Substance Abuse: Neuropathways Flashcards
Substance abuse is more common is individuals between the ages of ____-____ years and is twice as common in ______.
18-24; males
Potential for abuse is not always linked to intensity of ______ or ______. As an example, ______ is one of the most addictive substances, but it does not cause an ______ effect.
Euphoria; reward; nicotine; euphoric
Define substance-induced disorders
States/symptoms/syndromes that are CAUSED by the drug ITSELF or by WITHDRAWAL from the drug
- Includes intoxication, withdrawal, and substance- (or medication-) induced mental disorders
Define substance-use disorders
Sometimes referred to ADDICTION. Characterized by manifestations of maladaptive patterns of substance use despite continued adverse consequences.
APA definition: “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems”.
Long-lasting changes in neurocircuitry are often observed; persists beyond drug intoxication/withdrawal.
DSM-5 Criteria for Substance-Use Disorder (definition, requirements for dx [11], and severity)
Defined as “a problematic pattern of substance use leading to clinically significant impairment or distress”
Requires at least 2 of 11 criteria occurring within a 12-month period.
- Substance is taken in larger amounts or over a longer period than intended
- Persistent desire or unsuccessful efforts to cut down or control use
- Great deal of time spent to obtain or use substance, or recover from effects
- Craving the substance
- Use resulting in failure to fulfill major role obligations at work, school, home
- Continued use despite persistent or recurrent social/interpersonal problems
- Important activities are given up or reduced due to substance use
- Recurrent use in situations physically hazardous
- Use continued despite knowledge of having persistent/recurrent problems from substance
- Tolerance: need more of substance for desired effect or markedly diminished effect with continued use of same amount
- Withdrawal: withdrawal syndrome or same substance taken to relieve/avoid withdrawal symptoms
Severity scale:
2-3 symptoms = mild
4-5 symptoms = moderate
6 or more symptoms = severe
Lab values such as urine or blood drug levels inform the presence of a drug, but these are NOT useful for ______ ______-______ ______ ______.
assigning substance-use disorder diagnoses
Lab values ARE useful during ______/______/______ states.
intoxication/overdose/withdrawal
Acute treatment for intoxication or withdrawal includes (2)
- Pharmacotherapy (if available)
2. Supportive care
Chronic treatment for recovery and abstinence includes (3)
- Psychotherapy
- Social support
- Pharmacotherapy (if available)
All substances of abuse or substances with abuse liability either directly or indirectly ______ ______ release in the brain’s ______ center.
increase; dopamine; reward
Examples of direct and indirect dopamine elevation that results in “reward” (2)
- Amphetamines increase DA levels
2. Opioids reduce tonic inhibition of DA release (disinhibition)
Acute drug abuse may result in ______. Chronic drug abuse may result in neuroadaptive changes, such as ______ (higher drug dose required to achieve same effect), ______ ______ (continued drug use is necessary to maintain “normalcy”), and ______ (may emerge after stopping or decreasing drug use).
intoxication; tolerance; physical dependence; withdrawal
Define Substance Intoxication Syndrome
Substance exerts behavioral or psychological changes on the central nervous system: sedation, agitation, belligerence, mood lability, impaired cognitive function, judgement, social or occupational function, etc.
Reversible, substance-specific syndromes.
Caused by RECENT substance ingestion or exposure.
Symptoms must not be due to a general medical condition.
Different substances may produce similar or identical syndromes.
Define Substance Withdrawal Syndrome
Substance-specific syndrome resulting from abrupt cessation of heavy and prolonged use. Clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Symptoms must not be due to a general medical condition.
Define Precipitated Withdrawal
Acute administration of an antagonist or weaker agonist.
E.g., opioid withdrawals can be precipitated with naloxone (Narcan) administration.
Generalizations and significant features of intoxication/withdrawal syndromes (sedatives vs. stimulants)
Drugs with sedative effects (alcohol, hypnotics, opioids, BZDs, etc.) produce DEPRESSIVE symptoms (like respiratory depression) with INTOXICATION and ANXIETY during WITHDRAWAL.
Drugs with stimulant effects (PCP, MDMA, etc.) generally induce ANXIETY/PSYCHOSIS during INTOXICATION and DEPRESSIVE symptoms upon WITHDRAWAL.
Symptoms upon ED observation during intoxication vs. withdrawal (pupil dilation, pupil constriction, psychosis, cardiovascular symptoms)
Pupil dilation:
INTOXICATED - stimulants/hallucinogens
WITHDRAWAL - opioids/sedatives/alcohol
Pupil constriction:
INTOXICATED - opioids
WITHDRAWAL - stimulants
Psychotic symptoms:
INTOXICATED - stimulants/hallucinogens/alcohol
WITHDRAWAL - sedatives/alcohol
Cardiovascular symptoms:
INTOXICATED - stimulants
WITHDRAWAL - sedatives/alcohol
Route of administration influences both the plasma concentration and speed of substance effects. Higher plasma concentration = ______ pharmacologoical effects. Rapid onset = ______ is more ______ associated with the ______ and ______ is acquired ______.
greater; reward; closely; behavior; learning; faster
Duration of substance effect: ______-acting agents carry ______ risk of ______. ______-acting agents have ______ ______ symptoms, but symptoms are ______ ______.
Short; greater; withdrawal; longer; longer withdrawal; less intense.
Negative Reinforcement and Motivational Withdrawal Theory
CNS compensates for intense emotional, hedonic, or affective states to reduce the intensity of feelings. Motivational withdrawal occurs when DRUG REWARD FADES, BUT CNS COMPENSATION PERSISTS.
Contributes to an understanding as to why patients pursue drug beyond physical withdrawal symptoms.
Impulsitivity vs. Compulsitivity
Impulsitivity: Observed EARLY in drug use and is a RISK FACTOR for DEVELOPMENT of substance use disorder. Contributes to ESCALATING drug use.
Compulsivity: Observed LATER in addiction and CONTRIBUTES to MAINTENANCE of use disorder. Contributes to INABILITY to STOP drug-seeking behavior once initiated.
The Addiction Cycle (3)
Addition is a progressive, cyclical disorder that REPEATS.
- Binge/Intoxication - “high” or “reward”
- Withdrawal/Negative Affect - “withdrawal”
- Preoccupation/Anticipation - “craving”
Binge/Intoxication Stage associated with: (3)
- Reward circuitry
- Motivation and salience
- Habits
Negative Affect/Withdrawal Stage associated with: (2)
- Stress and emotional processing
2. Memory and learning
Preoccupation/Anticipation Stage associated with: (2)
- Cognitive control
2. Inhibitory control over action
The Addiction Cycle is perpetuated by ______. (4)
- neuroplasticity.
- Neuroplasticity increases with continued drug use.
- Gradual reorganization of reward, motivation, and memory circuits occurs
3a. Mediates shift from impulsive to compulsive drug-taking - Long-term recovery and relapse prevention is challenging
Define Stress-induced Relapse (3)
- Stress signaling induces cravings
- Drug is sought to alleviate stress and anxiety
- Individuals are vulnerable during stressful life transitions
Define Cue-induced Relapse (3)
- Stimuli associated with either positive or negative reinforcement of the drug induces craving
1a. Example: environment where individual experienced “high” and/or relief from withdrawal symptoms - Conditioned withdrawal occurs when individual encounters stimulus associated with withdrawal
- Drug re-exposure can trigger relapse
