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BRS 1b > Substance abuse & Addictions > Flashcards

Substance abuse & Addictions Flashcards

1
Q

What is harmful use of alcohol/drugs?

A

A pattern of substance use that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others.

Examples include: Depression, anxiety, liver problems, high blood pressure & aggression .

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2
Q

What is positive reinforcement?

A

Positive reinforcement is defined as a pattern of behaviour in response to a desirable stimulus that is strengthened in future due to the gain of positive outcome.

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3
Q

Give examples of positive reinforcement in terms of alcohol/drug use?

A

Escapism
Get high
Stay awake
like it

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4
Q

Give examples of negative reinforcement in terms of alcohol/drug use?

A

Boredom
To get to sleep
Reduce anxiety
Feel better

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5
Q

What is the course of behaviour for individuals with harmful use of alcohol/drugs?

A

There is a shift in motivational desire, as the urgency and necessity increases (regular use –> period of stress where the euphoric effects subside the fears)

It is reversible

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6
Q

How is harmful substance abuse defined by the ICD-10?

A

Actual damage should have been caused to the mental or physical health of the user in the absence of diagnosis of dependence syndrome.

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7
Q

What is hazardous use of alcohol/drugs?

A

Likely to cause harm if the harmful substance use continues.

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8
Q

What is dependence in terms of alcohol/drug use?

A

Begins to dominate lifestyle, there is dependency to the drug (lack of self-control to regain the situation and revert back to the original)

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9
Q

What is the diagnostic criteria for dependence syndrome in terms of the ICD-10 criteria?

A

1) A strong desire or sense of compulsion to take the substance
2) Difficulties in controlling substance taking behaviour in terms of its onset, termination or levels of use.
3) A physiological withdrawal state when substance use has been stopped or been reduced.
4) Evidence of tolerrance: Need to take more to get the same effect.
5) Progressive neglect of alternative interests
6) Persisting with substance use despite clear evidence of overtly harmful consequences.

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10
Q

In terms of prevalence compare alcohol and opiate dependence?

A

Alcohol > Opiate

595,000 > 257,476

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11
Q

What is the definition of addiction?

A

Compulsive drug use despite harmful consequences, characterised by an inability to stop using a drug; failure to meet work, social, or family obligations; and, (depending on the drug) tolerance and withdrawal.

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12
Q

What is dependence?

A

Refers to a physical adaptation to a substance
-Tolerance and withdrawal
(Opioids, benzodiazepine, and alcohol)

So can be dependent by not addicted.
Symptoms of tolerance

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13
Q

What is gambling disorder defined as?

A

Behavioural addiction in DSM-5

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14
Q

What is internet gaming disorder?

A

added to ICD-11 under addictive disorders

in the DSM-5 is under “Conditions for Further Study

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15
Q

What type of use is this case:

Drinks four pints of Stella most evenings. Says his drinking doesn’t cause problems.

A

Hazardous use

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16
Q

What type of use is this case?

Drinks a bottle of wine most evenings, more at the weekends. Occasionally misses work because of hangovers.

A

Consequences: Harmful use

Physical, psychological, social impact.

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17
Q

What pattern of drinking is this case?
Drinks cider first thing each morning to stop himself shaking. Regards drink as a medicine, believes he wouldn’t get by without it. Doesn’t tend to get drunk.

A

Addiction/dependence

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18
Q

What type of drug use is this case?

Broke her ankle 6 months ago which healed well and is back to playing football. Is still taking her opioid painkillers which are on repeat prescription

A

Likely biologically dependent as has been taking opioids for many months; no evidence of taking more than is prescribed (ie suggesting ‘abuse’) however need to ask if this
is the case and why it is on repeat – has it just happened through error/lack of review or has she requested it?

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19
Q

What type of drug use is this case?
Broke his ankle 3 months ago and says he is still in pain. Is still taking his opioid painkillers and often requests his prescription earlier.

A

Likely biologically dependent as has been taking opioids for many months; is taking more than is prescribed so need to ask why – for pain or to deal with withdrawal or ‘likes how it makes him feel’. Consider harmful use, ask about any other addiction behaviours to clarify if addicted

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20
Q

What does alcohol do to the brain’s inhibitory system?

A

Alcohol behaves as a modulator of GABA-benzodiazepine coupling leading to an enhanced inhibitory system. Concerns the GABA-A receptor

21
Q

Which receptor is predominantly involved in terms of the brain’s inhibitory system?

A

GABA-A receptor

22
Q

Which receptors are concerned with the excitatory glutamate system?

A

NMDA receptors

23
Q

What impact does alcohol have on NMDA eceptors?

A

Alcohol alters the coupling and modulatory sites of the receptor, impairing the excitatory system.

24
Q

What effects does acute alcohol consumption have on the inhibitory system?

A

Enhancement of GABA-A receptors leads to sedation and anxiolysis

25
Q

What effect does acute alcohol have on the excitatory system?

A 
Impaired memory (alcoholic blackouts)
There is no recollective memory of the drunken state.
26
Q

What neuroadaptations take place due to chronic alcohol exposure?

A

GABA-A receptor subunit becomes less sensitive to alcohol - there is a reduced function in the inhibitory function - tolerance, given that alcohol consumption retains a GABAergic balance.

Chronic alcohol consumption also leads to an upregulation in the excitatory system (NMDA receptors)

27
Q

Which drugs are used t help boost GABA function in patients in the withdrawal state of chronic alcohol exposure?

A

Benzodiazepines

28
Q

What happens to patients in an alcohol withdrawal state?

A

There is an upregulation of the excitatory system.

An increase in calcium dynamics is toxic leading to hyperexcitability (seizures) and atrophy.

29
Q

What is the pattern of glutamate release in patients with alcohol withdrawal?

A

There is a significant increase in glutamate (Both metabolic and synaptic) due to upregulation of excitatory neurones.

30
Q

What drugs are used to treat patients with alcohol withdrawal?

A

lorazepam

Diazepam (benzodiazepines)

31
Q

What is the effect of acamprosate in alcohol-dependent individuals?

A

Reduction in MRS glutamate, and NMDA function to downregulate the excitatory system.

32
Q

Name some examples of natural rewards:

A

Sex and food

33
Q

Which hormone is associated with natural rewards?

A

Dopamine

34
Q

Which region of the brain is concerned with natural rewards?

A

Ventral striatum

35
Q

Which pathway is concerned with the pleasure-reward motivation system?

A

Dopamine pathway

36
Q

Which hormone is a key modulator in the opioid system?

A

Mu opioid

37
Q

What impact is exhibited by mu opioids?

A

Mediates pleasurable effects, leading to an endorphin rush.

38
Q

What type of reward state is exhibited by patients with addiction?

A

Reward deficient state

39
Q

What impact does cocaine, and amphetamines have on the dopaminergic system?

A

Blocks dopamine transport re-uptake proteins, elevating concentrations of dopamine within the synaptic cleft.

Amphetamine also enhances the release of dopamine.

40
Q

What impact does nicotine, opiates and alcohol have on the dopaminergic system?

A

Increase dopamine neurone firing in the ventral tegmental area.

41
Q

What is the proposed relationship between D2 receptors and drug use?

A

Low levels of D2 receptors predispose subjects to use drugs

42
Q

What is the relationship between ventral striatum activity and problematic drug use?

A

There is a reward deficiency thus activity in the ventral striatum

43
Q

Which cerebral structure is associated with preoccupation and craving?

A

Prefrontal cortex

44
Q

Which cerebral structure is concerned with negative reinforcement?

A

Amygdala

45
Q

Which type of reinforcement develops and dominates in patients with dependence?

A

Negative reinforcement

46
Q

Which hormones are released in a stressed system?

A

Kappa opioids (dynorphine), NA and CRF

47
Q

Which system is dysregulated in alcohol addiciton?

A

amygdala

48
Q

What is the pattern of amygdala regulation in patients with polydrug addiction compared to alcoholism?

A

In polydrug, there is a heightened response to aversive stimuli

BRS 1b (62 decks)

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