Substance use disorders Flashcards
What is substance abuse?
excessive use of a substance that leads to dangerous behavior and continued use despite problems (social, psychological, occupational, and health)
What is substance dependence?
when substance abuse leads to tolerance and withdrawal
Tolerance
a physiological need to keep increasing the amount of a substance to experience the same effects
What causes the development of tolerance?
biochemical changes affecting one’s metabolism rate and the elimination of the substance from the body
Withdrawal
physical symptoms that result from stopping use (e.g. nausea, sweating, tension, headaches, tremors)
5 stages of substance abuse
positive attitude, experimentation, regular use, heavy use, physical dependence/abuse
Alcohol use disorder according to the DSM-5
a problematic pattern of drinking that leads to impairment when at least 2 symptoms are present within 12 months (applicable to substance use disorders too)
Symptoms of alcohol use disorder in DSM-5
more use than intended; desire to control use; time spent in alcohol pursuit; craving; use leading to interpersonal problems; use despite interpersonal problems; activities given up because of use; use in physically dangerous situations; use despite physical/psychological problems due to alcohol; tolerance; withdrawal
Harmful alcohol use according to WHO
heavy episodic drinking or having at least 6 drinks at least once a month
Factors affecting blood alcohol concentration
amount ingested in a particular period of time, food in the stomach (vs absorption in the small intestine), sex, age, medications
Short-term effects of alcohol
stimulation then depression; interference with complex thought and motor coordination; interaction with several neural systems; effects tied to expectations (especially aggression and sexual drive)
How does alcohol affect neural systems?
stimulates GABA receptors (decreases tension and motor coordination); increases 5-HT and DA (motivation for pleasure, craving, addiction); inhibits glutamate receptors (lower cognitive functioning)
Long-term effects of alcohol
malnutrition (e.g. memory loss due to vitamin B deficiency); cognitive impairment; cirrhosis; cardiovascular problems (e.g. heart failure, hypertension, stroke, capillary hemorrhages), reduced immune functioning (increased breast cancer risk); fetal alcohol syndrome; psychosis
Biological factors of alcohol abuse
genes (e.g. alcohol risk personality, ability to tolerate/metabolize alcohol, motivation for substance use (to reduce tension or increase pleasure); reinforcement of substance effects
Psychological factors of alcohol abuse
drinking motives like sensation/novelty-seeking, stress/tension reduction, expectations of social success; when perceived benefits outweigh costs
Which drinking motives place a person at most risk?
enhancement (positive-internal) and coping (negative-internal)
Sociocultural factors of alcohol abuse
culture (e.g. attitudes, use patterns, tradition of aggression, religion), family (e.g. parent use/guidance, family/marital problems, older siblings), exposure and learning, availability, peer/social influences, media
Biological treatment for substance abuse
medications (e.g. antabuse and naltrexone to block the desire to drink; valium to lower side effects of withdrawal)
Psychological treatment for alcohol abuse
transtheoretical or stages of changes model; CBT and behavioral therapy (e.g. aversion conditioning, skills training, self-control, motivational enhancement); controlled drinking vs. abstinence
5 stages of TTM
precontemplation, contemplation, preparation, action, maintenance (may lead to relapse)
Social treatment for alcohol abuse
group therapy, alcoholics anonymous, environmental intervention (e.g. halfway houses)
Factors affecting treatment efficacy for alcohol abuse
severity of substance and type of treatment
Most common drugs associated with addiction
narcotics, sedatives, stimulants, anti-anxiety drugs, pain medication, hallucinogens
Derivatives of narcotics or opioids
morphine, heroin, codeine
Synthetic opioids (e.g. fentanyl)
50-100x as potent as morphine; often unknowingly mixed with heroin and codeine; responsible for 72% of overdose deaths in Canada in 2017
Short-term biological effects of addiction
decreased physical pain and anxiety; relaxation; euphoria
Long-term biological effects of addiction
physiological craving, withdrawal symptoms, physical deterioration
Factors of addiction
pleasure-seeking, curiosity, peer pressure, stress relief, personal maladjustment, sociocultural conditions
Comorbidities of addiction
70% of other psychological disorders, 50% of other substance abuse, 36% with history of trauma, depression, anxiety, antisocial personality disorder
Biological treatment for addiction
methadone and buprenorphine
Psychosocial treatment for addiction
TTM, CBT, group therapy, environmental interventions, controlled intake vs. abstinence, narcotics anonymous
Types of stimulants
cocaine, amphetamines (including methamphetamine), caffeine, nicotine
Effects of stimulants
increased alertness and reduced fatigue
Effects of amphetamine abuse
intense fatigue, psychologically and physically addictive, brain damage (e.g. psychosis), suicide, homicide, violence
Treatment for amphetamine abuse
withdrawal from drug, depression (peaks in days and can last for months), gastrointestinal symptoms
Effects of methamphetamine abuse
highly addictive, increased dopamine in brain, structural changes in brain, treatment resistance (usually ends in relapse), long-term cognitive effects (e.g. psychosis, paranoia, learning and memory problems)
Types of hallucinogens
LSD/acid, mescaline, psilocybin/mushrooms, MDMA/ecstasy/molly
What is MDMA?
both a hallucinogen and stimulant; chemically similar to methamphetamine; a popular party drug
Short-term effects of MDMA
rush of pleasure, sense of well-being, depressed mood for days after use
Occasional negative effects of MDMA
psychosis, anxiety disorders, death
Long-term effects of MDMA
all negative: brain damage (frontal and temporal lobes), memory deficits, hallucinations
Short-term effects of cannabis
relaxation, sense of well-being, euphoria, hallucinations, increased perpetual acuity
Therapeutic effects of cannabis
reduced nausea and pain, increased appetite and sleep
Long-term effects of cannabis
psychosis/schizophrenia (if the person has a diathesis), memory loss
Factors of gambling disorder
sensation-seeking personality type, maladaptive behavior (e.g. due to problems in relationships, finances, responsibilities)
Treatment for gambling disorder
relapse
