substance use and addictions

Question 1

what is a harmful substance under icd10

Answer 1

actual damage caused to mental/physical health of user in absence of diagnosis of dependence syndrome

Question 2

what is dependence syndrome according to icd10

Answer 2

1. strong desire/sense of compulsion to take substance
2. difficulties in controlling substance taking behaviour in terms of it onset,termination, or levels of use
3. physiological withdrawal when substance has been stopped
4. evidence of tolerance: need to start taking more
5. persisting despite knowing harm
   (need 3 to be dependent)

Question 3

what is addiction

Answer 3

compulsive drug use despite harmful consequences, characterised by inability to stop using a drug, failure to meet work, social or fam obligations, tolerance and withdrawal

Question 4

what does dependence mean in biology/pharmacology

Answer 4

refers to physical adaptation to a substance

• tolerance/withdrawal
• can be dependent but not addicted

Question 5

what are some behavioural addictions

Answer 5

gambling disorder

internet gaming disorder

Question 6

what is gambling disorder

Answer 6

similarities in aetiology, neurobiology and treatment approaches and comorbidities with substance dependence.

Question 7

why do some individuals drink?

Answer 7

alcohol alters balance between brains inhibitory and excitatory systems

Question 8

what happens if you drink alcohol acutely

Answer 8

blocks excitatory system
- impaired memory (alcoholic blackouts)
boosts inhibitory system 
- anxiolysis
- sedation

Question 9

what does chronic alcohol exposure result in

Answer 9

neuroadaptations so gaba and glutamate remain in balance in presence of alcohol

• upregulation of excitatory system
• reduced function in inhibitory system (tolerance)

Question 10

what is the treatment to help with alcohol withdrawal?

Answer 10

treat with benzodiazepines to boost gaba function

Question 11

where is dopamine found

Answer 11

in part of brain called ventral striatum

Question 12

what can increased dopamine levels in brain

Answer 12

natural rewards e.g food, sex

drugs of abuse can also increase dopamine

Question 13

how does cocaine and amphetamine affect domaine levels

Answer 13

cocaine and amphet block reuptake of dopamine

amphetamine enhances release of dopamine

Question 14

change from voluntary drug use to more habitual and compulsive drug use involves transition from….

Answer 14

prefrontal to striatal control over drug taking i.e prefrontal control is diminished with greater striatul reward drive

Question 15

what is positive reinforcement controlled by

Answer 15

dopaminergic mesolimbic system

Question 16

what can be given to support abstinence and neuroprotection in alcoholism

Answer 16

acamprosate

Question 17

what is naltrexone

Answer 17

opioid antagonist

- blocks heroin use in opioid addicts and to modulate reward system in alcoholism