Substance Use and Impulse Control (week 12) Flashcards
Substance:
Chemical compounds ingested to alter mood or behaviour
Psychoactive substances:
alter mood, behaviour, or both
includes: Commonplace legal drugs, such as alcohol, nicotine, found
in tobacco, the caffeine in coffee and tea
Polysubstance:
Using multiple substances
Levels of substance involvement
- Substance use
- Substance intoxication
- Substance abuse
- Substance dependence
- Substance withdrawal
Substance use criteria
- Ingestion of psychoactive substances in moderate
amounts - does not significantly interfere with social, educational, or
occupational functioning - Examples of use: coffee, drinks with a friend
Substance intoxication criteria
- Substance intoxication: drunkenness
- Interaction of variables
- Type of drug taken, the amount ingested, and the person’s
individual biological reaction - Intoxication experienced as impaired judgment, mood
changes, and lowered motor ability
Substance use disorder
- Problematic substance use
- Interference with life
- Job, relationship, education, risk taking (e.g., driving)
- Disorder described as an “addiction”
Substance use disorder DSM criteria
*** at least 2 syptoms in the past year: mild - 2-3, moderate- 4-5, severe - 6 or more
1) Taken in larger amounts or over longer period then intended
2) Persistent desire to use/ unsuccess effort to cut down
3) Great deal of time spent obtaining substance
4) Craving
5) Recurrent use results in failure to fulfill major role obligations
6) Causes social or interpersonal problems
7) Important social, job, or rec activities given up or reduced
8) Use in situations that are hazardous
9) Continued despite recurrent physical or psychological problems
10) Tolerance
11) Withdrawal
Physiological dependence:
- Tolerance: greater amounts of drug needed to experience same
effect - Withdrawal: negative physical response when the substance is no
longer ingested
Psychological dependance
behavioural reactions to
substance dependence
* Drug-seeking behaviours
Diagnostic issues in substance use disorder
- Substance use might occur concurrently with other
disorders - Drug intoxication and withdrawal cause increased risk
taking, which increases drug use - Mental health disorders cause substance use disorder
- Depression → alcohol use OR alcohol use → Depression
5 general categories of substances
- Depressants
- Stimulants
- Opioids
- Hallucinogens
- Other drugs
Alcohol-related disorders clinical description
- Depressant, inhibitory centres in the brain are depressed, or
slowed - Continued drinking depresses more areas of the brain
- Impaired motor coordination
- Slower reaction time
- Confused, poor judgments
- Vision and hearing affected
Alcohol-related disorder effects
- Influences several neuroreceptor systems
- GABA, inhibitory neurotransmitter, blackouts
- Releases natural analgesics
- Organ damage (liver cirrhosis)
Delirium tremens (DTs)
Frightening hallucinations and body tremors
Fetal alcohol syndrome (FAS)
Affects child whose mother drank while she was pregnant
Sedative related disorders:
Calming
Hypnotic related disorders:
sleep-inducing
Anxiolytic related disorders:
anxiety-reducing
Barbiturates:
relax muscles
- low doses produce mild feeling of well being
-overdosing is common means of suicide
Benzodiazepines:
calming, induces sleep
- tolerance and dependence with repeated use
Stimulants:
Amphetamines
Cocaine
Tobacco
Amphetamines
- DSM-5 diagnostic criteria for intoxication in amphetamine use
disorders include - Behavioural symptoms: euphoria or affective blunting, anxiety etc.
- Physiological symptoms: changes in HR, BP, chills etc.
- Stimulate central nervous system
- Enhance activity of norepinephrine and dopamine
- Lead to hallucinations and delusions
Cocaine
- Derived from leaves of the coca plant
- Increases alertness, euphoria, increases BP and pulse
- High from dopamine system impact
- Snorted, smoked or injected (crack cocaine)
cocaine clinical description
increases alertness, blood pressure; causes
insomnia
Caffeine related disorders
- “Gentle stimulant” found in tea, coffee, many soda drinks,
cocoa products - Elevates mood, decreases fatigue
- Causes insomnia
- Tolerance and dependence with overuse
- DSM-5 includes caffeine use disorder:
- Problematic caffeine use that causes significant impairment and
distress
Opioids
- Opiate: natural chemicals in opium poppy having a
narcotic effect - Sleep-inducing, pain-relieving (analgesic)
- Canada in grip of opioid crisis: prescription and illegal; high in
First Nations adults - Withdrawal is unpleasant
- Intravenously taken: risks of HIV
LSD
- LSD (acid; d-lysergic acid diethylamide)
- “Acid”
- Historically used as part of therapy
- Other drugs
- Psilocybin (mushrooms), lysergic acid amide, dimethyltryptamine
(DMT), mescaline (peyote), phencyclidine (PCP) - Tolerance develops quickly
- Limited withdrawal symptoms
LSD DSM criteria
- Perceptual changes: subjective intensification of perceptions,
depersonalization, and hallucinations - Physical symptoms: pupillary dilation, rapid heartbeat, sweating,
blurred vision (American Psychiatric Association, 2013). - “Bad trips” High Risk/ concerns with psychotic reactions
Cannabis
- Cannabis (marijuana) most routinely used drug in Canada;
2019 cannabis use was 15% - Alters perceptions; mood swings
- Impairment of memory, concentration, motivation, self-
esteem, relationship with others - Potentially helpful for some medical conditions (e.g., nausea
in chemo patients)
causes of substance use
Familial and Genetic Influences
* Genetic vulnerability to drug abuse, alcoholism
* A gene of chromosome 4 may prevent alcohol dependence
* Alcohol dehydrogenase (ADH) may be absent in some
people
* Gene DRD2 may be related to alcoholism
Neurobiological Influences
* Psychoactive drugs activate reward centre of the brain
* Sensitization: repeated exposure to stimulant drugs leads to increased
dopamine release when taking the drug
Causes: psychological dimensions of substance use
Positive Reinforcement
* Psychoactive drugs provide a pleasurable experience
* Use increase leads to tolerance increase
* Sometimes drugs are combined to enhance pleasurable experience
Negative Reinforcement
* Psychoactive drugs provide escape from physical pain (opioids), from
stress (alcohol), or from panic and anxiety (benzodiazepines)
* Opponent-process theory
* Experience an unpleasant crash after being high
Treatment of substance use
- Substance abusers arrive at treatment at different stages to
change substance use behaviour - Motivational enhancement therapy (MET): increase
motivation to change behaviour - Also called “Motivational interviewing”
Biological treatment (antagonist)
block or counteract the effects of psychoactive drugs
What is Naltrexone?
Opioid-antagonist drug
* Produces immediate withdrawal symptoms
* Also given for alcohol dependence
* A relatively new drug, ondansetron, is being studied
Biological treatment (aversive)
- Prescribed drugs make ingesting abused substances
extremely unpleasant - Disulfiram (Antabuse) used for alcohol disorder
- Problem of noncompliance
- For smoking aversion: silver nitrate in lozenges or gum
different Psychosocial treatments for substance use
- Inpatient facilities
- Alcoholics Anonymous (AA)
- Controlled use
- Component treatment
- Relapse prevention
How does psychosocial treatment help with substance abuse?
Harm Reduction
* Controlled drinking
* Safe injection sites (SISs)
Prevention
* Education-based programs
* Community-based interventions
* Cooperation of governmental, educational, and other social
institutions determine success
Impulse control disorder: Gambling disorder
- Lifetime estimate of approximately 2% Americans
- Job loss, bankruptcy, arrests
- Similar to substance use disorders
- Tolerance and withdrawal
- DSM-5: addictive disorders
- People with gambling disorder: in denial, impulsive,
continually optimistic - Internet gambling disorder
impulse control disorder: intermittent explosive disorder
Aggressive impulses
resulting in serious assaults, destruction of property
* Lifetime prevalence is 7%
Impulse control disorder: Kleptomania
recurrent failure to resist urges to steal things;
stigma associated; illegal
Impulse control disorder: pyromania
irresistible urge to set fires
Treatment for Impulse control disorders
cognitive-behavioural
