Substance Abuse Flashcards
substance related and addictive disorders
abuse of drugs and other substances people take to alter the way they think, feel and behave
psychoactive substances
chemical compunds that alter mood, behaviour or both
substance use
ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational or occupationa fucntioning
substance intoxication
physiological reaction to ingested substances (drunkeness or getting high)
substance abuse
pattern of psychoactive substance use leading to significant distress or impairment in social and occupational roles in hazardous situations
substance dependence (aka addiction)
a maladaptive pattern of sibstance use characterized by:
-the need for increased amounts to achieve the desired effect (tolerance)
-negative physical effects when the substance is withdrawn (withdrawal)
-unsuccesful efforts to control its use
-substantial efforts expended to see it or recover from it
it is possible to be physically dependent on a drug but not abuse or be addicted to it
depressants
result in relaxation and sleepiness
alcohol, barbituates, benzo
stimulants
increase altertness and elevate moss
amphetamines, cocaine, nicotine, caffeine
opiods
produce pain relieve (analgesia) and euphoria
heroin, opium, morphine, codeine, methadone, oxycodone, hydrocodone
hallucinogens
alter sensory perception, can produce delusions, paranoia and hallucinations
LSD, psilocybin, DMT, mescaline, ketamine, PCP, MDMA
cannabis
marijuana
results in silliness or dreamlike state, possibly heightened sensory experiences
other drugs of abuse
inhalents, anabolic steriods, medication etc
what is the leading cause of preventable death and disease
smoking
1 in every 5 deaths
opiod dependency impact stats
rapid growth over the last 10 years
majority of drug overdoses invole an opiod
since 1999, rate of prescription opiod related deaths has quadrupled
12.3% of high school senior reported using opiods for nonmedical reasons
consequences of substance use
• Child and spousal abuse
• STDs including HIV
• Teen pregnancy and fetal health problems
• Problems at school and work – low productivity
• Family and social problems
• Health problems – cardiovascular, liver, brain,
immune system, gastrointestinal, pancreas,
kidneys, lungs…
• Motor vehicle crashes, homicides, suicides,
accidental death
what did DSM5 do in changing its definitions of substance abuse
substance use disorders (SUD)
no longer distinguishes substance abuse from substance dependence
combined the two with a couople of changes
features of dsm5 substance use disorders
At least two of:
- Doesn’t meet obligations
- Use in hazardous situations
- Use despite social or interpersonal problems
- Tolerance
- Withdrawal
- Use larger amounts or for more time than intended
- Can’t cut down or control use
- Much time spent getting, using, or recovering
- Important activities given up or reduced
- Use despite physical or psychological problems
- Craving or a strong desire or urge to use
overview 6 reasons people become addicted
bio learning cognitive factors social factors comorbid disorders personality features
biological mechanisms of addiction
reward pathway
-mesolimbic dopamine system
-ventral tegmental area (VTA) -> nucleus accumbens
amygdala, hippocampus and PFC also involved
explain dopamine cells in the nucleus accumbens
see textbook to fill in
vulnerabilities of bio to substance abuse
level of response
-low response = vulnerable, runs in families
genetic factors
-vulnerability
-also protective
eg alcohol metabolism
alcohol ->ADH to acetaldehyde ->ALDH2 acetic acid
asians = no ALDH2 so poisoning = red blotches etc so less alcoholic asians
classical conditioning model of addiction
drug cue (neutral) drug (unconditioned stimuli) brain changes (unconditioned response) over time turns to drug cue (conditioned stimulus) brain changes (conditioned response)
evidence for classical conditioning in alcohol drinkers
alcohol use disordered teens showed more brain response to alcohol pictures than nondrinkers
visual cortex and nucleus accumbens lit up
what is operant conditioning and how does it relate to substance abuse
positive reinforcement - pleasure of intoxication
negative reinforcement - avoiding withdrawal, stress relief, self-medication
cognitive factors to addiction
expectancy effect
social factors to addication
perceived norms
parental supervisions
cultural factors to addiction
norms/ expectations
comorbid disorders
high rates of comorbidity between SUD and other psychiatric disorders
mood
anxiety
psychotic dis
antisocial personality dis
but chicken and egg problem which came first
high rates of poyubstance use among those with SUD
personality features
behavioural disinhibition -umpusivity -sensation seeking extraversion neuroticism
treatment of sud overview
75-80% relapse in first year average 5-7 quit attempts before final success treatments -biological -psychosocial
biological treatments of sud
agonist subsitution -methadone maintaenance for opiods -nictonie patch/ gum antagonist treatments -naltrexone for opiates and alcohol -acamprosate for alcohol aversive treatment -antabuse for alcohol, blocks ALDH2 enzyme = asian reaction to alcohol
psychosocial treatment of sud
inpatient or outpatient alcoholics anonymous CBT -contingency management -community reinforcement -skills training, particularly important for comorbidity with other psych problems
explain how depressants like alcohol work
GABA agonist -relaxation and sleepiness -frontal lobe = dishinibition -cerebellum = motor impairment glutamate antagonist -hippocampus = impairs memory tolerance = yes -brain adaptation -metabolic change withdrawal = yes - after 8-12 hours -agitation, insomnia, tremors, increased heart rate, seizures -"delerium tremens" confusion, delusions, hallucinations -37% mortality without treatment --detox with benzodiaxepines (GABA)
alcohol and brain damage
wernicke-korsakoff syndrome
thiamine deficieny
early = reversible - confusion, visual problems, stupor, coma, hypothermia, hypotension
late = irreversible - anteretrograde amnesia
10-20% mortality
stimulants effects
acute
-euphoria
-psychostimulant effect = increased positivity, improved performance
-sympathetic arousal = decreased appetite, increased heart rate
-psychotic symptoms = hallucinations and delusions, paranoia
tolerance
-euphoria and appetite supresion
-no tolerance to physical stimulation
sensitisation - increased effect with increased use
-stimulant effects
-psychosis and paranoia
withdrawal
-depression
-irritability
-fatigue
opiates effects
morphine, heroin, codein, oxycontin, vicodin
endogenous opiod agonists
-3 receptor systems
-many endogenous chemicals
tolerance
-euphoria > analgesia > respiratory depression > consitpation
-situation tolerance
withdrawal
-starts in 6-12 hours, lasts 5-10 days
-flu-like state
-methadone - slow acting opiate used for detox
-naltrexone - antagonist used for detox
-naloxene - antagonist = immediate withdrawal used for overdose
hallucinogens
LSD, mushrooms, peyote
ecstasy
marijuana
alter sensory perceptions
marijuana
tolerance
-modest in heavy users
withdrawal
-starts in approx 12 hours, lasts 3-4 days
-relatively mild
-tired, weak, anxious, irritable, trouble concentrating
ecstasy
tolerance - mechanism unclear withdrawal -depression -anxiety and panic -insomnia -paranoia
