Substance Abuse: Neuropathways

Question 1

Substance abuse is more common is individuals between the ages of ____-____ years and is twice as common in ______.

Answer 1

18-24; males

Question 2

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.

Answer 2

Euphoria; reward; nicotine; euphoric

Question 3

Define substance-induced disorders

Answer 3

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

Question 4

Define substance-use disorders

Answer 4

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.

Question 5

DSM-5 Criteria for Substance-Use Disorder (definition, requirements for dx [11], and severity)

Answer 5

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.

1. Substance is taken in larger amounts or over a longer period than intended
2. Persistent desire or unsuccessful efforts to cut down or control use
3. Great deal of time spent to obtain or use substance, or recover from effects
4. Craving the substance
5. Use resulting in failure to fulfill major role obligations at work, school, home
6. Continued use despite persistent or recurrent social/interpersonal problems
7. Important activities are given up or reduced due to substance use
8. Recurrent use in situations physically hazardous
9. Use continued despite knowledge of having persistent/recurrent problems from substance
10. Tolerance: need more of substance for desired effect or markedly diminished effect with continued use of same amount
11. 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

Question 6

Lab values such as urine or blood drug levels inform the presence of a drug, but these are NOT useful for ______ ______-______ ______ ______.

Answer 6

assigning substance-use disorder diagnoses

Question 7

Lab values ARE useful during ______/______/______ states.

Answer 7

intoxication/overdose/withdrawal

Question 8

Acute treatment for intoxication or withdrawal includes (2)

Answer 8

1. Pharmacotherapy (if available)

2. Supportive care

Question 9

Chronic treatment for recovery and abstinence includes (3)

Answer 9

1. Psychotherapy
2. Social support
3. Pharmacotherapy (if available)

Question 10

All substances of abuse or substances with abuse liability either directly or indirectly ______ ______ release in the brain’s ______ center.

Answer 10

increase; dopamine; reward

Question 11

Examples of direct and indirect dopamine elevation that results in “reward” (2)

Answer 11

1. Amphetamines increase DA levels

2. Opioids reduce tonic inhibition of DA release (disinhibition)

Question 12

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).

Answer 12

intoxication; tolerance; physical dependence; withdrawal

Question 13

Define Substance Intoxication Syndrome

Answer 13

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.

Question 14

Define Substance Withdrawal Syndrome

Answer 14

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.

Question 15

Define Precipitated Withdrawal

Answer 15

Acute administration of an antagonist or weaker agonist.

E.g., opioid withdrawals can be precipitated with naloxone (Narcan) administration.

Question 16

Generalizations and significant features of intoxication/withdrawal syndromes (sedatives vs. stimulants)

Answer 16

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.

Question 17

Symptoms upon ED observation during intoxication vs. withdrawal (pupil dilation, pupil constriction, psychosis, cardiovascular symptoms)

Answer 17

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

Question 18

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 ______.

Answer 18

greater; reward; closely; behavior; learning; faster

Question 19

Duration of substance effect: ______-acting agents carry ______ risk of ______. ______-acting agents have ______ ______ symptoms, but symptoms are ______ ______.

Answer 19

Short; greater; withdrawal; longer; longer withdrawal; less intense.

Question 20

Negative Reinforcement and Motivational Withdrawal Theory

Answer 20

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.

Question 21

Impulsitivity vs. Compulsitivity

Answer 21

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.

Question 22

The Addiction Cycle (3)

Answer 22

Addition is a progressive, cyclical disorder that REPEATS.

1. Binge/Intoxication - “high” or “reward”
2. Withdrawal/Negative Affect - “withdrawal”
3. Preoccupation/Anticipation - “craving”

Question 23

Binge/Intoxication Stage associated with: (3)

Answer 23

1. Reward circuitry
2. Motivation and salience
3. Habits

Question 24

Negative Affect/Withdrawal Stage associated with: (2)

Answer 24

1. Stress and emotional processing

2. Memory and learning

Question 25

Preoccupation/Anticipation Stage associated with: (2)

Answer 25

1. Cognitive control

2. Inhibitory control over action

Question 26

The Addiction Cycle is perpetuated by ______. (4)

Answer 26

1. neuroplasticity.
2. Neuroplasticity increases with continued drug use.
3. Gradual reorganization of reward, motivation, and memory circuits occurs
   3a. Mediates shift from impulsive to compulsive drug-taking
4. Long-term recovery and relapse prevention is challenging

Question 27

Define Stress-induced Relapse (3)

Answer 27

1. Stress signaling induces cravings
2. Drug is sought to alleviate stress and anxiety
3. Individuals are vulnerable during stressful life transitions

Question 28

Define Cue-induced Relapse (3)

Answer 28

1. 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
2. Conditioned withdrawal occurs when individual encounters stimulus associated with withdrawal
3. Drug re-exposure can trigger relapse