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Year 3 Neuro > Substance use and Addictions > Flashcards

Substance use and Addictions Flashcards

1
Q

Why might people take recreational drugs?

A 
Reduce anxiety
Rebel
Get high
Escapism
Everyone does
Curious
to fit in
Why not?
Stay awake
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2
Q

What reasons for taking drugs are positively reinforced?

A

Escapism
Get high
Stay awake
Like it

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3
Q

What reasons for taking drugs are negatively reinforced?

A

Boredom
Reduce anxiety
To get to sleep
Feel better

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4
Q

What is the course of alcohol/drug use , harmful uses, addiction?

A

I like
I want
I nees

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5
Q

When does substance use become harmful?

A

damage to their physical or mental health

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6
Q

What is hazardous use?

A

Likely to cause harm if they continue

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7
Q

What are the ICD-10 diagnostic criteria for dependence syndrome?

A

Strong desire to take the substance

Difficulties in controlling onset, termination or levels of use

Physiological withdrawal state

Evidence of tolerance: need to take more to get same effect

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8
Q

What is addiction?

A

Compulsive drug use despite harmful consequences, characterised but an inability to stop using

Failure to meet work, social or family obligations

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9
Q

What is dependence?

A

Refers to adaptation to a substance
Can be dependent not addicted

e.g. opiod

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10
Q

What are other behavioural addictions?

A

gambling disorder

internet gambling disorder

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11
Q

How are drugs made more addictive?

A

Speeding up brain entry

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12
Q

What elements are involved in alcohol/drug use and addiction?

A

Social, environmental factors
Drug factors
Personal factors e.g. genetic personality traits

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13
Q

What is the pathway from use to addiction?

A 
Pre-existing vulnerability
Family history
Age
Drug exposure 
Tolerance
Resilience
Recovery sustained
Cycles of remission
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14
Q

Why do people drink?

A

To get to sleep

Reduce anxiety

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15
Q

What does alcohol do?

A

Alters the balance between brain’s inhibitory and excitatory system

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16
Q

What happens when you acutely drink alcohol?

A

Boosts inhibitory system
(anxilysis and sedation)

Blocks excitatory system
(impaired memory)

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17
Q

What does chronic alcohol exposure result in?

A

Neurodaptations so GABA and glutamate remain in balance in presence of alcohol

Upregulation of excitatory system

Reduced function in inhibitory system tolerance

GABA-A receptors: switch in subunits to make less sensitive to alcohol

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18
Q

What happens after chronic alcohol exposure when alcohol is no longer present?

A

GABA and glutamate are no longer in balance - withdrawal state

NMDA receptor
increase in Ca2+
toxic leading to hyper excitability (seizure) and cell death (atrophy)

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19
Q

What are the models of addiction?

A

Rewards deficiency
Overcoming adverse state
Impulsivity/Compulsivity

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20
Q

What has the dopamine pathway been referred to?

A

pleasure-reward-motivation system

21
Q

What can addiction be conceptualised as?

A

Reward deficient state

22
Q

How can drugs of abuse modulate dopamine?

A

Drugs block dopamine reuptake
Increased conc in the synapse

Or increase dopamine neurone firing

23
Q

How can you assess function in the reward pathway?

A

fMRI
Monetary incentive delay task - anticipation of winning money
Ventral striatum lights up

24
Q

What are targets for treatment?

A

Brain regions associated with withdrawal and negative emotional states in addiction

25
Q

What is the target in the reward system?

A

Reduced dopamine and mu opiod function

26
Q

What is the target in the stress system?

A

Increased activity in many including kappa opioid, noradrenaline, stress etc.

27
Q

What is seen on fMRI in withdrawal?

A

Heightened brain response in left amygdala in abstinent polydrug addicts to aversive images

28
Q

What does a change from voluntary drug use to more habitual and compulsive use involve?

A

prefrontal to stratal control over drug taking

Ventral (limbic or emotional) to dorsal (habit) striatum

29
Q

When are benzodiazepines used?

A

To treat alcohol withdrawal

30
Q

When is acamprosate used?

A

To support abstinence, neuroprotection in alcoholism

31
Q

When is naltrexone used?

A

Opioid antagonist

Block heroin use in opioid addicts and to modulate reward system in alcoholism

32
Q

What is harmful use?

A

A pattern of substance use that causes damage to health.

The damage may be: (1) physical or (2) mental (This criterion MUST be present if harmful use is diagnosed)

Adverse social consequences

Harmful use includes bingeing on substances. Does not include ‘hangover’ alone

Does not fulfil any other diagnosis within substance use e.g. dependence

33
Q

How do you classify dependence disorder?

A

3 or more of the following in past year:

A strong desire or sense of compulsion to take a substance

Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use

A physical withdrawal state when substance use has ceased or been reduced
(This is mainly relevant to alcohol, opiates, benzodiazepines, G-drugs)

Tolerance (ie. need to take more of the substance to get the same effect)

Progressive neglect of alternative pleasures or interests because of substance use,
increased amount of time necessary to obtain or take alcohol or to recover from its effects

Persisting with substance use despite clear evidence of overtly harmful consequences

34
Q

What were the DSM5 changes for classification?

A

Renamed:

OPIOID USE DISORDER
ALCOHOL USE DISORDER

Single continuum of MILD, MODERATE, SEVERE, so a dimensional approach

No longer uses the terms ABUSE or DEPENDENCE

35
Q

What comprises a substance misuse history?

A

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)

Assess triggers to use substances/alcohol
Assess motivation to change/engage in treatment

36
Q

What are common co-morbid conditions?

A 
Depression (15% in community, 32% in Alcohol treatment, 43% in Drug treatment)
Anxiety (17%)
Suicidality (x6 risk increase)
Personality Disorder
PTSD
Bipolar Disorder
37
Q

What features of an examination are specific to alcohol?

A

Comment on the presence of jaundice, anaemia, clubbing, cyanosis, oedema, ascites, lymphadenopathy, DVT

38
Q

What investigations are specific to alcohol?

A

Fibro scan / Ultrasound
Bloods (LFT, GGT, Lipids, U&E, amylase)
Breathalyser
Urine Drug Screen

39
Q

What must you note when assessing for alcohol misuse?

A

Note any history of Alcohol related seizures, Delirium Tremens, Alcohol psychosis, haematemesis, melaena

40
Q

What features of an examination are specific to opioids?

A 
Collapsed veins / track marks
Endocarditis 
Skin abscesses
Hepatitis / HIV
Pneumonia
41
Q

What investigations are specific to opiods?

A

Bloods (LFT, U&E, GGT, Glucose)
Breathalyser
Urine Drug Screen
Sexual health screening/BBV

42
Q

How is a CAGE screening conducted?

A

Have you ever felt you needed to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning (Eye-opener)

43
Q

Why is alcohol withdrawal more dangerous than opiate?

A

You can have seizures

Onset usually from 6 hours

Hallucinations can occur any time

DT is a late sign
(Delirium Tremens)

44
Q

What do opioids do?

A

Relieve pain – ANALGESIC effect

Create a sense of EUPHORIA

45
Q

What are the differences between opioids and opiates?

A

Opiatesrefer to naturalopioidssuch as morphineandcodeine, and heroin to some extent.

Opioidsrefer to all natural, semisynthetic,andsyntheticopioids.

46
Q

What are the features of opiate overdose?

A 
Not moving cannot be waken
Slow/no breathing
Chocking/Gurgling
Tiny pupils
Clammy cold skin
Blue lips and nails
47
Q

What drugs are used to help with abstinence from alcohol?

A

Acamprosate
Disulfiram
Naletrexone
Nalmefene

48
Q

What drugs are used to help with abstinence from opiods?

A

Methadone

Buprenorphine

49
Q

What other drugs should we be aware of?

A 
Cannabis / synthetic cannabinoids (Spice)
Cocaine / Crack
Amphetamines
Methamphetamine
MDMA / Ecstasy
Ketamine
Mephedrone
Hallucinogens (LSD, Psilocybin, DMT)
NPS (Novel Psychoactive Substances

Year 3 Neuro (17 decks)

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