Substance use Flashcards
Whats the DSM 5 criteria for substance use disorder
Need 2 or more within a year:
- Taking more of the substance than intended
- Desire to cut down use but unable to do so
- Excessive time spent using/acquiring/recovering
- Craving
- Role disruption (e.g. at work)
- Interpersonal problems (e.g., arguments about use)
- Reduction of important activities (social, hobbies, work)
- Use in physically hazardous situations (e.g. driving)
- Keep using despite causing problems
- Tolerance
- Withdrawal
How many symptoms for Mild, moderate and severe substance use
Mild: 2-3
Moderate:4-5
Severe: 6+
What is tolerance?
Effects of the drug are less if usual amount taken
Larger doses are needed to produce the desired effect
What is withdrawal?
Negative psychological and physical symptoms when reducing or stopping use
Substance taken to relieve/avoid withdrawal symptoms, ie. f the person doesn’t consume the drug they feel worse
What are examples of withdrawal symptoms?
Sensitive to pain
Low mood
Anxiety
Sweating
Lack of appetite
Flu like symptoms
Vomiting
Insomnia
What are the 5 main categories of substances?
Depressants
Stimulants
Opiates
Hallucinogens
Other drugs of abuse
What do depressants do
Give examples
Behavioural sedation
Examples:
Alcohol
Sedatives
Anxiolytics
What do stimulants do
Give examples
Increases alertness and elevates mood
Examples:
Cocaine
Nicotine
What do opiates do
Give examples
Produces euphoria and analgesia(reduces pain)
Examples:
Heroin
Morphine
Codeine
What do hallucinogens do
Give examples
Alter sensory perception
Examples:
Marijuana
LSD
What are other drugs of abuse
Inhalants
Anabolic steroids
Club/designer drugs
What class of substance is an alcohol
Its a depressant, it slows down the funntioning of the central nervous system
How does Alcohol effect the brain
- Alcohol stimulates Gamma-aminobutyric acid GABA receptors
- Makes the person feel relaxed but also causes motor impairment
- Increases serotonin and dopamine initially
- Decreases glutamate- impairs memory/judgement
What happens when someone consumes larger quantities of alcohol?
- Limbic system n o longer inhibited, emotions are more exaggerated and mood swings
- Hippocampus compromised interfering with the ability to form new memories- blackouts
- All initial effects are amplified,ie. mood sleepiness
What is BAC
Blood alcohol concentration
The percentage of your blood that is concentrated with alcohol
What are factors related to BAC
Amount ingested in a period of time
Empty/full stomach
Size of body
Efficiency of liver
Gender
What are the consequences of alcohol abuse
Acute withdrawal symptoms
Headache,nausea
Anxiety/depression
Organ failure
fetal alcohol syndrome
Delirium
Tremens- DTs
Whats the prevalence of alcohol abuse
8.5% of the US population
Prevalence of alcohol use in Ireland
Half of the Irish population aged 18-64 classified as harmful drinkers
What are the effects of other depressants
Similar to using large doses of alcohol
What are the categories of depressants
How do all these drugs exert their influence
Sedative
Hypnotic
Anxiolytic
Rohypnol
Influence through GABA
What do sedatives do and give an example
Calming
Barbiturates
What do hypnotic drugs do and give an example
Sleep inducing
GHB
What do anxiolytics do and give an example
Reduce anxiety
Benzodiazepines
What does rohypnol do and give an example
Date rape drug, sedative effects 10 times stronger
Diazepam
What are stimulants?
Stimulants act on the brain and the sympathetic nervous system to increase alertness and motor activity.
What are examples of stimulants?
ADHD meds- adderall/ritalin
Cocaine
Methamphetamine- meth
Ecstasy-MDMA
Crystal meth
Nicotine
Coffee- not recognised as a disorder
What does amphetamine do
Increases heart rate and increases confidence
reduces fatigue
Large doses can cause anxiety, agitation or nervousness
Can be followed by extreme fatigue and depression
How does amphetamine work?
It stimulates the central nervous system by increasing dopamine,norepinepherine
What does dopamine do
Makes you feel reward
What does norepinephrine/noradrenaline do?
Prepares the body for flight/fight
Who was cocaine made by
Pharmacist John Pemberton in 1886
What does cocaine do?
Similar to amphetamine
Effects shorter lived due to shorter half-life
Reduced fatigue
Vasoconstrictor- narrow blood vessels - increases risk of stroke
What does cannabis do
Effects vary from person to person
Experience euphoria, laughter
Short term memory impairment
Apetite stimulation
Pain relief
How does cannabis work
Brains have endogenous cannabinoids- effects pleasure/memory
Cannabis causes dopamine release
Delta 9 tetrahydrocannabinol/THC causes the high
CBD/cannabidiol doesn’t cause high and has medical potential
The progression of cannabis use
Marijuana is now more potent than ever before – the ratio of THC to CBD is increasing
When you have too much product, THC acutely induces psychotic symptoms (paranoia, hallucinations, disorganized thought)
Whats the link between cannabis use and schizophrenia?
Someone who used cannabis more than 50 times has a relative risk of developing schizophrenia than non- users
BUT
schizophrenia rates haven’t increased with increases of overall cannabis use in the population
What are opioids?
Opioids are natural and synthetic substances w narcotic effects
They are analgesics
What are examples of opioids
Heroin
Codeine
Morphine
Hydrocodone
Oxycodone
What do opioids do
Reduce pain
Low doses induce euphoria
high doses can result in death
Withdrawal symptoms can be lasting and severe.
What are analgesics
Painkillers
Work similar to endorphins(natural opioids)
Can produce through exercise
Why do we need to use opioids sometimes?
Why is this a problem sometimes?
Because humans aren’t good at producing enough to deal with pain.
LEADS TO THE RISK OF ADDICTION AND OVERDOSE
Whats the opioid epidemic
They were marketed to treat chronic pain conditions
But they were highly addictive
Tolerance and withdrawal happened frequently
People would then turn to heroin because it was cheaper
Whats the genetic aetiology of Substance disorders
Twin studies suggest that genetics play a substantial role
Not for a particular disorder, but the disorders in general
Some have specific genesis. Alcohol-ADH2
Whats the neurological aetiology of Substance use disorders
They affect the pleasure pathway of the brain
Withdrawal is the driving factor
Whats the incentive sensitisation theory?
The liking of a drug plays a role initially but then the brain becomes hypersensitive to drug cues so it becomes a wanting thing
Whats the psychological aetiology of Substance use disorders
They are more habit prone
More compulsive
Temporal discounting- higher cost on waiting
Whats the environementall/social/cultural aetiology of substance disorders
Family/ peers can influence
Binge drinking pressured for naive 14 year olds
What is valence?
How happy or sad the effect is
Whats the pharmacological treatment for Substance use disorders
Agonist substitution-similar drug but not as dangerous
Antagonist treatment- a drug that blocks the effects of the addictive drug
Aversive treatment: drug that makes the initial drug implant
What are the types of treatment for Substance use
Interventions
Community support programs
Contingency management
Controlled use
CBT
Interventions
Confront sufferer and ask them to go to rehabilitation
Community support programs
Alcohols anonymous
Learn to live with the addiction
Effective for some, but not all benefit
Contingency management
Vouchers for good behavior.
CBT
Highlight the consequences of use
Increase motivation to change
Train coping skills
Addiction is the most stigmatised disorder
Highly criminalised
Should be a public health issue, to prevent all the consequences that stem from them
