W7: Substance Related & Addictive Disorders Flashcards
What is a psychoactive substance
Any chemical compound which passes through the blood brain barrier and alters mood and/or behaviour
What is substance use
The ingestion whether that be inhalation, Injection, transdermal of a substance
What is intoxication
The physiological response to the substance
What is tolerance
Needing a larger dose for the same effect 
What is withdrawal
A strong, negative physiological and often psychological reaction which occurs when a psychoactive substance is removed
The DSM four had two categories of substance use disorders what were these
Substance abuse and substance dependence
The DSM-V now only has one category of substance disorders what is it
Substance use disorder that is characterised by specific substances

What is the DSM criteria for substance use disorder
 problematic pattern of use that in pairs functioning with two or more of the following within 12 months:
– Substance taken in larger amounts or for a longer period than planned
– Persistent desire and/or failed attempts to reduce or control use
-A large amount of time is spent either trying to attain the substance or recover from its use
– Cravings
– Use is resulting in inability to fulfil obligations at work or at home
– Continued use despite ongoing exacerbation of psychosocial problems
– Social hobbies or work activities are given up or reduced
– Recurrent use in situations which maybe dangerous such as driving under the influence
– Continue used despite knowing the problems are caused by the substance
– Tolerance
– Withdrawal


What are the Drug types specified in the DSM under substance use disorder(9)
Alcohol Sedative Stimulant Tabacco Caffeine Opioid Cannabis Other hallucinogens Inhalant
How many symptoms for a mild substance use disorder?
2-3
How many symptoms for a moderate substance use disorder?
4-5
How many symptoms for a severe substance use disorder?
6+
What are the four broad drug categories
Depressants that decrease physiological arousal such as alcohol
Stimulates that increase physiological arousal such as cocaine and nicotine
Opiates for pain relief such as morphine and heroin
Hallucinogens and psychedelics that alter sensation and perception such as cannabis and LSD
How much do Australians spend on illicit drugs
$7 billion p.a
This is more than five times that on licit substances
Illicit does not equal
It doesn’t equal more addictive or more deadly
Explain alcohol use disorder
It is diagnosed if physiologically dependent on alcohol or a heavy user
Delerium tremens can occur when blood alcohol levels drop suddenly and result in deliriousness tremulousness and hallucinations that are primarily visual but they may be tactile 
What is polydrug abuse
Many users abuse multiple substances for example 85% of alcohol abuser are smokers
What is the prevalence of alcohol abuse
8.6%
What is binge drinking
Having five standard drinks in a short period (1hr)

Who is binge drinking most prevalent amongst
College and university students at 43.5%
What is heavy use drinking
Five drinks five or more times in a 30 day period
Which areas is alcohol dependence higher
In rural areas
What percentage of those with alcohol use disorder also have at least one mental disorder
21.3%
This could be self-medicating or it could be contributing to it
What are the short term effects of alcohol in terms of neurotransmitters
It stimulates GABA receptors that are the key inhibitory neurotransmitter – reduces tension
Increases dopamine and serotonin to produce pleasurable effects
Inhibits glutamate receptors – glutamate is a key neurotransmitter in a range of functions notably memory and learning so it produces cognitive difficulties this is one memory can become impaired
What are the short term effects of ingesting large amounts of alcohol
Significant motor impairment
Poor decision-making
Poor awareness of errors made
What are the long-term effects of alcohol
Malnutrition – Calories from alcohol lack nutrients and alcohol interferes with digestion and absorption of vitamins from food
E.g. deficiency of the complex vitamins cause amnesic syndrome such as Korsakoff syndrome
Cirrhosis of the liver
– Liver cells in engorged with fat and protein impeding functioning the cells dies triggering scar tissue which obstructs bloodflow
Damage to endocrine glands and pancreas
Heart failure
Hypertension
Stroke
Capillary haemorrhages
Destruction of brain cells especially in areas important to memory
What is fetal alcohol syndrome
Causes physiological cognitive and behavioural changes during gestation we could have lifelong impacts
What is marijuana
It is classed as a hallucinogen
It is derived from dried and ground leaves and stems of the female hemp plant
The most frequently used illicit drug in Australia – Greater use by men than women
What is hashish
It is stronger than marijuana and is produced by drying the resin of the tops of plants and buds
There is evidence for a range of benefits of marijuana what are they
Relieving discomfort of chronic pain
Reducing frequency of epileptic seizures
Reduces nausea and loss of appetite caused by chemotherapy
What is the major psycho active ingredient in marijuana
THC (delta-9-tetrahydrocannabinol)
What are the psychological effects of marijuana
Relaxation and sociability
Rapid shifts of emotion
Interferes with attention, memory and thinking with a decline in IQ over time
Heavy doses can induce hallucinations and panic
Interferes with cognitive functioning impaired memory and complex motor skills
Why is it difficult to regulate the dosage of marijuana
The effects take 30 minutes to appear so you may smoke more than intended waiting for the effects
Where are the cannabinoid receptors in the brain
CB1 and CB2
High concentration in the hippocampus
There is evidence that cannabis increases the risk of what
Psychosis for people with a genetic predisposition for psychosis
What is synthetic cannabis
It is the same chemical compound but a synthetic reproduction
It is early days but evidence of more severe side-effects compare to cannabis and more frequent admission to A&E for drug related events
Increased risk of stroke and heart failure
What are opiates
They are a group of addictive sedatives that in moderate doses relieve pain and induced sleep such as opium, morphine, heroin, codeine
Can be legally prescribe this pain medications in hydrocodone and oxycodone
How many Australians use heroin in a 12 month period
.1%
What is the big concern with opiate use
Important to recognise the miss use stemming from legal prescriptions for example oxycodone prescriptions dropped 1800% between 1996 and 2000

What are the psychological and physical effects of opiates
Produces euphoria, drowsiness, and a lack of coordination
Loss of inhibition and increase of confidence however there is a severe let down after about 4 to 6 hours
Heroine and OxyContin produces a rush of intense feelings of warmth and ecstasy following injection
They stimulate receptors of the bodies opioid system the nucleus accumbens which is important in reward
Tolerance develops and withdrawal occurs
Muscle soreness and twitching tearfulness and yawning becomes more severe and may also include cramps choose sweating increase in heart rate and blood pressure insomnia and vomiting withdrawal last for about 72 hours
29 year follow-up of 500 heroin addicts found
28% were dead before the age of 40 Half by suicide homicide or accident
And 1/3 by overdose
Explain the exposure to infectious disease via shared needles
Exposure to things such as HIV
Evidence suggests that free needles reduce infectious diseases associated with intravenous drug use
What is methamphetamine
Classed as a stimulus – increases alertness and motor activity and reduces fatigue
Produces high levels of energy and sleeplessness, reduced appetite, increased heart rate
Explain the effect on neurotransmitters methamphetamine has
It triggers a release of an block of re-uptake of norepinephrine and dopamine
What can high doses of methamphetamine lead to
Nervousness, agitation, irritability, confusion, paranoia and hostility
After how many days of use do you see tolerance develop for methamphetamine
Only six days use
How does chronic use of methamphetamine damage the brain
It impacts dopamine and serotonin systems with a reduction in hippocampus volume 
What is ecstasy
Sometimes classed as a hallucinogens that is a type of amphetamine
Induces a sense of well-being, feeling close to others, increased tactile sensation.  
Often experience depression in the following days
What Neurotransmitters does ecstasy act on
Serotonin
Dopamine
Norepinephrine 
What does cocaine do
It blocks the re-uptake of dopamine in the mesolimbic areas of the brain
What is involved in an overdose of cocaine
Chills, nausea, insomnia, paranoia, hallucinations, possibly heart attack and death
What is phencyclidine (PCP)?
 initially used as an anaesthetic but stopped in 1965 due to negative after effects which were mainly severe hallucinations
Was considered a relatively popular recreational drug but has been steadily declining
Causes severe paranoia, violence, selfharm and depersonalisation 
What is ketamine
Used in surgical and veterinary procedures - anaesthetic and analgesic properties
But is also used as a party drug and sometimes sold as ecstasy
It does have the potential for dependency
What are ketamine and PCP
Dissociative anaesthetics
What do dissociative anaesthetics do
They block the action of NMDA receptors and increase the availability of serotonin dopamine and norepinephrine by reducing re-uptake
What is LSD
It is a hallucinogen with effects such as colourful visual hallucinations and psychedelic trips which are an expansion of consciousness
what is psilocybin
Extracted from mushrooms and is a hallucinogen
There is emerging evidence for the use of illicit drugs for psychological disorders. Give some examples
Ketamine - depression
Ecstasy- PTSD, anxiety
Cannabis - complex pain
Psilocybin - anxiety
Explain genetics in alcohol use
Relatives and children of problem drinks have higher than expected rates of alcohol abuse or dependence
Ability to tolerate large quantities of alcohol maybe inherited – people from Asian countries have low rates of alcohol use
There is some evidence that people dependent on drugs or alcohol have a deficiency in
Dopamine D2 receptor
What do all drugs stimulate in the brain
The dopamine mesolimbic pathway - produces rewarding or pleasurable feelings
Depressants target what area in the brain
The ventral tegmental area
Stimulants target what area in the brain
The nucleus accumbens
What role does availability play in substance use disorders
Usage is higher when alcohol and drugs are easily available
Drug use among youths who had been approached by drug dealers for 35% compare to just under 7% of you two had not been approach there is a role in opportunity
What family factors increase substance use disorders
Parental alcohol use (modelling)
Marital discord, psychiatric or legal problems in the family linked to substance abuse
Lack of emotional support from parents increases the use of cigarettes, marijuana and alcohol as a coping mechanism
Lack of parental monitoring
How might your social network increase substance related disorders
There is evidence for having peers who drink influencing drinking behaviours but individuals also choose friends with drinking patterns similar to our own so it is probably a bit of both of social influence and social selection
How does advertising or media influence Substance related disorders
Countries that ban ads have 16% less consumption than those that don’t
What is agonist treatment of Substance related disorders
Replacing the harmful drug with a safe one – for example, heroin substitutes such as synthetic narcotics are used to wean heroin users from dependence
What are antagonist treatment of substance related disorders
Using medication that will block the effects of the drug
For example in opiates there’s naltrexone that prevents you from feeling high so if you don’t experience the positive feelings you are less inclined to use the drug
What is aversive treatment of substance use disorders
Aversive treatment runs along classical conditioning
For example with alcohol there is a medication that you can give people (Antabuse, disulfiram) that produces nausea and vomiting if alcohol is consumed this is most effective when combined with CBT to break a cycle of beliefs
Explain in patient hospital treatment
It is a form of detoxification
Withdrawal from the alcohol or other under medical supervision
This may be necessary for those without social support or with other serious psychological problems
What is alcoholics Anonymous
It is the largest self-help group for problem drinkers consisting of regular meetings to provide support, understanding and acceptance
They promote complete abstinence
Although some studies have shown participation predicts better outcome recent studies suggest it is no more affective than other forms of therapy
What are motivational interventions
There is an emphasis on empathy and understanding in the client council relationship and it focuses on the positive outcomes associated with cessation
What is contingency management therapy
Patient and family reinforced behaviours inconsistent with drinking for example avoiding places associated with drinking
They teach the problem drinker how to deal with uncomfortable situations such as refusing the offer of a drink
And give vouchers that can be traded for desirable goods are given to use him staying this is a form of positive reinforcement for the desired behaviour 

What a self-help residential homes
They are a non-drug environment that May be inclusive of group therapy and guidance or support from former users 
What elements can be used to prevent substance use disorders
Enhancing self-esteem Social skills training Peer pressure resistance training Parental involvement in school programs Warning labels on alcohol bottles Education regarding alcohol impairment Testing for drugs and alcohol at school or work Correction of beliefs and expectations Peer leadership
Not always done particularly well and not always a lot of success in this
