Substance Use Disorders Flashcards
historical perspective of substance use disorders
- 6400 BCE discovered how to make alcohol
- Egyptians, hebrews, greeks, romans
- distillation of whiskey common in Ireland by 1500 CE
- Opium derivatives used in asian cultures, chewing leaf of coca plant, flower of peyote cactus
- prohibition in 1920 but it did not last long
classes of substances
alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants, tobacco, other
can be diagnosed in one or more classes
what is substance use disorder?
substance use disorder refers to recurrent use of one of these specific substances that leads to adverse consequences
mild - moderate - severe
11 indicators of substance abuse disorder
impairment of control - taking the substance in largre amounts for longer than intended
social impairment - failure to fulfill major roles, continued use despite clear negative consequences, reduction of other involvements to give priority to using the substance
risky use - use in situations where it might be hazardous, and continued use despite physical or psychological problems
pharmacological dependence - tolerance and withdrawal
substance induced disorders
intoxication, withdrawal, substance or medication induced mental disorders
use of multiple substances
- common - those who drink more likely to use cannabis or others drugs
- history of poly substance misuse - more diagnosable mental problems
cross tolerance
when 2 substances affect body and brain similarly - tolerance to alcohol increases tolerance to sedatives, hypnotics, anxiolytics - also a persona prescribed these while drinking will have a stronger and longer drug effect - drug potentiation
gambling disorder
- generate short lived pleasurable feelings and provide relief from negative feelings and both ultimately create cravings to repeat the behaviour
- alter mood and level of arousal, induced an altered state of perception
- pre occupied with gambling, unable to resist despite negative consequences
- some pathological gamblers report withdrawal like symptoms
general theory of addiction
phase 1: learn that a substance or behaviourr can reduce negative moods
2: continued positive reinforcement leads to learned behaviours associated with continued use
3: despite harms associated with use an individual continues to use the substance or behaviour to avoid negative mood it alleviated
syndrome model of addiction
people inherit or encounter different life experiences that interact to increase likelihood of developing an addiction.
neurobiological, psychological, sociocultural factors interact - increase vulnerability
repeated engagement in the substance or behaviour combined with the vulnerability - addiction syndrome
heritability of substance use disorders
higher concordance in MZ twins for alcohol, nicotine, cannabis, illicit drugs
33-71% heritability for nicotine, 79% for cocaine, 49% for gambling
large male twin study - shared genetic risk factors for addiction across six different illicit substances
between 30-45% of genetic vulnerability for gambling disorder also increases risk for alcohol use disorder
biology and alcohol dependence
GABAergic, dopaminergic, glutamatergic, serotonergic, opioid and cholinergic systems
low serotonin associated with alcohol related characteristics - impulsivity, aggression, antisocial behaviour, reward processing
genetics implicated in ability to metabolize alcohol - less aldehyde dehydrogenase
neurotransmitters and substance use disorder
dopamine system - all classes
GABA, beta-endorphin, serotonin - potential markers
changes in serotonin system - development and maintenance of addiction to cocaine, amphetamine, ecstasy, heroin, cannabis, nicotine
neurotransmitters and amphetamines
reduced dopamine transmission in striatum in young adults using amphetamine with a family history of addiction vs those with no family history - dopamine transmission is a marker for vulnerability to amphetamine use disorder -PET
EEG and alcohol dependent fathers
EEG - children with alcohol dependant fathers - more elevation of resting state beta wave activity than do children of fathers who are not dependent
reduced P300 response predicts the early onset of alcohol problems
psychological factors of substance abuse disorder
strongest association - behavioural disinhibition
more rebellious, more impulsive, more aggressive, more willing to take risks
severity of alcohol abuse - positively associated with the level of impaired inhibitory control over behaviour - observed as early as age 3
negative emotionality and alcohol use disorder
self medication hypothesis
individuals use substances to relieve symptoms of other mental disorders like anxiety or depression - inconsistent
alcohol expectancy theory
drinking behaviour determined by reinforcement that an individual expects to receive from it
positive alcohol expectancies has been found to increase subsequent alcohol consumption in heavy drinkers
positive expectancies of alcohol effects predict higher levels of subsequent alcohol use
behavioural tolerance
drug tolerance partially conditioned to the envrionment to which the substance is used - cues in the environment can become conditioned stimuli to the effects of drug use
why someone can overdose taking the same amount in new environments
socio cultural factors of substance abuse disorder
family values, attitudes, expectations - passed on through generations
cultural and familial traditions and attitudes toward substance abuse combine to influence the individuals expectations of the effects of substances or behaviours
acculturation
process and degree of adapting to the dominant culture among individuals who have immigrated
gender roles and substance use disorder
substance use more socially acceptable for men - protective factor for women
alcohol - canadian consumption
most common - 78%
age 20-24 most likely to drink and most heavily - 83%
consumption peaks in mid 20s
ages 15-19 57%
single people, high income earners - more likely to be casual and heavy drinkers
those with least education and out of work - heaviest drinking
four categories of consumption patterns
- light infrequent - less than weekly fewer than 5 per occasion - 36%
- light frequent - more than weekly fewer than 5 - 32%
- heavy infrequent - less than weekly more than 5 - 5%
- heavy frequent - more than weekly 5 or more - 4%
high risk drinking test
AUDIT - Alcohol use disorders identification test - score of 8 or higher means high risk
effects of alcohol
ethyl alcohol - reduces anxiety, produces euphoria, creates sense of well being, reduces inhibitions
* expressed as a percentage - 80ml per 100kml of blood is 0.08%
short term effects of alcohol based on BAC
- biphasic - lower doses its stimulating and pleasant, higher doses its a depressant
- 0.01 - hand eye coordination
- 0.05 - starts to impact driving
- 0.06 - drowsiness, 40% decrease in steadiness
- 0.08 - decreased visual acuity, decreased sensitivity to taste, smell, pain
- 0.08-0.1 - time slows by 10%, performance on IQ tests fall, poorer memory, perception of time altered
blackouts and hangovers
- blackouts - interval of time for which the person cannot recall key details or entire events
- hangover symptoms - nausea, fatigue, headache, thirst, depression, anxiety
long term effects of alcohol
- high in calories - reduce food intake - interfere with absorption of nutrients - lead to weight gain
- cancer of the mouth, tongue, pharynx, esophagus, stomach, liver, lung, pancreas, colon, rectums
- damage to heart muscle, high blood pressure and strokes
wernicke-korsakoff syndrome
inability to form new memories and a loss of contact with reality
fetal alcohol spectrum disorder
facial dysmorphology, slowed growth, CNS dysfunction
* FAS, partial FAS, alcohol related neurodevelopmental disorder, alcohol related birth defects
social effects of alcohol
- can impact frienships, social life, physical health, happiness, financial situation, home life or marriage, work or studies, legal situation, learning abilities, housing in previous 12 months
- largest alcohol related causes of death are liver cirrhosis, motor vehicle accidents, suicide
barbiturates and benzodiazepines
- depressants - inhibit neurotransmitter activity in CNS - sedative, hypnotic or anxiolytic drugs
- barbituric acid - one of the first sleeping medications/anti anxiety meds - downers
- benzodiazepines - valium, librium, xanax, Ativan - more frequently prescribed
barbiturates and benzodiazepines prevalence
12% of population aged 15 and older
barbiturates and benzodiazepines - effects
- small doses - mild euphoria
- large doses - slurred speech, poor motor coordination, impairment of judgementt and motor control
- DSM-5-TR criteria for sedative, hypnotic, anxiolytic intoxication is similar to alcohol
- combination with alcohol is synergistic - effect of both is greater than the effect of the sum of the drugs taken sepreately
barbiturates and benzodiazepines dependency
- tolerance to barbiturates develops rapdily
- tolerance to benzodiazepines develops much slower
- withdrawal reactions - delirium, convulsions, sleep disruptions
nicotine prevalence
- number of Canadians deaths directly attributable to tobacco use - 18%
- 2017 - 15.3% of Canadians over age 12 smoked cigarettes - 13.7 a day
- e-cigarettes - 20%
CNS stimulant
short term nicotine effects
- stimulating or arousing effects - influence rate of uptake of the neurotransmitters dopamine, norepinephrine, serotonin
- lower dosages - interfere with thinking, problem solving, extreme agitation, irritability, mood changes
- small amount in cigarettes - increase alertness and improve mood - stimulates release of dopamine in the nucleus accumbens - rewarding and addictive properties
nicotine long term effects
long term - lung, esophagus, larynx, other cancers - respiratory illness, heart dise
nicotine second hand smoke effects
more dangerous - no filter - more ammonia, carbon monoxide, nicotine, tar
smoking during pregnancy effects
low birth weight, spontaneous abortion, stillbirth, infant illness and disability
nicotine dependency
- even greater than produced by other substances, dependence develops quickly
- prevent the effects of severe withdrawal
amphetamines and designer drugs
- amphetamine, methamphetamine, methylated amphetamines (MDMA)
- originally developed as a nasal decongestant and asthma treatment, used to treat narcolepsy, ADHD
- appetite-suppressant qualities of amphetamines - treatment of obesity
amphetamines and designer drugs prevalence
- difficult to determine, drugs marketed as one might not be that drug
- 4% lifetime 0.2% past year methamphetamine use
- 8% lifetime 1% past year ecstasy use
- youth have highest rates - 4.3% of high school students - 1.3% illegal amphetamines, 2% ecstasy
amphetamines and designer drugs effects
- low doses - increase alterness, allow user to focus attention effectively
- higher doses - feelings of exhilaration, extraversion, confidence
- very high doses - restlessness, anxiety
- chronic amphetamine use - fatigue and sadness, periods of social withdrawal, intense anger
- toxic psychosis - repeated high doses
cocaine effects
small amounts - feelings of euphoria, well-being, confidence, alert, talkative, reduced appetite, increased excitement and energy
cocaine prevalence and dependency
- highest in young adults - 6.2% past year use
- average 2.5% past year use
intense psychological dependence
opioids prevalence
CNS depressants
- heroin is least frequently used substance - less than 1% of Canadians, 0.5% highschool
- 12% used opioids generally, 2% to get high
opioids effects
- mimic endogenous opiates - natural painkillers - are called exogenous opiates
- heroin - intense pleasurable rush, euphoria, dulled sensations and dreamlike sedation
- higher doses - pupils construct, skin may turn blue and clammy, breathing slows, coma
- withdrawal can last 5-10 days
cannabis prevalence
- 2015 - 37.5% lifetime, 12% previous year
- slightly higher rates after legalization
- hashish - much stronger form of cannabis - generally depressant but also increases users heart rate like a stimulant, can produce hallucinogens in large doses
cannabis small dose effects
- acts on cannabinoid receptors and mimics effects of naturally occuring substances
- small doses - most users report feeling mildly euphoric and sociable - well being and relaxation usually begins within minutes of ingesting the drug - some find it stimulating and panic or have anxiety
- deficits in complex motor skills, short term memory, reaction time, attention
long term cannabis user effects
- long term users - greater lung problems than tobacco smokers
- amotivational syndrome - patten of apathy, profound self absorption, detachment from friends and family, abandonment of career and educational goals
- about 30% of regular cannabis users have depression symptoms
- regular use linked to increased onset of psychosis
cannabis treatment effects
used in treatment of cancer, AIDS, glaucoma - can alleviate nausea and encourage eating
cannabis dependency
- regular use results in tolerance and withdrawal
- withdrawal is milder - irritability, nervousness, anxiety, loss of appetite, restlessness, sleep disturbances, anger/aggression
hallucinogen effects
- change a persons mental state by inducing perceptual and sensory distortions or hallucinations
- expectations of effects play a large role in determining their reaction
- visual hallucinations, synesthesia, most not actually dangerous
- no withdrawals, but there is dependency
hallucinogens prevalence
- peaked in 1960s
- 15% reported lifetime usage, 1.5% last year
treatment of substance abuse disorders
- complicated - co-morbid mental disorders, more than one substance dependency
- inpatient treatment programs with pharmacological assistance are recommended for individuals with severe problems
pharmacotherapy - alcohol
benzodiazepines to reduce severity of withdrawal symptoms
- antagonist drug - targets neurotransmitters that mediate alcohols effects on the brain - reduces cravings
- agonist drug - facilitates the inhibitory action of GABA at its receptors - mimics effects- reduces gratification
- Antabuse - blocks action of acetaldehyde dehydrogenase - buildup of acetaldehyde, makes drinking unpleasurable
pharmacotherapy - amphetamine and cocaine
- medications usually used as adjuncts - antidepressants prescribed to combat depression that occurs during withdrawal
- psychostimulant drugs - may be given to reduce withdrawal symptoms and cravings
pharmacotherapy - opioids
- naltrexone - opioid antagonist - alleviate initial symptoms of withdrawal
- clonidine - reduces severity of withdrawal symptoms during detoxification
- methadone - heroin replacement
- naloxone - reduces cravings
pharmacotherapy - tobacco
- over the counter - gum, lozenges, inhalers, skin patches - to reduce cravings, break behavioural habits
- bupropion hydrochloride and varenicline tartrate - target receptors in brain and do not deliver any nicotine to the body
pharmacotherapy - barbiturates and benzodiazepines
- administering progressively smaller doses of the abused drug
- abstinence syndrome - insomnia, headaches, aching all over the body, anxiety, depression, can last months
pharmacotherapy - gambling
- naltrexone - effective at reducing urges to gamble
- antidepressants and mood stabilizers - may improve gambling severity symptoms
mutual support groups
- assistance from others with similar addiction and mental health problems
- Alcoholics Anonymous, gamblers anonymous, sex addicts anonymous
- 12 step programs - goal of abstinence - as effective if not more than other interventions
psychological treatments
- face-to-face, brief counselling, telephone counselling, online support grous
- behavioural or cognitive in nature
- self monitoring, goal setting, reinforcement
behavioural treatment
- treats addiction as learned behaviour
- contingency management - manipulate reinforcement contingencies for substance use and gambling
cognitive behavioural therapy
- first choice
- helps client achieve and abstinence goal through cognitive and behavioural strategies
- self monitoring - identify pattern of use and triggers - people, places, things, experiences that lead to urges or cravings
release prevention
- innocent decisions based on distorted beliefs can chain together to create circumstances that increase the risk of relapse
- attempt to help identify distorted beliefs and replace them with adaptive ones
marital and family therapy
- the relationship is seen as the patient
- codependents - established roles for themselves that are defined by substance misuse that they become enmeshed in the drinking problem
brief interventions
- 1-3 sessions, offering time limited and specific advice regarding the need to reduce or eliminate substance use or gambling
- motivational interviewing - used with clients with varying levels of readiness to change their behaviour
- brief self directed interventions - workbooks, worksheets - many people recover without fromal treatment, only 10% with addictions attend formal treatment, the change strategies used are similar to those used by those attending treatment
