Substance Use And Addiction

Question 1

Drug

Answer 1

• Any chemical that affects the body/mind other than food (food provides nutrition, drugs don’t)
• generally, a drug also refers to substances taken knowingly/intentionally (excluding toxins, poisons, etc, which maybe encounters unknowingly/accidentally)
• can be pharmaceutical or recreational
• classified according to their primary effect on the CNS (stimulants, depressants, hallucinogens, deliriants, etc.)

Question 2

Tolerance

Answer 2

When increased dosages are required to produce desired / consistent effects
→ tolerance has built up over the so they need more of the drug to get the same effect

Question 3

Dependence

Answer 3

When regular use of a drug is necessary to maintain stable biophysiological functioning
→ body habituates to the drug, if it is taken away it results in withdrawal symptoms (symptoms depend on the type of drug and the level of usage)

Question 4

Drug abuse

Answer 4

The use of drugs for unintended purposes (ie. Higher dosages or alternate methods of administration)

Question 5

Addiction

Answer 5

A disorder whereby people persistently use substances despite harm from use (substantial medical, interpersonal, and/or socioeconomic consequences)

Question 6

Pharmaceutical drugs

Answer 6

• These drugs are taken for the purpose of alleviating medical symptoms and/or treating a medical disorder
• “over-the-counter” medication: drugs which can be bought without a prescription
• prescription medication: drugs which require a physician to prescribe them and a pharmacist to dispense them

Question 7

Over-the-counter drugs

Answer 7

• Treat minor ailments that don’t require medical attention
• have been proven to be safe and effective in low doses (receomended dose)
• have a low potential for dependence or abuse
• there are still potential risks:
  → Benadryl can interact with alcohol to enhance effects such as sedation and uncoordinated motor skills
  → Tylenol overdose con cause serious or fatal liver damage

Question 8

Prescription drugs

Answer 8

• Require a prescription in order to be legally acquired
• classed according to the system they affect, as well as those effects
  → each drug receives its own unique code depending on its classification at each level (can have multiple codes if they affect multiple systems or have multiple effects)

Question 9

Illicit drugs

Answer 9

• high potential for addiction/dependency and overdose
• severe side-effect profile (high risk of side effects)
• treat conditions which cannot be self-diagnosed or self-managed
• no medical purpose

Question 10

Recreational drugs

Answer 10

• Drugs that are used for non-medical reasons
  → intent is to alter ones experiences by altering nervous system functioning
• some of these drugs can be legally purchased and consumed for recreational purposes (caffeine, alcohol, nicotine, etc.)
• some are pharmaceutical-grade drugs which are acquired and taken for non-medical reasons (ex. Amphetamines to treat ADHD can also be used recreationally)
• many are “bootleg” products or “street drugs” which are manufacturer and sold by private individuals or criminal enterprises
• motives for substance use include enhancing experiences, facilitate social interactions, cope with stress etc.

Question 11

Biological / disease perspective

Answer 11

• Addiction is a neurological dysfunction
  → tolerance as a chronic decrease in neurotransmitter availability (drugs enhance NT efficacy)
  → withdrawal as a sudden lack of NT availability in the absence of the drug (brain must readjust its rate of production/reuptake)
• abnormal circuitry in the brain’s reward circuit may lead to hypersensitivity to stimulation or the circuit may be underactive (leads to sensation-seeking behaviour)

Question 12

Cognitive / developmental perspective

Answer 12

• Addiction is a learning disorder caused by coping, reinforcement and expectation (may explain why substance use often overlaps with depression)
  → learning something that is problematic
  → becomes ingrained in your behaviour

Question 13

Sociocultural perspective

Answer 13

• Substance use/addiction is a response to adverse socioeconomic/sociocultural conditions
  → substance use disorders are countercyclical with economic conditions
  → substance use/addiction disproportionately impacts marginalized minorities (especially those directly impacted by that status)

Question 14

Moral perspective

Answer 14

• Drug use and addiction are en individual choice and a moral failing
  → generally dismisses socioeconomic factors (social determinants) related to drug use
• education about substances and substance use is deemphasized in favour of “skills training”
  → teaching people to resist social conformity by building self-esteem

Question 15

“Civil liberty” perspective

Answer 15

• Drug use is an individual choice but not a moral failing; drugs are neutral/beneficial, can be used responsibly, and are compatible with daily functioning

Question 16

Harm reduction

Answer 16

• Described the goals of the “Mersey model” (goal to prevent HIV in drug users)
  → involved recede exchange programs, opiate prescriptions, and educational materials
• rather than advocating abstinence, the advocated for controlled use of substances making rational choice, care, and moderation

Arguments for harm reduction:
1. People get high for pleasure, to relieve boredom, to relax, to satisfy curiosity, to socialize etc., and these are normal motores not deviance
2. Many illicit substances used knowledgeably and in moderation are less harmful than legal substances (tobacco, alcohol, pollutants)
3. When drug use is suppressed and criminalized, people use drugs “underground” (out of reach from services that could help their problem use)

Question 17

Contemporary harm reduction

Answer 17

• Overdose reversal: for some drugs like opiates, there are other drugs that can counter their effects
  → issue is many drugs lack reversal drugs, and opiates are often taken simultaneous with other substances
• supervised use / safe consumption: facilities where people can use drugs under the supervision of medical staff
  → also provide single-use medical supplies, addiction treatment, mental health support, and other services

Question 18

Substitution (harm reduction)

Answer 18

Drug users may be prescribed one drug as a substitute for another (ex. Methadone for heroin; is long-acting which reduces frequency of use and aids in cessation

Question 19

Safe supply (harm reduction)

Answer 19

• Street drugs are unpredictable (doses not standardized) because they may be contaminated with other substances and availability fluctuates
  → if a drug-dependent person takes the same dose at the same the same time everyday, tolerance to the psychoactive effects allows them to function normally while avoiding withdrawal

Question 20

Issues with substitution / safe supply

Answer 20

• Diversion: people who acquire drugs through safe supply programs may give or sell them to other users
  → patents who divert their prescription fail to receive full benefits of the program and remain “street-involved” (could be seen positively because more people get safe drugs, could use money for pooch other drugs)
• concerns about programs normalizing addiction and minimizing perceived harms (potentially generates new users)
  → substitution programs ineffective in adolescents using opioids; lack of uptake/retention (reduces drug use but not other measures)
• some doctors and researchers argue that addiction is a brain disease that can be treated, meaning these programs are a denial of treatment
• recovery-oriented programs where the goal is abstinence can be effective if integrated care, extended care, and social support is provided

Question 21

CBT for recovery

Answer 21

• Relapse prevention: users ore taught to keep track of them substance use and identity situations which trigger use or an urge to use
  → combined with coping strategies to moderate or avoid use when situations arise (“positive addiction” as a coping substitute)
• contingency management: people are incentivized to not use drugs
  → rewards for non-use can be social or economic

Question 22

Detox for recovery

Answer 22

• Detoxification (detox or rehab): medically-supervised cessation of the drug
  → typically requires ongoing therapy and social support (promotes recovery maintenance without relapse)
  → can be done on on out-patient or in-patient basis (“residential treatment”)