Substance-Related and Addictive Disorders Flashcards
The leading cause of preventable neurodevelopmental disorders
Prenatal alcohol disorders
The DSM uses two major categories of substance-related disorders:
- Substance use disorders: patterns of maladaptive behaviour involving the use of a psychoactive substance. Substance-use disorders include substance-abuse disorders and substance dependence disorders
- Substance-induced disorders: disorders induced by the use of psychoactive substances, including intoxication, withdrawal syndromes, mood disorders, delirium, and amnesia
Gambling disorder
- used to be considered an impulse control disorder
- DSM 5: classified with other substance use disorders
- commonalities in expression, causes, comorbidity, and treatment with substance use disorders
- the broader category, though not formally mentioned in DSM is process addictions (partial exception is internet gaming disorder)
Hallmarks of disordered substance use
- Tachycardia
- Delirium tremens
- Delirium
- Disorientation
- Physiological dependence (addiction) = tolerance and withdrawal
- Psychological dependence
Top 3 commonly used drugs in North America
- tobacco (~25% of population)
- alcohol (~15% of population)
- marijuana (~5%)
Pathways to drug dependence
- experimentation
> most often in a social context
> no loss of control - routine use
> alterations to lifestyle and personal values
> borrowing, pawning, theft, lying, manipulation
> may still believe they have control - addiction or dependence
> efforts center on avoiding withdrawal symptoms
> life is centered on getting the drug
Drugs of abuse (4)
- depressants = depress CNS activity (alcohol, barbiturates, opiates)
- stimulants = heighten CNS activity (amphetamines, cocaine, nicotine)
- hallucinogens = distort sensory perceptions (eg. synesthesia, colours, sounds, textures) (LSD, PCP, marijuana)
- inhalants = GABA effects (relaxing)
Most commonly consumed intoxicant on Earth
Alcohol
Risk factors for alcoholism
- gender = rates about equal, but women start later and progress faster
- age (starting before 40)
- antisocial personality disorder
- family history (both heritable and modelling effects)
- sociodemographic factors = lower SES and education , aboriginal > non-aboriginal; the damaging effects of alcohol abuse vary across ethnic groups in Canada, likely because of different cultural constraints and biological tolerance of alcohol
Psychological effects of alcohol is…
circumstantially and dose dependent and is also different for everybody
Alcohol can act as a ________ reinforcer
negative
use it to reduce unpleasant internal state; thus keep repeating if successful managing anxiety (or something else) through alcohol
FASD - facial features arise if mom consumes alcohol on which days?
19, 20, 21 of pregnancy
Facial features that arise from FASD
- philtrum (thinner, flat lips)
- shorter eyes and farther spaced apart
- microcephaly (shorter head)
Korsakoff’s syndrome
Alcohol-induced persisting amnestic disorder
- looks like dementia and delirium (confusion, disorientation – idk… person, place, time)
Vitamin B12 injections reduce rather than completely eliminate it
Synesthesia
crossing over of sensory experiences ; ; brain has lost ability to differentiate different sensory channels
Ex: taste colour
Conceptions of alcohol
- moral defects
- behavioural pattern (bad habit)
- disease (genuine)
Dimensions of orientation
person, place, time
T or F. In FASD, a child can have neurological damage without physical/growth impairments
T
T or F. Alcohol consumption has health benefits
T! MODERATION is key;
associated with high levels of HDL, slight decreased chance of developing clotting risk
Maximum amounts of alcohol consumption recommended for men and women
M : <14/wk
F : <9/wk
no more than 2/day for either
Alcohol plays a role in deaths due to:
- snowmobile accidents: 77% of cases
- homicides over 50% of cases
- traffic accidents: over 40%
- boating accidents: about 40%
- suicides: over 20%
Sedatives
Barbiturates
- mostly among middle-aged adults (prescribed to help sleep)
- synergistic effect with alcohol (~4x)
- requires medically supervised withdrawal (hazardous to quit cold turkey; degree of dependence is super high!!)
Intense rush
Opiates (a deep sense of euphoria; painkillers like morphine, heroin)
- narcotics
- analgesics
- endorphins
- —> rewarding effects are high enough that they will go through exhausting activity to get this rush
Amphetamine psychosis
- doesn’t have to be a long period of time (risk factor even for individuals who are reasonably new to it)
- similar to acute schizophrenia spectrum psychosis
Cocaine consumption
- snorted or ingested
- often consumed in binges then crash
- crack - for smoking, fast, concentrated rush
- freebasing (heating with ether)
Effects of cocaine
- birth defects: auditory info processing more than anything
- sexual dysfunction for both M and W
- sharp increases in body temp, respiratory distress, appetite suppression
Mechanisms of overdose
1) Effective vs. Toxic doses (Primary physiological)
- tolerance to intoxicating effects to a drug and the lethal dose both increase over time
- tolerance builds more quickly
**Although toxic dose may move slightly to right, tolerance will increase much more (as said earlier)
In order to get high, they will actually administer closer to the toxic dose = OVERDOSE **
2) Compensatory conditioning
- over the course of conditioning, a CS may elicit physiological CRs that oppose the US (compensatory CRs). These CSs may include contextual cues present during conditioning
- contributes to withdrawal symptoms and tolerance
Heroin
Heroin = use for any period of time and HOOK on it, thus starting dose to lethal dose doesn’t take quick
Neuroadaptation
Brain changes that take place overtime to compensate for the presence of foreign chemicals
explains tolerance
Factors that play a role in cigarette smoking in Canada:
- prevalence of smoking among adults is higher among Aboriginal than non-Aboriginal people, regardless of whether they live in rural or urban environments
- smoking is becoming increasingly concentrated among the poorer and less well-educated segments of the population
Angel dust
PCP (phenylcyclidine)
Effective dose (ED50)
= point necessary to achieve a certain level of intoxication for 50% of the population
Nucleus acumbens
Input pt to the prefrontal cortex
- important esp in young ppl
- all the structures leading up to nucleus acumbens tend to be matured much sooner than rest of cortex; ie, much of the inhibition and executive functioning that doesn’t fully solidify until early in to twenties is less active which is why sometimes we have less favourable decisions being made and more impulsive behaviour
- see this in conduct disordered children
Brain’s reward centers
- neurotransmitters: dopamine
- mesolimbic pathway
- nucleus accumbens
Abstinence violation effect
People believe they are a failure
-> sometimes people will try half heartedly to quit and when they can’t do it, they say “well im obvs a failure” when in REALITY, attempts at quitting increases with sincere and persistent attempts
Self-efficacy
do people believe in themselves?
What you believe is what you get
- amount consumed is influenced by the expectation of alcohol
- actual alcohol content didn’t matter
Biological approaches to treating addiction
- detoxification (first step)
- antabuse (disulfram)
- antidepressants (SSRIs)
- Nicotine replacement therapy
- Methadone Maintenance Program (methadone not different from meth and heroin but not quite as severe either)
- Naloxene & Naltrexone (block high from opiates; poor long-term compliance)
Other approaches to treating addiction
- nonprofessional support groups (Ex: Al-Anon)
- Residential approaches
- Psychodynamic approaches (not very good)
- Behavioural approaches (self-control strategies, aversive conditioning, social skills training)
Relapse-Prevention Training
- Pattern/high risk factor recognition (predictability, behaviours/thoughts/feelings – chains)
- Specific coping strategies (escape/avoidance)
- weekly “bring-backs”
- SUDs (seemingly unimportant decisions – tell tale sign if they become defensive about it)
- Abstinence Violation Effect
Controlled drinking
Closely related to harm reduction
- controversial
- done in 70’s
