Substance Use Part 2 Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

– At least 1 drink in the past year

– At least 12 drinks during lifetime

A

current drinker

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2
Q

– ≥5 drinks on the same occasion at least once per month

A

binge drinker (10%)

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3
Q

– Men: >14 drinks per week

– Women: >7 drinks per week

A

heavy drinker

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4
Q

– Men: ≤ 2 drinks per day
– Women: ≤ 1 drink per day
– Both genders: ≤ 5 days per week

A

reccomendations for low risk drinking

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5
Q

standard drink is 10 grams of alcohol

A

for each mL of ethanol, there are .79 grammes of pure thanol

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6
Q

rates of alcohol use vary based on

A

– Ethnicity
• Any drinking: European Americans highest and Asian Americans lowest
• Binge drinking: Native Americans highest
– Age:
• Current: Adults 25-44 years highest; olderadults lowest
• Binge & heavy: 18-24 years
– Gender
• Men > women
– Education
• Current: Increases with education
• Binge & heavy: decreases with education

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7
Q

– Physical addiction to alcohol
– Withdrawal symptoms when abstaining from alcohol
– High tolerance for alcohol
– Little ability to control drinking
• Problem drinkers: may not have symptoms listed above, but do have substantial social, medical or psychological problems resulting from alcohol

A

alcoholic

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8
Q

CAGE (in the last 12 months)
– felt you should Cut down on your drinking?
– Have people Annoyed you by criticizing your drinking?
– ever felt bad or Guilty about your drinking?
– ever had a drink first thing in the morning to “steady your nerves” or get ride of a hangover “Eye Opener”?
• CONSUMPTION
– On avg, days per week do you drink alcohol?
– On a typical day how many drinks do you have?
– maximum number of drinks on any occasion during the last month?
• SCREEN IS POSITIVE IF:
– A positive response on 1 or more questions from CAGE and/or
Consumption:
• Men > 14 drinks/week or > 4 drinks/occasion
• Women and both sexes > 7 drinks/week
• over 65 years of age > 3 drinks/occasion

A

CAGE Screening Tool

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9
Q

THEN ASSESS FOR:
Medical problems: Black outs, depression,
hypertension, injury, abdominal pain, liver dysfunction, sleep disorders
-Laboratory
-Behavioral problems
-Alcohol Dependence
If at-risk drinker:
-Advise patient of risk.
-Set drinking goals.
-Provide referral to primary care.
If alcohol dependent drinker:
-Assess acute risk of intoxication/withdrawal.
-Negotiate referral i.e. detoxification, AA and primary care.
-Continue exploring Pros & Cons and Assessing
Readiness to Change if appropriate.
Reference: The Physician’s Guide to Helping Patients with Alcohol Problems. National Ins

A

cage screening tool

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10
Q

• In your body 2 enzymes turn alcohol into vinegar
(acetic acid)
– Alcohol dehydrogenase
• Enzyme in liver that converts alcohol to aldehyde (very toxic)
– Aldehyde dehydrogenase
• Enzyme that converts it to acetic acid

A

• 3 health-related outcomes
– Increase in lactic acid → anxiety
– Increase in uric acid → gout
– Increase of fat in liver and blood

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11
Q

– In part body weight
– Men’s brains are more strongly affected than
women’s
– Women’s stomach’s absorb more efficiently
• Tolerance, dependence, addiction, abuse

A

effects of alcohol in gender

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12
Q

Alcohol-related unintentional injuries:

A

– 40% of traffic-related deaths related to alcohol
• Increases other risky behaviors & intentional
injuries
– Aggression, crime, sex, assault, homicide, suicide
– Make more risky decisions

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13
Q

• There is a U- or J- shaped relationship between
alcohol use and mortality
– Light to moderate drinkers (1-5 drinks/day)have the best
heath
• Reduced cardiovascular mortality
– (increases HDL and decreases clotting)
• Reduced risk for ischemic strokes but increased risk for hemorrhagic strokes
• Also lowers risk for
– Diabetes, gallstones, H. pylori infection, Alzheimer’s disease

A

health benefits of NONalcohol usage

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14
Q

why do ppl drink?

A

• Genetic factors appear to be involved (20-30%)
– Twins studies
– Frequency of alcoholism in sons of alcoholics
– Gene variant can’t break down alcohol, produces unpleasant
flushing, & decreases risk of abuse
• Men traditionally were at greater risk
– With changing norms, women are “catching up”
• Physiological, behavioral, and sociocultural factors are involved
• Alcoholism is tied to the drinker’s social and cultural environment.
– Window of vulnerability: Ages 12 to 21
– Window of vulnerability: Late middle age

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15
Q

– People have free will and choose to drink

A

Moral Model

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16
Q

Alcoholism has a genetic component

A

Medical Model

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17
Q

– People drink excessively because they have the
disease of alcoholism
– Dominant view in medically oriented treatment
programs but not in psychologically oriented programs
– Jellinek identified two types:
• Gamma alcoholism: loss of control once drinking begins
• Delta alcoholism: inability to abstain
– Variation: Alcohol Dependency Syndrome

A

Disease Model

18
Q

– A group of concurrent behaviors that accompany alcohol dependence
– Impaired control versus loss of control
– Used for diagnosis of substance abuse dependency in the DSM
– Seven essential elements:
• Narrowing of drinking repertoire
• Salience of drink-seeking behavior
• Increased tolerance
• Withdrawal symptoms
• Avoid withdrawal symptoms by further drinking
• Subjective awareness of the compulsion to drink
• Reinstatement of dependence after abstinence

A

Alcohol Dependency Syndrome

19
Q

– Too simplistic to view alcoholism as an incurable unitary disorder
– Doesn’t answer why people begin or why people drink in moderation
– The key concept of loss or impaired control is not supported in the research
– Many effects of alcohol are due to expectations rather than pharmacological effects

A

• Evaluation of the Disease Model

20
Q

• Drink to relax
• Not supported by research
• Expectations determine tension reduction associated with
drinking

A

tension reduction hypothesis(Cognitive-Physiological Theories)

21
Q
  • Describes the phenomenon that occurs when people who have been drinking do not respond as strongly to physiological or psychological stressors
  • Use alcohol to buffer stressful situations
  • A large SRD effect is associated with higher risk for problem drinking
A

– Stress response dampening (SRD) [cog physiological theory]

22
Q

• Alcohol produces a myopia by blocking out insightful cognitive processing and altering thoughts related to the self, stress, and social anxiety
• Drunken excess: behave more excessively
• Self-inflation: inflate self-evaluations
• Drunken relief: worry less & pay less attention to worries
• Research supports this theory that information is processed in a
limited way depending on environmental cues rather than general inhibition
– Focus on arousal – less likely to use condom
– Focus on risks of sex – more likely to use condom

A

Alcohol Myopia[cog physiologocal theory]

23
Q

Acquire drinking behavior just like any other behavior through
• positive reinforcement – pleasure of taste, social interaction, mood enhancement
• negative reinforcement – avoid withdrawal
• modeling– observe others
• cognitive mediation – consistent with personal standards
– Offers explanations for all three questions of why people begin or drink in moderation or excess
– Useful for treatment

A

Social Learning Model

24
Q

– Spontaneous remission
– 10 to 20% of alcoholics stop drinking on their own
– 32% of alcoholics can stop with minimal help
• Can be treated successfully through cognitivebehavioral modification
But
– High rate of relapse– as high as 60%
– Alcoholic’s environment must be considered
• Without employment or social support, prospects for recovery
are dim

A

“Maturing Out” of Alcoholism

25
Q
• Hard-Core Alcoholics
– Detoxification
– Short-term, Inpatient Therapy
– Continuing Outpatient 
Treatment
• Self-Help Groups are most 
commonly sought source of 
help(AA)
A
Treatment Programs (700,000ppl)
goal=abstinence
26
Q

• Philosophy
– The best person to reach an alcoholic is a recovered alcoholic
– Immersion: Attend 90 meetings in 90 days
• Recovery depends on staying sober
• Members provide social reinforcement for one
another’s abstinence
• Alcoholism
– A disease that can be managed, never cured
– Alcohol plays no part in the person’s future

A

Profile of Alcoholics Anonymous

27
Q

• Often combined with detoxification
• Many techniques can be used and are effective
• Self-Monitoring
– Person begins to understand situations that give rise to drinking
• Contingency contracting
– Person agrees to a costly outcome (financial or
psychological) in the event of failure
• Medications that block alcohol-brain interactions
• Stress management techniques
• Motivational interviewing
– Keeping the client motivated with individualized feedback
about his/her efforts

A

Psychotherapy

28
Q
Administer drugs that interact with alcohol to 
produce unpleasant effects or decrease reward
• Disulfram (Antabuse) 
– Aversion therapy
• Naltrexone 
– Blocks opiates in brain
• Acamprosate
– Affects GAMA neurotransmitter in brain
– Reduces craving and relapse
A

Chemical Treatments

29
Q

• Social engineering may represent the best
approach
– Banning alcohol advertising
– Raising the legal drinking age
– Strictly enforcing the penalties for drunk driving
• These approaches reach the untreated majority

A

Social Engineering

30
Q

Can Recovered Alcoholics Drink again?

A
• Alcoholics Anonymous Philosophy
An alcoholic is an alcoholic for life
• Drinking in moderation seems possible
– For young, employed problem drinkers
– Who have not been drinking for long
– Who live in supportive environments
• Drinking in moderation 
– May be a more realistic goal for college students
– May prevent high dropout rates in more traditional 
programs
• Not for everyone
31
Q

• Most U.S. college students drink alcohol
– 15%-25% are heavy drinkers
– 45% engage in occasional binge drinking
• Successful interventions:
– Encourage students to gain self-control over drinking rather than eliminating alcohol
– Self-monitoring often reduces drinking

A

drinking college student

32
Q

– Identify circumstances when drinking to excess
occurs
– Placebo drinking
• Consuming nonalcoholic beverages while others are drinking
• Alternating alcoholic and nonalcoholic drinks

A

skills training for college student

33
Q

• Relapse rates
– 65-75% relapse within 1 year after treatment
– 50% or more relapse within first 3 months
• Helpful for problem drinkers to know
– An occasional relapse is normal
– Relapse doesn’t signify failure
• Important relapse prevention skills
– Learning “drink-refusal skills”
– Learning nonalcoholic beverage substitutions

A

Treatment Programs: Relapse

Prevention

34
Q

FDA classifies drugs into 5 schedules based on their

potential for abuse and medical benefits

A

– Schedule I: High abuse potential, no medical use, illegal
• Examples: Heroin, LSD, marijuana
– Schedule II: High abuse potential, can cause physiological or psychological dependence, but have some medical use
• Examples: Opiates, some barbiturates, amphetamines, cocaine
– Schedule III: moderate or low physical dependence or high psychological dependence but have accepted medical uses
• Examples: Some opiates, some tranquilizers
– Schedule IV: Low abuse potential, limited dependence, accepted
medical uses
• Examples: Phenobarbital, most tranquilizers
– Schedule V: Lowest abuse potential
• Examples: Over-the-counter medications

35
Q

– Induce relaxation and sometimes intoxication by lowering the activity
of the brain, the neurons, the muscles, and the heart, and decreasing metabolic rate
• Low doses: relaxation and euphoria
• High doses: Coma and death
• Alcohol, barbiturates, tranquilizers (benzodiazepines), opiates (morphine,
heroin, cheese, methadone, oxycodone, hydrocodone)

A

Sedatives

36
Q

– For some, more alert, energetic, able to concentrate, and able to work long hours
– For other, feel jittery, anxious, and unable to sit still
– Similar to norepinephrine
• Amphetamines, cocaine, cocaethylene, crack cocaine, Ecstasy (MDMA)

A

Stimulants

37
Q

– Most commonly used illegal drug in US
– Intoxicating ingredient is delta-9 tetrahydrocannabinol (THC) that comes from the resin of the Cannabis sativaplant
– Acts in brain to induce altered thought processes, memory
impairment, relaxation, euphoria, increased appetite, coordination impairment, increased heart rate
– Direct health risks are fewer than other drugs, but at increased risk for respiratory problems and lung cancer
– Increases risk for injury
– Beneficial effects of decreasing nausea and vomiting associated with chemotherapy, analgesic properties, decrease in glaucoma

A

Marijuana

38
Q

– Endogenous (cortisone, estrogen, testosterone)
– Exogenous
– Medically used to decrease inflammation
– Abused most by athletes and bodybuilders
• Increase muscle bulk and decrease body fat
– Potentially dangerous
• Shut off body’s own steroids, alter immune and reproductive functioning, increase CVD, affect liver, stunt growth,
• Behavioral problems such as moods swings, aggression,
confusion, distractibility, euphoria

A

Anabolic Steroids

39
Q

• Similar to treatment of alcohol abuse, both in the philosophy and administration of treatment
• Goal: total abstinence
• Self-help groups[ Narcotics Anonymous]
• Inpatients treatment programs
– Detoxification tailored to type and severity of
withdrawal effects
• High relapse rate
– Aftercare and booster session are important

A

treatment for drug abuse

40
Q

– Assume that people will use but act to reduce harm
– Harm reduction strategy
• Needle exchange
• Designated drivers

A

Control the harm of drug use

41
Q

Prevention programs for children and adolescents aimed

at delaying or prohibiting use

A

– Programs similar to ones for smoking
– Life Skills Training program teaches social skills to help resist social pressure and increase personal competence
– Ineffective programs are those who rely on scare tactics (DARE),
moral training, factual information about risks