Substance Use Disorders Flashcards
Illicit drug use has ____ in the past ____ years.
increased, 10
In 2019,
12-17: 17.2%
18-25: 39%
26+:18.3%
13% of Americans have started or increased substance use to ______.
cope with stress and emotions during the pandemic (2019 to 2020)
There was ______ deaths by overdose in 2020.
93,000
70% of all overdose deaths in 2019 involved what drug?
opioids especially fentanyl
Substance Use
taking moderate amounts of a substance in a way that doesn’t interfere with functioning
Substance Intoxication
physical reaction to a substance (being drunk) and involves impaired judgement, mood changes and lowered motor ability
Substance Abuse
use in a way that is dangerous or causes substantial impairment in your life (affecting job or relationship)
Substance Dependence
drug-seeking behavior that is defined by tolerance and withdrawal (spending too much money on substance)
Tolerance
needing more of a substance to get the same effect and reduced effects from the same amount
Withdrawal
physical symptom reaction when substance is discontinued after regular use
In the DSM-5, there are no longer separate designations for
intoxication, abuse, and dependence
Severity qualifiers are ….
-mild (2 to 3 of the 11 criteria are met)
-moderate (4 to 5 of the 11 criteria are met)
-severe (6 or more of the 11 criteria are met)
DSM-5 Criteria: Substance Use
- taking more of the substance than intended
- persistent desire or unsuccessful efforts to control use
- excessive time spent using substance
- craving for or strong desire to use the substance
- failure to fulfill major role obligation at work, school or home
- continued use despite persistent social or interpersonal problems caused by substance use
- important social, occupational or recreational activities are given up or reduced due to substance use
- recurrent substance use in physically hazardous situations (driving)
- recurrent substance use despite knowing it is causing physical or psychological problems
- tolerance
- withdrawal
What are the 5 main categories of substances?
- depressants - behavioral sedation (alcohol, sedative, anxiolytic drugs)
- stimulants - increased alertness and elevate mood (cocaine, nicotine)
- opiates - produce analgesia and euphoria (oxycodone, fentanyl, heroin, morphine, codeine)
- hallucinogens - alter sensory perception (weed, LSD)
- other drugs of abuse - inhalants, anabolic steroids, medications
What are the brain’s pleasure centers?
the limbic system
-ventral tegmental area
-nucleu accumbens
-hippocampus
-locus coeruleus
-amygdala
Reward circuits are linked to
Ventral tegmental area. (VTA) -> Ventral Striatum (VS) -> nucleus accumbens -> locus coeruleus
What is the locus coeruleus?
it is the alarm center triggered from a lack of the drug/norepinephrine that drives the person to seek out the drug (in the prefrontal cortex - planning and motivating action)
The stimulation of GABA receptors cause ____ to be released so that it reduces ______.
dopamine, tension
Increase levels of ____ to create ______.
dopamine and or endorphins, pleasurable feelings
Inhibit the ______, to have cognitive effects such as _____.
glutamate receptors
slurred speech, impaired decisions and memory loss
What is Jellinek’s sequence of behaviors associated with alcohol dependence?
-periodic, excessive drinking
-blackouts
-sneaking drinks
**loss of control over drinking
-remorse and rationalization
-changing patterns
-morning drinking
-benders
-defeat
What are the incidence rates for alcohol dependences in the US?
men is over 20% and women is over 8%
Who have the highest rates of alcohol dependence?
Native American youth
What is the Native American death rate from alcohol abuse?
40%
Alcohol Use Effects
-effects the GABA, glutamate system, excitatory, serotonin
-at low blood alcohol levels (0.3 to 0.6): disinhibitory effect and impaired judgement
-at higher blood concentrations (0.6+): psychomotor incoordination and more impaired judgement
-hangovers
What are the negative physiological effects of alcohol dependence?
-hepatitis (inflammation of the liver) that is treatable
-cirrhosis of the liver (fat buildup along with fibrous tissue replacing liver cells) that is nonreversible as the toxins destroy the liver
-wernicke-korsakoff’s syndrome (dementia) which impairs the memory, flat affect, and blackouts
-delirium tremens can be fatal (seizures, hallucinations)
Etiology of Alcoholism
social factors = more available then the higher the rates, usage in parents increases risk in children, martial problems, legal problems
psychological factors = reinforcement by mood states, alcohol > stress > more alcohol
biological factors = higher in fraternal twins, low risk in asians
What are the two variables that predicted the development of alcohol abuse in men?
Schuckit
1. self-report of low level of intoxication after a dose of alcohol
2. less body sway after drinking
Treatment of Alcoholism
- Alcoholics Anonymous (AA)
-12 step program
-abstinence - Smart Recovery
(no 12 steps) - Inpatient Treatment
-detox
What is the controlled drinking treatment?
Sobell in 1993: Guided Self-Change
-cognitive-behavioral approach
-personal responsibility and control
-identify negative aspects of drinking (the cost and behavior)
-sip instead of gulp
-resist the urge to drink
-alternative coping skills developed
What are the medications for alcoholism?
-disulfiram/antabuse (violent vomiting if ingested with alcohol, high drop out rates)
-opiate antagonists - naltrexone/revia (blocks activity of endorphins to reduce cravings)
-acamprosate/campral (used to maintain sobriety, acts on glutamate system i=to reduce withdrawal symptoms)
-SSRI anti-depressants (improve treatment when comorbid with depression)
What was the Global Strategy to Reduce the Harmful Use of Alcohol in May of 2010 by WHO?
10 target areas for national action:
1. leadership, awareness and commitment
2. health service response
3. community action
4. drink-driving policies
5. availability of alcohol
6. pricing policies
7. reduce negative consequences of intoxication
8. reduce public health impact of unrecorded alcohol
9. marketing of alcoholic beverages
10. monitoring and surveillance
Narcotics
have sedative and analgesic effects
What are the types of narcotics?
- Barbiturates (powerful sedative and anticonvulsants)
-phenobarbital
-seconal - Tranquilizers (anti-anxiety meds and mild sedative)
-Benodiazepines: valium, xanez, rohypnol (roofie)
*can die of withdrawal & extremely addictive
What are the effects of narcotics?
similar to alcohol, act on GABA (inhibitory neurotransmitter), CNS depressants
Stimulant Drugs
-amphetamines
-nicotine
-caffeine
-cocaine
What are the effects of stimulant drugs?
effects dopamine by blocking its reuptake in the synapse by binding to sites on the dendrites which stimulates dopamine in pleasure pathways of the brain
**very addictive
Opiates
-opium
-morphine
-heroin
-oxycodone + other pain killers
-fentanyl
What are the effects of opiates?
effects the natural opioids in the brain, enkephalins and endorphins
*very addictive
Hallucinogens
distortions in sensory perceptions
-LSD
-psilocybin (mushrooms)
-mescoline (peyote)
-PCP (angel dust)
-ecstasy
What are the effects of hallucinogens?
LSD = serotonin
peyote = norepinephrine
ecstasy = serotonin and dopamine
*some may affect acetylcholine
Is Cannabis a hallucinogenic?
Yes
-marijuana (leaves)
-hashish (dried resin)
*active ingredient is THC
What are the effects of cannabis?
activates the cannaboid/anandamide receptors in brain and has pain relieving effect (in limbic system, cortex, cerebellum) which interferes with normal functioning
*affects dopamine
*long term use = reduction in hippocampal activity (memory)
Principles of Effective Treatment for Substance Use Disorders
- No single treatment is appropriate for all individuals
- Treatments needs to be readily available
- Effective treatment attends to multiple needs, not just drug use
- Treatment and services must be assessed continually and modified
- Treatment for adequate period of time
- Counseling and other behavioral therapies are critical for addictions
- Medications
- Addictions and other comorbid disorders should be treated
- Medical detoxication is the first stage and does little for long term
- Treatment does not need to be voluntary to be effective
- Possible drug use during treatment must be monitored constantly
- Recovery from drug addiction can be long term process and requires multiple episodes of treatment
What is the new disorder in the DSM-5 under addictive disorders?
Gambling Disorder
*recurrent gambling lead to clinically significant distress or impairment
What is the Diagnostic Criteria for Gambling Disorder?
A. Persistent and recurrent problematic gambling behavior if 4 or more is exhibited in a 12-month period:
1. Needs to gamble with increasing amounts of money to achieve desired excitement
2. Is restless or irritable when attempting to cut down or stop gambling
3. Repeated unsuccessful efforts to control, cut back or stop
4. Often preoccupied with gambling thoughts
5. Often gambles when feeling distressed
6. After losing money returns to get even
7. Lies to conceal the extent of involvement with gambling
8. Jeopardized or lost significant relationship, job or career because of gambling
9. Relies on others to provide money to relieve desperate financial situations caused by gambling
B. Gambling behavior is not better explained by a manic episode
What is the treatment for gambling disorder?
-psychosocial treatment similar to substance abuse
-treatment is often ineffective
-motivation to get better is critical
-high dropout rate
-research is limited
-CBT interventions (alternative activities, financial limits, relapse prevention)
ICD-11 Diagnosis of Gaming Disorder
*not a diagnosis in DSM yet
-“a pattern of gaming behavior characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities”
Internet Gaming Disorder
1 in 10 (5.3%) university students engaged in online gaming for at least 15 hours a week that were accompanied by:
-lying about gaming habits
-inability to stop gaming
-fewer closer friends
-poor to fair health
-higher incidence of depression, suicide, non-restorative sleep, excessive fatigue, social anxiety
Impulse-Control Disorders are characterized by
-impairment of social and occupational functioning
-involve increased tension prior to the act, pleasurable anticipation or sense of relief
INCLUDES: intermittent explosive disorder, kleptomania, pyromania
Intermittent Explosive Disorder
-rare condition
-characterized by frequent aggressive outbursts
-leads to injury, destruction of property
-few controlled treatment studies
Kleptomania
-failure to resist the urge to steal unnecessary items
-highly comorbid with mood disorders
-occurs with substance related problems
Pyromania
-irresistible urge to set fires
-diagnosed in 3% of arsonists
-little treatment research
-treatment focuses of identifying urges and practicing behaviors
