Substance Related, Addictive & Impulse Control Disorders Flashcards
Impulse control disorders represent what?
A number of related problems that involve the inability to resist acting on a drive or temptation.
What problems do impulse control disorders include?
Aggressive impulses
Stealing impulses
The impulse to set fires
The term substance refers to?
Chemical compounds that are ingested to alter mood or behaviour.
Psychoactive substances include?
Cocaine, heroine etc but also includes alcohol, nicotine, caffeine etc (anything that effects mood and behaviour)
Substance use refers to?
The ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning.
Like smoking the occasional joint or having a cup of coffee in the morning.
Intoxication refers to?
Our physiological reaction to ingested substances-drunkenness or getting high
The DSM-5 defines substance use disorders in terms of?
How significantly the use interferes with the user’s life.
How many criteria must someone meet to meet criteria for substance use disorder?
For at least 2 symptoms in the past year that interfered with their life or bothered them a great deal.
In regards to substance use disorders, someone with four or five symptoms are considered to fall in the ,,, range.
Moderate
In regards to substance use disorders, someone with six or more symptoms are considered to have ?
A severe substance use disorder
Substance use disorders: tolerance and withdrawal - withdrawal from many substances can bring on what?
Chills, diarrhoea, nausea, vomiting, aches and pains.
Substance use disorders: tolerance and withdrawal - withdrawal from alcohol can cause alcohol withdrawal delirium which is an extreme example and is characterised by?
Frightening hallucinations and body tremors
Cocaine withdrawal has a pattern that includes?
Anxiety, sleep changes , lack of motivation and boredom.
Cannabis withdrawal includes symptoms such as?
Irritability, nervousness, appetite change, and sleep disturbances.
Other symptoms that make up substance use disorder include “drug seeking behaviours”. Give examples.
A desperate need to ingest more of the substance, The repeated use of a drug )stealing money to buy drugs)
In the DSM-5, substance-related disorders include how many symptoms, ranging from relatively mild (such as substance use results in failure to fulfill major role obligations ) to more severe (for example, occupational or recreational activities are given up or reduced because of substance use)
11 symptoms
Researchers estimate that almost 3 quarters of the people in addiction treatment centers have an additional psychiatric disorder. What percentage of these people with mood disorders?
More than 40%
Researchers estimate that almost 3 quarters of the people in addiction treatment centers have an additional psychiatric disorder. What percentage of these people with anxiety and posttraumatic stress disorder (PTSD)?
More than 25%
Substance use might occur concurrently with other disorders due to chance etc. Drug intoxication can cause symptoms of anxiety, depression and psychosis, adding to the complicated nature of substance-related disorders and thus diagnosis. For someone to be diagnosed with a seperate disorder like schizophrenia or depression, how many weeks after they stopped taking substances would these symptoms need to persist?
6 weeks after
Name the following general category of problematic behaviour:
These substances result in behaviour sedation and can induce relaxation. They include alcohol and the sedative and hypnotic drugs in the families of barbiturates (for example, Seconal) and benzodiazepines (for example, Valium and Xanax).
Depressants
Name the following general category of problematic behaviour:
These substances cause us to be more active and alert and elevate mood. Included in this group are amphetamines, cocaine, nicotine, and caffeine.
Stimulants
Name the following general category of problematic behaviour:
The major effect of these substances is to produce temporary analgesia (reduce pain) and euphoria. Heroin, Kratom, opium, codeine, and morphine and included in this group.
Opiates
Name the following general category of problematic behaviour:
These substances alter sensory perception and can produce delusions, paranoia, and hallucinations. Cannabis and LSD are included in this group.
Hallucinogens
Name the following general category of problematic behaviour:
Other substances that are misused but do not fit neatly into one of the categories here include inhalants (for example, airplane glue), anabolic steroids, and other over the counter and prescription medications (for example, nitrous oxide). These substances produce a variety of psychoactive effects that are characteristic of the substances described in previous categories.
Other commonly misused substances
Name the following general category of problematic behaviour:
As with the ingestion of substances described, individuals who display gambling disorder are unable to resist the urge to gamble which, in turn, may result in negative personal consequences (such as divorce and loss of employment)
Gambling disorder
Clinical description; apparent stimulation is the initial effect of alcohol, although it is a depressant. We generally experience a feeling of well being, our inhibitions are reduced, and we become more outgoing. Why is this?
Because the inhibitory centers in the brain are initially depressed - or slowed.
Name 2 types of organic brain syndromes that can result from long term heavy alcohol use.
Dementia and Wernicke-Korsakoff syndrome
Dementia (or neurocognitive disorder) involves what?
The general loss of intellectual abilities
Wernicke-Korsakoff syndrome results in what symptoms?
Confusion, loss of muscle coordination, and unintelligible speech
Dementia by way of excessive amounts of alcohol is a direct result of?
Neurotoxicity or poisoning of the brain
Wernicke-Korsakoff syndrome is believed to be caused by a deficiency in?
Thiamine, a vitamin metabolised poorly by heavy drinkers
What syndrome is now generally recognised as a combination of problems that can occur in a child whose mother drank while pregnant?
Fetal alcohol syndrome
What are these symptoms associated with? Fetal growth retardation, cognitive deficits, behavioural problems and learning difficulties.
Fetal alcohol syndrome
We metabolise alcohol with the help of an enzyme called ?
Alcohol dehydrogenase (ADH)
Three different forms of the enzyme alcohol dehydrogenase have been discovered. Which form has been found to be prevalent among children with Fetal Alcohol Syndrome and among what group of people is this variant most commonly found?
Beta-3 ADH
African Americans
Jellinek analysed only 98 out of the 1600 surveys sent out by the newly formed self-help organisation Alcoholics Anonymous in 1945 and developed a four-stage model for the progression of alcoholism. Yet this faulty study appears to be inaccurate. Was was predictive of later alcoholic disorders in an Australian study of adolescents?
Early onset heavy drinking
In another study, what age of starting to consume alcohol was predictive of higher risk for chronic and severe alcohol use disorders?
11 or earlier
Research on the mechanisms responsible for the differences in early alcohol use suggests that a person’s response to the sedative effects of the substance affects later use. In other words, those who do not develop the slurred speech, staggering, and other sedative effects of alcohol are more likely to use it in the future. Why is this of particular concern?
Given the current trend to mix highly caffeinated drinks with alcohol which can reduce the sedative effects of alcohol, thus increasing the chances of later excessive use.
The general group of depressants in addition to alcohol also includes sedative, hypnotic, and anxiolytic drugs. What effect does each have?
Sedative = calming
Hypnotic = sleep inducing
Anxiolytic = anxiety reducing
For the group of depressants being sedative, hypnotic, and anxiolytic drugs. Name the 2 drug families associated.
Barbiturates and benzodiazepines
Clinical description: at low doses, barbiturates?
Relax the muscles and can produce a mild feeling of wellbeing
Clinical description: at larger doses, barbiturates?
Can have similar results to those of heavy drinking: slurred speech and problems walking, concentrating , and working.
Clinical description: at extremely high doses, barbiturates?
Diaphragm muscles can relax so much that they cause death by suffocation
Like barbiturates, benzodiazepines are used to calm an individual and induce sleep. In addition, drugs in this class are prescribed as muscle relaxants and anticonvulsants (anti seizure medications). People who use them for nonmedical reasons report first feeling?
A pleasant high and a reduction of inhibition, similar to the effects of alcohol.
Like barbiturates, benzodiazepines are used to calm an individual and induce sleep. In addition, drugs in this class are prescribed as muscle relaxants and anticonvulsants (anti seizure medications). People who use them for nonmedical reasons will with continued use, however, possibly develop?
Tolerance and dependence
Stimulant Related Disorders: Amphetamines at low doses can induce?
Feelings of elation and vigorous and can reduce fatigue.
Amphetamines are prescribed for people with?
Narcolepsy
DSM-5 criteria for intoxication in amphetamine use disorders include?
Significant behavioural symptoms such as;
Euphoria or affective blunting (a lack of emotional expression), changes in sociability, interpersonal sensitivity, anxiety, tension, anger, stereotyped behaviours (repetitive motor movements), impaired judgment, and impaired social or occupational functioning.
In addition, physiological symptoms occur during or shortly after amphetamine or related substances are ingested and can include?
Heart rate or blood pressure changes, perforation or chills, nausea or vomiting, weight loss, muscular weakness, respiratory depression, chest pains, seizures, or coma.
Amphetamines stimulate the central nervous system by …?
Enhancing the activity of norepinephrine and dopamine. Specifically, amphetamines help the release of these neurotransmitters and block their reuptake, thereby making more of them available throughout the system.
Too much amphetamine, and therefore too much norepinephrine and dopamine can lead to hallucinations and delusions. This effect has sparked theories on the causes of which disorder?
Schizophrenia
Clinical description: like amphetamines, in small amounts cocaine increases?
Alertness, produced euphoria, increases blood pressure and pulse, and causes insomnia and loss of appetite.
Cocaine is in the same group of stimulants as amphetamines because?
It has similar effects on the brain.
The cocaine experience of being “up” seems to come primarily from the effects of cocaine on the?
Dopamine system
Cocaine enters the bloodstream and is carried to the brain where the cocaine molecules act to?
Block the reuptake of dopamine
Few negative effects are noticed at first, but with continued cocaine use?
Sleep is disrupted, increased tolerance causes a need for higher doses, paranoia and other negative symptoms set in, and the user gradually becomes socially isolated. Chronic use may result in premature aging of the brain.
Cocaine withdrawal produces
pronounced feelings of apathy and boredom. You are bored with everything and find little pleasure from everyday activities.
The DSM-5 does not describe an intoxication pattern for tobacco (nicotine ) related disorders, rather it lists withdrawal symptoms, which include what?
Depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness, and increased appetite and weight gain
Nicotine in small doses stimulates the central nervous system and can?
Relieve stress and improve mood. However, it can also cause high blood pressure, can increase the risk of heart disease and death worldwide.
High doses of nicotine can?
Blur vision, cause confusion, lead to convulsions, and sometimes even cause death
The high or “rush” experienced by opioid users comes from activation of the body’s natural opioid system. In other words, the brain already has its own opioids that provide narcotic effect. These are called?
Enkephalins and endorphins
The DSM-5 diagnostic criteria for hallucinogen intoxication are similar to those for cannabis. They include?
Perceptual changes such as subjective intensification of perceptions, depersonalisation, and hallucinations. Physical symptoms include, pupillary dilation, rapid heartbeat, sweating, and blurred vision.
Hallucinogens seem to affect the brain in diverse snd nonspecific ways, meaning by affecting multiple different receptors at one time in opposing ways. It is thought that this broad impact on brain receptors may lead to?
Consciousness expanding experienced by some.
Most of these hallucinogen drugs bear some resemblance to neurotransmitters: LSD, psilocybin, lysergic acid amide, and DMT are chemically similar to?
Serotonin
Mescaline (hallucinogen) chemically resembles?
Norepinephrine
Inhalant use is highest in what age group and in what environments?
Ages 13 to 14, especially in those in correctional or psychiatric institutions.
Additionally, higher rates of inhalant use are found among Native Americans and white persons, as well as those who live in rural or small towns, come from disadvantaged backgrounds, have higher levels of anxiety and depression, and show…?
More impulsive and fearless temperaments
The high associated with the use of inhalants resembles that of alcohol intoxication and usually includes…?
Dizziness, slurred speech, lack of coordination, euphoria, and lethargy.
Withdrawal from inhalants which involves sleep disturbance, tremors, irritability and nausea can last from ..
2 to 5 days
Long term use of inhalants includes ..?
Damage to bone marrow, kidneys, liver, lungs, nervous system, and the brain
Research on the long term effects of steroid use seems to suggest that mood disturbances are common, for example.?
Depression, anxiety, and panic attacks
In terms of familial and genetic influences, what is the field of research that looks to answer the question oh how genes function when it comes to addiction?
Functional genomics
What are the psychological dimensions of substance use?
Positive reinforcement (pleasurable feelings)
Negative reinforcement (to escape from unpleasantness)
Causes of substance-related disorders (p 424): what are the 2 biological dimensions?
Familial and genetic influences
Neurobiological influences (the activation of the brain’s pleasure pathway)
Social dimensions of substance use (p 428); Two views of substance related disorders characterise contemporary thought being?
The moral weakness model of chemical dependence
The disease model of physiological dependence
The moral weakness model of chemical dependence - drug use is seen as a failure of self control in the face of temptation. This type of perspective is this?
Psychological perspective
The disease model of physiological dependence assumes that drug use disorders are caused by an underlying physiological cause. What type of perspective is this?
Biological perspective
As per the moral weakness model of chemical dependence acts to punish those afflicted with the disorder. Whereas a disease model includes seeking treatment for a medical problem, sending messages that …?
The disorder is out of their control
Treatment for substance related disorders focuses on multiple areas. The national institute on drug abuse (p 431) recommends how many principles based on more than 35 years of research?
13
Antagonist drugs act to?
Block or counteract the effects of psychoactive substances.
Or
What is aversive treatment?
Clinicians may prescribe drugs that make ingesting the misused substances extremely unpleasant
Controlled use studies for alcohol as opposed to abstinence indicates (p 434)?
Controlled drinking is at least as effective as abstinence but neither treatment is successful for 70% to 80% of patients over the long term.
Component treatment: (p 435) Aversion treatment uses what type of model?
A conditioning model
Component treatment (p 435): What is covert sensitisation?
It follows the conditioning model for treatment aversion and involves imaging unpleasant scenes, picturing yourself having a drink to then being interrupted with visions of becoming violently ill
Component treatment p 435: name the below component that seems to be a valuable part of therapy for substance use.
The clinician and client together select the behaviours that the client needs to change and decide on the reinforcers that will reward reaching certain goals (like money or small retail items).
Contingency management
Component treatment p 435: name the following package of treatments.
First, a friend or relative who is not a substance user is recruited to participate in relationship therapy. Second, clients are taught how to identify the antecedents and consequences that influence their drug taking. This includes recognising relationships with whom for example they use cocaine with, and thus to avoid these relationships. Third, clients assisted with employment, education and finances, or other services aimed at minimising stress. Fourth, new recreational options help replace substance use with new activities.
Community reinforcement approach
Strong empirical evidence that this approach is effective for alcohol and cocaine use
Component treatment p 435: Name the below increasingly common intervention approach .
Aimed at building an awareness that the user has a problem and helping the user be willing to change. Reminds the client of what they cherish most and that any change will be beneficial.
Motivational enhancement therapy (MET)
Component treatment p 435: name the below approach.
Is an effective treatment approach for many psychological disorders and is one of the best designed and best studied approaches for treating substance dependence. This treatment addresses multiple aspects of the disorder, including a person’s reactions to cues that lead to substance use (like being among certain friends), and thoughts and behaviours to resist use. Also addressed the problem of relapse.
Cognitive behavioural therapy (CBT)
Heroin and methadone are … which means they affect the same neurotransmitter receptors.
Cross tolerant
The ….. model involves therapy that helps individuals remove ambivalence about stopping their drug use by examining their beliefs about the positive and negative aspects of drug use.
Relapse prevention
P 435 Another target of CBT
P 438 Research shows strong similarities in the biological origins of gambling disorder and what disorders?
Substance abuse disorders
The following is characteristic of what disorder?
Poor impulse control and risky decisions are both processes that involve ventromedial prefrontal cortex, and individuals with higher problems in these areas also show poorer response to treatment and higher relapse rates. P 438
Gambling disorder
Gambling disorder p 438
Evidence of effectiveness for gamblers anonymous (that incorporates the 12 step program ) suggests that 70% to 90% drop out of these programs and that the desire to quite …. ?
Must be present before intervention
Name 2 addictive disorders listed in the DSM-5
Gambling disorder
Internet gaming disorder
P 438 name 3 impulse control disorders as per the DSM-5
Intermittent explosive disorder
Kleptomania
Pyromania
Intermittent explosive disorder: recent studies have proposed that there is a diary of the orbital frontal cortex’s role ( the executive part of the brain) in inhibiting amygdala activation ( emotional part of the brain), combined with changes in the ….? P 439
Serotonin system
