Substance use/abuse Flashcards
how costly is substance use/abuse to economy?
~20 billion a year
substance-related disorders : alter patterns of?
thinking, feeling and behaving
DSM-5, what counts as substance-related and addictive disorders?
use of depressants, stimulants, opiates, hallucinogens and gambling
further categorization of specific diagnoses
- dependence
- abuse
- intoxication
- withdrawal
define substances in abuse
drugs that, when taken in excess, have some direct activation of brain-rewards system
- powerful reinforcers + impact/interfere with memory
what are issues with abuse?
produce intense activation of reward system, that normal activities of daily life are neglected.
how many classes of drugs involved in substance-related disorders?
10
what is the high
pharmacological mechanisms by which each class of drugs produces reward are different, but the drugs typically activate the system and produce feelings of pleasure
who is particularly predisposed to developing substance use disorders?
those with lower levels of self-control.
- roots of substance use disorders are in place before the behaviour starts
what is physiological dependence defined by?
tolerance + withdrawal
what is tolerance?
need for greater amounts of some drug to achieve similar effect
what is withdrawal?
physical response that comes in place when substane is no longer ingested
what is psychological dependence
behavioural reactions assoc with substance dependence
two views/definitions of addiction
- addiction is a physiological dependence on drugs that almost necessarily involves withdrawal and tolerance
- drug seeking behaviours themselves as a measure of psychological dependence
diagnostic issues re: addictive disorders
- occur concurrently with other disorders (cause?)
- drug intoxication and withdrawal causes increased risk-taking
- mental health disorders may cause substance use disorder
define risk taking
making decisions that wouldn’t have been made otherwise
how mental health disorder may CAUSE subs abuse?
disorder may want to see relief + turn to substance for quick relief
function of depressants on CNS?
reduces CNS activity, reduces arousal + increases relaxation
4 types/classes of depressants
- alcohol
- sedatives
- anxiolytics
- hypnotics
depressants + their relation to addiction?
leads to dependence, tolerance + withdrawal.
what is the clinical description of alcohol-related disorders?
- inhibitory centres in the brain are depressed or slow
- continued drinking depresses more areas of the brain
consequences of body function under influence of alcohol?
depresses more areas of the brain
- decrease motor coordination
- slower reaction time
- confused and poorer judgment
- vision + hearing affected
- memory and sexual performance impacted
DSM classification of Alcohol Use Disorder (8)
- problematic problem, 2 of the following within 12-month period
- larger amounts or longer period than was intended
- persistent desire or unsuccessful efforts to control alcohol use
- great deal of time spent to obtain, use or recover from use.
- craving or strong desire
- recurrent use resulting in failure to fulfill major role
- continued use despite social or interpersonal problems as result
- social, occupational, recreational activties given up as result of use
- recurrent alcohol use in physically hazardous situations
other conditions in DSM
- knowledge?
- co-morbidity?
- continued use despite knowledge of physical or psychological problem as a result of use.
- more than half of alcohol disorders + co-morbid
alcohol related effects
- several NT systems
- blackouts
- natural analgesics
- Delirium Tremens
- Fetal Alcohol Syndrome
what are Delirium Tremens
frightening hallucinations, body tremors/ shakes and disorientation
what is FAS?
physical and psychological effects to a child whose mother drank while she was pregnant with them .
- neuro mis-wirement due to in utero enviro
= failure to profit from experience, problem with impulsivity
brain of alcoholic vs non-alcoholic
- global neurological damage in alcoholic.
- irreversible damage
statistics on use + abuse of Alcohol
- 23% of canadians exceed low-risk guidelines
- binge drinking is common in college-age
- men drink more than women
- single males most likely to be heavy drinkers
- cultural differences exist: diff metabolization
progression of alcohol-related disorders
- fluctuation between heavy drinking + abstinence
- gets worse if untreated
- early consumption can predict dependence later on
- linked with violent behaviour
- treatment lasts month or two.
what are sedatives?
drugs that have calming effect
what are hypnotics
drugs that have sleep-inducing effects
what are anxiolytic drugs?
drugs that have anxiety reducing effects
what are barbiturates?
large class of sedative
- relax muscles
- produce mild feelings of wellbeing
- suicide by overdose is common = asphyxiation
what are benzodiazepines
calming, induce sleep
- addictive, build tolerance + dependence quickly
statistics - use of barbiturates and benzo’s
barb = decline benzo = increase
higher rates in women, smokers, seniors
what are stimulants?
a drug class
- stimulate, increase alertness + energy
- most widely consumed drugs in canada
examples of stimulants
caffeine
nicotine
amphetamines
cocaine
what are amphetamines?
- stimulant drugs
- Upper (stimulant, euphoria), leading to down + crash.
- reduce appetite, weight, fatigue
- stimulate CNS: enhance NA and DA
what is cocaine?
- stimulant drug
- from coca plant
- coca-cola had 60mg of coke.
clinical description of cocaine use?
- increase alertness, activity levels, bp, and insomnia
DSM criteria for stimulant/amphetamine-type substance disorder?
- 2+ in 12 months
1. larger amounts, longer period
2. desire, unsuccessful in cutting down
3. time spend to obtain, use, recover
4. craving, desire, urge to use
5. use = failure to fulfill major role obligation
6. use despite persistent + recurrent social or interpersonal problems
7. things given up due to use
8. use is physically hazardous
9. use despite knowledge that subs is bad
tobacco as subs of abuse
- nicotine is psychoactive substance
- dependence, tolerance + withdrawal
- less than 20% of canadians smoke
- inhaled nicotine enters blood in 7-19 secs.
- nicotine use assoc with depression
- genetic vulnerability + life stresses combine vulnerability to nicotine use + depression
caffeine-related subs disorders
- gentle stimulant
- elevates mood, decreases fatigue
- causes insomnia
- tolerance + dependence increases with over-use
what are opioids?
natural chemicals found in opium poppies, that have narcotic effects
- sleep-inducing, pain-relieving
- heroin most common. opium, codein, morphine. methadone - synthetic, endorphins are comparable
- thru IV = other health consequences
- high mortality rates
DSM classification of Opioid use disorder
opioid use = impairment distress, 2+ below in 12-month
- larger amounts, longer period
- desire, but no success in cutting down
- lots of time spent in activities necessary
- craving to use
- failure to meet obligations due to use
- social + interpersonal problems due to use
- social, occupational, recreational activities given up
- physically hazardous
- continued use despite knowledge of problem
effects of cannabis
-alters perceptions, mood swings
- impairment of memory, concentration, motivation, self-esteem + relationship with others
- reverse tolerance (myth)
tetrahydrocannabinols
- certain ppl given prescriptions
what is reverse tolerance?
more pleasureable with repeated use.
- contradictory to tolerance.
what are hetrahydrocannabinols?
thc: active substance in cannabis.
- some cannabis strains have cbd.
- may help with pain management
- little evidence to support pharmacological use
DSM criteria for Cannabis use disorder
impairment/distress 2+ in 12-month
- larger amount, longer period
- desire, unable to cut down
- time to obtain, use, recover
- craving, urge to use
- failure to fulfill role
- social + interpersonal problems due to use
- activities given up,reduced
- physically hazardous
- continued use despite KNOWLEDGE physical or psychological problem
other drugs of use - 3 types in broad category
inhalants: breathed in/inhaled to lungs directly
anabolic-androgenic steroids: abused, T-synthetic, tolerance is different
designer drugs: new drugs created to target specific disorder/disease
4 dimensions of causes of subs abuse
biological
psychological
social
cultural
how biology may cause subs abuse
- familial/genetic, neurobiological
- diathesis is higher/lower
- twin, family + adoption studies show genetic influence
- impact some reward centre in brain
psychological dimension of cause of subs abuse
+/- reinforcement (feel good +, get rid of withdrawal feeling - )
cognitively rewarding
social dimensions of cause of subs abuse
culture glorifies alcohol+ drugs
cultural dimensions
diff cultural expectation
- drinking vs drunk
define equifinality
disorder may arise from multiple/diff paths.
- not linear formation of problem, cause may increase use, but use may increase cause = reinforcing
types of treatment
biological
psychosocial
harm reduction
prevention
what are 3 biological treatments?
agonist substitution
antagonist treatment
aversive treatment
what is agonist substitution?
provide person with safe drug that has chemical composition similar to abused drug
ex: methadone: heroine substitute. no high, but decreases withdrawal symptoms
what is antagonist treatments
drugs that block/counteract the (+) effects of psychoactive drugs
ex: maltrexone - combat effects of opioids quickly
what is aversive treatment?
- give drug that can lead to profoundly negative events when abused substance is ingested
ex: antibuse: + alcohol = terrible experience
3 types of psychosocial treatments
inpatient facilities
alcoholics anonymous
relapse prevention
what are inpatient facilities?
hospital, residential facilities, rehab.
- help ppl thru withdrawal, provide supportive therapy to help return to community
what is alcoholics anonymous?
12-step program views alcoholism as disease
- says ppl are powerless without assisstance
- advocates for social support to overcome addiction
- strong religious undertones
12-steps of AA
- admit to powerlessness
- power is greater than self to restore
- decision to turn will + life to God
- make moral inventory of self
- admit nature of wrongs
- ready to stop
- ask for removal of shortcomings
- list the ppl you harmed + make amends
- direct amends
- continued personal inventory
- sought prayer + meditation
- spiritual awakening
what is harm reduction?
controlled drinking/drug use - no abstinence so control.
safe injection sites.
– what is desired outcome? some data to support
what is prevention?
community-based interventions
- difficult
- can include political efforts
Consequences of Gambling disorders?
- lifetime estimate?
- problem with ppl who have disorder?
job loss, bankruptcy, arrests.
- stimulates neural pathways similar to substance abuse disorder
- 2% of americans have.
- problem: commonly in denial - impulsive, unrealistically optimistic, craving - functionally dependent
DSM classification of Gambling Disorder
- impairment or distress, 4+ in 12-month period
1. increasing amount of money for desired excitement
2. restless or irritable when cut down
3. unsuccessful efforts to stop
4. pre-occupied with gambling
5. gambles when feeling distressed
6. chases losses
7. lies to conceal extent of involvement
8. lost a significant opportunity because of gambling
9. relies on others for financial situation
extra DSM classification
NOT better explained by manic episode
3 major categories of impulse-control disorders
- intermitent explosive disorder
- kleptomania
- pyromania
what is intermittent explosive disorder
aggressive impulses that result in serious assault + destruction of property.
- lifetime prevalence - 7%
what is kleptomania?
recurrent failure to resist urges to steal things
what is pyromania
irresistible urge to set fires
treatment for impulse-control disorders
cognitive-behavioural
– distort thoughts, feelings assoc with action
