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Yr2 Lily BRS Psych > Substance use addictions > Flashcards

Substance use addictions Flashcards

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1
Q

what are some examples of substances that can be abused?

A

actual drug may not be integral, it is more how it is used

Alcohol
Nicotine
Cannabis

Stimulants:
Amphetamine
Cocaine
Crack
Ecstasy

Opioids (prescribed, OTC):
Heroin, fentanyl
DF118

Ketamine
Solvents
GHB, GBL
Benzodiazepines

Psychedelics:
LSD, Magic mushrooms

Nitrous oxide
Khat

‘Novel psychoactive substances’:
~950 synthetic (UNODC); 
new: ~1/wk
Categories:
Depressant, stimulant, hallucinogenic. cannabinoid
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2
Q

what does experimental/recreational use mean?

A

causing no/limited difficulties

majority of population

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3
Q

what is a possible definition of substance abuse?

A

A pattern of substance use that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others

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4
Q

why might people take recreational drugs (split into categories)?

A 
positive reinforcement:
(gain positive state)
escape
get high
they like it
stay awake
negative reinforcement:
(overcome adverse state)
boredom
reduce anxiety
to get sleep
to feel better

rebel
fit in
why not?
everyone does

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5
Q

why is it important to ask why people do drugs?

A

then you can start to understand why and formulate a plan to address it.

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6
Q

what is the course of alcohol/ drug use to abuse?

A

Experimental/‘recreational’ use,
causes no/limited difficulties
(majority of population)

first they would “like” a drink ->

then they “want” a drink ->

then they “need” a drink ->

Increasingly regular use
(fewer people)
harmful
this first step is reversible, so intervention should be done here

this goes along with increasing problems

lastly they will spiral, “needing” it
this is dependance

this last step is one way. once you are dependant it is ver very hard to go back

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7
Q

what is the definition of harmful substance use?

A

Actual damage should have been caused to the mental or physical health of the user in the absence of diagnosis of dependence syndrome.
(as a Dr, the fact that they are seeing you may mean that many people will fulfill criteria for this diagnosis)

(Hazardous use – likely to cause harm if continues at this level - one step before harmful)

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8
Q

what is the definition of dependance syndrome (diagnostic criteria) (6 points)?

A
  1. a strong desire or sense of compulsion to take the substance
  2. DIFFICULTIES ON CONTROLLING substance taking behaviour in terms of its onset, termination, or levels of use
    who has control, you or ‘the drug/behaviour’?
    when did you last have a drink/drug?
  3. a physiological withdrawal state when substance use has stopped or been reduced
    - a ‘negative’ state (from uncomfortable to intolerable) so user takes drug/alcohol to get relief from it or ‘treat’ it
  4. evidence of tolerance: need to take more to get same effect
  5. progressive neglect of alternative interests
  6. persisting with substance use despite clear evidence of overtly harmful consequences

have to meet 3 of these in the last 12 months

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9
Q

what is the epidemiology of alcohol dependance?

A

Alcohol dependence :
595, 000 estimated prevalence
103,471 in treatment
~82% of adults in need of specialist treatment for alcohol not receiving it.

Impact of Covid 2020:
Over 8.4 million people are now (September) drinking at higher risk, up from 4.8 million in February

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10
Q

what is the epidemiology of opiate dependance?

A

Opiate dependence:
257,476 estimated prevalence.
170,032 in treatment
~46% of adults in need of specialist treatment for opiates not receiving it.
Death rates rising from opiates and from cocaine

Impact of Covid 2020:
3,459 new adult cases in April 2020 - up 20% from 2,947 in April 2019 - the highest numbers

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11
Q

which drugs are most and least harmful?

A 
most:
alcohol
heroin
crack cocaine
meth
least:
mushrooms
LSD
ecstacy
anabolic steroids
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12
Q

what is the difference between addiction and dependance?

A

addiction:
compulsive drug use despite harmful consequences, characterised by an inability to stop using a drug; failure to meet work, social, or family obligations; and, (depending on the drug) tolerance and withdrawal.

dependance:
In biology/pharmacology, dependence refers to a physical adaptation to a substance

Tolerance/withdrawal
Eg opioid, benzodiazepine, alcohol

So can be dependent and not addicted

these are used pretty interchangeably, but are not the same
you have to be precise
especially in GP referrals etc

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13
Q

what are some behavioural addictions?

A

Gambling disorder:
Many similarities in aetiology, neurobiology and treatment approaches, as well as comorbidity, with substance dependence

Reclassified as behavioural addiction in DSM-5/ICD-11 from an ‘impulse control disorder’ previously

Internet gaming disorder :
added to ICD-11 under addictive disorders
in the DSM-5 is under “Conditions for Further Study”

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14
Q

why is entry of drugs sped up?

A

Faster brain entry –> more “rush” and more addiction

opium -> morphine -> heroin -> snorted heroin -> IV heroin

coca leaves -> coca paste -> cocaine -> crack

chewing tobacco -> snuff -> cigarettes

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15
Q

what factors are involved in drug/alcohol use and addiction?

A

Social (eg. pub nights, or smoking together),
environmental factors

Personal factors eg genetic, personality traits

Drug factors

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16
Q

how does the brain change from use to addiction?

A

pre existing vulnerability:
family history
age (young more vulnerable)

->

drug exposure:
Compensatory 
neuroadaptations
to maintain 
brain function

resilience/tolerance (have to do more to get the same effect)
withdrawal

->

recovery:
sustained
or
Cycles 
of remission 
and relapse
17
Q

what does alcohol do in the brain acutely?

A

Alcohol alters the balance between brain’s inhibitory and excitatory system

Excitatory system: Glutamate system
NMDA receptors

Inhibitory system
GABA-benzodiazepine (GABA-A) system:
GABA-A receptor

it blocks the excitatory system (leads to impaired memory)

and boosts the inhibitory system (anxiolysis, sedation)

18
Q

what does alcohol do to the brain chronically?

A

Chronic alcohol exposure results in neuroadaptations so that GABA & glutamate remain in balance in presence of alcohol:

doesnt have to be drinking very much

tolerance:

reduced function of inhibitory system
GABA-A receptor - switch in types to make it less sensitive to alcohol

upregulation of the excitatory system

19
Q

what does absence of alcohol do to the brain after chronic exposure?

A

Chronic alcohol exposure results in neuroadaptations: in absence of alcohol GABA & glutamate are no longer in balance – withdrawal state:

still reduced function in inhibitory system

really high upregulation of the excitatory system
NMDA receptor:increase in Ca2+
- toxic leading to hyperexcitability (seizures) and cell death (atrophy)

20
Q

how is alcohol withdrawal treated?

A

Treat with benzodiazepines to boost GABA function

21
Q

what are the 3 models of addiction?

A 
Reward deficiency
(positive reinforcement)

Overcoming adverse state eg withdrawal, anxiety (negative reinforcement

Impulsivity/ compulsivity

22
Q

how is dopamine related to addiction?

A

Natural rewards such as food, sex increase levels of a chemical – dopamine - in a part of the brain called ventral striatum.
Drugs of abuse also increase levels of dopamine here.

This dopamine pathway has 
been referred to as the 
‘pleasure-reward-motivation’ 
system 
it tarts being the part that motivates you to get more of that drug

addiction has been conceptualized as
a ‘reward deficient’ state
- so people take drugs to overcome this

A key modulator is opioid system
– particularly mu opioid that 
mediates pleasurable effects (eg 
of alcohol, ‘endorphin ‘rush’); 
others include GABA-B, cannabinoids, 
glutamate etc that are targets 
for treatment
23
Q

how do substances of abuse interact with the dopamine system?

A

dopamine is released from the presynaptic neurone

it binds to receptors on the post synaptic neurone

the dopamine is taken back up into the presynaptic neurone

substances of abuse (eg. cocaine and amphetamine) prevent this reuptake
(they are dopamine transporter reuptake blockers)

so there is a lot more dopamine present in the synapse and a lot more of a signal produced
(direct effect)

amphetamine also increases the release of dopamine from the presynaptic neurone
(direct effect)

other drugs of abuse (alcohol, opiates, nicotine) increase dopamine neurone firing in VTA (indirectly)

24
Q

how do we assess function of the reward system (dopamine)?

A

fMRI
(not PRT coz it is quite expensive and involves radiation)

using “winning money”
as an incentive
this will make the reward centres light up

25
Q

what is reward deficiency hypothesis?

A

people with a predisposition for lower reward system activity (dopamine in the striatum)
ie. the striatum lights up less

have more of a tendency towards drug use

maybe because they dont feel as much pleasure anyway so seek things to change this

IMGEN study has shown this in 14 year olds

when you revisit them at 16, the ones with higher reward centre activity are fine, but the ones who originally had it lower now take substances like cannabis, alcohol and nicotine

so maybe boosting the reward system without drugs will help people remain abstinent

26
Q

what part of the brain is involved in the negative reinforcement (eg reducing anxiety) pathways of addiction?

A

the amygdala
and brain stem

this is partially responsible for the stress system

27
Q

how does positive reinforcement change into negative?

A

as you take a drug more you build up tolerance

your ‘high’ (positive reinforcement) gets less
but your withdrawal gets more (negative reinforcemnet)

goes away from reward system in the striatum to a hightened response in the stress system in the amygdala

28
Q

how does voluntary drug taking lead to impulsivity and compulsion?

A

Change from voluntary drug use to more habitual and compulsive drug use involves transition from:
prefrontal to striatal control over drug taking

i.e. prefrontal ‘top-down’ control is diminished with greater striatal reward drive
ventral (limbic or emotional) to dorsal (habit) striatum.

from ventral striatum to dorsal striatum (more habitual)

Role for ‘memory’ (eg hippocampus) in craving

29
Q

tutorial?

A

look at slides on insendi

Yr2 Lily BRS Psych (3 decks)

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