Substance Related and Addictive Disorders Flashcards
How are substance abuse and substance dependance classified?
mild, moderate, and severe
What are the 5 types of substance abuse/dependance disorders
- substance use disorder
- substance intoxication
- substance withdrawal
- other (induced-mental-disorder)
- unspecified (old NOS)
Name some of the substances that are abused/dependent
- alcohol
- caffeine
- hallucinogens
- inhalants
- opioids
- sedatives
- hypnotics and anxiolytics
- stimulants
- tobaccos and other
What is DSM diagnostic criteria for substance abuse and substance dependence disoders?
- substance is often taken in larger amounts or over a longer period than
- there is a persistent desire or unsuccessful efforts to cut down or control alcohol use
- a great deal of time is spent in activities necessary to obtain, use, or recover from its efforts
- craving, or strong desire or urge to use
- recurrent use resulting in a failure to fulfill major rile obligations at work, school, or home
- continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
- important social, occupation, or recreational activities are given up or reduced bc of the substance
- recurrent use in situations in which it is physically hazardous
- use is continued despite knowledge of having persistent or recurrent physical problems that is likely to have been caused or exacerbated by (drug)
- tolerance - increased or decreased need
- withdrawal - syndrome- or taken to relive or avoid withdrawal symptoms
What are the 4 categories of symptoms of substance use disorders? - describe
- Impaired Control
- using more of a substance or more often than intended
- wanting to cut down or stop but not being able to
= unable to control self around substance… Ill only have 1 drink, end up having 5 - Social Problems
- Neglecting responsibilities and relationships
- Giving up activities they used to care about bc their substance use
- inability to complete tasks at home, school or work - Risky Use
- Using in risky settings
- continued use despite known problems
= drinking and driving, injections - Physical Dependence
- Needing more of a substance to get the same effect (tolerance)
- Having withdrawal symptoms when a substance isn’t used
What are the Substance Use Disorder specifiers:
mild = 2-3 criteria med
moderate = 4-5 criteria are met
severe = 6+ criteria are met
Describe the 3 substance-induced disorders
Intoxication
- reversible symptoms occurring after exposure to a drug
- can occur in those w/o substance use disorder
- not attributed to another medical disorder or mental condition
Withdrawal
- behavioral, physical, and cognitive symptoms occurring after reduction or discontinuation of heavy and prolonged substance use
- not attributed to another medical disorder or mental condition
Other substance/medication induced mental disorder
- psychotic, bipolar, depression, anxiety, OCD, sleep, sexual disorders, delirium, neurocognitive disorders
Describe the etiology of substance use disorders?
Genetic factors:
- genes involved in sensitivity of the reward system
- genes related to neurotransmitter systems
= GABAergic, dopaminergic, glutamatergic, serotonergic, opioid, and cholinergic systems implicated in the vulnerability to alcohol dependence
Neurobiological factors:
- changes in dopamine transmission and reward system
= its about the anticipation/pursuit/ motivation to seek reward
- changes in serotonin system
- evidence for some neurobiological vulnerabilities: reduced dopamine transmission; brain activity measured using EEG
- hard to know if the brain looked like this before substance abuse, or if its a result of
Personality:
- behavioral disinhibition; negative affectivity/neuroticism
Learning models: Jacobs general theory of additions
- self medication and tension reduction
- positive reinforcement -> learned behaviors
- continued use despite harms
- substance abuse as a means to cope with negative affect
- expectancies influence use and relapse
Behavioral tolerance:
- use associated with cues in typical enviro; effects are diminished
- novel environment, no learning effects so drug effects magnified; effects on heroin overdose ( use in a novel environment so don’t have the same behavioral enviroment cues thus overdose)
Role of expectancy effects
- expectancies influence use and relapse
Socio-Cultural factors:
- social learning theory -> influences expectancies and scripts acculturation
- gender effects
(more common in men bc women are more likely to turn to social support than men)
Describe the Biological treatments of substance related disorders
Agonist substitution
- safe drug with a similar chemical composition as the abused drug
- ex. methadone for heroin addiction and nicotine gum or patch
Antagonistic treatment
- drugs that block or counteract the positive effects of substances
- ex. naltrexone for opiate and alcohol problems
Aversive treatment
- drugs that make the injection of abused substances extremely unpleasant
ex. Antabuse (disulfiram) for alcoholism = inhibits metabolism of alcohol causing immediate hangover effects
Efficacy of biological treatments
- usually not effective when used alone ^^above drugs,
Describe the psychosocial treatments
- Cognitive-behavioral, relapse-prevention, address comorbid mental disorder
- impatient vs outpatient care
= little diff in effectiveness - debate over controlled use vs complete abstinence as treatment goals
= abstinence more effective for heavy users - community support programs
= ex. AA
= as effective as CBT, mindfulness-based relapse prevention
= controversial and difficult to evaluation bc lack of manualization/high variation btwn sites
Describe the 3 models of addictions
Model: Sin
Tenants: lack of will; moral ineptitude
Treatment: punishment; shame; retribution
Model: Medical/Disease Model/Syndrome
Tenants: faulty brain function; genetic liability; controlled use never possible
Treatment: AA, inpatient treatment; medications to modulate response to reward
Model: Learning mode
Tenants: additions is a developmental process; societal factors like isolation; adverse events shape learning and reward processing; brain learns from use
Treatments:
developmental growth; psychological intervention
Describe the cycle of addiction
Drink -> fell good -> sleep poorly -> wake up hungover, vow to not drink anymore -> anxiety increases causing you to want to drink -> willpower fails -> drink
Describe the arguments for and against ?Is addiction a brain disease?
YES
- many people use not all get addicted
- genetic risk is important
NO
- brain change is learning, not necessarily disease
- natural process corrupted by subtances
- neural networks are formed by drug use by plasticity (learning thru the use of addictive substances) rather than causing a disease state -> drug addiction
- most people with addition recover without treatment
Describe the Nature and effect of opioids
Opioids
Nature of opiates and opioids
- opiate = natural chemical in opium poppy with narcotic effects
- opioids - refers to a class of natural and synthetic substances with narcotic effects
- such drugs are often referred to as analgesics
- ex. heroin, opium, codeine, and morphine
Effects
- activate body’s enkephalins and endorphins
- low does induce euphoria, drowsiness, and slowed breathing
- high doses result in death
- withdrawal symptoms can be lasting and severe
Describe Cannabis
- previously considered hallucinogen
- depending on individual, could be stimulant, depressant, hallucinogen
– THC is active chemical - produce severe symptoms
- impairment in motivation is not uncommon
- major signs of withdrawal and dependence don’t typically occur
