more amount to feel the effects
- withdrawal: experiencing negative symptoms when not using drug
psychological: behaviours and beliefs surrounding the substance
- engage in negative behaviors to continue use
- believe we need the drug
misconceptions
“Illegal drugs have no positive effects”
* In reality, illegal substances can have medicinal effects
“If you use an illegal drug once, you will become addicted”
Cannabis is a “gateway” drug
notes:
- Psychedelics for treatment of resistant depression, cannabis for glaucoma/cancer, cocaine used medicinally, MDMA used to treat PTSD
- Less than 10% that tried illegal substances become addicted
- Majority don’t become addicted
more misconceptions
Prohibition decreases drug availability
* Portugal’s success with decriminalization
- Banning drugs doesn’t work, people find other ways
- More kids and pregnant women had more access during prohibition
Only former drug abusers make good drug therapists
- commonly believed still
- not true, any trained therapist works
substance use disorder
how many criteria and how can it be grouped?
11 Criteria in DSM-5-TR can be grouped based on:
1) Physical Dependence
2) Risky Use
3) Social Problems
4) Impaired Control
note:
criteria is the same for all disorders
for diagnosis, you need to meet at least 2 of 11 criterias within a 12-month period
substance use disorder
A pattern of use that causes significant impairment and distress, as indicated by:
1) Using more of a substance than intended or for longer than you’re meant to
= impaired control
2) Persistent desire or repeated unsuccessful efforts to cut down or control use
= impaired control
3) Spending more time getting and using drugs and recovering from substance use
= dependence
4) Craving or strong desire/urge to use substance
= dependence
5) Recurrent relationship problems caused by or worsened by use
= social problems
6) Negative impact on work, home, or school performance = social problems
7) Give up important social, recreational, or work activities because of substance use = social problems
8) Recurrent use of substance in situations where it is physically dangerous to do so = risky use
9) Recurrent physical or psychological problem that are caused by or worsened by use = risky use
continued
10) Tolerance, as defined by at least 1 of
- Increased amounts are required for intoxication or desired effect
- Diminished effect with continued use
11) Withdrawal, as defined by at least 1 of
- Characteristic withdrawal syndrome associated with that substance
- The substance (or a closely related substance) is taken to relive or avoid withdrawal symptoms
- negative reinforcement pattern
general biological factors & treatment
etiology (general across all substances)
1) genetics
- component to some substances (alcohol, tobacco, and opiates) but less research to support link for other substances
2) reward areas in the brain
- dopamine most related system and opioid system
- drugs highjack these systems in the brain
- reward areas responsible for enjoying things like food
general biological factors and treatment
medically supervised withdrawal
Medications simulates effects of illegal substance to help gradually ween them off
-may have medications to lessen symptoms or side effects of withdrawal
general biological factors & treatment
replacement medications
Replacement medications
- Methadone (opioid to replace illegal drug)
tobacco replacement (nicotine patchs)
general biological factors & treatment
antagonists
1) Antagonists exist to counter-act overdose for some substances
- Naloxone: stops overdose from opioids
- Valium: decreases heart rate and blood pressure (cocaine overdose)
general psychological etiological factors
disease model
Disease model: historically prevalent, view addiction same as asthma or diabetes. A physical illness. Have access to substance and have no control over actions/use
General Psychological Etiological Factors
parental influence
Parental influence: grow up seeing drug use (social modelling, appropriate coping mechanism), mediating factor/cause of psychological trauma and use as coping strategy
-Behavioural control: exert more behavioural control, prevent peer pressure (may stop effects of negative peer pressure)
General Psychological Etiological Factors
expectancy effects
Expectancy effects: how beneficial we believe a drug will be increases likelihood of use
-More likely associated to abuse of drug but not dependence
General Psychological Etiological Factors
positive vs negative reinforcement
Positive reinforcement: continue to do something because they get reward from it (high is rewarding, or social aspect is reinforcing)
-Polysubstance use: use more types to enhance effects
Negative reinforcement:removal of physiological (withdrawal) or psychological (mental health issues) distress increases the behaviour
Self-medication as negative reinforcement, less linked to substance abuse and more linked to dependence
General Psychological Etiological Factors
opponent-process theory
Opponent process theory: theory of emotional and motivational states. Initially, emotions have a paired opposite (ie. happiness/sadness, fear/relief) and cannot experience them simultaneously
Opposite of pleasure is pain. When experiencing one emotion/pleasure, it inhibits pain temporarily
- When pleasure goes away, pain increases. Second emotion goes back around to experience first emotion??
- Second emotion likely to suppress first emotion
Addiction: result of emotional pairing of pleasure and withdrawal symptoms
- Repeated exposure shifts. From little pleasure to more pain
Feel intense levels of pleasure when first using drug, overtime pleasure levels decrease and withdrawal symptoms increase (pleasure and withdrawal symptoms opposite)
- Need more frequently and in larger quantities to feel more pleasure again and avoid pain of withdrawal
- What leads to addiction
General Psychological Etiological Factors
conditioned place preference
Conditioned place preference
Conditioned place preference: individuals develop context associations that have formed related to their substance abuse
- Context associations in drug use (reward behaviours). Body physiologically prepares
- Cues signal that this is what we need to do (Pavlovian). Could also be emotional states
- Drug use in new areas can lead to different effects and possible overdose (without previous cues). Overdose can also happen if go back to cues if weren’t around them before??
- Cravings may be a response to conditioned place preferences
general psychological treatments
12-step programs (support disease model)
- good for social support
- not super effective
- Often religious component/male dominated
- Not open to research
General Psychological Treatments
support groups and inpatient programs
Support groups/community resources: Generally ineffective
* Help with issues go hand in hand
* Access or support
Inpatient programs: No more effective than outpatient
* Needed for detox (not more effective beyond that)
General Psychological Treatments
CBT and motivational interviewing
CBT: more cognitive focused (exposure not useful), used to treat comorbid symptoms that go along with substance use disorders
Focus on establish controlled use, not complete abstinence
Motivational interviewing/enhancement: * help person resolve whether or not they want to be in treatment
Motivations for being in treatment
general psychological treatments
harm-reduction
Harm reduction: help individual reach goals but be safe. Reduce harm in use
* Not looking at abstinence (maybe for some substances)
* Mainly look at control use and reducing harms
* Provide safe injection sites, safe needles
* Lots of research to support, can’t force abstinence on everyone. Can alleviate surrounding issues
Relapse and multiple treatment attempts are very common
* Cravings may never leave
overview
substance-related disorders
- alcohol
- tobacco
- cannabis
- amphetamines/ cocaine
- opioids
- hallucinogens
gambling disorder
alcohol
1) intoxication
- Initial increase in well-being, decreased inhibitions
- Decreased motor control, coordination, reaction times, poor judgement, blackouts
2) Withdrawal
- Hand tremors, nausea, anxiety,
insomnia, hallucinations, and delirium tremens (severe hallucinations or body tremors) - withdrawal is the most severe for alcohol use disorder, people can actually die from the withdrawal symptoms
12mo% = 12% men, 5% women
note:
Long term and more chronic use can result in dementia and brain damage
More moderate use however may help protect against cognitive decline (??)
- high rate for men
- rates of addiction are higher in teens and young adults and young males are more at risk
Binge drinking – for men it would be 5 or more drinks (2 hr period of time) / women 4
alcohol biological factors & treatments
etiological factors
1) genetics
2) glutamate and GABA
3) Serotonin, dopamine, and opioids
4) Alcohol dehydrogenase
alcohol biological factors & treatments
etiological factors: genetics
Genetics – twin and adoption studies for men have genetic contribution to alcohol dependency , no strong evidence for women
Heritability for alcoholism is high as 70% / may be linked to the same genes that can predispose someone to being antisocial
alcohol biological factors & treatments
etiological factors: neurotransmitters
1) glutamate and GABA
- Alcohol decreases glutamate (an explanation to blackouts)
- Increases GABA – GABA slows down the system –
2) serotonin, dopamine and opioids
- Increases serotonin (linked to cravings)
- Long term use can decrease serotonin
- Same thing with dopamine, initially an increase in dopamine, but long term can decrease it which leads to dependence
- Opioids – natural opioids increases, overtime decreases
- Dopamine and opioids are associated with the pleasure centre of the brain, helps us enjoy food / sex
alcohol biological factors & treatments
etiological factors: alcohol dehydrogenase
Alcohol dehydrogenase – enzyme in liver that breaks down alcohol (necessary when ure drinking alcohol)
Dehydrogenase is not present in some Asian individuals (30-50% skin flushing response when they drink alcohol), lower rates of alchol abuse in Asian communities
alcohol biological treatment
1) Antabuse - makes you nauseous when drinking, makes drinking very unpleasant
- Operant conditioning principle – positive punishment (adding nausea to try and decrease drinking behaviour) won’t be on the exam
- can be effective but most stop using it
2) naltrexone - stops the euphoria associated with alcohol,
psychological factors & treatment
etiological factors: cultural differences
- some cultures and religion that discourage use of alcohol, more Eastern cultures
- culture influence what we drink (Italy = wine)
- some cultures are comfortable with children drinking wine (Greece and Italy) / interestingly, there’s higher rates of dependency and lower rates of abuse
psychological factors & treatment
etiological factors: alcohol myopia
- people lose sight of things, only paying attention to what is happening right now
- nearsightedness – care abt what is happening now, lose sight of things of what is happening further away
- increase your chances of making dangerous choices
psychological factors & treatment
etiological factors: motivations for use
- why are we using alcohol in the first place?
- to get drunk, escape, avoid negative feelings,
alcoholpsychological factors & treatment
1) alcoholics anonymous
- based on the disease model of addiction
- you must turn urself over to a higher power
- lack of stigmatization and social support
- huge dropout rates
- hard to get an estimate of how effective these are (30-60% benefit)
2) CBT
- AA - complete abstinence
- CBT – focus might be on control drinking
- control drinking programs, seems to be more effective than abstinence - less dropout rate, relapse is still prevalent anyways (no matter what program)
- 70-80% will relapse
3) harm reduction
- how can we reduce the riskiness / harm of drinking behaviour?
amphetamines / cocaine
1) Intoxication
* Initial increase in euphoria, alertness, insomnia
- Hallucinations, anxiety, vomiting, weight loss, seizures, coma
- initial euphoria (positively reinforced)
- chronic use can age the brain quicker
- long term side effects take awhile to develop, even then it’s just sleep disturbance and social isolation
- more concerned to the criminal aspect to it (because it can be laced)
2) Withdrawal
- Apathy, boredom, depression, increased sleep, irritability
- apathy – they get bored
- increased sleep – hypersomnia and irritability
- boredom is the most withdrawal symptom
3) 12mo% = 0.2%
- no difference all together between men and women
- men tend to use more cocaine
- relatively uncommon (10%)
cocaine biological factors
1) Norepinephrine and dopamine
- Increase NE – system is more sensitized for those who use it
- Increase Dopamine – causes of hallucinations
2) Reverse tolerance/sensitization
- takes less and less
- opposite of developing a tolerance
- repeated use alters sensitivity, you can become sensitized
- with repeated use, your body has more enhanced effect (you don’t need more to get high)
cocaine biological treatments
1) Propranolol - reduces anxiety associated with cocaine withdrawal
2) Modafinil - give individuals any attention improving effects without actually getting high
3) ADHD medications - give individuals any attention improving effects without actually getting high
cocaine psychological factors
Apathy and boredom prompt re-use
- they get bored so they would want to engage again
Impulsivity linked to sensitization
- impulsivity can prompt more use as well
cocaine psychological treatments
Cocaine anonymous – similar to AA, same pricinples
CBT - contingency management – using operant conditioning, setting up programs in their life, structures where they get positive rewards when they start reaching goals in thgeir life
CBT - Community Reinforcement – family members can join in their treatment programs to improve relationships around them, help with housing, work, education
Harm reduction – testing strips (make sure cocaine is not laced), cleaner methods to snort cocaine (straws) , promote nonsharing methods of use, promote clean needles
cbt and harm reduction – u are paying attention to meet their needs,
tobacco (nicotine)
1) intoxication
Relieves stress and improves mood
Blurred vision, confusion, convulsions
- study shows that nicotine may improve cognitions and can be a treatment for dementia patients, but tobacco is very harmful
2) withdrawal
Depressed mood, insomnia, anxiety, difficulty concentrating, restlessness, increased appetite/weight gain
3) 12mo% = 15%
men tend to start smoking younger
- female rates can jump up to first year of uni
- 40% of people have been smokers at some point in their life
- 20% smoke monthly
- 12mo% - 15% which is pretty high
tobacco biological factors
1) Nicotinic acetylcholine receptors
- smoking may influence receptors and alcohol as well
- in the limbic system – pleasure system
- can have an effect in dopamine which can increase alcohol use
- enhance the effect of alcohol (I only smoke when I drink)
2) Genetic predisposition
tobacco biological treatment
1) Nicotine replacement therapy
- moderately effective, should be used in combinations of psychological treatment (patch, gum), some people may be dependent to the gum
2) Wellbutrin/Zyban
- antidepressant, they stop smoking when using this, side effect: hallucinations or delusions
3) Champix
- decrease cravings and the pleasurable effects of tobacco, 20-25% effective
4) Silver acetate
- a chewing gum, when you smoke it makes the taste awful
tobacco psychological factors
etiological factors:
1) Depression / Anxiety prompt relapse - intoxication of tobacco- people calm down, so when they experience anxiety, it can prompt relapse
2) Motivation for use – is it positive or negative reinforcement?
3) Environmental stimuli – “I only smoke when I..” then look at those environment
tobacco psychological treatment
Cbt – how can we adjust things so we can stop smoking?
- abstince is almost always the goal
- harm reduction is not used in this area
- 50-60% relapse
opioids
1) Intoxication
- Euphoria, drowsiness, slowed breathing
- Death due to depressed respiration
Heroin, prescription medications (oxy, perc, fentanyl..)
- overdose can lead to death
2) Withdrawal
- Nausea, chills, diarrhea, insomnia
- alcohol withdrawals is far far worse still
3) 12mo% = 0.1-1%
- individuals many will actually die because of suicide, overdose or homicide
- 12mo% is pretty low
- usage was increasing and now seems to decline
- pretty unclear how common opoid use in general
opioids biological factors
etiological factors:
Enkephalin and endorphin systems
- general opioid system in ur body
- natural version of opioids
- one of the main things nsg that influence opioid use is negative reinforcement (it removes pain)
opioids biological treatment
Methadone – basically is an opioids agonist – help improve quality life and decrease criminal acts, legal substance to help them wean off
Buprenorphine – partial opioid agonist (not as strong as methadone, so easier to get off)
Naltrexone – stops the person from experiencing the high that they would get
opioid psychological factors
Withdrawal symptoms prompt re-use
- it is important to look for their motivation of use
Sensation seekers vs. emotional copers
- Sensations seekers (to get high) or are we trying to remove pain (emotional copers)
opioid psychological treatment
Narcotics anonymous – same principle
Cbt – same principle
Harm reduction –
cannabis
1) Intoxication
- Euphoria, loss of time, heightened sensory experiences, mood swings, anxiety
- Paranoia, hallucinations, dizziness
- Both tolerance and sensitization
individuals can experience sensitization, which means u experience a more heightened effect (you take the same amount, but you experience more effect)
- THC and CBD are the most studied
- intoxication vary from person to person
- there is no strong effect that smoking cannabis alone can cause lung cancer
- short term, smaller amounts can improve brain functioning
- other research suggest that ur brain can age faster
2) Withdrawal
- Irritability, appetite loss, difficulties sleeping
individuals can experience sensitization, which means u experience a more heightened effect (you take the same amount, but you experience more effect)
- withdrawal rare
- cravings low compared to other
- use of cannabis decreases with age
- drop in alcohol sales and increase in cannabis purchases (Canada)
3) 12mo% = 1-4%
cannabis biological factors
1) Endocannabinoids – basically pur natural receptors in our body, it hijacks the system, all throughout body and brain
- when people smoke cannabis, it can be wide in effects, various effects in cognition (disrupt ur ability to remember things that just happened, slowed reaction time, can affect judgement)
- overtime THC can change the endocannabinoids, motor control, memory there regions work (addiction, memory, mental health issues)
2) Sensitization – you can get this euphoria with just little use
cannabis biological treatment
treat comorbid conditons
- anxiety or sleep difficulties / look at motivations for use
- smoking because people are anxious / maybe we can treat the anxiety
cannabis psychological factors and treatment
Etiological Factors
- Motivations for use
Treatment
- CBT – relapse prevention
- what are the factors associated with relapse? paired association
- Harm reduction
hallucinogens
1) Intoxication
Hallucinations, depersonalization, distorted sensory perceptions
Increased heart rate and perspiration
Rapid tolerance
- gaining popularity
- depersonalization – detach from yourself, you don’t feel connected to your body
- rapid tolerance / hallucinogens to treat mental health / single dose of shrooms can improve personality for a long time
2) Withdrawal
None, but “bad trips” may occur
3) 12mo% = 0.1%
hallucinogens biological factors and treatments
1) Etiological Factors
Serotonin and norepinephrine - we know it is involved, but no idea how
2) Treatment
None
- why would there be none? NO WITHDRAWAL
hallucinogens psychological factors & treatment
1) Etiological Factors
- Motivations for use
-sensory experiences, positive or rewarding effect, to escape - motivations for use is important for all substance abuse
2) Treatment
- CBT
- Harm-reduction
If there is no withdrawal symptom, why should they seek treatment?
if there is significant impairment in functioning (family, social relationships)
gambling disorder
Persistent and recurrent problematic gambling behaviour, as indicated by
1) Needs to gamble with increasing amounts to achieve desired level of excitement (tolerance)
2) Is restless or irritable when attempting to cut down or stop (withdrawal)
3) Repeated unsuccessful efforts to control, cut down, or stop (impaired control)
- 4/9 criteria over a 12-month period to be diagnosed
- In contrast to substances, 2/11 over 12 month period
- Tolerance – they want more and more
gambling disorder - criteria cont’d
Often gambles when distressed
After losing money, often returns another day in an attempt to break even
- chasing loses - they want to get it back
Has jeopardized or lost significant relationships, educational, or job opportunities
12mo% = 0.2-5%
- higher among men compared to women
- elderly individual may be at risk / social isolation,
- not common in teens
gambling disorder can be episodic
- if they meet
- 4 – 5 criteria : mild gambling disorder
- 6-7 criteria: moderate gambling disorder
- 8-9 criteria : severe gambling disorder
gambling disorder biological factors
Etiological Factors
1) Dopamine and serotonin systems
- sense of am I going to win this time
- increase in dopamine and serotonin short term, but decreases long term
2) Decreased activity in brain areas associated with impulse control
- casinos rely on intermittent reinforcement
gambling disorder biologival treatment
Opioid antagonists– medication have some effectiveness, they block the effectiveness of opioids so we are not getting that same high
SSRIs – useable in the long term
Lithium – one study found that lithium was useful in reducing thoughts about gambling, but not actual gambling behaviour
gambling disorder psychological factor
Etiological Factors
1) Positive and negative reinforcement
- Trying to avoid emotional distress (negative reinforcement)
- Gambling behaviour is very behaviourally conditioned through those operant principles, it is what explains gambling behaviour
2) Overestimates skill
- overestimates their ability to accurately or play well
- emotionally vulnerable people will use gambling to escape feelings
3) Lack of understanding of “chance” and “random”
Subtypes:
-Behaviourally conditioned ( ones that are drawn because of the flashing lights, intermittent)
-Emotionally vulnerable
-Antisocial-impulsive (individuals may rob others to bet, they need that rush)
gambling disorder psychological factors and treatment
treatment
Harm reduction
- 1) remove any high risk situation (banned from the casinos, destroy credit card)
- 2) try to change thinking around chance and randomness, skill (cognitive restructuring)
- 3) develop some coping skills (how to cope with emotions instead of gambling, add activities to replace gambling behaviour)
- basically u want them to gain that sense of control
Gambler’s anonymous
- rarely effective
