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Psychopathology > Substance-Related and Addictive Disorders > Flashcards

Substance-Related and Addictive Disorders Flashcards

1
Q

Substance-Related and Addictive Disorders

A
  • Alcohol-Related Disorders (use, intoxication, withdrawal, other, unspecified)
  • Caffeine-Related Disorders (intoxication, withdrawal, other, unspecified)
  • Cannabis-Related Disorders (use, intoxication, withdrawal, other, unspecified)
  • Hallucinogen-Related Disorders (Phencyclidine/Other Hallucinogen use, intoxication, other, unspecified, and Hallucinogen Persisting Perception Disorder)
  • Inhalant-Related Disorders (use, intoxication, other, unspecified)
  • Opioid-Related Disorders (use, intoxication, withdrawal, other, unspecified)
  • Sedative-, Hypnotic-, or Anxiolytic-Related Disorders (use, intoxication, withdrawal, other, unspecified)
  • Stimulant-Related Disorders (use, intoxication, withdrawal, other, unspecified)
  • Tobacco-Related Disorders (use, withdrawal, other, unspecified)
  • Other Substance-Related Disorder (use, intoxication, withdrawal, other, unspecified, non-substance-related)
  • Gambling Disorder
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2
Q

DSM-IV to DSM-5

A
  • DSM-IV: differentiated between abuse and dependence
  • DSM-5: “substance use disorders”; intoxication and withdrawal independent diagnoses; “substance-induced disorders”
  • –included 10 classes of substances
  • –deleted legal problems and added craving
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3
Q

Abuse

A
  • Difficulty with role obligations (in job, as parent, friend, student)
  • Repeated use in hazardous situations (while driving, operating machinery)
  • Repeated legal problems (DUI, etc.)
  • Continued use despite social/interpersonal problems
  • One may exhibit high levels of abuse without becoming dependent
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4
Q

Dependence

A
  • Tolerance (need higher doses for effect)
  • Withdrawal (negative reaction when substance discontinued)
  • Take larger amounts or over longer periods than intended
  • Desire to reduce use or unsuccessful efforts to reduce use
  • Substance-related activities consume high amounts of time
  • Stop other social, occupational, or recreational pursuits
  • Continued use despite knowing problems
  • Not synonymous with addiction (DSM-5 combined abuse and addiction)
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5
Q

Addiction

A
  • Progressive behavior pattern compromising biology, psychology, and sociology
  • Behaviors include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, craving
  • People can be addicted but not physically dependent (e.g. chippers)
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6
Q

Intoxication

A
  • Immediate effects of the drug
  • Symptoms that are reversible and specific to the substance ingested
  • Maladaptive behavioral or psychological changes due to effect of substance on CNS
  • Develop during or shortly after use
  • Not due to medical condition or other MD
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7
Q

Alcohol Use Disorder

A

A) Problematic use of alcohol as characterized by 2+ in 12 months:

  • Large amounts, over longer periods than intended
  • Desire to stop
  • Great deal of time spent
  • Cravings
  • Unable to fulfill obligations, interpersonal/occupational problems
  • Hazardous use and/or use despite knowing hazards
  • Tolerance
  • Withdrawal
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8
Q

Alcohol Intoxication

A 
A) Recent drinking
B) Problematic behavioral or psychological changes during or shortly after drinking
C) One or more:
- Slurred speech
- Incoordination
- Unsteady gait
- Nystagmus 
- Attention/memory impairment
- Stupor or coma
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9
Q

Alcohol Withdrawal

A

A) Stop or significantly reduce heavy/prolonged use
B) 2+ of following
- Autonomic hyperactivity (e.g., sweating, pulse rate)
- Hand tremor
- Insomnia
- Nausea or vomiting
- Transient hallucinations or illusions
- Psychomotor agitation
- Anxiety
- Generalized tonic-clonic seizures
C) Distress or impairment
D) Not due to medical condition or other MD
Specify if with perceptual disturbances (hallucinations with intact reality testing)

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10
Q

Cannabis Use Disorder

A

A) A problematic pattern of cannabis use with 2+ of following in 12 months:

  • Taken in larger amounts or over a longer period than intended
  • Desire or unsuccessful efforts to cut down
  • A great deal of time spent
  • Craving
  • Failure to fulfill major role obligations at work, school, home
  • Continued use despite social or interpersonal problems, occupational problems
  • Hazardous use, continued use despite known hazards
  • Tolerance
  • Withdrawal
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11
Q

Cannabis Intoxication

A 
A) Recent use of cannabis
B) Clinically sig problematic behavioral or psychological changes (e.g., impaired motor coordination, sensation of slowed time)
C) 2+ of following within 2 hours:
- Conjunctival injection
- Increased appetite
- Dry mouth
- Tachycardia (increased heart rate)
D) Not attributable to other medical condition or MD
Specify if with perceptual disturbances
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12
Q

Cannabis Withdrawal

A

A) Cessation of cannabis use that has been heavy and prolonged
B) 3+ of following within 1 week after criterion A:
- Irritability, anger, aggression
- Nervousness or anxiety
- Sleep difficulty
- Decreased appetite or weight loss
- Restlessness
- Depressed mood
- Abdominal pain, shakiness/tremors, sweating, fever, chills, or headache
C) Distress or impairment
D) Not attributable to another medical condition or MD

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13
Q

CNS Depressants

A
  • CNS Depressants: alcohol, downers, sedatives (barbiturates, benzodiazepines), opiates (heroin, morphine)
  • physical addiction potential is very high
  • withdrawal can be fatal
  • detox in hospital is essential for severe users
  • high potential for injury or death due to dangerous behavior
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14
Q

Inhalants

A
  • Inhalants: paint, butyl nitrite, glue, gas, etc.
  • Effects are almost immediate
  • Prognosis is very poor; brain damage, homelessness, jail, death
  • Popular among teenagers; youth in third world countries
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15
Q

Stimulants

A
  • Stimulants: cocaine, amphetamines, MDMA
  • Highly psychologically addictive; not nearly as physically addictive (low withdrawal)
  • Low recovery rates
  • High potential for heart, kidney, and brain damage
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16
Q

Marijuana

A
  • Not considered physically addictive, but psychologically addictive
  • Lung damage possible; possible risk factor for later psychotic disorders
  • Memory and cognitive deficits while intoxicated; may remain for chronic users
  • New weed more potent?
17
Q

Hallucinogens

A
  • Hallucinogens: LSD, Mescaline, Psilocybin, MDMA
  • No physical addition but psychological addiction is possible
  • Acting on delusions is rare
  • Possible long-lasting or permanent effects on brain (especially on serotonin with ecstasy and LSD)
  • Evidence of flashbacks mostly anecdotal
  • Faked or mismanufactured substance a high possibility
18
Q

Phencyclidine (PCP)

A
  • PCP: very unpredictable
  • Many psychological and physical effects: alterations in mood, belligerence, poor judgment, hallucinations, perceptual atypicalities, euphoria, paranoia, confusion, numbness, poor coordination, slurred peech, catatonia, coma, death
  • Similar to disorganized schizophrenia?
19
Q

Gender Differences

A
  • Men more likely to use in general

- Women’s misuse more likely to be in response to stress, self-medicating a mental illness, etc.

20
Q

Demographic Correlates

A
  • Lower education
  • Ethnicity (Native Americans highest rates, then Caucasians, Hispanics, African Americans)
  • African Americans less likely to use but persistent dependence more likely for those who do use (SES may be a confound and may relate to poor access to services)
  • Hispanic youth use alcohol and other hard drugs more than Caucasian and African American males
  • High rates of alcohol abuse and dependence among Native American and Alaskan Natives
21
Q

Moral Model of Addiction

A
  • Use has poor character/no willpower
  • Guilt based
  • Value judgments
  • Abstinence is the goal
  • Demotivating
  • High cost
  • Blamed for ill-conceived (and ineffective) plans like “just say no,” prohibition, DARE, the war on drugs
22
Q

Medical Model of Addiction

A
  • Some validity as it pertains to etiology and treatment
  • Inherited vulnerability is accepted for alcohol
  • Dependence is primarily a biological phenomenon
  • Drug effects and damage are often biological
  • Abstinence is the goal
  • Model of addiction as a disease is debated
  • Some, but not all, respond well to accepting oneself as diseased and helpless (essentially 12-step) model for treatment
23
Q

Spiritual Model of Addiction

A
  • 12 step model
  • Weak in spirit (character)
  • Need higher power (God or another entity)
  • Abstinence is the goal
  • Seems that it can work for people with these belief systems
  • Social support thought to be aplus
  • Abstinence likely best choice for chronic users
  • This model can be wrong for many people
24
Q

Biobehavioral Interactionist Models of Addiction

A
  • Simply superior to the others
  • Includes good parts of the other models
  • Not based in blaming the user
  • Explains addiction via genetics, modeling, maladaptive coping, conditioning, physiological dependence, and sociocultural factors
  • Goals: harm reduction, gaining control, abstinence
25
Q

Etiological Factors of Addiction

A
  • Genetics
  • Learning
  • Family
  • Life Stress
  • Culture
  • Cognitions
26
Q

Etiological Factors: Genetics

A
  • Strong support for involvement in alcohol use
  • Link not as strong for other drugs
  • Effect more clear for males than females
  • Heredity explains quarter to half of variance in drug abuse/dependence
27
Q

Etiological Factors: Learning

A

Mowrer’s 2-factor

  • Classical: euphoria caused by substance paired with context stimuli; phobic response conditioned by withdrawal symptoms; use to obtain pleasure AND avoid pain
  • Operant: receive chemical reward, receive relief from withdrawal reward, receive social reward (fitting in), receive functional reward (avoid social anxiety), comfort engaging in structure of habit
28
Q

Etiological Factors: Family

A
  • Healthy family bonds reduce risks
  • Conflict/ lack of cohesion increases risk
  • Modeling of use/maladaptive coping behaviors in family
  • Parental monitoring
  • Greatest risk: genetic risk combined with antisocial or substance abusing parents, low parental involvement, few affectionate/supportive parent-child interactions
29
Q

Etiological Factors: Life Stress

A
  • Use associated with significant loss, failure, relationship problems, legal troubles, etc.
  • Substance abuse within families can be sources of stress
  • The abusing/dependent lifestyle itself can be very stressful once started
30
Q

Etiological Factors: Culture

A
  • Culture normalizes drug/alcohol use; increases the likelihood of any given person developing a problem (few alcoholics in countries where alcohol use in not culturally accepted)
31
Q

Etiological Factors: Cognitions

A
  • Expectancies: positive expectations about drug use common among those who become addicted; those with negative expectancies less likely to use
  • Misperceptions of normality: “everyone’s doing it”
  • —- think own use is in normal range, denial, selective memory
32
Q

Ouzir and Errami article

A
  • vulnerability to drug addiction suggests an interaction between many brain systems (reward system, decision making system, serotonergic system, oxytocin system, interoceptive insula system, stress system…), genetic predisposition, sociocultural context, impulsivity, and drug types
33
Q

Petry et al. article

A
  • study using the NODS screener for gambling problems
  • findings: Eliminating the illegal acts criterion did not impact internal consistency and modestly improved variance accounted for in the factor structure. In comparing a classification system using four of ten criteria versus one using four of nine, the four of nine system yielded equal or slightly better classification accuracy in all comparisons and across all samples
  • recommendations: eliminate the criterion related to committing illegal acts and reduce the threshold for diagnosis from five to four criteria

Psychopathology (16 decks)

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