Substance Use and Abuse - Chappy 5

Question 1

Define addiction

Answer 1

A condition, produced by repeated consumption of natural/synthetic psychoactive substance - physically and/or psychologically dependent
Phys D: body adjusted + incorporated into functioning (tolerance, withdrawal)
Psych D: typically occurs 1st.. cravings/desire (time, energy)
Disruption in life functioning (2 or more of 12 characteristics)

Question 2

What are the factors that can influence dependence?

ask after:
what are the theories attached to substance related cues and avoiding withdrawal

Hint: there are 6 - think basics

Answer 2

Genetics
-Identical - more similar addictive behaviours than fraternal
Diff genes for diff substances
High risk genes - counteracted by parental monitoring

Expectancies
-Ideas about outcomes of behaviour - what we learn to expect from drug and alc use (some posi, some negi)

Personality
-Impulsive, low self-regulation, risk taking, sensation seeking

Reinforcement
-Posi (buzz), negi (removes tension, pain, stress)
Quick effects, use for cognitive/emotional regulation

Substance related cues (classical conditioning)
-Repeated pairings, stimulus - drugs - want to do drugs
Incentive sensitization theory - dopamine enhances salience of stimuli w/use, makes substances increasingly powerful in directing behaviour

Avoiding withdrawal
-Delirium tremens: intense anxiety, tremors and frightening hallucinations when blood alc drops

Question 3

Why do people smoke? Think psych (3) and social aspects

Answer 3

Psych
Beliefs: perceive low risk, high benefits
Expectations: enhance self image
Personal factors: low self-esteem, impulsive/sensation seeking, concerns about body weight

Social
Idols, parents, PEER influence (reduce perception of harm)
School - poor regulation/enforcement
Standard of thinness

Question 4

What are the age differences in smokers?

Answer 4

Begins at 13 (gr.8), few reg smokers begin after early 20s - more risk if no plans for secondary
% levels off at early adult hood (declines 35years)

Question 5

Why do smokers maintain the habit: what is the affect management model?

Answer 5

smokers strive to regulate emotional states
(+) posi effect = stimulation, relaxation, pleasure
(-) nega effect = relieves boredom, stress, depression

Question 6

What is the role of incotene in cig addicts?

What is the nicotene regulation model? - what is the associated study?

Answer 6

Alveoli straight to bloodstream - stimulates NS, all the good feels

NRM
Accumulates rapidly but soon decreases through metabolism, in about 2 hours half the nicotine has decayed
Study - adult smokers given low nic and high nic cigs, those with low nic smoked 2x as much
Does not explain why people quit or why they return to the habit

Question 7

What are the consequences of smoking? what happens if you quit?

Answer 7

Consequences
Primary risk factor for chronic obstructive LD: poor airflow resulting from decayed lung tissue (emphysema + dysfunction of small airways)
80% cases due for smoking

Quit after 15yrs, odds are similar to those who never smoked

Question 8

What are the age and social-cultural factors in alcoholism?

Answer 8

Age diff
Begin 15-16 yr
Uni students: 63 binge, 35 8+ drinks (last year)
Most young adults/middle-aged in CAN drink, then prevalence decreases in older age

Socio-cultural diff
2 approaches: restrict (more intoxication) & integrate (more daily but moderate drinking) but changing (all intoxication)
First nations - less likely to drink, but for those who do, more likely to drink heavily

Question 9

How do you define alc use disorder? How many adults in NA abuse alc?

Answer 9

AUD: drink heavily on reg basis AND suffer social/occupational impairments

17%, more males than females, 1/2 + are physically dependent

Question 10

What are the factors that contributed to people starting on heavy alc?

Answer 10

Expects: heightened sociability, reduced tension + stimulant effects
Learning: watching pp turn up (ex: alc in movies = alc in real life)
Underage drinking predictors: more feelings of depression, friends drink allot, low school grades, parents who drink/don’t monitor drinking
Biological factors - genetic risk, heredity, modeling, higher tolerance, strong cravings

Question 11

What are the short term effects of heavy drinking?

Answer 11

Enters the bloodstream through the small intestine - metabolises in liver
Biphasic effect: initially stimulates, later depresses
Interacts w/several neural systems (ex: bind gaba)
Accounts for sedating effect (judgement, movement)

Question 12

What are the risks associated with fetal alc spectrum disorder? how much drinking will cause some effects?

Answer 12

Increased risk of fetal defects
Most severe form FASD (abnormal face, growth deficiency, CNS disorder, mental retardation)
Moderate/light drinking (2 a day) - unlikely FASD but linked with decreased cog functioning, increased risk of stillbirth, lower average birthweight

Question 13

Name all the severe health issues that can arise from alc addicts?

Answer 13

Cirrhosis (blocks meta of protein/fat - scar tissue obstructs blood flow)

Capillary hemorrhaging - alc = vasodilation, exploding caps - face and skin all blotchy and gross

Brian damage - occurs in several structures of central NS + impairs perception + memory, my recover gradually after quits but some impairments may persist

Erectile dysfunction - damages blood vessels + contributes 2 hypertension/HD = erectile D

Question 14

What are the different types of drugs? what are their effects if used chronically?

Answer 14

Stimulants
Phys + psych arousal, keeps user awake (caffeine/cocaine)
Chronic use - mental confusion, exhaustion, weight loss - can lead 2 psych dependence but not w/cocaine (phys d)
Depressants
Decrease arousal, increase relaxation (alc, benzos, barbs)
Chronic use: motor function decrease, emo stability decreases, can produce psych + phys dependence
Hallucinogens
Perceptual distortions (body or mind) - weed, mescaline, lsd, pcp
Chronic use: psych dependence, phys dependence w/marijuana
Narcotics
Relieve pain (opiates), euphoria + relaxed feeling (morphine, codeine, heroin)
Cause intense psych + phys dependence in continual large doses

Question 15

Why do people do drugs?

What are the general resulting health defects?

Answer 15

Psych reasons - low self control, high sensation seeking
Social reasons: models of behaviour (friends + families), positive attitude gain/celebrities

Health: preg (born addicts), overdosing, driving drunk/high, damage 2 the lungs, cardio effects, neurological issues

Question 16

What are the three main ways to prevent drug use to being with?

Answer 16

Public policy - barriers to usage
Health promotion + education - media campaigns
Also focus on immediate consequences to fight optimism bias
Family involvement approaches - high monitoring
Study: gr. 6 students, parents weekly sessions (teach skills 2 help delay use), monitor behaviour + use appropriate discipline, teach child how to avoid peer pressure
Results: follow up gr. 10 - less likely 2 have begun drug use/use much less

Question 17

What are the primary ways to quit addictive behaviors without the use of therapy?

Answer 17

Maturing out (over 22)
Stopping on one's own - deciding that risks/health defects are far too great 
Stopping use completely (abstinence)
Early intervention (info, advice, support venues)

Question 18

Treatment methods, describe psychosocial (4) and psychological methods? (1 - 3 sublets)

Answer 18

Psychosocial
Motivational interviewing: move along stages of change - finding internal motivation to make change
Reduce negative reinforcement: regulation emo w/relaxation/cog restructuring (replace stress provoking w/realistic and helpful thoughts)
Cue exposure: reduce internal reactions 2 external stimuli
Skills training: social anxiety, increasing self efficacy

Psychological
Behavioural: gain control over enviro conditions that sustain undesirable behaviour (changing antecedents + consequences) ]
Self monitoring: record information (when, how much, with whom, circumstances)
Stimulus control: reduce cues to perform the behaviour
Behavioural contracting: rewards/punishment

Question 19

What is the difference between total abstinence (aa) and controlled drinking?

Answer 19

AA
Largest group, disease model, never recover but always recovering, promotes complete abstinence, receive support + mentoring from others w/similar issues
Research: anonymity presents barriers 2 research on effectiveness
AA as effective as other methods, not suitable for all (some reject)

Controlled drinking
Non-dependent problem drinking - belief that problem drinkers can consume alc in moderation (ability to avoid inebriation)
Use cog behaviour techniques - goal setting, self-monitoring, self-control
Narrow group: young, employed, not been drinking long, supportive enviro
Potential advantages
More realistic goal than total abstinence, especially when in heavy drinking enviro
TA has high dropout rate - may foster greater adherence

Question 20

Describe inpatient and outpatient processes?

Answer 20

1) In
Detox/withdrawal under medical supervision
After usually short-term, intensive treatment (av 28 days)
Limited # residential care facility - supervised living + therapy
2) Out
Discharged to follow-up sessions or supervised living
Various approaches (cog/behave strat) + (couples/family therapy)

Question 21

Why do people relapse (2), how can we prevent this?

Answer 21

Why
Typically begin with trying to manage withdrawal (intermittently between first 7-11 days)
Stress: primary reason for relapse (smoking/the socializing that comes with smoking)
Motivated reasoning + denial (perceive less risk after relapse) + decreased self-efficacy after relapse (slide 79 - relapse rate chart)

Relapse Prevention
Programs 2 reduce relapses (before never talked about)
Relapse prevention program
Therapist - supervised / self-management program
Clients
Learn to identify high-risk situations
Acquire competent/specific coping skills (eg: w/stress, social skills, assertiveness)
Practicing coping or soc skills for high-risk situations