substance use and addictions

Question 1

how drugs become addictive- explain the 2 types of reinforcement giving an example for each

Answer 1

Negative reinforcement: ​
-Overcome adverse state= ​
ie. reduce anxiety/Help me fall asleep ​

Positive reinforcement ​
-Gain positive state​=
ie. Stay awake /Get high /I like it

Question 2

Course of alcohol/drug use

Answer 2

Like -> want -> need

Question 3

what is addiction vs dependence

Answer 3

addiction= continuous use even though it’s harmful consequence ie. failure to meet work, sodial, fam obligation. +/-tolerance, withdrawals.

Dependence = body physically adapted to the drug/alcohol . Ie. Tolerance/Withdrawal.
can be dependent and not addicted

eventually dependence will lead to addiction

Question 4

dependence syndrome ICD-11 diagnostic criteria

Answer 4

1+ is sufficient: over 12 months/continuous use (approx daily) for at least 3 months

1.Impaired control over substance use

2.Prioritizing substance use over other aspects of life

3.neuroadaptation to the substance, (e.g. tolerance, withdrawal, use of pharmacologically similar substances to prevent or alleviate withdrawal symptoms.

Question 5

what behaviours can people get addicted to

Answer 5

gambling disorder,
internet gaming disorder

Question 6

Levels of addiction: hazardous use, harmful use, dependence/addiction:

Answer 6

hazardous use-quantity and freq is high

harmful use- consequences (physical, mental, social)

dependence/addiction- tolerance and withdrawal

Question 7

Why do some people struggle with addiction while others don’t ​

Answer 7

Drug factors ​
-Some drugs more addictive than others ​
-Faster entry to brain more addictive ​
ie. IV heroin is more addictive than opium ​

Environment/social ​
-Raised in an environment where excessive drug use normal ​
-ACEs​
-Life stressors ​

Personal factors
-genetic
-personality traits

Question 8

model of addiction:

Answer 8

-reward deficiency (positive reinforcement) (increase in dopamine)

-overcoming adverse state ie. withdrawal/anxirty (negative reinforcement)

-impulsivity/compulsivity= personality factors.

Question 9

As addiction/dependence develops, how does positive/negative reinforcement change

Answer 9

from positive to negative reinforcement

Question 10

alcohol effect on brain

Answer 10

Alcohol is a depressant cos it boost the inhibitory GABA system -> sedation and decreases anxiety ​

It blocks the excitatory system -> memory blackouts ​

Question 11

receptors involved in alcohol and how is it like in normal human

Answer 11

Glutamate = excitatory system and uses NMDA receptors ​

GABA-benzodiazepine (GABA-A) = inhibitory system and uses GABA-A receptors ​

In a normal human these two systems are in balance ​

Question 12

how to treat alcohol withdrawal

Answer 12

treat with benzodiazepines to boost GABA function​

Question 13

what happens in chronic alcohol exposure and what happens when you suddenly stop drinking

Answer 13

In chronic alcohol exposure the brain increases the number of NMDA receptors and makes GABA A receptors less sensitive to accomated for the excess alcohol ​

However if this person stops drinking, there is nothing to inhbit NMDA so it is now more powerful than gaba a ​

NMDA causes increase in Ca2+​ -> toxic leading to hyperexcitability (seizures) and cell death (atrophy)​​

Question 13

types of alcohol assessment tools

Answer 13

CAGE questionnaire and AUDIT (alcohol use disorders identification test)

CAGE=
Cut down
Anger
Guilty
Even in mornings

Question 13

alcohol withdrawal. Duration, onset, when seizures happen? What is associated with this?

Answer 13

6-72hrs
-Worsening as time goes on ​
-Hallucinations can happen at any stage​
-Seizures happen between 12hrs – 48hrs​
-Delirium tremens​

Question 14

what is delirium tremems

Answer 14

late sign-
medical emergency-

Question 15

opioid addiction- 2 effects, withdrawals symptoms give 5 examples ?

Answer 15

effect- analgesic, euphoria

withdrawals- tachy, sweaty, snotty, achy (bone/abdo), worry

Question 16

opioid addiction- signs seen on withdrawal vs overdose and treatment

Answer 16

dilated eyes= withdrawal

pin prick eyes +slow breathing, clammy cold, blue lips = overdose

overdose-> inject naloxone/nasal spray. If no response after 3 mins- repeat. provide airway support, recovery position

Question 17

This dopamine pathway (in ventral striatum) has
been referred to as the
‘pleasure-reward-motivation’
system
what is addiction conceptualised as?

Answer 17

reward deficient state

Question 18

what does cocaine and amphetamine do to increase dopamine in synapse (in ventral striatum)

Answer 18

both block reuptake

amphetamine enhances release of dopamine

Question 19

auditory and visual hallucinations, confusion, disorientation, hypertension, agitation, tachycardia (100+), fever, severe tremours in hand and body- what is this an indication of?

Answer 19

delirium tremens

Question 20

difference between opiates and opioids

Answer 20

opiates= natural opioids ie. morphine, codeine

opioids=all natural, semisynthetic and synthetic opioids
–synthetic=fentanyl, methadone
–semi-synthetic= heroin