Substance Abuse Flashcards
Self administration of any drug in a culturally disapproved manner that causes adverse consequences
abuse
A behavioral pattern of drug abuse characterized by overwhelming involvement with the use of a drug, the securing of its supply, and high tendency to relapse after discontiunation.
Addiction
Repetitive actions inappropriate to the situation that persist, that have no obvious relationship to the overall goal, and that often results in perseveration in responding in the face of adverse consequences; preservation in responding in the face of incorrect responses in choice situations or persistent reinitiation of habitual acts.
Compulsivity
The ability of one drug to suppress the manifestations of physical dependence produced by another drug to maintain the physically dependent state
Cross tolerance/cross dependence
The physiological state of adaptation produced by repeated administration of certain drugs such as alcohol, heroin, and benzodiazepine’s when they are abruptly discontinued, and are associated with physical drug withdrawal distinct from the motivational changes of acute withdrawal and protracted abstinence, which is part of addiction.
Dependency
A response triggered by environmental stimuli irrespective of the current desirability of the consequences. This conditioned response to a stimulus has been reinforced and strengthened either by experience, risk reward, or by the omission of an aversive event.
Habit
The tendency to act prematurely without foresight; actions which are poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation and that often result in undesirable consequences; predisposition toward rapid, unplanned responses to internal and external stimuli without regard for the negative consequences of those reactions to themselves or others.
Impulsivity
The exaggerated expression of the original condition sometimes experienced by persons immediately after cessation of an effective treatment.
Rebound
The tendency of a pleasure producing drug to lead to repeated self-administration
Relapse
Developed when after repeated administration, a given dose of a drug produces a decreased effect or when increasingly larger doses must be administered to obtain the effects observed with the original use.
Tolerance
The psychological and physiological reactions to abrupt cessation of a dependence producing substance
Withdrawal
This aspect of the brain is known to play a critical role in goal directed behavior
prefrontal cortex
What is the central structure of reward?
mesolimbic dopamine system including the ventral tegmental area and nucleus accumbens (aka ventral striatum)
Behaviors that people enjoy seem to percipitate
an increase in the DA produced a the Nucleus Accumbens
This part of the brain is critically involved in the process of acquiring and retaining lasting memories of emotional experiences whether they are pleasurable or traumatic.
Amygdala
The mesolimbic DA pathway is less about liking and more about
craving
It is the activation of these in a few regions of the brain that facilitates the real pleasure or liking
opioid receptors
These have all been identified as hedonic hotspots (pleasure centers)
parts of the orbitofrontal cortex, amygdala, NAc, and ventral pallidum
What is the one spot in the brain that is absolutely essential for pleasure and destruction of it results in loss of hedonic pleasure?
ventral pallidum
What is the most consistently reproducible brain changes found in those with addiction?
Reduction in total volume and gray matter particularly in frontal lobes and declines in cognition and memory
What happens to the dopamine receptors in someone with addiction?
They downregulate in D2 receptors resulting in the development of tolerance and need for more and may result in the abstinent user having difficulty experiencing pleasure with the natural joys of life.
What is the source of craving?
The prefrontal cortex particularly the orbitofrontal cortex and dorsolateral prefrontal cortex
Glutamate as a source of
craving
Impulsivity involves a brain circuit centered on the BLANK that links to
ventral striatum linked to the thalamus, ventromedial prefrontal cortex, and the anterior cingulate cortex
Compulsivity is centered on this brain circuit
dorsal striatum, thalamus, and orbitofrontal cortex
What is the “top down” circuit that attempts to suppress the drive to be impulsive or compulsive?
Prefrontal cortex
ACC
Anterior cingulate cortex
DLPFC
Dorsolateral prefrontal cortex
OFC
orbitofrontal cortex
T
thalamus
VMPFC
ventromedial prefrontal cortex
What is the difference between the casual drug user and an addict?
The impulse loop in a casual user turns into a compulsive loops for the drug addict
What is the most rapid and robust way to deliver drugs to the brain?
to smoke it
The reinforcing effects and abuse of stimulants is not the reward of the drug/behavior but
the anticipation of the reward
Dopamine neurons stop responding to the primary reinforcer in addiction and start to respond to
the conditioned stimulus
What is the most addicting substance known?
nicotine
What are the receptors that lead to nicotine addiction?
alpha-4-beta-2-nicotinic receptors
What are the five As that are a model for treating tobacco use and dependence
Ask-screen all patients for tobacco use
Advise-tobacco users to quit
Assess-willingness to make a quit attempt
Assist with quitting-offer medication and provide or refer to counseling
Arrange follow-up contacts, beginning within the first week after the quit date
What are the nicotinic full agonists-nicotine replacement therapy?
chewing gum (nicorette), lozenges (commit, thrive C), transdermal patches (nicoderm c, nicoderm CQ, nicotrol), nasal spray (nicotrol NS), inhaler (nicotrol inhaler, nicorette inhaler C)
What is the nicotinic partial agonists?
Varenceline (selective alpha-4-beta-2-nicotinic partial agonists)
What dopamine reuptake inhibitor is used to help with nicotine addiction?
Bupropion
Alcohol enhances inhibition at
GABA synapses and reduces excitation at glutamate synapses
What are the three different medications used to treat alcohol addiction?
Naltrexone, Acamprosate, Disulfiram
How does Naltrexone work?
breaks the cycle of pleasurable effects of alcohol by blocking the mu-opioid receptor
How does Acaprosate work?
substitutes for alcohol during withdrawal (artificial alcohol)
How does Disulfiram work?
inhibits aldehyde dehydrogenase; aversive reactions (negative conditioning)
What is the reversal agent for benzodiazepines?
flumazenil (Romazicon)
What can minimize abstinence syndrome with benzodiazepines?
slow withdrawal over months
What two things increase the risk for death when taking benzodiazepines?
IV administration or PO administration with CNS depressants
What are the reversal agents for opioids?
naloxone and naltrexone
What are the signs of autonomic hyperactivity that may occur with opioid use and withdrawal?
tachycardia, tremor, sweating, and piloerection
What medication can reduce signs of autonomic hyperactivity during withdrawal and aid in the detoxification process?
Clonidine (alpha-2-adrenergic agonist)
Methadone can be used
to assist in the detoxification process that allows opioid receptors to readapt to normal but may be too difficult to tolerate without the methadone
What medications are used for Medication Assisted Treatment (MAT)?
Buprenorphine + naloxone
What long acting injectable medication can be used for opioid addiction?
naltrexone
