Substance Use Disorder Flashcards
1
Q
What are the DSM-5 criteria for Substance Use Disorder (10 in total)? How many symptoms need to be present, and for how long?
A
Two or more symptoms within a 1-year period:
- Failure to meet obligations
- Repeated use of substance in situations where it is physically dangerous
- Repeated relationship problems
- Continued use despite problems caused by the substance
- Tolerance
- Withdrawal
- Substance taken for longer time or greater amounts than intended
- Efforts to reduce or control use do not work
- Much time is spent trying to obtain the substance
- Social, hobbies, or work activities given up or reduced
- Craving to use the substance is strong
2
Q
What symptoms may accompany alcohol withdrawal?
A
- Muscle tremors
- Elevated pulse
- Blood pressure
- Temperature
- **Delirium tremens
3
Q
What is Delirium tremens?
A
Rare withdrawal symptom when alcohol in blood drops suddenly. Intense symptoms: - Delirium (state of confusion) - Tremulous (shaking) - Visual hallucinations
4
Q
What are two key features of Substance Use Disorders?
A
- Tolerance - Larger doses of drug needed to produce desired effect, effects of drug decrease if usual amount is taken.
- Withdrawal - Negative physical and psychological effects from stopping substance use, E.g., muscle pain, twitching, sweats, vomiting, diarrhea, insomnia.
5
Q
What percentage of people with Alcohol Use Disorder smoke tobacco?
A
80-85%
6
Q
How many criteria qualify for mild, moderate and severe Substance Use Disorder?
A
- Mild - 2-3
- Moderate - 4-5
- Severe - 6+
7
Q
Which age population is alcohol use disorder common in?
A
College-age adults.
- 39.4% report binge drinking (5 drinks in a short period of time)
- 12.5% report heavy-use drinking (5 drinks on the same occasion 5 or more times a month)
8
Q
Is there a gender rate difference between genders?
A
Yes, it is more common in men but the difference is shrinking.
9
Q
In what marital status is it most common to have alcohol use disorder?
A
Rate higher for never married / divorced people.
10
Q
What is substance use disorder comorbid with?
A
Borderline and antisocial personality disorders, mood disorders, anxiety disorders.
11
Q
What neurotransmitter does alcohol interact with? What psychological effects does this cause?
A
- Stimulates GABA receptors, reducing tension
- Increases dopamine and serotonin, has a pleasurable effect
- Inhibits glutamate receptors, causing cognitive difficulties
12
Q
What are the long-term effects of prolonged use of alcohol?
A
- Impaired digestion of food and absorption of vitamins, E.g., efficiency of B-complex vitamins – severe memory loss
- Cirrhosis of the liver
- Damage to the endocrine glands, brain, pancreas, heart failure, erectile dysfunction, hypertension, stroke, capillary hemorrhages
13
Q
What are the effects of high dose of alcohol (.08 blood alcohol content)?
A
- Significant motor impairment
- Difficulty monitoring errors and making decisions
14
Q
What is Fetal Alcohol Syndrome?
A
Heavy alcohol intake during pregnancy causing:
- A leading cause of intellectual disability among children
- Slowed fetal growth
- Cranial, facial, and limb anomalies
15
Q
How does nicotine affect the brain?
A
It stimulates dopamine neurons in mesolimbic area (involved in reinforcing effect of most drugs).
16
Q
What are some of the medical conditions that cigarettes can cause or worsen?
A
- Emphysema, cancers of larynx, esophagus, pancreas, bladder, cervix, and stomach, cardiovascular disease
- Sudden infant death syndrome and pregnancy complications
17
Q
In what socio-economic groups is smoking most prevalent?
A
Lower socio-economic classes
18
Q
What particular effects does cigarette smoking have on African Americans, compared to other groups?
A
- Less likely to quit
- More likely to get lung cancer
- Nicotine is metabolized more slowly
- More likely to smoke menthol cigarettes(direct advertisement to this community) - people tend to inhale more deeply and hold the smoke for longer
19
Q
What particular effects does cigarette smoking have on Chinese Americans, compared to other groups?
A
- Metabolize less nicotine from cigarettes than European American or Latino smokers
- Lung cancer rates are lower
20
Q
What are the effects of second hand smoke?
A
It contains higher concentrations of ammonia, carbon monoxide, nicotine, and tar than smokers. It’s also dangerous, can cause lung damage, possibly permanent.
Babies of women exposed to secondhand smoke during pregnancy are more likely to: be born prematurely, have lower birth weights, have birth defects.
21
Q
What are some symptoms that children of smokers are likely to suffer from?
A
Upper respiratory infections, asthma, bronchitis, and inner-ear infections.
22
Q
How do FDA regulations treat E-cigarettes and why?
A
FDA regulations treat E-cigarettes like other regulated tobacco products. because among young people, those who vape (E-cigarettes) are more likely to take up smoking cigarettes.
23
Q
Is there a gender difference in the rates of Marijuana Use Disorder?
A
Yes, more common among men.
24
Q
Is there a difference in rates of Marijuana Use Disorder between races and ethnic groups?
A
Hah! no.
25
What are the mental effects of marijuana? what are effects of large and heavy doses?
- Feelings of relaxation and sociability
Large doses:
- Rapid shifts of emotion
- Interferes with attention, memory, and thinking
Heavy doses:
- Hallucinations and panic
- Cognitive impairment
26
What are short-term physical effects of marijuana?
- Bloodshot and itchy eyes
- Dry mouth and throat
- Increased appetite
- Reduced pressure within the eye
- Increased blood pressure
27
What are long-term physical effects of marijuana?
- Damage to lung structure and function in long-term users
- Cognitive problems linked to the effects of marijuana on CB1 and CB2 receptors in the brain (e.g., hippocampus)
- Different patterns of connectivity between amygdala and frontal cortex among users compared to non-users
- Users can develop tolerance and withdrawal
28
What are therapeutic effects of marijuana?
- Reduce nausea and loss of appetite caused by chemo
| - Can relieve discomfort associated with cancer, glaucoma, chronic pain, muscle spasms, seizures, AIDS
29
Name some opioids.
opium, morphine, heroin, codeine
30
How prevalent is opioids abuse?
Prescription pain medications are among the most abused of all drugs (Vicodin, Zydone, Lortab, Percodan, Tylox, OxyContin).
"Opioidic crisis" - 7% of US population misused opioids at least once.
31
Is there a gender difference in the rate of heroin use disorder?
Yes, more common among men.
32
Is there a gender difference in the rate of prescription pain medication abuse?
Yes, slightly higher in men.
33
Is there an (American) ethnic difference in the rate of prescription pain medication abuse?
Yes, higher among white Americans compared to other ethnic groups/
34
What are the psychological and physical effects of opioids?
- Produce euphoria, drowsiness, and lack of coordination - loss of inhibition, increased self-confidence. Severe letdown after about 4 to 6 hours
- Heroin and OxyContin - intense feelings of warmth and ecstasy following injection.
- Stimulate receptors of the body’s opioid system
- Exposure to infectious agents (e.g., HIV) through intravenous drug use
35
How long does it take for opiate withdrawal to begin? what are the symptoms?
How long does it take for withdrawal symptoms to get severe? what are the symptoms?
How long does withdrawal take?
- Opiate withdrawal may begin within 8 hours after high tolerance develops. Symptoms include muscle pain, sneezing, sweating, tearfulness, yawning. Resembles influenza.
- Within 36 hours, becomes more severe: uncontrollable muscle twitching, cramps, chills, flushing/sweating, elevated heart rate/blood pressure, insomnia, vomiting, diarrhea.
- Withdrawal lasts about 72 hours.
36
What are the 9 groups of substances that may be abused and cause a use disorder?
1. Alcohol
2. Cannabis
3. Hallucinogens
4. Inhalants
5. Opioids
6. Sedatives, hypnotics, or anxiolytics
7. Stimulants
8. Tobacco
9. Other
37
Which psychoactive substance does not qualify for a disorder?
Caffeine.
| BUT - it's listed "for further research" in DSM-5.
38
Which psychoactive substance cannot cause intoxication?
Tobacco.
39
Which psychoactive substance groups do not have withdrawal effects?
- Hallucinogens
| - Inhalants
40
Which group of DSM disorders is not I/W comorbid with most substance use disorders?
Obsessive-compulsive and related disorders (only with stimulants)
41
Which substance use disorder is not I/W comorbid with most groups of DSM disorders?
Tobacco.
42
We should probably go over the table of comorbidities!
:)
43
What are the 3 types of stimulants (that we talked about)?
1. Amphetamines (Dexedrine, Adderall)
2. Methamphetamine
3. Cocaine and crack
44
How do amphetamines affect neurotransmitters?
Trigger release and block reuptake of norepinephrine and
| dopamine.
45
What are the psychological effects of amphetamines? and high doses?
The person becomes alert, euphoric, outgoing, feels boundless energy and self-confidence.
High doses can lead to nervousness, agitation, confusion, suspiciousness, hostility.
46
How long does it take for tolerance to amphetamines to develop?
6 days.
47
What is the lifetime prevalence of methamphetamines use?
5.4%
48
Is there a gender difference in methamphetamines use?
Yes, men tend to use more than women.
49
Is there a demographic difference in methamphetamines use?
Used more often in small towns than in cities.
50
What are the psychological effects of methamphetamine?
Immediate high, or rush, that can last for hours. Good feeling crashes and person becomes agitated.
51
How long may cravings for methamphetamine last?
Several years after last use.
52
What are the main damages cause by methamphetamine use?
```
Use is associated with brain damage:
- Affects dopamine and serotonin systems
- Reductions in brain volume
- Damage to areas associated with reward and decision
making
```
53
Is there a gender and demographic difference in cocaine use?
Yes, mostly used in urban areas by men.
54
How are the brain and psychological effects of cocaine?
It acts rapidly.
- Blocks reuptake of dopamine in mesolimbic areas
- Induces pleasurable states - increased sexual desire, self-confidence, stamina
55
What are the effects of cocaine overdose?
Chills, nausea, insomnia, paranoia, hallucinations, possibly heart attack and death.
56
What is the problem with some users not developing tolerance to cocaine?
It may increase the risk of overdose.
57
What brain system does ecstasy affect?
Primarily on the serotonin system.
58
What are the psychological effects of ecstasy?
Increases feelings of intimacy, insight, positive emotions, self-confidence.
Can also cause muscle tension, nausea, anxiety, depression, confusion, depersonalization
59
What is the average age of first use of ecstasy?
21
60
Is there a gender difference in PCP (phencyclidine) use rate?
Yes, used more by men.
61
What are some negative psychological and physical effects of PCP (phencyclidine)?
- Causes severe paranoia and violence
| - Coma and death are possible
62
Is there a gender and demographic difference in hallucinogens use rate?
Yes, used more often by men and European Americans.
63
Is there withdrawal and tolerance for LSD?
Withdrawal - no.
| Tolerance - develops rapidly.
64
What brain system do hallucinogens affect?
The serotonin system.
65
What are the psychological effects of hallucinogens?
- Hallucinations, sense of time, mood swings, expanded consciousness
- Flashbacks – visual recurrences of perceptual experiences after effects of drug have worn off
66
Does alcohol use disorder have family-genetic factors?
Yes. Relatives and children of problem drinkers have higher-than-expected rates of alcohol use disorder.
Specifically - tolerance for large quantities of alcohol may be inherited.
67
What do researches on twins show about substance use disorder?
Greater concordance in monozygotic than in dizygotic twins in general, and specifically in alcohol, tobacco and heavy use of marijuana.
68
What does genetic research show on smoking?
Defect in CYP2A6 gene > less likelihood for dependency.
69
What is a shared effect of nearly all drugs on the brain?
Nearly all drugs stimulate the dopamine system, particularly the mesolimbic pathway - linked to pleasure and reward.
70
What is the difference between the vulnerability model and the toxic effect model in the neurobiological etiology of substance use disorder?
Vulnerability model = vulnerable dopamine system causes substance use disorder.
Toxic effect model = substance use causes a vulnerable dopamine system.
71
What explains frequent relapse into drug use?
People take drugs to avoid bad feelings - also withdrawal symptoms, and this may explain the frequency of relapse.
72
How does the incentive-sensitization theory explain the neurobiological etiology of substance use disorder?
Incentive-sensitization theory:
- Distinguishes wanting (craving for drug) from liking (pleasure obtained by taking the drug).
- Dopamine system becomes sensitive to the drug and the cues associated with drug (e.g., needles, rolling papers, etc.). (Brain imaging studies show that cues for drug activate the reward and pleasure areas of the brain which are involved in the drug use).
- Over time, liking for drugs decreases, but wanting remains intense
- Craving (wanting) is associated with use
73
What may be psychological etiological explanations of substance use disorder?
1. Short-term vs. long-term rewards - people dependent on substances discount delayed rewards more steeply than do people not dependent. This recruits different brain regions: Delayed rewards - prefrontal cortex; Immediate rewards - amygdala, nucleus accumbens.
2. Emotional regulation - mood alteration enhances positive feelings or diminishes negative ones. People with substance use disorder may be less successful in regulating negative emotions. substance use as an emotional regulation tool:
- Dampen down thoughts of rejection in social situations
- Provide relief or distraction from negative emotions
- Increase positive emotions when bored
3. Expectancy and personality factors - people who expect alcohol to reduce stress and anxiety are most likely to drink. So expectancies about drug's effect predict increased drug use in general.
- Personality factors that predict onset of substance use disorder - high levels of negative emotionality or neuroticism, and persistent desire for arousal and positive affect.
74
What is the most common abused substance in the world?
Alcohol.
75
What are some socio-cultural factors for etiology of alcohol use disorder?
- Cultural attitudes and patterns of drinking influence the likelihood of drinking heavily and therefore of abusing alcohol.
- Family factors - parental alcohol use, marital discord, lack of parental support and monitoring.
- Social networks, media, advertisements influence substance use.
76
What percentage of people physiologically dependent on alcohol ever get treatment?
24%
77
What are treatments for Alcohol Use Disorder?
- Detoxification in hospital under medical supervision
- Alcoholics Anonymous (AA)
- Couples therapy
- Motivational interventions (for college students)
- Controlled drinking
- Medications
78
What is the effectiveness of AA for treatment of Alcohol Use Disorder compared to other treatments?
Some studies have predict better outcomes, but recent studies suggest AA is no more effective than other forms of therapy.
79
What is the benefit of couples therapy for Alcohol Use Disorder?
It is more effective than individual treatment approaches.
80
What are some medications used for treatment of Alcohol Use Disorder?
- Antabuse (disulfiram): produces nausea and vomiting if alcohol is consumed, dropout rates are high (80%)
- Other medications: naltrexone and acamprosate: most effective when combined with CBT
81
What are some treatments for Tobacco Use Disorder??
- Laws prohibiting smoking in public places
- Physician's advice
- Gradual reduction of nicotine intake
- Nicotine replacement treatments (gum, patches, inhalers, e-cigarettes)
82
What percentage of people who need treatment for substance use disorders do not get it?
90%
83
What are psychological treatments for Substance Use Disorder?
- CBT
- Contingency management (vouchers)
- Motivational enhancement therapy
- Self-help residential homes (drug-free environment + group therapy + guidance and support)
84
What medications are used to treat Opioid Use Disorder?
- Opioid substitutes
| - Opioid antagonists
85
What is effective at reducing teenage smoking (prevention)?
Statewide tobacco control programs, such as increasing taxes on cigarettes, restricting advertising, conducting educational campaigns and creating smoke-free environments.
