substance abuse Flashcards
is substance abuse higher in bipolar or depression?
bipolar
dual diagnosis:
individual who has both mental disorder and substance use disorder
What does having dual diagnosis mean?
greater severity of illness, worse course of illness, greater difficulties in overall functioning, poorer treatment response
Secondary psychiatric disorder model:
incidence of SUD increases risk for mood disorder
secondary substance abuse model:
incidence of mood disorder increases risk for SUD
Bidirectional model:
each disorder involve separate etiologies, but exacerbate each other
Third variable or common factor models:
shared mechanisms for development of both disorders
criteria of substance use disorder, manifested by at least 2 of the following:
-increased drug taking
-unsuccessful efforts to cut down
-a great deal of time spent obtaining, using, recovering from the drug
-craving to use
-social activities reduced due to drug use
-physically hazardous use
-tolerance (increased dose to achieve desire effect)
-withdrawal
Categories of this disorder depend on:
categories for type of drug, intoxication, or withdrawal. e.g. categories for opioids: opioid use disorder
Specifiers for SUD:
mild (2-3 symptoms), moderate (4-5 symptoms), severe (6 or more symptoms)
what is addiction?
a primary chronic disease of brain reward, motivation, memory and related circuitry
addiction is characterized by these 4 things:
- inability to consistently abstain from use
- impairment in behavioral control and craving
- diminished recognition of significant problems with ones behaviors and interpersonal relationships
- dysfunctional emotional response
how many shifts are there as addiction progresses?
2 shifts
what are the 2 shifts?
- shift from positive reinforcement to negative reinforcement
- shift from impulsivity to compulsivity
what is the positive reinforcement in addiction progresses?
addition of a reinforcing stimulus, I take the drug because it makes me feel good
what is the negative reinforcement in addiction progresses?
removal of an aversive stimulus; I take the drug so I dont feel bad anymore
what system do drugs impinge on to cause rapid drug addiction increases?
mesocorticolimbic dopamine system, Ventral segmental area to nucleus accumbens
dopamine is involved in:
motivation and learning
drug addiction biological frameworks:
binge/intoxication
withdrawal
preoccupation/anticipation
binge/intoxication stage:
habits, goal directed action, reward seeking e.g feeling euphoric, feeling good, escaping dysphoria
withdrawal stage:
dysphoric, negative emotional states, irritability, stress, anxiety
preoccupation/anticipation
craving, decision-making, self-regulation (inability to resist strong urges), memory impairments
addiction 2 diathesis components:
- addiction has a heritable component of this disease (40-60% of addiction risk is due to genes)
- early life experiences/environment can affect vulnerability
twin studies in addiction:
higher rate of shared substance use disorder observed in monozygotic twins than between dizygotic twins
adoption studies in addiction:
higher rate of shared substance use disorder observed in adoptees who’s biological parents had history of substance abuse
diagnostic confounding:
overlapping of symptoms of addiction and mood disorders can confuse the diagnostic process and lead to misdiagnosis. drug abuse symptoms/states can mimic mood disorder symptoms
symptoms in mood disorder and drug addiction comoribity:
euphoria, increased energy, decreased appetite, paranoia, grandiosity, anhedonia, depressed moos, suicidal ideation, apathy, lack of concentration, restlessness, agitation
a substance abusing patient who exhibits symptoms of a mood disorder could be exhibiting:
substance induced mood disorder
substance induced bipolar:
disturbance in mood developed during or soon after substance use that is characterized by elevated, expansive or irritable mood with or without depressed mood/ or markedly diminished interest or pleasure in all, or almost all, activities
evidence that it is substance induced bipolar:
symptoms developed during or soon after substance intoxication or withdrawal or after exposure to a medication and substance/medication is capable of producing the indicated symptoms
evidence of an independent mood disorder could include:
the symptoms precede the onset of the substance/medication use and the symptoms persist for a substantial period of time (e.g one month)
what to specify in substance induced bipolar:
- onset during intoxication
- onset during withdrawal
disorder fostering disorder/kindling hypothesis:
one disorder may sensitize the brain to make individuals more vulnerable for another disorder when a potential stressor occurs
self-medication:
treat symptoms via drugs of abuse to relieve distress/suffering/emotions (drugs used to cope)
are there medications developed to treat dual diagnosis?
no
what is the strategy for medication for comorbid treatments?
wait to start medication until after detox/withdrawal ends
integrated group therapy:
form of CBT specifically designed to treat dual diagnosis of bipolar and substance use disorder
central theme of integrated group therapy
rather than viewing the patient as having two distinct disorders, the patient/therapist should view it as having a single disorder, “bipolar substance abuse”
goal of integrated group therapy:
treat both disorders with equal weight to the point that its viewed as one disorder and understand the relationships between the 2
integrated group therapy steps:
starts with a check in (did you use any drugs this week? how was your overall mood?) then analogous relapse and recovery thoughts
combination therapies:
relative treatment efficacy when combining psychosocial treatments usually with CBT
motivational interviewing plus cbt:
shifts clinical from authoritarian stance to empathetic/collaborative approach to elicit patients’ point of view1
contingency management plus cbt:
uses tangible incentives/rewards to encourage sobriety
dual recovery therapy:
integrates relapse prevention therapy, motivational enhancement therapy, and aspects of the 12 step program
relapse prevention therapy:
form of cbt used to anticipate/cope with triggering situations that may cause relapse
