SUD Flashcards
Historical context of AUD
Time where the consumption of beer was so normative that pple would drink beer throughout the day (breakfast, lunch…). In part bc the water quality was so poor → beer = safer option. Pple would spent much of the day a little intoxicated.
Fredrick II of Prussia was very suspicious of which substance?
Coffee
The high consumption of beer/alcohol continued for a long time (both in Europe & North America)… Until the ________________. End of 19th and beginning of 20th century.
Temperance movements
Temperance movements
Movement largely driven by Christian religious groups + Burgeoning feminist movements
=> Both noted that men were coming home wasted at the end of the day - and oftentimes pounding on their families
=> Huge movement in North America to ban the sale of alcohol + consumption of liquor
Consuming alcohol as a character deficit
-> This alienated you from your community + God
-> If drinking too much = no chance of getting into heaven
Historical Context of Cocaine
Formerly legal & widely used drug. Used to be sold in cigarette, coca-cola, toothache drops given to children to make them feel better…
Not restricted until 1911 in Canada.
AUD in DSM-1 (3)
(1) Excessive use of alcohol/drug was a symptom of “sociopathic personality disorder”
(2) No classes of drugs specified
(3) No specific criteria
AUD in DSM-2 (3)
(1) Still a personality disorder
(2) Specifying some classes of drugs: Barbiturates, cannabis, cocaine, hallucinogens, opioids
(3) Some criteria specified: “…the inability of the patient to go one day without drinking…”; “…habitual use or a clear sense of need for the drug…”
AUD in DSM-3 (4)
(1) Introduced more specific diagnostic criteria
(2) “Substance use disorders” separated from personality (you can have one without the other)
(3) Each class of substance recognized as a distinct disorder
(4) Sets of diagnostic criteria established
In the DSM-3, diagnostic criteria for AUD was heavily based on the __________________.
FEIGHNER criteria
-> Criteria for alcohol dependence
AUD: Distinction established in the DSM-3
Introduced distinction between Abuse & dependence (not in DSM-5)
=> Alcohol abuse = pathological alcohol use, impairment in social/occupational functioning, duration of disturbance ~at least a month. (even without dependence → AUD)
(3) Alcohol dependence = meet criteria for physiological tolerance or withdrawal symptoms
Alcohol abuse vs dependence: Implication
Everyone who meets criteria for dependence must also meet criteria for abuse.
The DSM-5 no longer recognizes a distinctionbetween substance “abuse” and “disorder.” Instead…
A single disorder: e.g., alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.
A huge “social” difference between the DSM-IV and DSM-V in the diagnostic criteria of AUD is that…
Legal problems included in the DSM-IV.
E.g. In the past year, have you “More than once gotten arrested, been held at a police station, or had other legal problems bc of your drinking?”
Substance Abuse criteria
A maladaptive pattern of substance use leading to distress or impairment.
ONE or more of:
- Failure to fulfill role obligations
- Physically hazardous situations (“have you ever driven a car when you were intoxicated?”
- Legal problems (problematic criteria)
- Social problems (“do pple around you get upset w you about your consumption of those substances?”)
Substance Dependence criteria
Thought to be the next level up (after abuse). A maladaptive pattern of substance use leading to distress or impairment.
THREE or more of:
- Tolerance
- Withdrawal
- More than intended
- Failure to cut down
- Time spent
- Other activities given up
- Physical or psychological problems
In DSM-5, _________ disorder included in category for future consideration
Internet gaming disorder
Prevalence rates for use of ANY illicit drugs is the highest among ______.
College student
Prevalence alcohol USE
From 0 to 16 liters
Rates of AUD typically lower in East Asian and Jewish populations in part because…
Bc of a genetic polymorphism that deals with alcohol dehydrogenase → makes it much more uncomfortable to consume alcohol
=> Rates of abuse ofothersubstances similar or higher
Stimulants are the most ______ and _____ class of drugs
widely used, abused
Stimulants include… (4)
(1) Amphetamines
(2) Cocaine
(3) Nicotine
(4) Caffeine
(Tobacco & caffeine classified diff in DSM-5 bc their effects differ somewhat - less severe effects)
Stimulants increase _____, improve _____, increase ______ (at least in the short term).
alertness, memory, energy
Benzedrine (amphetamine) historical context
Something pple would take for stuffy noses. Were in common use.
“Wonder pills”
=> Used on both sides in WW2 to keep soldiers alert in very brutal conditions on very little sleep
=> Particularly Germany during WW2 used very high levels of Benzedrines to keep soldiers engaged in warfare
Pervitin historical context
Contains methamphetamine. Crystal meth.
Also used in coffee by a lot of the armies during WW2 - formally distributed to german soldiers.
Stimulants are associated with ________ Use Disorder
Amphetamine
Effects of Amphetamines (5)
(1) Produce elation, vigor, reduce fatigue (pleasure)
(2) Similar to the effects of adrenaline rush -> Followed by a crash
(3) Chronic use can lead to fatigue, sadness, intense anger
(4) Enhance release of dopamine and norepinephrine, while blocking reuptake.
(5) Can cause psychotic symptoms
=> High risk of dependency and withdrawal
____________________ (even more than other amphetamines) is HIGHLY addictive and extended use of it is associated with ________________
Methamphetamines; structural changes in the brain
-> Can rewire and reshape the brain
-> Discontinuing use can result in paranoia and hallucinations so it has to be discontinued under very carefully observed circumstances
Methamphetamines — often amphetamine of choice for ______________.
poorer people/criminal
=> Consequences in the criminal justice system for methamphetamine use/sale is much more severe than other classes of stimulants/amphetamines
Effects of Cocaine (4)
(1) Short-lived sensations of elation, vigor, reduced fatigue
(2) Effects result from blocking the reuptake of dopamine
(3) Cocaine is highly addictive, but addiction develops slowly (after 2 to 5 years)
(4) Withdrawal(boredom, tolerance, paranoia) -> Evidence that withdrawal, particularly once someone has developed dependence upon it, can be very painful
Crack def
Crystallized form of cocaine that is smoked; acts faster.
-> More pleasurable/addictive
Crack is also more often consumed by _____ people
poorer
Very diff laws surrounding the consumption of crack vs cocaine. Penalize pple at the ____ levels of SES + racial/ethnic groups much more severely than others.
lowest.
Difference between Opiate & Opioids
Opiate: Natural chemical in opium poppy with narcotic effects (i.e., pain relief).
Opioids: Broader term that refers to a class of natural & synthetic substances with narcotic effects.
Opioids activate ________________________ receptors: ________.
endogenous opioid; Endorphins
Endorphines often have an _______ effect: stop neurons from firing in the brain + will decrease the experience of _____.
inhibitory; pain
-> Sometimes blocking the activity of pain receptors
Morphine historical context
Developed as a treatment for intense and unbearable pain. Very popular on battlefields (lot of amputations, limb wounds…).
=> Too addictive - even after only a few instances of administration, pple had a rly hard time stopping taking it
Heroin historical context
Bc morphine was too addictive, developed heroin.
-> Acts more rapidly than morphine
-> Also arguably a lot more addictive
-> Then heroin became the problem
Methadone historical context
Methadone was developed to treat heroin addiction
=> But now, a lot of concerns that methadone itself also has addictive properties
-> Has to be administered very carefully to people
Withdrawal from opioids (2)
RLY severe. Devastating experience.
(1) Nausea, extreme vomiting, chills, aches, insomnia, intense anxiety…
(2) Feeling like your body is on fire while they’re trying to stop taking these
-> Very hard class of substances to stop taking once you have initiated use
Opioids effects at low doses
Euphoria, drowsiness, slurred speech, memory impairment, & slowed breathing.
-> High can be sustained 4 to 6 hours
Opioids effects at high doses
High doses can result in death (e.g. respiratory failures associated with over sedation, crashes in blood pressure leading to heart failure from high doses of the drug…)
Withdrawal symptoms of opioids can be lasting (_______) & severe
1 week
-> Sometimes 10 days
-> Means that relapse is very common: consequences of not taking the drug once an addiction has been instantiated are rly severe & difficult to tolerate for pple
