Substance abuse and dependence - Rotem

Question 1

What is the definition of priming?

Answer 1

A new exposure to a formerly abused substance which precipitates rapid resuption of abuse at previous or higher levels (why smokers don’t get a headrush like young first timers), receptors upregulated with first use.

Question 2

What is the difference between substance abuse and dependence?

Answer 2

Abuse:
Characterized by adverse consequences by repeated use, continued use despite presistent/recurrent social/interpersonal problems

Dependence:
Cluster of symptoms with continued use despite substance-related problems. May be drug seeking. Must have 3 of the following:
-symptoms of tolerance
-symptoms of withdrawal
-Use of larger amounts for longer periods than intended
-Persistent desire or unsucecssful attempts to reduce or control use
-Spending of considerable time in efforts to obtain the substance
-Reduction in important social, occupational, or recreational activities because of drug use
-Continued use of a substance despite attendant health, social, or economic problems

CANNOT COEXIST IN THE SAME PATIENT WITH THE SAME SUBSTANCE

Question 3

What are the modifiers for remission in substance dependence?

Answer 3

Early full remission:
After one year of dependence, no signs of abuse or dependence between one month and one year later.

Early partial remission:
Dependence cessation followed by relapse after between one month and a year.

Sustained full remission:
Dependence cessation followed by no signs of abuse or dependence at least one year later.

Sustained partial remission:
Dependence cessation for at least one year containing at least one criteria for dependence or abuse (or relapse after one year according to lecturer).

Question 4

What are the stages and factors of drug addiction?

Answer 4

The 3 major components of the addiction cycle are preoccupation–anticipation, binge–intoxication, and withdrawal–negative affect
The cycle is conceptualized as a spiral that increases in amplitude with repeated experience, ultimately resulting in the pathologic addictive state

Question 5

What is the physiologic mechanism of addiction and withdrawal in the brain?

Answer 5

Stimulation of the limbic system

Nicotinic receptors (many between pons and midbrain-ventral tegmental area-VTA)
 Nucleus Accumbens (more myelinated with more receptors in adolescence)

Increased dopamine (from nictonic stimulation of the VTA), also released in hypocampus and frontal cortex (cognitive connection)’

Locus ceruleus most responsible for withdrawal symptoms (releases NE and causes anxiety)

SSRIs can help diminish withdrawal of marijuana and other drugs because of serotonin depletion

Question 6

What is the chain of impulse and motivation?

Answer 6

Impulses can be generated by

• Triggers interacting with innate dispositions (instincts) and learned dispositions (habits)
• ‘Motives’: feelings of desire (anticipated pleasure or satisfaction) and/or need (anticipated relief from unpleasantness or tension)
• They decay quickly once the triggers or motives are no longer present

Motives can be generated by:

• Reminders interacting with the level internal tension at the time
• ‘Evaluations’: beliefs about what is good/bad, right/wrong, useful/detrimental etc.

Evaluations are generated by:

• Recall of observations
• Analysis, inference
• Accepting what others say
• Motives
• Plans