Substance Use and Addiciton Flashcards
What are the 2 main ways drugs work?
They can be stimulants or depressants
What is negative reinforcement
When people take drugs to overcome bad states
What is positive reinforcement
When people take drugs to gain positive states
How do we figure out wether there is positive or negative reinforcement or neither?
Ask why they are taking the drug
What qualifies as harmful substance use?
When actual damage has been caused to the mental or physical health of the user in the absence of diagnosis of dependence syndrome
What qualifies as hazardous substance use?
When harm is likely to be caused if the user continues at the current level
What are the criteria for dependence syndrome?
A strong desire or compulsion to take the substance, there is difficulty controlling usage, there is physiological withdrawal state when substance use stops, there is evidence of tolerance, persisting usage despite harmful consequences, progressive neglect of alternate interests
How many criteria must be met to qualify as dependant?
3 criteria for dependance
What are the criteria for addiction?
Compulsive drug use despite harmful consequences, inability to stop using the drug, failure to meet work/social/family obligations and sometimes tolerance and withdrawal
What is the difference between dependance and addiction?
Dependance refers to a physical adaptation to a substance, it is therefore possible to be dependant and not addicted
What makes a drug more addictive?
If it can reach the brain faster
What balance does alcohol disrupt? In which direct
Balance between the inhibitory and excitatory systems, it increases the effectiveness of the inhibitory system
What is the bodies inhibitory and excitatory system in reference to alcohol? Include the names of the neurotransmitters and receptors
Inhibitory: GABA-A system, GABA-A receptor
Excitatory: Glutamate system, NMDA receptor
What happens during alcohol withdrawal?
The alcohol is no longer making the inhibitory system more effective, so the excitatory system becomes unregulated in compensation
What medication is given to help alcohol withdrawal?
Acamprosate
How does acamprosate work?
It reduces NMDA function so there is redcued compensatory upregulation of the excitatory system and withdrawal is reduced
How are some ways addiction develops?
Due to positive reinforcement
Due to overcoming an adverse state (negative reinforcement)
Impulsivity
What neurotransmitter is highly involved with addiction?
Dopamine- drugs often increase levels of dopamine in the brain
How does dopamine work as addiction worsens?
It becomes more about motivation to get the drug rather than feelings of reward
What system is a key modulator of dopamine?
Mu opioid
How may drugs increase levels of dopamine?
Block reuptake, enhance release, indirectly by increasing firing dopamine neurons
Which drugs block dopamine reuptake?
Cocaine and amphetamine
Which drug enhances dopamine release?
Amphetamine
Which drugs work indirectly by increasing dopamine neurone firing?
Alcohol, opiates, nicotine
What are dopamine receptors called?
D2 receptors
What happens when someone has fewer D2 receptors?
They are likely to be more responsive to stimulants as they already have lower levels of dopamine functioning in their brain
What brain region is associated with binge/intoxication?
Thalamus
What brain region is associated with withdrawal/negative effect?
Hypothalamus, brainstem effectors, amygdala
What brain region is associated with pre-occupation/anticipation/craving?
Hippocampus
Which out of positive and negative reinforcement develops as addiction gets worse?
Goes from positive reinforcement to addiction developing and turns into negative reinforcement
What happens to motivation as addiction develops and why?
Motivation increases because the addiction is present due to negative reinforcement so there is a lot of motivation/anxiety to acquire the drug
Where is dysregulation most apparent during addiction?
Amygdala
What system is the stress system?
Kappa opioid system
What lights up the amygdala on an fMRI?
Showing a normal image then an aversive one
How may units is a bottle of beer?
1.6 units
How many units is a pint of beer?
2.3 units
How many units is a pint of cider?
2.6 units
How many units is a shot?
1 unit
How many units is a medium glass of wine?
2.3 units
How many units is a bottle of wine?
9.8 units
How many units of alcohol is the limit for one week?
14 for both men and women
What acronym is used to assess alcoholics and what does it stand for?
CAGE
Cut down- have you ever felt you need to cut down on your drinking?
Angry- has anyone annoyed you and made you angry by talking about your drinking?
Guilty- have you ever felt guilty about drinking?
Eye opener- have you ever felt you need a drink first thing in the morning?
What are some symptoms of alcohol withdrawal?
Hot, sweaty, tremor of hands, retching/belching, abdominal pain
What are some symptoms of opiate withdrawal?
Tachycardia, sweating, breathlessness, restlessness, dilated pupils, bone aches, runny nose, GI upset, tremor, yawning, anxiety, irritability, gooseflesh skin
What terms are used when talking about conditions where people are addicted to alcohol or opiates? What terms used to be used?
Used to use abuse and dependence, we how use alcohol use disorder and opiate use disorder
What is the name of the criteria used for opiate and alcohol use disorder?
DM5 criteria- the words alcohol and opiates can be used interchangeably depending on which youre assessing
What does a history for someone who is addicted include?
Presenting complaint History of presenting complaint (onset, time frame etc) Substance misuse history Family history Past psych history Social and personal history
In a history taking for addiction, what must be included in the substance misuse history?
Length of current use and when last used.
Current amount (units/grammes per day) and for how long at this level.
Total length of use, max use, and any periods of abstinence
Mode/method of use
Evidence of withdrawals and severity (e.g. seizures, admissions)
Any previous treatments - medication, psychotherapy, detox, rehab.
Any previous substance overdoses (accidental vs deliberate)
Out of alcohol and opiate withdrawal, which is worse and why?
Alcohol withdrawal as it an cause seizures whereas opiate withdrawal doesn’t
What should you examine for in alcohol use disorder?
Clubbing, anaemia, DVT, cyanosis, jaundice, collapsed veins, track marks
What are the 2 ways opiates work?
Reducing pain (analgesia) Euphoric feelings
What is the difference between opiates and opioids?
Opiates are natural (e.g. opium, morphine)
Opioids are all natural, semisynthetic, synthetic or natural
What are signs of opiate overdose?
Tiny pupils Slow or no breathing Choking/snorling/gurgling sounds No moving, cant be woken Clammy/cold skin Cyanosis
What do you do when you find someone who has overdosed?
Inject naloxone into upper arm or thigh, if no response repeat after 3 mins
Provide airway support and put them in the recovery position
