Substance Abuse reading Flashcards
1
Q
define substance related and addictive disorders
A
one of a range of probems associated with the use and abuse of drugs (alcohol, cocaine, heroine or other substances people use to alter the way they think, feel and behave). they are hugely costly to humans in financial terms
2
Q
impulse control disorder
A
a disorder in which a person acts as on irresistible but potentially harmful impulses
3
Q
polysubstance abuse
A
the use of multiple mind-behaviour altering substances such as drugs
4
Q
define substance
A
chemical compound ingested to alter mood and behaviour
5
Q
define psychoactive substances
A
substances such as ecstacy, that alter mood or behaviour
-safe drugs = no, nicotine, caffeine. greater mortality than all illegal combined
6
Q
substance use
A
the ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational or occupational functioning
7
Q
intoxication
A
a phsyiological reaction, such as impaired judgement and motor ability as well as mood changes reacting from the ingestion of a psychoactive substance
8
Q
substance abuse
A
a pattern of psychoactive substance use leading to significant distress or impairment in social and occupational roles and in hazardous situations
DSM5 defines by how significnat interferes with life and not by amounts ingested
9
Q
study of drug use and job outcomes
A
repeated hard drug (barbituates, amphetamines etc) use predicted poor job outcomes after college (with everything else controlled for)
10
Q
how should we define addiction
A
a maladaptive pattern of substance use characterised by the need for increased amounts to achieve the desired effect when the substance is withdrawn, unsuccesful efforts to control its use and substantial effort expended to seek it or recover from it = addiction
11
Q
tolerance
A
the need for increased amounts of a substance to achieve the desired effect, and a diminished effect without continued use of the same amount
12
Q
withdrawal
A
a severly negative physiological reaction to removal of a psychoactive substance which can be alleviated by the same or similar substance
eg headache in the morning without caffeine
alcohol = delerium, hallucinations, body tremours
cocaine = anxiety, lack of motivation, boredom
LSD = severe physical
cannabis = nervousness, appetite change, sleep disturbance
13
Q
drug seeking behaviours
A
measure of dependence
eg stealing, even standing outside in the cold, alone to smoke
14
Q
how DSM5 describes substance abuse and addiction
A
4 = abuse and dependence were different 5 = combined and described in terms of levels of severity mild = 2 or 3 /11 symptoms moderate = 4 or 5 /11 symptoms severe = 6 or more /11 symptoms
15
Q
why is use of substances dangerous full stop
A
we can use them and not abuse them but we do not know ahead of time who might lose control and abuse / dependence
16
Q
can there be dependence but no abuse
A
yes
cancer patient dependent on morphine but not abusing it as manages their pain
17
Q
diagnostic issues with sud
A
used to be part of other problems = sociopathic personality disturbances
sign of moral weakness
genetics and bio vulnerability was hardly acknowledged
researchers estimate 3/4 of those in treatment = an additional dis (mood, anxiety, PTSD)
=6 week rule
18
Q
explain the six week rule
A
if symptoms appear during intoxication or within 6 weeks after withdrawal from drugs = not considered a separate disorder
19
Q
how do we group drugs
A
6 categories depressant stimulants opiates hallucinogens other drugs gambling
20
Q
depressants
A
psychoactive substance that results in behavioural sedation eg alcohol, sedatives, hypnotic and anxiolytic drugs
21
Q
stimulants
A
psychoactive substance that elevates mood, activity and altertness eg amphetamines, caffeine, cocaine and nicotine
22
Q
opiates
A
addictive psychoactive substance (heroine, opium, morphine) that causes temporary euphoria and analgesia
23
Q
hallucinogens
A
any psychoactive substance (LSD, mrijuana) that can produce delusions, hallucinations, paranoia and altered sensory perception
24
Q
other drugs of abuse
A
other substances that are abused but do not fit neatly into one of the major drug categories (inhalants, steroids)
25
gambling disorder
unable to resist the urge to gamble = results in negative consequences
26
how depressents work
decrease CNS
reduce physiological arousal = relax
most likely to produce symptoms of physical dependence, tolerance and withdrawal
27
alcohol-related disorders
cognitive, bio, bahevioural andsocial processes associated with alcohol use and abuse
28
effects of alcohol when ingested on the body
esophagous
stomach (small amounts absorbed)
small intestine (easily absorbed)
blood = contact with all major organs
lumgs = vapourised and exhaled - how cops test
liver = broken down into CO2 and water by enzymes
29
effects of alcohol on the brain
number of neurotransmitter systems
GABA - inhibitory neurotransmitter
-interfers with firing of neurons attached
Cl- ions enter cell = less sensitive to the effects of other neurotransmitters
alcohol seems to reinforce cl- ion movement
=difficualt for neurons to communicate with one another
GABA pathway = why alcohol decreases anxiety
glutamate = excitatory
learning and memory
how alcohol effects our cognitive abilities
serotonin = mood, sleeping and eating
- overall many neurotransmitter systems with complex effects
30
withdrawal from chronic alcohol abuse
withdrawal delerium
the frighteneing hallucinations and body tremours that result when a heavy drinker withdraws from alcohol. also known as delerium tremes (DTs) - medical treatment can reduce
31
what effects the damage caused by alcohol
genetic vulnerability
frequency of use
length of drinking binges
blood alcohol levels
whether body is allowed to recover from binges
long term use = liver damage, pancreatitis, cardiovascular disorder and brain damage
32
dementia
general loss of intellectual abilities and can be direct result of neuroanatomy by excessive amounts of alcohol
does not always go away once brain damage has occured
note mild / moderate drinking may serve a protective role in cognitive decline as we age
33
fetal alcohol syndrom
learning difficulties, behavioural deficits and characteristic physical flaws resulting from heavy drinking by the victims mother when she was pregnant
-white americans
34
students and binging
men in college most likely
| a students binge less than d-f students
35
binge drinking definition
+5 drinks on one occacion at least once a month
| heavy if more than 5 days in a month
36
progression of alcoholics
normal to be functional
20% with severe alcohol dependence = have a spontaneous remission and do not reexperience problems with alcohol
dependence course is progressive for most people but abuse may be more variabe
drinking at an early age (11-14) = predictive of later alcohol related dis
37
study following male impatients at alcohol rehad centre
3/4 = moderate consequences of their drinknig
20s = demotions at work
30s = regular blackouts and serious withdrawal
40s = long term consequencies (hallucinations, convulsions, hepatities, pancreatitis)
not inevitable for everyone
research on mechanism for differences in easly alcohol use = ones response to the sedative effects affects later ise
so those who no slurred speech, staggering etc = more likely to abuse it
concern as high caffeine drinks now used as mixer = increase likelihood of later abuse?
38
alcohol and violent behaviour
correlational links
lab studies = alcohol makes you more aggressive but if this was larer outside of the lab = lots of interrelated features
so alcohol does not cause aggressive behaviours but it may increase a persons likelihood of engaging in impulsive acts and impair the ability to consider the consequences of acting impulsively
39
barbituates
```
a seditative (and addictive) drug such that is used as a sleep aid
originally prescribed to help sleep in the 30s and 40s
50s = most abused drug in america
```
40
benzodiazepines
an antianxiety drug (valium) also used to treat insomnia
effective against anxiety (and at high potency = panic dis)
show more side effects
eg cognitive and motor implications and may result in substance dependence
relapse rates are extremely high when drug discontinued
originally = miracle cure for anxiety
safer than barbituates
rohypnol = date rape drug
41
barbituates clinical description
low dose = relaxing and mild feeling of well-being
larger doses = slurred speech, walking problems, concentrating and work problems
extremely high doses = death by suffocation as diaphragm relaxes
barbituate overdose = common method of suicide
42
benzos clinical description
calm individual and induce sleep
muscle relaxant and anticonvulsant
pleasant high and a reduction in inhibition (similar to alcohol)
after continued use tolerance and dependece can develop
withdrawal felt when tried to stop
43
sedative hypnotic and anxiolytic related disorders
cognitive, bio and behavioural and social problems associated with the use and abuse of sedative, hypnotic and anxiolytic drugs
dont differ significantly from alcohol in DSM 5
both include maladaptive behavioural changes (inappropriate sexual or aggressive behaviour, variable moods, impaired judgement and social / occupational functioning, slurred speech, motor co-ordination)
GABA - but different mechanism to alcohol
drugs + alcohol = synergistic effects = dangerous levels
44
stats of bezos and barbituates
barbituates decreasing, benzos increasing
| those who do seek help for treatment = female, caucasian and +35
45
stimulants
caffeine, nicotine, amphetamine and cocaine
| more alert and energetic
46
amphetamines
low dose = elevtion and vigour and reduce fatigue
but will crash back down = crash, depressed, tired
used for asthma, nasal decongestant, also reduce appetite = weight loss
also used for people to pull all nighters / give a boost
used for ADHD in kids but can be abused for pscyh effect
47
amphetamine use disorder
stimulant medication used to treat hypersomnia by keeping the person awake during the day and to treat narcolepsy including sudden onset episodes by suppressing REM sleep
severe intoxication / overdose = cause hallucinations, panic, agitation and paranoid delusions
tolerance quickly builds
withdrawal = apathy, prolonged periods of sleep, irritability and depression
48
crystal meth
ingested through smoking
marked aggresive tendencies and stays in the system longer than cocaine = particularly dangerous
originally popular in the community but spread elsewhere
high risk for dependency
repeated use of MDMA = lasting memory problems
49
how amphetamines act on the brain
stimulate CNS by enhancing the activity of norepinephrine and dopamine (helps release the neurotransmitters and blocks their reuptake)
too much = hallucinations and delusions
this effect = ideas about the causes of schizophrenia
50
cocaine
replaced amphetamines as stimulant of choice 1970s
from leaves of coca plant
small amounts increase alertness, euphoria, increased bp and pulse and insomnia and loss of appetite
effects = short lived
cocaine induced paranoia = common in users (2/3)
heart beats more rapidly and irregularly = can be fatal
used medically as a local anesthic and narcotic
51
stats on cocain abuse
white males = most common users
17% = crack cocaine too (crystallised, snorted)
increasing proportion of users seeking treatment are young, unemployed living in urban areas
up seems to come from the dopamine system
52
how cocaine works
inhaled
enters bloodstream through lungs. in the brain in seconds
acts on the pleasure pathway in the limbic system. occurs at synapses
cocaine molecules bind to the dopamine transporter blocking the route by which dopamine would re enter the transmitter cell. so accumuates in the synaptic space
53
how cocaine is different to other drugs
does not resemble that of many drugs = typically people find they have a growing inability to resist taking more
few negative side effects at first
but then disrupted sleep, increased tolerance, paranoia, other negative symptoms
become socially isolated
chronic use may equal premature ageing in the brain
different withdrawal = feelings of apathy and boredom = visicious cycel can easily develop (due to this atypical withdrawal pattern meant people originally didn't think was addictive)
54
tobacco-related disorders defined
cognitive, bio, behavioural and social problens associated with the use and abuse of nicotine
55
tobacco use stats / background
20% US smoke - decrease from the past
56
how DSM defines tobacco related dis
DSM does not describe and intoxication pattern for tobacco related dis
instead lists withdrawal symptoms, inc depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness and increased appetite and weight gain
57
nicotine clinical description
in small doses = stimulates CNS, relieves stress and improves mood. bp increases and increased risk of heart disease and cancer
high doses = blurry vision, confusion, lead to convulsions and cause death
once dependent = withdrawal starts if stopped
smoking = linked with negative affect (depression, anxiety, anger)
58
how nicotine acts on the body
inhaled
enters bloodstream, brain after 7-19 seconds
stimulates nicotinic acetylchloride receptors nAChRs n midbrain reticular formation in the limbic system = site of brains pleasure pathway
smokers dose throughout the day = keep nicotine at steady levels in the bloodstream
59
maternal smokers
can predict later substance related disorders in their children (appears to be environmental rather than bio)
60
caffeine related disorders
most common
gentle stimulant - thought to be least harmful of addictive drugs
some energy drinks baned in Fr and other countries
smalle doses = elevates mood and decreases fatigue
larger doses = jittery, cause insomnia
takes 6h to leabe body = disturbs sleep
esp pronounced in those already suffering from insomnia
moderate caffeine = ok for fetus
tolerance and withdrawal = headaches
61
defintion of caffeine use disorder
cognitive, bio, behavioural and social problems associated with the use and abuse of caffeine
DSM 5 = condition for further study
62
caffeine effects on the brain
involve neuromodulator adenosine and also dopamine (to a lesser extent)
blocks adenosine reuptake
-but we do not yet know how the role of adenosine in brain function or whether its interruption = elation and increased energy
63
opiods
opium poppy - narcotic effect (reduces pain, induces sleep)
disorder = bio, cognitive, behavioural and social problems associated with the use and abuse of opiates and their synthetic variants
induce euphoria, drowsiness and slowed breathing
high dose = death if respiration fully decreased
64
withdrawal from opiods
yawning, nausea, vomiting, chills, muscle aches, diarrhea, insomnia = disrupts school, work and social relationships
symptoms = 1-3 days, withdrawal process complete in a week
65
heroin
most commonly abuse opiod and rising
| risks even beyond addiction and overdose. HIV and AIDS as inravenous injections
66
longitudinal study following 80 heroin addicts
30 years later
22% dead - overdose and suicide
of those alive, 80% no longer using opiods, 20% treated with methadone
67
brain and opiods
has its oen = enhephasis and endorphins
heroin activates this systme
discovery of this system = major breakthrough in neuropharmacology
also helped us treat people dependent on drugs
68
cannabis-related disorders
most routinely used illegal drug
dried part of the hemp plant; a hallucinogen that is the most widely used illegal substance
use-dis = cognitive, bio, behavioural and social problems associated with the use and abuse of cannabis
grows in the wild throughout tropical and temperate regions of the world = weed
mood swings, dreamlike state (time stands still)
heightened sensory experience
different reactions in different people (more so than any other drug)
not uncommon for no reaction first time using the drug
appears people can turn off the high if sufficiently motivated
69
cannabis clinical description
small doses = well being
| high doses = change to paranoia, hallucinations and dizziness
70
high school cannabis smokers
lower grades and less likely to graduate (not clear on direction of causation)
not clear if physiological problems preceed or cause - impaired memory, concentration, relationships with others and emplyment
71
synthetic marijuana
K2, spice, herbal incense = alarm as can be purchassed legally and this reaction to its use can be extremely harmful (hallucinations, seizures, heart rhytmn problems, etc)
72
tolerance for cannabis
contradictory evidence
chronic and heavy users report tolerance especially to the euphoric high - unable to reach the kind of pleasure they had earlier
also reverse tolerance reported = regular users experience more pleasure from the drug after repeated use
73
withdrawal from cannabis
minor
| period of irritability, restlessness, appetite loss, nausea and difficulty sleeping
74
cannabis as medical treatments
chemo induced nausea and vomiting
HIV associated anorexia
neuropathic pain in MS
cancer pain
75
smoking cannabis problems
carcinogenic
76
cannabiods
80 cannabioids
most common = THC
brain makes it own THC = anandamide
only beginning research
77
hallucinogenic-related disorders
dsm5 similar as cannabis
| psychotic risks - can fly etc (maybe no worse risks than being drunk though)
78
lsd
the most common hallucinogenic drug; a synthetic version of grain fungus ergot
79
study comparing hallucinogen psilocybin versus control (ritalin)
individual reactions included perceptual changes and moof changes
2 months later rated the experience as having a spiritual significance
more research needed
80
tolerance and withdrawal and lsd
develops quikcly
if taken repeatedly over a period of days = drugs lose their effectiveness
sensitivty returns after a week of abstinence
most hallucinogenics = no withdrawal reported
81
how we think hallucinogenics work
not fully understood
most of these drugs resemblence to other neurotransmitters = similar to serotonin; others norepinephrine, other acetylcholine
but mechanism remains unknown
82
inhalants
volatile solvents
spray paint etc
male, caucasian, rural or small town = typical users
higher levels of anxiety and depression + show more impulsivity and fearless tempermaments
drugs = rapidly absorbed into bloodstream through lungs
dizziness, slurred speech, incoordination, euphoria, lethargy
users build up tolerance and withdrawal (2-5 days) = sleep distrubances, tremors, irritability and nausea
use = aggression and anti-socail behaviour increase
long term use = damage bone marrow, kidneys, liver, brain. if startled can cause cardiac arrest
83
anabolic-androgenic steroids
synthesised form of testosterone
legitimate medical uses = asthma, anemia, breast cancer, males with inadequate sexual development
but anabolic = increased body mass = illict use by bodybuilders
cycling = regular use for several weeks (or months) then break or combine several types of steroids = stacking
steroids = no high, body changes
long term effects = mood dis, serious physical consequences from regular use
84
dissociative anesthetics
drowsiness, pain relief and feelings of being out of ones body
designer drugs
originally developed by pharmaceutical companies to treat specific diseases and disorders
MDMA, MDEA, BDMPEA
heightens a persons auditory and visual perception (also taste and touch)
85
ketamine
associative anesthetic = sense of detachment along with a reduced awareness of pain
86
GHB
```
CNS depressant (originally marketed to stimulate muscle growth)
low dose = relaxation, increased tendency to verbalize
high dose = seizures, severe respiratory depression and coma
```
87
bio causes of substance related dis overview statement
twin + family + adoption studies = genetic vulnerabilities
| in general genetic risk factors cut accross all mood-altering drugs
88
most bio research on causes focuses on
alcoholism
| legal
89
twin studies on substance related disorders
genetics play an important role but no reliable findings to specific genes as influenceing these disorders
90
functional genomics
how these genes function when it comes to addiction
91
genetic factors and drugs
may affect how people experience certain drugs = partly determines who may become abusers
also help predict which treatments may be effective
92
neurobio influences on causing substance related dis
positve reinforcement when using drugs
natural pleasure pathway (up for discussion exactly where in the brain but inc dopaminergic system and its opiod releasing neurons- begins in midbrain ventral tegmental area then works its way forward through the nucleus accumbens and frontal cortex) = mediates our experience of reward - all abused substances seem to effect this
so psychoactive substances = ability to activate reward centre
93
amphetamines and cocaine which bit of the brain
directly on the dopamine system
94
opiates act on which bit of the brain
inhibit GABA
"brain police"
stops the GABA neurons inhibiting dopamine so more dopamine available for pleasure pathway
nicotine and alcohol too
95
anxiolytic effects
ability to reduce anxiety (eg alcohol)
acts on septal hippocampal system including large numbers of GABA sensitive neurons
enhance GABA activity in this area = inhibits brains normal reaction to anxiety-producing situations
96
individual differences in the way people respond to alcohol
compare individuals with and without family history of alcoholism
conc alcoholics may be more sensitive to alcohol when it is first ingested and then become less sensitive to its effects as the hours pass
significant as euphoric effects of alcohol = just after drinking but after a few hours = sadness and depression
so alcoholics may better appreciate the good without experiencing the bad so ideal candidates to continue drinking
97
psych dimensions for causing substance related disorders
substances people use to alter mood and behaviour have unquie effects = still important to point out similaritites in ways people mentally react to these substances
positive reinforcement (many drugs pleasureable to animals so more than social and cultural influences)
social contexts may encourage its taking
negative reinforcement
people also reliably crash after taking drugs so why do they keep taking them
98
adolescent vulnerability
just having a parent ith alcohol dependence was a major factor in predicting who would use alcohol and other drugs
also found adolescence who reported negative affect = more likley to use drugs
so to prevent = adress influences inc stress and anxiety
99
opponent-process theory
increase in positive feelings = followed shortly by an increase in negative feelings
similarly increase in negative feelings will be followed by a period of positive feelings
the mechanisms this is strenghtened with use and weakened by disuse
so person uses drug for a long time = need more to achieve same results
at same time negative feelings that follow tend to intensify
so motivation for drug taking = shifts from desiring the euphoric high to alleviating the increasingly unpleasant crash
=insidious cycle
100
self-medication study
study treated a group of cocaine addicts who had ADHD with ritalin = they hypothesised that these individuals used cocaine to help focus their attention. once their ability to concentrate improved with ritalin, the users reduced their use of cocaine
101
cognitive dimensions of causing substance related disorders
what people expect to experience = influences how they react to drugs
eg less inhibited whether given alcohol or placebo told its alcohol = expects to become disinhibited
adolescents may begin using alcohol / drugs because they belive these substances will have positive effects
expectations change as people experiment with drug
use triggered by factors like availability, contact with things associated with the drug, specific moods, having a small dose of the drug
102
social dimensions of causing substance related dis
drug addicted parents = less time monitoring their children, self-perpetuating pattern
societal view dictates how drug-dependent
103
moral-weakness model of chemical dependence
drug users lack moral fibre to resist lure of drugs
104
disease model of dependence
drug dependence is caused by an underlying physiological disorder (bio perspective)
AA and similar organisations work from this viewpoint
105
cultural dimensions of substance abuse
must reconsider abnormal for each culture
different consequences
different social situations
different genes eg ALDH2
106
integrative model
```
need drug
exposure
cultural expectations
use = abuse
-major stressor
-genetic influence
-psych dis
```
107
neuroplasticity
continued use of certain substances change the way our brain works
so brain increases drive to obtain the drug and decreases the desire for non-drug experiences
108
personal motivation for treatment
important but not necessarily critical
109
treatment must focus on
mutliple areas
help through withdrawal process
ultimate goal = abstinence
community wide approach to screen for drug abuse in settings like doctors offices etc important as only 25% come forward for treatment
110
agonist substitution
a replacement of a drug on which a person is dependent with one that has a similar chemical makeup, an agonist
used as treatment for substance dependence
eg methadone for heroin - but can develop tolerance for methadone
111
buprenorphine
blocks the effect of opiods and encourages better compliance then would a non opiod or opiate agonist
112
nicotine patch
patch placed on the skin that delivers nicotine to smokers without carcinogens in the cigarette smoke
somewhat more successful than nicotine gum because it requires less effort by the wearer and delivers the drug more constantly; should be coupled with conselling to stop smoking relapse
113
antagonist treatments
the medications that block or counteracts the effects of a psychoctic drug
naltrexone = opiate antagonist
-produces immediate withdrawal symptoms
-so a person must be free from withdrawal symptoms completely before starting naltrexone and must be highly motivated to use as removes euphoric effects of opiods
acamprosate = decrease cravings in people dependent on alcohol
best in highly motivated people who are participating in psychosocial interactions
114
aversive treatment
clinics may prescribe drugs that make ingesting the abused substances extremely unpleasant
= associate feelings of unplesantness with the drug
antabuse = enduces nausea, vomiting, elevated heart rate and respiration after drinking alcohol
should be taken each morning before the desire to drink arises
but problem of noncompliance = can start drinking again
115
clonidine
treat hypertension for people withdrawing from opiates
116
using benzos for treatment
sedative, often prescribed to minimise discomfort for people withdrawing
117
psychosocial treatment
all need social and therapeutic intervention
| lots of models = invalidated and untested
118
inpatient facilities
help people through initial withdrawal period and provide supportive therapies so can go back to their communities
expensive
research = may be no real difference with outpatient care in outcomes of alcoholics and drug abus ein general and outpatient = much cheaper
119
AA and its variants
foundation = alcoholism is a disease and alcoholics must acknowledge their addiction and its destructive power over them
addiction = more power so must submit to a higher power
freedom from stigmatization
social support provided through groups meetings
research = people who regularly participate in AA or similar, follow its guidelines carefully are more likely to have positive outcomes - so effective for highly motivated people, but dont know who it will and wont wor for
120
controlled use
research = a portion of several substances may be capable of becoming social users without returning to abuse
121
controlled drinking
an extremely controversal treatment appraoch to alcohol dependence in which severe abusers are taught to drink in moderation
classic study = 40 male alcoholics in an alcohol treatment program and thought to have a good prognosis
controlled drinking
2 years later and 10 years later followed up
sobell study = problematic as concluded it worked without checking up on controls
so in USA not really implemented but is in UK
122
covert sensitization
imagining unpleasant scenes eg beginning to snort cocain interrupted with visions of becoming violently ill
123
contingency management
clinician and client together select the behaviours the client needs to chnge and decide on reinforcers thay will reward certain goals
eg recieve cash for clean urine samples
124
community reinforcement program
spouses, friends, relatives etc who are not a substance abuser help abuser improve relationships with other important people
clinician teaches client to identify antecedents and consequences that influence drug taking and avoid certain friendships
help with finances, education etc
new recreational options
empirical support for this with cocaine
125
obstacles for successful treatment
lack of personal awareness
| unwilling to change
126
motivational enhancement therapy
behavioural changes in adults is more likely with empathetic and optimistic counselling and focus on personal connetion with the clients core values
reminding client what they cherish most
=improves individuals beliefs any changes made will have positive outcomes
127
CBT
addresses multiple ascpects of the dis
reactions to cues that lead to substance abuse
thoughts and hierarchies to resist use
128
relapse prevention
the extending therapeutic program by teaching the client how to cope with future troubling situations
learned aspects of dependece and sees relapse as a failure of cognitive and behavioural coping skill
high risk situationss identifies and strategies are developed to deal
relapse = dealt with as a occurence from which people can recover from
may be particularly effective for alcohol and other substance related dis
129
prevention
education
laws
community
DARE - drug abuse resistnce education = no drug use instilled by fear of consequences, rewards for commitments to not use drugs and strategies for rejecting drug offers. may not have intended effects
cultural strategies must be powerful - role of society
130
gambling disorder
clinically significant impairment or distress as the result of persistent and recurrent problematic gmabling
job loss, bankrupcy
same pattern of urges as in substance abuse = so classified with them
131
study of gambler watching other people gamble
detected level of activity observed in regions of the brain that are involved in impulse regulation when compare with controls
= interaction between environmental cues to gamble and the brains response
abnormalities in the dopamine system (pleasure of gambling) and serotonin (impulse behaviour) also found
132
treatment of gambling
```
hard as usually denial, impulsivity and continuing optimism
cravings
gamblers anonymous like AA (70-90% dropout). desire to quit must be present before starting treatments
cognitive behavioural = looks promising
-setting financial limits
-planning alternative activities
-prevent relapse
-imaginal desensitization
```
133
internet gambling disorder
condition for further study
134
intermittent explosive disorder
the epidoes during which a person acts on aggressive impulses that result in serious assaults for destruction or property
-controversial as may be used for legal defence
-serotonin and norepinephrine and testosterone levels and psychosocial influences
help people identify triggers and drugs to control
135
kleptomania
a recurrent failure to resist urges to steal things not needed for personal use or their monetary value
rare
hard to study as illegal
tensions before strealing, pleasure / relief when theft committed
impulsivity = unable to judge their immediate gratification of stealing comapred with the long term negative consequences
often no memory of act of shoplifting
high comorbidity with mood dis, act of stealing acts as an anti-depressant
136
pyromania
impualse control dis that involved having an irresistible urge to set fires
parallels with kleptomania
preoccupation with fires and associated equioment
3% of arsonists
family history of fire setting and comorbid impusle control dis
cbt - identify signals that initiate the urges and teaching coping strategies
