Substance abuse + society

Question 1

What is substance abuse?

Answer 1

A disorder characterised by the destructive pattern of using a substance which leads to problems or distress

Question 2

Define addiction

Answer 2

a state characterized by compulsive engagement in rewarding stimuli despite adverse consequences

Question 3

Define reinforcing stimuli

Answer 3

stimuli that increase the probability of repeating behaviours paired with them

Question 4

Define rewarding stimuli

Answer 4

stimuli that the brain interprets as intrinsically positive or as something to be approached

Question 5

Define addictive drug

Answer 5

a drug that is both rewarding and reinforcing

Question 6

Define addictive behaviour

Answer 6

a behaviour that is both rewarding and reinforcing

Question 7

Define sensitisation

Answer 7

an amplified response to a stimulus resulting from repeated exposure to it

Question 8

Define tolerance

Answer 8

the diminishing effect of a drug resulting from repeated administration at a given dose

Question 9

Define dependence

Answer 9

an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)

Question 10

Define Physical dependence

Answer 10

dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens)

Question 11

Define Psychological dependence

Answer 11

dependence that involves emotional–motivational withdrawal symptoms (e.g., dysphoria and anhedonia)

Question 12

State some stats in relation to alcohol and drug addiction in the UK

Answer 12

5% of adults alcohol dependent
1% adults addicted to heroin or crack cocaine

Cost of alcohol harm = £21 billion per year

Question 13

What are the factors leading to addiction?

Answer 13

Abuse- sexual, psychological, emotional
Underlying emotional disorders - anxiety, depression
Family history - alcoholic parents/drug addicted higher chance
Inherited factors - genetic/biological traits
Low frustration tolerance
The substance

Question 14

Name the categories of drugs that are abused

Answer 14

Alcohol
Nicotine
E.g. cigarettes, e-cigarettes
Euphorics:
E.g. cannabis, ketamine, nitrous oxide, salvia
Opiates
E.g. heroin, morphine, codeine
Benzodiazepines
E.g. diazepam
Stimulants
E.g. cocaine, amphetamine, ethylphenidate

Question 15

What do the following drugs act on?
piracetam
caffeine
cocaine +amphetamines
benzodiazepines
yohimbine
ketamine
heroin + buprenorphine
Modafinil

Answer 15

Acetylcholine + AMPAR: piracetam
Adenosine: caffeine
Dopamine: cocaine, phenidates, amphetamines
GABA: benzodiazepines
Norepinephrine: yohimbine
NMDAR -ketamine
Opioid receptors- buprenorphine, heroin
Orexin receptor- modafinil

Question 16

What are the two categories of treatment?

Answer 16

Pharmacotherapy
Behavioural therapies

Best if combined

Question 17

What are the behavioural treatment approaches?

Answer 17

Cognitive-behavioural therapy
Based on behaviours being learned responses which, through learning different responses, can be altered.

Contingency Management Interventions
Rewards compliance with abstinence

Motivational Enhancement Therapy
Focusses on identifying the need to change behaviours

Family Behaviour Therapy
Therapy undertaken with at least one significant other at session

Question 18

What are the pharmacological therapy options?

Answer 18

Abstinence:
included as can include use of pharmacological treatments which deter misuse e.g. Disulfiram for alcohol abuse, naltrexone after detoxification is complete)

Detoxification:
Pharmacological induction of withdrawal e.g. naltrexone to block opioid receptors plus lofexidine (a2A adrenoceptor agonist) to reduce withdrawal symptoms)

Replacement/substitution therapy:
Replacement of abused substance with, typically, a longer acting but less euphoric substitute (e.g. buprenorphine to replace heroin)
Encourages stability and routine

Formulation or distribution to reduce misuse potential of replacement therapies:
E.g. sublingual buprenorphine and naloxone has poor naloxone (antagonist) bioavailability but, if injected, blocks effects of buprenorphine (and other opiates)

Question 19

Which are the top 5 prescription drugs seized in 2013 and 2014?

Answer 19

1. Buprenorphine
2. Diazepam
3. Testosterone
4. Methadone
5. Sildenafil

Question 20

Describe the role of the pharmacist in substance misuse

Answer 20

Provision of substance misuse services 
Primarily pharmacological therapies
>200,000 people in treatment in a given year (~18 per UK pharmacy)
Reporting missed doses
Needle exchange schemes
Health promotion and harm reduction

Identifying interactions

Detecting misuse:
Unusual patterns of OTC medicine purchase (e.g. of codeine-containing medicines)
Altered prescriptions (quantity, strength)
Diversion of medicines