Substance Abuse

Question 1

Topics

Answer 1

1) Types of substances abused according to DSM 5
2) DSM 5 criteria for disorder
3) Comorbidity
4) Depressants
5) Stimulants
6) Opiates
7) Hallucinogens
8) Ingestion of psychoactive substances
9) Substance use vs Substance Abuse
10) Drug Seeking behaviour
11) Dependence without abuse
12) Dopaminergic mesolimbic system & GABA
13) Dopamine D2 receptor
14) Genetic findings vs Environmental factors
15) Addictive personality
16) Stress and living conditions
17) Rat experiments
18) Neuroplasticity
19) Treatment
20) Agonist treatment
21) Aversive treatment
22) Controlled drinking
23) Community reinforcement approach
24) CBT
25) Prevention
26) Impulse-Control Disorders
27) 5 impulse control disorders
28) Pathological Gambling
29) Addiction related disorders
30) Treatment of pathological gambling
31)

Question 2

Names and Years

Answer 2

1) Kulka et al (88) - Koala
2) Portenoy & Mathur (09) - Port Pinot & Martir
3) Strain (09) - String
4) Trifilieff & Martinez (14) - Trifan & Martinez
5) Strain (09) - String
6) Kendler et al (03) - Kendel Jenner
7) Terracciano et (08) - Terronaccio
8) Alexander (70s) - Dinu
9) Russo et al (09) - Russo
10) Schwartz et al (09) - Swarowski
11) Ivanov (09) - Ivankov
12) Sobell & Sobell (78) - Sober & Sober
13) Higgins et al (08) - Michael D. Higgins
14) Higgins et al (08) - Michale D. Higgins
15) Marlatt and Gordon (85) - Marmellata & Gordon Ramsey
16) Pentz (99) - Penitenza
17) Grant et al (06) - Grant $
18) Bayle et al (03) - Garrett Bale
19) Gerstain et al (99) - German Einstein
20) Moeller (09) - Muller
21) Moeller (09) - Muller
22) Wulfert et al (08) - Wolf fart

Question 3

What are the 4 substances?

Answer 3

Depressants (alcohol, barbiturates, and benzodiazepines)
Stimulants (amphetamine, cocaine, nicotine, and caffeine)
Opiates (heroin, codeine, and morphine)
Hallucinogens (marijuana and LSD)

Question 4

What is the DSM 5 criteria for disorder?

Answer 4

• Larger amounts taken than intended, cravings, impairments in work/school/social areas, tolerance, withdrawal
• Specific diagnoses are further categorized as substance dependence, substance abuse, substance intoxication, and substance withdrawal

Question 5

Give an example of Comorbidity

Answer 5

2 in 3 veterans seeking treatment for PTSD also abuse substances (64% to 84% met lifetime criteria for an alcohol use disorder and 40% to 44% met lifetime criteria for a drug use disorder, including nicotine dependence) (Kulka et al., 1988)

Question 6

What are Depressants?

Answer 6

Group of drugs that decrease central nervous system activity. The primary effect is to reduce our levels of physiological arousal and help us relax.

Question 7

What are stimulants?

Answer 7

The most commonly consumed psychoactive drugs.

Stimulants make us more alert and energetic.

Question 8

What are opiates?

Answer 8

The broader term opioids is used to refer to the family of substances that include these opiates and synthetic variations created by chemists (e.g., methadone) and the similarly acting substances that occur naturally in our brains (beta endorphins).

Question 9

What are hallucinogens?

Answer 9

Change the way the user perceives the world. Sight, sound, feelings, and even smell are all distorted, sometimes in dramatic ways, in a person under the influence of drugs such as marijuana and LSD.

Question 10

What happens when ingesting psychoactive substances?

Answer 10

To ingest psychoactive substances - which alter mood, behaviour, or both - to become intoxicated or high, to abuse these substances, and to become dependent on or addicted to them. Intoxication is our physiological reaction to ingested substances- drunkenness or getting high.

Question 11

What is the difference between substance use and abuse?

Answer 11

• Substance use is different from substance abuse, as this the ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning. Defining substance abuse by how much of a substance is ingested is problematic. The DSM-5 defines substance abuse in terms of how significantly it interferes with the user’s life.
• Substance Dependence is usually described as addiction. In one definition, the person is physiologically dependent on the drug or drugs, requires increasingly greater amounts of the drug to experience the same effect (TOLERANCE), and will respond physically in a negative way when the substance is no longer ingested (withdrawal).

Question 12

What are drug seeking behaviours?

Answer 12

The repeated use of a drug, a desperate need to ingest more of the substance (stealing money to buy drugs, standing outside in the cold to smoke), and the likelihood that use will resume after a period of abstinence are behaviours that define the extent of drug dependence. Such behavioural reactions are different from the physiological response to drugs we described before and are sometimes referred to in terms of psychological dependence.

Question 13

Can dependence occur without abuse?

Answer 13

Dependence can be present without abuse. For example, cancer patients who take morphine for pain may become dependent on the drug – building up a tolerance and go through withdrawal if it is stopped - without abusing it (Portenoy & Mathur, 2009).

Question 14

Describe the roles of Dopaminergic mesolimbic system and GABA

Answer 14

• Most psychotropic drugs seem to produce positive effects by acting directly or indirectly on the dopaminergic mesolimbic system (the pleasure pathway). In general, the pleasurable experiences reported experiences reported by people who use psychoactive substances partly explain why people continue to use them (Strain, 2009). It is believed that dopaminergic system, its opioid-releasing neurons, and the nucleus accumbens are involved.
• Also, the GABA system is involved, as it inhibits dopamine. By blocking GABA neurons, the reuptake of dopamine is decreased. One aspect that awaits explanation is how drugs not only provide pleasurable experiences (positive reinforcement) but also help remove unpleasant experiences such as pain or anxiety (negative reinforcement). Aspirin is a negative reinforce: we take it to stop feeling bad.

Question 15

Describe the role of dopamine d2 receptor

Answer 15

Also, imaging studies in human subjects show that addiction is associated with a significant decrease in striatal dopamine transmission, measured as dopamine D2 receptor binding and pre-synaptic dopamine release. Those with fewer D2 receptors more at risk of developing substance abuse, and prolonged use leads to a decrease in these receptors, thus falling under a vicious cycle (Trifilieff & Martinez, 2014).

Question 16

What can we learn from genetic vs environmental studies?

Answer 16

• Researchers conducting twin, family, and adoption studies have found that certain people are genetically vulnerable to drug abuse (Strain, 2009).
• Kendler and colleagues (2003) studied more than 1,000 pairs of male twins and questioned them about their use of illegal drugs (e.g. cocaine and hallucinogens). The findings suggest that there are common genetic influences on the use of these drugs. However, the use of illegal drugs was primarily influenced by environmental factors, whereas abuse and dependence may be influenced primarily by genetic factors.

Question 17

Is there such a thing as addictive personality?

Answer 17

Terracciano and colleagues (2008) found that compared to never smokers, current cigarette smokers score lower on Conscientiousness and higher on Neuroticism. Similar, but more extreme, is the profile of cocaine/heroin users, which score very high on Neuroticism, especially Vulnerability, and very low on Conscientiousness, particularly Competence, Achievement-Striving, and Deliberation.

Question 18

How do stress and living conditions affect substance abuse?

Answer 18

Stress, and cultural practices interact with the biological factors to influence drug use.

Question 19

Describe an animal comparative study

Answer 19

• In the late 1970s, experimental psychologist Alexander, conducted what is now known as the “rat park” experiment. Alexander’s hypothesis was that drugs do not cause addiction, and that the apparent addiction to opiate drugs commonly observed in laboratory rats exposed to them is attributable to their living conditions, and not to any addictive property of the drug itself. He noticed that when a rat is left alone in a cage, with no stimuli, except for drugs, they would go to it and become addicted. To test his hypothesis, Alexander built Rat Park, a large housing colony, 200 times the floor area of a standard laboratory cage. There were 16-20 rats of both sexes in residence, food, balls and wheels for play, and enough space for mating. The results of the experiment appeared to support his hypothesis.
• Obviously, being an animals study, this experiment cannot be directly translated into human beings. But it is interesting, as those in lower class areas tend to be more vulnerable to substance abuse.

Question 20

What is neuroplasticity?

Answer 20

We know also that continued use of certain substances changes the way our brains work through a process called neuroplasticity. This is the brain’s tendency to reorganize itself by forming new neural connections. With the continued use of substances such as alcohol and cocaine, the brain reorganizes itself to adapt. Unfortunately, this change in the brain increases the drive to obtain the drug and decreases the desire for other nondrug experiences - both of which contribute to continued use and relapse (Russo et al., 2009).

Question 21

How can we treat substance abuse?

Answer 21

Substance dependence is treated successfully only in a minority of those affected, and the best results reflect the motivation of the drugs and a combination of biological and psychosocial treatments. Programs aimed at preventing drug use may have the greatest chance of significantly affecting the drug problem.

Question 22

What are agonist treatments?

Answer 22

Agonist substitution involves providing the person with a safe drug that has a chemical makeup similar to the addictive drug. E.g. methadone is used as a heroin substitute (Schwartz et al., 2009).

Question 23

What are aversive treatments?

Answer 23

Aversive treatment is when clinicians prescribe drugs that make ingesting the abused substancs extremely unpleasant. The most common is disulfiram (Antabuse) with alcoholics (Ivanov, 2009). If a person drinks after taking Antabuse, they will experience negative symptoms such as nausea and vomiting.

Question 24

How effective is controlled drinking?

Answer 24

• In the alcoholism treatment field, the notion of teaching people controlled drinking is extremely controversial, partly because of a classic study showing partial success in teaching severe abusers to drink in a limited way (Sobell & Sobell, 1978). The participants were 40 male alcoholics in an alcoholism treatment program at a state hospital who were thought to have a good prognosis. The men were assigned either to a program that taught them how to drink in moderation or to a group that was abstinence oriented. The researchers followed the men for more than 2 years. During the second year after treatment, those who participated in the controlled drinking group were functioning well 85% of the time, whereas the men in the abstinence group were reported to be doing well only 45% of the time. The results of this study suggest that controlled drinking may be a viable alternative to abstinence for some alcohol abusers, although it clearly isn’t a cure.

Question 25

How effective are community reinforcement approaches?

Answer 25

Another package of treatment is the community reinforcement approach (Higgins et al., 2008). In keeping with multiple influences that affect substance use, several facets of the drug problem are addressed to help identify and correct aspects of the person’s life that might contribute to substance use or interfere with efforts to abstain. First, a spouse or a friend who is not a substance user is required to participate in relationship therapy to help the abuser improve relationships with other important people. Second, clients are taught how to identify the antecedents and consequences that influence their drug taking. For example, if they are likely to use cocaine with certain friends, clients are taught to recognize the relationships and encouraged to avoid the associations. Third, clients are given assistance with employment, education, finances, or other social service areas that may help reduce their stress. Fourth, new recreational options help the person replace substance use with new activities. There is now strong empirical support for the effectiveness of this approach with alcohol and cocaine abusers (Higgins et al., 2008).

Question 26

What is CBT?

Answer 26

Cognitive-behavioural therapy (CBT) is an effective treatment approach for many psychological disorders and it is also one of the most well designed and studied approaches for treating substance dependence. This treatment addresses multiple aspects of the disorder, including a person’s reactions to cues that lead to substance use (e.g. being among certain friends, and thoughts and behaviours to resist use. Another target for CBT addresses the problem of relapse. Marlatt and Gordon’s (1985) relapse prevention treatment model looks at the learned aspects of dependence and sees relapse as a failure of cognitive and behavioural coping skills. Therapy involves helping people remove ambivalence about stopping their drug use by examining their beliefs about positive aspects of the drug (“there’s nothing like a cocaine high”) and confronting the negative consequences of its use (“I fight with my wife when I’m high”). High-risk situations are identified (“Having extra money in my pocket”), and strategies are developed to deal with potentially problematic situations, as well as with the craving that arises from abstinence. Incidents of relapse are dealt with potentially problematic situations, as well as with the craving that arises from abstinence. Incidents of relapse are dealt with as occurrences from which the person can recover; instead of looking on those episodes as inevitably leading to more drug use, people in treatment stress or a situation that can be changed. Research on this technique suggests that it may be particularly effective for alcohol problems.

Question 27

How effective are prevention strategies?

Answer 27

Prevention. Many states in the US have implemented education-based programs in schools to try to deter students from using drugs. Unfortunately, several extensive evaluations suggest that this type of program may not have its intended effects (Pentz, 1999). Fortunately, more comprehensive programs that involve skills training to avoid or resist social pressures (such as peers) and environmental pressures (such as a media portrayals of drug use) can be effective in preventing drug abuse among some.

Question 28

What are impulse-control disorders?

Answer 28

Impulse-control disorders represent a number of related problems that involve the inability to resist acting on a drive or temptation. Controversy surrounds both substance-related and impulse-control disorders because our society sometimes believes that these problems result simply from a lack of “will”.

Question 29

Name 5 impulse control disorders?

Answer 29

• intermittent explosive disorder
• kleptomania
• pyromania
• pathological gambling
• trichotillomania

Question 30

What is pathological gambling?

Answer 30

• Pathological gambling affects an increasing number of people. It is estimated that among pathological gamblers, 14% have lost at least job and 195 have declared bankruptcy, 32% have been arrested, and 21% have been incarcerated (Gerstein et al., 1999).
• Brain imaging studies were used to observe brain function in gamblers. A decreased level of activity in impulse regulation when compared to normal controls, suggesting an interaction between the environmental cues to gamble and the brain’s response (which may be to decrease the ability to resist these cues). Abnormalities in the dopamine system (which may account for the pleasurable consequences of gambling) and the serotonin system (involved in impulsive behaviour) have been found in some studies of pathological gamblers (Moeller, 2009).

Question 31

What are addiction related disorders?

Answer 31

The DSM criteria for pathological gambling are similar to those of other impulse-control disorders, and there are parallels with substance dependence as there is a need to gamble increasingly and there are “withdrawal symptoms” such as restlessness and irritability when attempting to stop. In fact, these parallels to substance abuse have led to the discussion of the DSM-5 to recategorize pathological gambling from “impulse-control disorders” to “substance-related disorders” and that this “substance-related disorders” category should be renamed “addiction and related disorders” (Moeller, 2009).

Question 32

What are treatments for pathological gambling?

Answer 32

Treatment of gambling problems is difficult. Those with pathological gambling exhibit a combination of characteristics - including denial, impulsivity, and continuing optimism (“one big win will cover my losses!”) – that interfere with effective treatment. Pathological gamblers often experience cravings similar to those who are substance dependent (Wulfert et al., 2008). Treatment is often similar to substance dependence treatment, and there is a parallel Gambler’s Anonymous that incorporates the same 12-step program we discussed previously. However, the evidence of effectiveness for Gambler’s Anonymous suggests that 70% to 90% drop out of these programs and that the desire to quit must be present before intervention. CBT are also being studied and provide a more optimistic view of potential outcomes.