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