Substance Abuse Flashcards by Ella Scott

substance related and addictive disorders

abuse of drugs and other substances people take to alter the way they think, feel and behave

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psychoactive substances

chemical compunds that alter mood, behaviour or both

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substance use

ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational or occupationa fucntioning

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substance intoxication

physiological reaction to ingested substances (drunkeness or getting high)

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substance abuse

pattern of psychoactive substance use leading to significant distress or impairment in social and occupational roles in hazardous situations

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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-negative physical effects when the substance is withdrawn (withdrawal)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

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depressants

result in relaxation and sleepiness

alcohol, barbituates, benzo

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stimulants

increase altertness and elevate moss

amphetamines, cocaine, nicotine, caffeine

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opiods

produce pain relieve (analgesia) and euphoria

heroin, opium, morphine, codeine, methadone, oxycodone, hydrocodone

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hallucinogens

alter sensory perception, can produce delusions, paranoia and hallucinations
LSD, psilocybin, DMT, mescaline, ketamine, PCP, MDMA

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cannabis

marijuana

results in silliness or dreamlike state, possibly heightened sensory experiences

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other drugs of abuse

inhalents, anabolic steriods, medication etc

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what is the leading cause of preventable death and disease

smoking

1 in every 5 deaths

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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

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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

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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 ```