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Psyc 241 - Final Exam > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

1
Q

historical perspective of substance use disorders

A
  • 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
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2
Q

classes of substances

A

alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants, tobacco, other

can be diagnosed in one or more classes

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3
Q

what is substance use disorder?

A

substance use disorder refers to recurrent use of one of these specific substances that leads to adverse consequences

mild - moderate - severe

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4
Q

11 indicators of substance abuse disorder

A

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

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5
Q

substance induced disorders

A

intoxication, withdrawal, substance or medication induced mental disorders

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6
Q

use of multiple substances

A
  • common - those who drink more likely to use cannabis or others drugs
  • history of poly substance misuse - more diagnosable mental problems
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7
Q

cross tolerance

A

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

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8
Q

gambling disorder

A
  • 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
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9
Q

general theory of addiction

A

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

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10
Q

syndrome model of addiction

A

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

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11
Q

heritability of substance use disorders

A

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

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12
Q

biology and alcohol dependence

A

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

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13
Q

neurotransmitters and substance use disorder

A

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

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14
Q

neurotransmitters and amphetamines

A

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

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15
Q

EEG and alcohol dependent fathers

A

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

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16
Q

psychological factors of substance abuse disorder

A

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

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17
Q

self medication hypothesis

A

individuals use substances to relieve symptoms of other mental disorders like anxiety or depression - inconsistent

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18
Q

alcohol expectancy theory

A

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

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19
Q

behavioural tolerance

A

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

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20
Q

socio cultural factors of substance abuse disorder

A

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

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21
Q

acculturation

A

process and degree of adapting to the dominant culture among individuals who have immigrated

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22
Q

gender roles and substance use disorder

A

substance use more socially acceptable for men - protective factor for women

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23
Q

alcohol - canadian consumption

A

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

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24
Q

four categories of consumption patterns

A
  • 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%
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25
Q

high risk drinking test

A

AUDIT - Alcohol use disorders identification test - score of 8 or higher means high risk

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26
Q

effects of alcohol

A

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%

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27
Q

short term effects of alcohol based on BAC

A
  • 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
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28
Q

blackouts and hangovers

A
  • blackouts - interval of time for which the person cannot recall key details or entire events
  • hangover symptoms - nausea, fatigue, headache, thirst, depression, anxiety
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29
Q

long term effects of alcohol

A
  • 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
30
Q

wernicke-korsakoff syndrome

A

inability to form new memories and a loss of contact with reality

31
Q

fetal alcohol spectrum disorder

A

facial dysmorphology, slowed growth, CNS dysfunction
* FAS, partial FAS, alcohol related neurodevelopmental disorder, alcohol related birth defects

32
Q

social effects of alcohol

A
  • 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
33
Q

barbiturates and benzodiazepines

A
  • 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
34
Q

barbiturates and benzodiazepines prevalence

A

12% of population aged 15 and older

35
Q

barbiturates and benzodiazepines - effects

A
  • 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
36
Q

barbiturates and benzodiazepines dependency

A
  • tolerance to barbiturates develops rapdily
  • tolerance to benzodiazepines develops much slower
  • withdrawal reactions - delirium, convulsions, sleep disruptions
37
Q

nicotine prevalence

A
  • 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

38
Q

short term nicotine effects

A
  • 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
39
Q

nicotine long term effects

A

long term - lung, esophagus, larynx, other cancers - respiratory illness, heart dise

40
Q

nicotine second hand smoke effects

A

more dangerous - no filter - more ammonia, carbon monoxide, nicotine, tar

41
Q

smoking during pregnancy effects

A

low birth weight, spontaneous abortion, stillbirth, infant illness and disability

42
Q

nicotine dependency

A
  • even greater than produced by other substances, dependence develops quickly
  • prevent the effects of severe withdrawal
43
Q

amphetamines and designer drugs

A
  • 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
44
Q

amphetamines and designer drugs prevalence

A
  • 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
45
Q

amphetamines and designer drugs effects

A
  • 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
46
Q

cocaine effects

A

small amounts - feelings of euphoria, well-being, confidence, alert, talkative, reduced appetite, increased excitement and energy

47
Q

cocaine prevalence and dependency

A
  • highest in young adults - 6.2% past year use
  • average 2.5% past year use

intense psychological dependence

48
Q

opioids prevalence

A

CNS depressants

  • heroin is least frequently used substance - less than 1% of Canadians, 0.5% highschool
  • 12% used opioids generally, 2% to get high
49
Q

opioids effects

A
  • 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
50
Q

cannabis prevalence

A
  • 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
51
Q

cannabis small dose effects

A
  • 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
52
Q

long term cannabis user effects

A
  • 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
53
Q

cannabis treatment effects

A

used in treatment of cancer, AIDS, glaucoma - can alleviate nausea and encourage eating

54
Q

cannabis dependency

A
  • regular use results in tolerance and withdrawal
  • withdrawal is milder - irritability, nervousness, anxiety, loss of appetite, restlessness, sleep disturbances, anger/aggression
55
Q

hallucinogen effects

A
  • 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
56
Q

hallucinogens prevalence

A
  • peaked in 1960s
  • 15% reported lifetime usage, 1.5% last year
57
Q

treatment of substance abuse disorders

A
  • complicated - co-morbid mental disorders, more than one substance dependency
  • inpatient treatment programs with pharmacological assistance are recommended for individuals with severe problems
58
Q

pharmacotherapy - alcohol

A

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
59
Q

pharmacotherapy - amphetamine and cocaine

A
  • 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
60
Q

pharmacotherapy - opioids

A
  • naltrexone - opioid antagonist - alleviate initial symptoms of withdrawal
  • clonidine - reduces severity of withdrawal symptoms during detoxification
  • methadone - heroin replacement
  • naloxone - reduces cravings
61
Q

pharmacotherapy - tobacco

A
  • 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
62
Q

pharmacotherapy - barbiturates and benzodiazepines

A
  • administering progressively smaller doses of the abused drug
  • abstinence syndrome - insomnia, headaches, aching all over the body, anxiety, depression, can last months
63
Q

pharmacotherapy - gambling

A
  • naltrexone - effective at reducing urges to gamble
  • antidepressants and mood stabilizers - may improve gambling severity symptoms
64
Q

mutual support groups

A
  • 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
65
Q

psychological treatments

A
  • face-to-face, brief counselling, telephone counselling, online support grous
  • behavioural or cognitive in nature
  • self monitoring, goal setting, reinforcement
66
Q

behavioural treatment

A
  • treats addiction as learned behaviour
  • contingency management - manipulate reinforcement contingencies for substance use and gambling
67
Q

cognitive behavioural therapy

A
  • 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
68
Q

release prevention

A
  • 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
69
Q

marital and family therapy

A
  • 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
70
Q

brief interventions

A
  • 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

Psyc 241 - Final Exam (4 decks)

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