substance use disorder

Question 1

why is the term ‘addiction’ discouraged in clinical and research settings?

Answer 1

• it’s stigmatised > contributes to stereotypes w/ biases
• related to physiological state
• preferred term is substance use disorders

Question 2

what are the main four characteristics defining substance use disorder?

Answer 2

• lack of control
• preoccupation with substance
• neglect of other life activities
• chronic relapsing nature

Question 3

what is the DSM criteria for substance use disorder?

Answer 3

• presenting 11 diagnostic markers > requiring at least 2 for 12m
• categorised into severity levels >mild 2-3, moderate 4-5, severe 6 or more
• impaired control > (excessive use, unsuccessful attempts to cut down)
• social impairment > (craving, neglecting responsibilities)
• risky use > (continuing use despite risks)
• pharmacological criteria > tolerence/withdrawal

Question 4

what are common symptoms of substance use disorder?

Answer 4

• strong cravings for drug
• compulsive behaviours
• withdrawal symptoms
• neglect of other life activities
• higher rates of crime
• relapsing

Question 5

what are key facts about substance use disorder?

Answer 5

• 1 in 12 ppl aged 16-59 use illicit drugs > cannabis most prevalent
• mainly males than females > white British
• related to lifetime trauma, family issues etc
• comorbidity > bipolar, depression, PTSD, schizophrenia

Question 6

what category is alcohol use and what defines hazardous levels?

Answer 6

• hazardous lvls = defines 14 units per weeks > 20% ppl
• alcohol is legal & prevalent > 60% in UK use

Question 7

how are childhood & trauma factors related to substance use disorder?

Answer 7

• traumatic experiences e.g. being refugee or in war
• use as coping mechanism for emotional pain or stress from traumatic events
• various forms of childhood abuse + neglect & violence
• parental substance use: ineffective parenting, no protection + chaos, role modelling = offspring SUD
• childhood trauma can lead to neurobiological changes > affect areas related to impulse control, decision making & stress response

Question 8

how are genetic & neurobiological factors related to substance use disorder?

Answer 8

• dopaminergic system implicated in SUD
• sensitivity to positive reward, neurotransmitter > e.g. serotonin, noradrenaline
• Gene-Environment Interactions: Genetic vulnerabilities interact w/ environmental factors> e.g. exposure to stress or trauma= risk for SUD
  genetic factors: twin studies

Question 9

how are societal & environmental factors related to substance use disorder?

Answer 9

• poverty, low socioeconomic status
• peer pressure > to look cool or fit in with friends
• social norms
• gender important predictor

Question 10

What is the self-medication hypothesis, and what are its criticisms?

Answer 10

• People use substances to treat underlying mental health symptoms
• criticism: > Lack of a 1-to-1 relationship between specific disorders & drugs
  > questionable effectiveness of self-medication
  > not everyone w/ a mental health disorder develops SUD
  > continued substance use even after treating the underlying problem

Question 11

what is the gateway hypothesis + critiques?

Answer 11

• Starting with legal or less severe drugs leads to a progression to harder drugs
• Critiques: > Experimental studies don’t always support this
  > non-linear development of substance use
  > not a 1-to-1 relationship
  > some individuals skip certain substances.

Question 12

What are the processes involved in behavioural theories of substance use disorder?

Answer 12

• Positive reinforcement > operant conditioning (instrumental learning) = strengthen substance use due to pleasureable effects (drug=fun)
• Negative reinforcement> escaping withdrawal or distress = avoid unpleasant feeling = reinforcement
• opponent process model: Solomon > first use for fun (A process), then avoid withdrawal (B process) = repeated drug use & tolerance develops = cravings

Question 13

what Is the holistic approach to treating SUD?

Answer 13

• involves detoxification & withdrawal management + addressing physiological dependancy
• CBT > goal setting, problem solving. & motivational interventions
• contingency planning > reward conditioning
• recovery planning & addressing comorbidity
• family based treatment: addressing broader community + mental health needs

Question 14

What is the effectiveness of different treatments for substance use disorder?

Answer 14

• Meta-analysis suggests CBT + contingency management = best results.
• Effectiveness varies for different substances > cannabis showing relatively higher success rates in treatment

Question 15

What are the challenges and outcomes of treatment for SUD?

Answer 15

• High dropout rates in substance use disorder treatment
• 60-80% relapse risk > esp first months after treatment
• 20-80% ppl get better
  Predictors of relapse: intolerance to negative effects, stress, severity of disorder, and low social stability.