Substance related and addictive disorders Flashcards
Substances
- Alcohol,
- Caffeine,
- Cannabis,
- Hallucinogens (ex. LSD)
- Inhalants (ex. glue)
- Opioids (ex. morphine)
- Sedatives ( depressants )
- Hypnotics and anxiolytics (induce drowsiness and decrease emotional tension)
- Stimulants (ex. cocaine)
- Tobacco, and other (or unknown) substances)
DSM DIAGNOSTIC CRITERIA for Substance Abuse
1 Substance is often taken in larger amounts or over a longer period than was intended *
- 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 it’s effects
- Craving, or a strong desire or urge to use. (New) *
- Recurrent use resulting in a failure to fulfill major role 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, occupational, or recreational activities are given up or reduced because of
the substance * - Recurrent use in situations in which it is physically hazardous *
- Use is continued despite knowledge of having a persistent or recurrent physical problem that
is likely to have been caused or exacerbated by (drug) - Tolerance- increased or decreased need *
- Withdrawal- syndrome- or taken to relieve or avoid withdrawal symptoms
2-3 criteria are met - mild
4-5 criteria are met - moderate
6 or more are met - severe
Intoxication
Reversible symptoms occurring after exposure to
a drug
Can occur in those w/o substance use disorder
Not attributable to another medical disorder or
mental condition
Withdrawal
Behavioural, physical, and cognitive symptoms
occurring after reduction or discontinuation of
heavy and prolonged substance use
Not attributable to another medical disorder or
mental condition
Other substance/medication
induced mental disorders
Psychotic, bipolar, depressive, anxiety, OCD,
sleep, sexual disorders; delirium; neurocognitive
disorders
Genetic Factors of Substance Use Disorders
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 of Substance Use Disorders
Changes in dopamine transmission and reward
system
Changes in serotonin system
Evidence for some neurobiological
vulnerabilities: reduced dopamine transmission;
brain activity measured using EEG (p300; beta waves)
Jacobs General Theory of Addictions
- Self-medication and tension reduction
- Positive reinforcement - learned behaviours
- Continued use despite harms
- Substance abuse as a means to cope with negative affect
- Expectancies influence use and relapse
Vicious Addiction Cycle
Drink - feels good - passed out - wake up hungerover - anxiety increase - willpower fails - drink again - feels good …
Tolerance Dependency Model
Anxiety causes Alcohol which lowers anxiety + alcohol tolerance goes up. Withdrawal, anxiety goes up + tolerance goes up.
Agonist Substitution
Safe drug with a similar chemical composition as the abused drug
Examples include methadone for heroin addiction, and
nicotine gum or patch
Antagonistic treatment
Drugs that block or counteract the positive effects of
substances
Examples include naltrexone for opiate and alcohol
problems
Aversive treatment
Drugs that make the injection of abused substances
extremely unpleasant
Examples include antabuse (disulfiram) for alcoholism
Inhibits metabolism of alcohol causing immediate hangover
effects
MODELS OF ADDICTION: Sin
Lack of will; moral ineptitude
Treatment: Punishment; shame; retribution
MODELS OF ADDICTION: Medical/Disease
Model/Syndrome
model
Faulty brain function; genetic
liability; controlled use never
possible
Treatment: AA, inpatient treatment; medications to modulate response to reward
MODELS OF ADDICTION: learning model
Addiction is a developmental
process; societal factors like
isolation; adverse events shape
learning and reward processing;
brain learns from use
Treatment: Developmental growth; psychological intervention
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 substances
* Neural networks are formed by drug use by plasticity
(learning through use of addictive substances) rather
than causing a disease state à drug addiction
* Most people with addiction recover without treatment
Opioids
refers to a class of natural and synthetic substances
with narcotic effects
Opiate
natural chemical in the opium poppy with narcotic
effects (i.e., pain relief)
Cannabis
*Previously considered a hallucinogen
* Depending on individual, could be stimulant,
depressant, hallucinogen (and depending on type of
cannabis)
* Active psychoactive chemical is tetrahydrocannabinol
(THC)
* May produce several symptoms (e.g., Mood swings,
paranoia, hallucinations)
* Impairment in motivation is not uncommon (i.e.,
Amotivational syndrome)
* Major signs of withdrawal and dependence do not
typically occur
THC
euphoria, anti-inflammatory,
psychosis
CBD
non-psychoactive, anti-anxiety,
antipsychotic?
Perhaps CBD or other cannabinoids
may ultimately play a role in ongoing
treatment of psychosis
Short-Term Problems with Cannabis
decision-making, driving, psychotic-like experiences
Long-Term Problems with Cannabis
Poorer cognition, increased anxiety, increased depression, increased risk for psychosis
