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Y2 - BRS - Psych > Substance Abuse and Addiction > Flashcards

Substance Abuse and Addiction Flashcards

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1
Q

Why might people take recreational drugs?

A 
Reduce anxiety
Rebel
Get high
Escapism
Everyone does
Curiosity
To fit in
Why not?
Stay awake
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2
Q

What is a drug?

What is drug abuse?

A

Drug = any medication or compound that gets into the body and has an effect

It is about the habitual use, not the drug itself - can be legal or illegal drugs

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3
Q

Why might people take recreational drugs?

A 
Reduce anxiety
Rebel
Get high
Escapism
Everyone does
Curious
to fit in
Why not?
Stay awake
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4
Q

What reasons for taking drugs are positively reinforced and what reasons are negatively reinforced?

A 
Gain positive state (positive reinforcement) = 
Rebel
Get high
Escapism
Like it
Stay awake (i.e caffeine)
Overcome adverse state (negative reinforcement) = 
Boredom
To get to sleep
Reduce anxiety
Feel better
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5
Q

What reasons for taking drugs are positively reinforced and what reasons are negatively reinforced?

A 
Gain positive state (positive reinforcement) = 
Rebel
Get high
Escapism
Like it
Stay awake (i.e caffeine)
Overcome adverse state (negative reinforcement) = 
Boredom
To get to sleep
Reduce anxiety
Feel better
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6
Q

What is the course of alcohol/drug use, harmful use, and/or addiction?

A

I like - experimental / recreational use. causes no/limited difficulties
I want - increasingly regular use
I need - spiraling, dependence

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7
Q

When does substance use become harmful?

A

Actual damage to their physical or mental health

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8
Q

What are the ICD-10 diagnostic criteria for dependence syndrome?

A

Strong desire to take the substance

Difficulties in controlling onset, termination or levels of use

Physiological withdrawal state

Evidence of tolerance: need to take more to get same effect

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9
Q

What are the ICD-10 diagnostic criteria for dependence syndrome?

A

Strong desire to take the substance

Difficulties in controlling onset, termination or levels of use

Physiological withdrawal state

Evidence of tolerance: need to take more to get same effect

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10
Q

What is dependence?

A

Refers to physical adaptation to a substance - brain/body chemistry adapts to the constant presence of the drug = tolerant and dependent

Can be dependent not addicted - as there are no other beahviours e.g. there is no drug seeking behaviour, avoiding commitments, etc.

e.g. opiod

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11
Q

What are some examples of other behavioural addictions?

A

Gambling disorder
Internet gambling disorder

These are no longer classified as impulse control disorders

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12
Q

How are drugs made more addictive?

A

Speeding up brain entry - gives a greater ‘rush’

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13
Q

What are some issues with a health coaching / MI perspective?

A

You assume the patient’s resourcefulness

The relationship must have mutual trust and respect

Coaching is about change and action, but a patient may not want to explore the issue and move forward

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14
Q

What is the pathway from use to addiction?

A

Pre-existing vulnerability:
Family history
Age

Drug exposure:
Tolerance - compensatory neuroadaptations to maintain brain function
Resilience

Recovery:
Sustained recovery is achievable
Most go into cycles of remission and relapse

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15
Q

What is the pathway from use to addiction?

A

Pre-existing vulnerability:
Family history
Age

Drug exposure:
Tolerance - compensatory neuroadaptations to maintain brain function
Resilience

Recovery:
Sustained recovery is achievable
Most go into cycles of remission and relapse

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16
Q

How can alcohol addiction lead to tolerance and withdrawal?

A

Drinking often / constantly = alters brain chemistry and increases tolerance (by resetting the baseline)

This leads to withdrawal symptoms without the alcohol due to reset baseline

17
Q

How can alcohol addiction lead to tolerance and withdrawal?

A

Drinking often / constantly = alters brain chemistry and increases tolerance (by resetting the baseline)

This leads to withdrawal symptoms without the alcohol due to reset baseline

18
Q

What does alcohol do?

A

Alters the balance between brain’s inhibitory and excitatory system

19
Q

What does chronic alcohol exposure result in?

A

Tolerance:

Neurodaptations so GABA and glutamate remain in balance in presence of alcohol

Upregulation of excitatory system

Reduced function in inhibitory system - tolerance

GABA-A receptors: alcohol causes the receptor to switch in subunits that are less sensitive to alcohol

20
Q

What happens after chronic alcohol exposure when alcohol is no longer present?

A

Withdrawal:

GABA and glutamate are no longer in balance - withdrawal state

Reduced function in inhibitory system - GABA-A receptor (downregulation)

Upregulation of excitatory system - NMDA receptor:
leads to increase in Ca2+ entering the cell, causing more calcium channels to open
this toxicity leads to hyper excitability (seizure) and cell death (atrophy)

21
Q

What happens after chronic alcohol exposure when alcohol is no longer present?

A

Withdrawal:

GABA and glutamate are no longer in balance - withdrawal state

Reduced function in inhibitory system (downregulation)

Upregulation of excitatory system - NMDA receptor:
leads to increase in Ca2+ entering the cell, causing more calcium channels to open
this toxicity leads to hyper excitability (seizure) and cell death (atrophy)

22
Q

What are the models of addiction?

A

Rewards deficiency
Overcoming adverse state
Impulsivity/Compulsivity

23
Q

What is the dopamine pathway?

How does it feed into addiction?

A

Also known as the pleasure-reward-motivation system
Natural rewards e.g. food, sex - increase dopamine levels in the ventral striatum = feelings of pleasure / reward
Drug abuse has the same effect

Addiction = shift from pleasure state to motivation state with regular use of the drug = ‘reward deficient’ state

24
Q

How can drugs of abuse modulate dopamine?

A

Drugs block dopamine reuptake e.g. cocaine, amphetamines
Leads to increased conc. in the synapse = direct effect
Amphetamine enhances release of dopamine

Or other drugs e.g. alcohol, opiates, nicotine increase dopamine neuron firing = indirect effect

25
Q

How can you assess function in the reward pathway?

A

fMRI
Monetary incentive delay task - anticipation of winning money
Ventral striatum lights up

26
Q

What effects of the drug contribute greatest to the motivation of abusing drugs?

A

Negative reinforcement
Overtime, as the tolerance builds, lower high
But without the drug, negative affects of the withdrawal increases motivation to take the drug

27
Q

What are targets for treatment?

What is the target in the reward system?

What is the target in the stress system?

A

Brain regions associated with withdrawal and negative emotional states in addiction

Reduced dopamine and mu opioid function

Increased activity in many including kappa opioid (dynorphin), noradrenaline (arousal system), CRF (stress) etc.

28
Q

What is seen on fMRI in abstinent drug addicts’ withdrawal?

A

Heightened brain response in left amygdala in abstinent polydrug addicts to aversive images

29
Q

What does a change from voluntary drug use to more habitual and compulsive use involve?

A

Prefrontal to striatal control over drug taking

Ventral (limbic or emotional) to dorsal (habit) striatum

30
Q

How is the neurocircuitry system tested in inhibitory control?

A

Use fMRIs

Go-nogo task - series of symbols, press button when the symbol next to it differs, don’t press button if the symbol next to it is the same

Look at the dorsal striatum and inferior frontal gyrus

31
Q

When are benzodiazepines used?

When is acamprosate used?

A

To treat alcohol withdrawal

To support abstinence, neuroprotection in alcoholism

32
Q

When is naltrexone used?

A

Opioid antagonist

Block heroin use in opioid addicts and to modulate reward system in alcoholism

Y2 - BRS - Psych (8 decks)

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