Substance Abuse Flashcards
What is addiction ?
Biopsychosocial disorder manifested by compulsively seeking a desired effect (intoxication) despite harmful consequences
-intense focus on substance(s) takes over life, continued use even when it known to cause problems
Harmful changes in the brain functions long after the immediate effects of the drug (intoxication)
First use of a substance is often….
Voluntary
Use statistics and adolescence. (Peter pressure, undeveloped frontal lobe inhibitions, increased risk taking)
- follow-up use may be associated with intoxication experience
- Addictive substances tend to activate endogenous dopaminergic brain reward pathways
Explain prefrontal lobe etiology of addiction
- impaired inhibition
- reduced capacity for delayed gratification
- impaired working memory/central executive:
- maintaining information
- updating information
- switching between stimuli
- impaired decision-making and reasoning
- impaired long-term planning
Give the general etiology of addiction?
- brain changes can lead to physical withdrawal symptoms and discomfort
- over time, reduction in natural brain dopamine= dysphoria
- environmental and internal cues= trigger drug seeker behavior
What are the addiction risk factors?
- Genetics
- up to to 50% of total risk-crosses substances and behavior (e.g., gambling) - Environment
- early childhood trauma
- Peter pressure in adolescence
- Availability of substances (e.g., alcohol use) - Dual diagnosis
- mental illness or physical illness that requires pain medication, leading to potential addiction - Age at first use
- prefrontal lobes still developing- altering the dopamine reward pathway before executive function develops= risk factor - Substance of choice
- some drugs are more potent than others
- withdrawal symptoms more severe than others - Method of use
- injecting or smoking drugs more potent than swallowing
-efficient absorption into the bloodstream and brain
What are the potential diagnoses of substance abuse?
- Substance intoxication
- Substance withdrawal
- Substance use disorder
What is substance intoxication?
A reversible substance specific syndrome due to a recent ingestion of the substance, which causes maladaptive changes due to its central nervous system effects
E.g. DSM-V intoxication: significant maladaptive psychological/behavioral change( e.g., impaired judgement)
Plus. 1+ of the following
- Slurred speech
- Incoordination
- Unsteady gait
- Nystagmus
- Impaired attention/memory
- Stupor or coma
What is substance withdrawal?
A substance-specific syndrome occurring following cessation of a substance after heavy/prolonged use of the substance
E.g. DSM-V alcohol withdrawal 2+ 9f the following
- ANS hyperactivity
- Hand tremor
- Insomnia
- Nausea
- Hallucinations/illusions
- Psychomotor agitation
- Anxiety
- Generalized seizures
Contrast substance withdrawal and intoxication symptoms
In general, withdrawal symptoms are oppposite to intoxication symptoms(homeostasis)
Withdrawal symptoms usually appear 2-3 days after substance-use reduction or cessation
What are the diagnostic criteria of substance use disorder?
A maladaptive pattern of substance use manifested by 2+ of 11 symptoms in a 12-month period:
A. Impaired control
- Taken in a larger amount than intended
- Persistent unsuccessful attempts to cut back
- Time consuming(obtaining, using, recovering)
- Cravings or strong desire for the substance
B. Social impairment
- Failure to fulfill major role obligations (e.g.,work)
- Social/interpersonal problems related to substance
- Reduction of important activities
C. Risky use
- Use in physically hazardous situations
- Use despite having a physical/psychological problem related to the substance
D. Pharmological criteria (physical dependence)
- Tolerance(decreased effect of a dose due to repeated use)
- Withdrawal syndrome upon cessation
How is substance use symptoms categorized to severity?
2-3 = mild
4-5: moderate
6+ severe(aka addiction)
How is sedative intoxication?
Intoxication symptoms (suppression of function)
Alcohol, benzodiazepines, barbiturates (CNS depressants)
-Sedation, sleepiness, decreased anxiety
- Disinhibited, impaired judgement
- slurred speech, incoordination
- stupor or coma
- respiratory depression
- overdose potentially lethal
What is sedative withdrawal?
Alcohol, benzodiazepines, barbiturates (CNS depressants)
Withdrawal symptoms (activation of function):
- anxiety, insomnia
- hand tremor
- extreme tachycardia/ hypertension
- delirium(e.g. delirium tremens)
- hallucination (formication)
- seizures
What are the extreme panic reaction symptoms of sedative withdrawal?
- anxiety, insomnia
- hand tremor
- extreme tachycardia/ hypertension
What are the potentially lethal symptoms of sedative withdrawal?
Extreme tachycardia/hypertension
Delirium
