Substance use disorder Flashcards
Depressants: Alcohol use disorder 1) race 2) Effects on 3) Cognitive impact 4) Some symptoms
- Asians < AA < Hisp < White (recent article in news about punjabi culture & problem drinking –> won’t come forward due to family pride) (under represented)
- Reliance + leads to interference with work/social life
- MRI scans have revealed damage in various regions of their brains and impairments in memory, speed of thinking, attention skills and balance
- drinking more than intended, uncontrollable, activities directed @ alcohol, persistence even after problems occur
What are “DT’s”
only from withdrawal from alcohol
Delirium tremens - withdrawal reaction; terrifying visual hallucinations. Severe withdrawal reaction
Depressants:
- hypnotic drugs
- produce feelings of relaxation and drowsiness at low doses
- At higher doses they are sleep inducers or hypnotics
- Xanax, Vallium
- Bind to GABA receptors
Depressants:
Opioids
what?/binds to?
- Opimum - taken from poppies; makes up heroin, codeine & morphine
- Heroin was seen as the new wonder drug from morphine BUT was found to be more addictive; all opiates now illegal
- Binds to endorphin sites; which help relieve pain and reduce emotional tension
Opioid use disorder
- Heroin – after just a few week of use = opioid use disorder
- peaks after just 3 days of using
- Big problem in US
- Hep c / AIDS/ bacterial infections –> some saying @ risk for a HIV outbreak.
- Hep c is increasing with the increasing IV opioid use
- fentanyl, drug overdoses claimed 64,000 lives in 2016 alone, more than the entire death toll during the Vietnam War.
**synthetic opioid = fentanyl
similar structure of symptoms for most substance use disorders
- take more than intended
- persistent desire/unseccessful to cut down
- failure to fufill obligations
- use even in harmful situations/where there’s a problem already
Stimulants
Cocaine
- affects where?
- dangers of cocaine?
- largely increases the effects of dopamine & norepinphrine in the brain (reward)
- Overdose; strong doses can have effects on respiratory areas of the brain; stimulating -> suppressing
- Heart irregularities
- Brain seizures that make heart/brain stop
Stimulants:
Amphetamines
- Manufactured in the lab
- Dopamine, serotonin, norepinephrine action increased
Stimulant use disorder
- regular use may lead to this disorder
- poor functioning socially + at work etcetc
Hallucinogens
- cannabis
- LSD
LSD:
- binds to serotonin
- tolerance + withdrawal effects aren’t present
- flashbacks + anxiety disorders may occur
Cannabis:
- Hallucinogenic, depressant and stimulant effects
- Lower doses = relaxation and joy
- Higher doses = odd visual experiences, hallucinations, confusion, impulsivity
Cannabis use disorder
- Regularly getting high
- Tolerance for it can build up + withdrawal symptoms (flulike symptoms + irritable)
& the rest of common symptoms
Is marijuana dangerous?
- It is becoming stronger; can cause panic reactions + some can feel as if theyre losing their minds
- Memory can be affected
- Long term problems: lung disease, reproduction
combination of substances (disorder & interaction)
- Poly substance use
- interactions of drugs –> when taken together they seem to heighten each others effects
- *Synergistic effect - when the effect of the combo is greater than the sum of all the effects of the drugs alone
- when they have opposing effects - severe intoxication/death
Aetiology of substance use disorders
- Sociocultural Views: evidence for
(5)
- stressful socioeconomic conditions
a) poorer people have a higher rate
b) unemployed > employed
c) more intense discrimination = more use
d) family environments where substance use is normalised
e) Problem drinking are more likely to occur when the family/peers problem drink + whose families are unsupportive
Aetiology of substance use disorders
- Sociocultural Views:
EVALUATION
Discrimination
- a powerful link exists between discrimination and mood and substance-use disorders among racial/ethnic minority populations in the United States (AA)
- dose response relationship found too; the higher the discrimination, the higher the intake of drugs
- Rate varies according to the discrimination experienced: across multiple domains (character based, disrespect, hostility etc) – higher rate than if just one form experienced (i.e. just discrimination) Isolated exp of discrimination = not
enough
- mediated by anxiety?
Aetiology of substance use disorders
- Cognitive Behavioural Views: WHAT?
Operant conditioning:
a) temporary reduction in tension = positive, rewarding effects
b) Leads also to the expectancy of postive effects + this leads to people to be motivated to take the drug to relieve tension
Aetiology of substance use disorders
- Biological Views: what/support (4 factors)
GENETIC PREDISPOSITION
a) Identical twins have a higher concordance rate
BUT
* may simply be the same parenting that leads to it i.e. similar parenting may occur for identical twins rather than fraternal?*
b) Adoption studies - show higher rates of alcoholism when bio parent had alcohlism
BIOCHEMICAL FACTORS
- when drugs is taken, it alters the neurochems in the brain
- when people keep taking it permanently alters levels in brain
- withdrawal continues until back to normal
BUT
this theory explains why people who regularly take drugs, take them. But doesn’t explain why drugs are so rewarding + why do people turn to them in the first place?**
REWARD CENTRE
- Dopamine + other neurotransmitters
- When dopamine gets activated along those pathways a person feels pleasure
- when drugs repeatedly stimulate this area - it becomes hypersensitive to substances. i.e. fires more readily when stimulated by them
REWARD DEFICIENCY SYNDROME
- Reward centre not readily activated by usual events so they turn to drugs to stimulate it, particularly in times of stress (Garfield eta l. 2014)
- Abnormal genes (i.e. abnormal D2 receptor gene)
Aetiology of substance use disorders
- Biological Views: what/support (4 factors)
GENETIC PREDISPOSITION
a) Identical twins have a higher concordance rate
BUT
* may simply be the same parenting that leads to it i.e. similar parenting may occur for identical twins rather than fraternal?*
b) Adoption studies - show higher rates of alcoholism when bio parent had alcohlism
BIOCHEMICAL FACTORS
- when drugs is taken, it alters the neurochems in the brain
- when people keep taking it permanently alters levels in brain
- withdrawal continues until back to normal
REWARD CENTRE
- Dopamine + other neurotransmitters
- When dopamine gets activated along those pathways a person feels pleasure
- when drugs repeatedly stimulate this area - it becomes hypersensitive to substances. i.e. fires more readily when stimulated by them
REWARD DEFICIENCY SYNDROME
- Reward centre not readily activated by usual events so they turn to drugs to stimulate it, particularly in times of stress (Garfield eta l. 2014)
- Abnormal genes (i.e. abnormal D2 receptor gene)
REWARD CENTRE
EVAL
- mesolimbic dopamine pathway: VTA (dopamine producing) —> nucleus accumbens (reward & motivation)
- mesocortical pathway: VTA –> cerebral cortex
- DA release = wellbeing
- extraversion has been found to have a protective role over this reward system –> linked with an increased D2 density & also higher OFC activity (decision making)
NEED MORE??? - meds that target this dopamine system = quite successful
BIOCHEM FACTORS EVAL
this theory explains why people who regularly take drugs, take them. But doesn’t explain why drugs are so rewarding + why do people turn to them in the first place?**
internet gaming disorder
- Awaiting official status (?) —- not included in dsm5
- All or most of waking hours on it (networking, buying, gaming, browsing, virtual worlds etctec)
- symptoms are parallel to those with SUD***
Biological treatments
1) DETOXIFICATION
- systematic + supervised withdrawal from drug
- outpatient or inpatient
- removal of drug or put on another one to reduce symptoms of withdrawal
EVAL
- rarely work alone; need in combo
- helps those who are motivated
- Relapse rates are high for those who do not receive a follow-up form if treatment – psychological, biological, sociocultural – after detox
2) ANTAGONIST DRUGS
- block the effects of the drug
- Help resist temptation
Problem: only motivated people will take them as prescribed + need to be careful (EG heroin users may suffer severe withdrawal if not used precautiously)
3) DRUG MAINTENANCE THERAPY
- drug related lifestyle may be a bigger problem than the drugs direct effects (eg heroin & unclean needles)
- support for use comes from high HIV + hep c in drug users
- The research suggests= most effective when in combo with education, psychotherapy, family therapy, employment and counselling
Sociocultural therapies
SELF HELP
- alcoholics anonymous
- Members available to help each other 24 hours a day
COMMUNITY PREVENTION PROGRAMS
- PREVENTION
- involve the parents, peer group, school, community
- involving family seems to have an impact; but a problem is that some drug users don’t have a support network
