Task 9 - Substance use disorder Flashcards
Substance use
- Natural or synthesized product
- psychoactive effects
- > changes perceptions, thoughts, emotions and behaviors
Substance intoxication
- changes as a result of physiological effects of substance on CNS
- diagnosis of intoxication is only given when changes are maladaptive
Substance withdrawal
- stop or greatly reduce of use
- > symptoms are opposite of intoxication
Substance abuse
- recurrent use of substance resulted in harmful consequences in 4 categories:
1) failing to fulfill important obligations
2) physically risk
3) repeatedly legal problems
4) continues to use substance despite problems
Substance dependence
- people addicted/dependent show tolerance
- when stopping -> withdrawal
DSM 5 substance use disorder
Impaired control
1) taken increasingly larger amounts over longer period than originally intended
2) craving substance
3) user feels ongoing desire to cut down or control
4)
CNS depressants /
- alcohol
- barbiturates and benzodiazepines
- inhalants
- relax, sleepy, reduce concentration, impair thinking and other skills
Alcohol
- low doses: self confidence, relaxation, slightly euphoria
- higher doses: depression, fatigue, decreased motivation, sleep disturbance and confusion
alcohol - 3 stages of withdrawal
1) few hours after drinking: tremors, weakness, profuse respiration
2) after 12 hours, includes convulsive seizures
3) delirium tremens, hallucinations, delusions, little sleep, disorientation
alcohol gender differences
men: drink more, more socially acceptable
gender differences drug use disorder
men: drink more, more socially acceptable, don’t care as much about withdrawal
- Women more likely to experience greater cognitive & motor impairment and to suffer harm & sexual assault after alcohol use.
- women less likely to have personality traits associated with substance use disorder
- women less likely to expect positive outcome
Barbiturats and benzodiazepines
- legally manufactured and sold by prescription
- sedatives for treatment of anxiety and insomnia
- used as muscle relaxant and antiseizure medicines
- > decrease in blood pressure, respiratory rate and heart rate
- > overdose: cause death from respiratory failure or cardiovascular collapse
-> negative effects: impaired cognition, reduces sexual functioning etc
Inhalants
- volatile substances that produces chemical vapors
- > inhaled
CNS stimulants
- causing feeling of energy, happiness and power
- decreased desire for sleep
- cocaine
- amphetamines
- nicotine
- caffein
cocaine
- blocks reuptake of dopamine
- severe substance use disorder
- negative effects: chest pain, blurred vision, fever, muscle spasms, convulsions and coma
amphetamines
- inhances release of norepinephrine and dopamine
- > blocks reuptake
-usually treated for attention problems and narcolepsy
Nicotine
- increasing blood pressure and heart rate
- withdrawal: more hungry
caffeine
- increases alertness and motor activity
- upregulating dopamine, norepinephrine and seretonin levels
- increases in metabolism, body temperature and blood pressure
opioids
- morphine
- heroin
- codeine
- methadone
others: designer drugs
-ectasy etc
biological factors
- reward pathway
- dopamine
psychological factors
- social learning -> modeling
- cognitive theories -> people who expect alcohol to reduce their distress, have no more adaptive means of coping
- personality: behavioral under-control -> increased risk
sociocultural factors
- substance attractive to people under chronic stress
- > living in poverty, women in abusive relationships
biological treatments
- antagonist drugs: block/change effects of addictive drug, reducing desire for it
- acamprosate: affects glutamate and GABA receptors and can help maintain abstinence from alcohol
-antabuse: can make people feel dizzy, nauseous, blush and event faint, with just one drink
biological treatment - methadone maintenance programs
…
behavioral therapy
-aversion therapy: classical conditioning (give drug followed immediately by another drug that causes unpleasant physiological reactions)
-covert sensitization therapy:
imagery to create associations between thoughts of alcohol use and thoughts of highly unpleasant consequences
-contingency management programs: reinforce abstinence
cognitive therapy
- help clients learn to handle stressful situation in adaptive way
- identify situations in which they are likely to consume + expectations that alcohol will help them cope with those situations
- mindfullness, meditation
Therapy : motivational interviewing
- reinforce motivation to change habit/substance use
- empathic interaction style, drawing out user’s statements of desire, ability, reasons, need and commitment to change
relapse prevention
- avoiding specific environments and people
- abstinence violation effect
alcoholics anonymous
….
mild, moderate, severe SUD
- mild: 2-3 criteria
- moderate: 4-5
- severe: 6+
DSM 5 - substance use disorder
IMPAIRED CONTROL
- taken in increasingly larger amounts or over longer period originally intended.
- craves substance.
- ongoing desire to cut down or control substance abuse or has made unsuccessful attempts to do so.
- Much time is spent obtaining, using, or recovering from substance.
SOCIAL IMPAIRMENT
- inability to meet responsibilities at home, work, or school.
- Important social, work related, or recreational activities are abandoned or cut back
- Ongoing substance use despite recurring social or relationship difficulties caused or made worse by effects of substance.
RISKY USE
- in physically dangerous situations, such as driving a car or operating machinery.
- Substance use continues despite awareness of ongoing physical/psychological problems that have likely arisen or been made worse by substance.
PHARMACOLOGICAL
- Tolerance – Need for increased amounts of substance to achieve desired effect or by diminished experience of intoxication over time with same amount.
- Withdrawal – Substance user experiences characteristic withdrawal syndrome of substance and/or takes same/similar substance to relieve symptoms.
Choice model of addiction - Heyman
- addiction is a voluntary act
- immediate rewards take precedence over long-term gains
- repeatedly choosing immediate rewards -> LT rewards will get lower value
- does not deny biological part, but dismisses that dopamine is key neurotransmitter for motivation and directing goal-directed behavior
Disease model of addiction - Lewis
- involuntary bc it is primarily driven by cues (Classical conditioning)
- drug taking triggers dopamine release form VTA -> increases impact on nucleus accumbens and ventral pallidum (ventral striatum)
- striatal + orbitofrontal activity peaked right before drug use
- brain changes -> undermining inhibitory control, judgment, appraisal
- > harder to quit
Disease model of addiction - Incentive- sensitization hypothesis
- alteration in responsiveness of VTA
- > dopamine release is enhanced in relation to drug and its cues
- > decreased in relation to other stimuli
Choice model of addiction - Intertemporal Bargaining
- reward gives rise to bargaining between different ‘selves’/ ‘positios’
- > each position takes different point in time ( present, future)
- > addiction = consequence of poor bargaining
Article - Alcohol-induced place conditioning in moderate social drinkers - childs - aim and methods
- Testing whether non-dependent drinkers show preference for location paired with alcohol
- test if amount of time spent in alcohol-paired location is related to subjective alcohol effects
method:
- social drinkers assigned to paired condition : ALC and noALC in separate distinct rooms
- or unpaired condition: ALC and noALC in both rooms
- primary measure: pre- to post-test change n percentage of time spent in least preferred room
- secondary measure: included self-reported subjective mood and drug effects
Article - Alcohol-induced place conditioning in moderate social drinkers - childs - hypothesis
- significant group difference
- Time spent in ALC-paired room would increase among paired group individuals, but not in unpaired group
- change in time would be related to positive pleasurable effects of alcohol
Article - Alcohol-induced place conditioning in moderate social drinkers - childs - results
- groups differed in change in percentage
- paired group: increased 11p
- unpaired group: -1.4p
- Non dependent consumers of alcohol -> develop behavioral preference for locations paired with alcohol consumption
- > more so for those who experience sedative effects from alcohol in those locations.
