Week 12 Chapter 10 Substance Use Disorders Summary Caff

Question 1

What is the percentage of Americans reporting drug use in the past month (2009)

Answer 1

Alcohol = 51.9%
Cigarettes = 27.7%
Marijuana = 6.6%
Non-medical psychotherapeutics = 2.8%
Cocaine = 0.7%
Hallucinogens = 0.5%
Inhalants = 0.01%

Question 2

What is the general DSM-5 Criteria for Substance use disorder?

Answer 2

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:

1. Taking the substance in larger amounts or for longer than the you meant to
2. Wanting to cut down or stop using the substance but not managing to
3. Spending a lot of time getting, using, or recovering from use of the substance
4. Cravings and urges to use the substance
5. Not managing to do what you should at work, home or school, because of substance use
6. Continuing to use, even when it causes problems in relationships
7. Giving up important social, occupational or recreational activities because of substance use
8. Using substances again and again, even when it puts the you in danger
9. Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance
10. Needing more of the substance to get the effect you want (tolerance)
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.

Question 3

Define “Addiction”

Answer 3

Addiction typically refers to a more severe substance use disorder that is characterised by having more symptoms, tolerances, and withdrawal, by using more of the substance than intended, by trying unsuccessfully to stop, by having physical or psychological problems made worse by the drug, & by experiencing problems at work or with friends.

Question 4

Define “Tolerance”

Answer 4

Tolerance is indicated by either 1., larger doses of the substance being needed to produce the desired effect or 2., the effects of the drug becoming markedly less if the usual amount is taken.

Question 5

Define “Withdrawal”

Answer 5

Withdrawal refers to the negative physical and psychological effects that develop when a person stops taking the substance or reduces the amount.
Substance withdrawal symptoms can include muscle pains and twitching, sweats, vomiting, diarrhea, and insomnia.
Generally being physiologically dependent on a drug is associated with more severe problems

Question 6

Aside from an individual choosing to try a drug in the first instance, what factors can contribute to that individual becoming dependent?

Answer 6

The substance interacts with an individual’s neurobiology, social setting, culture, and other environmental factors to create dependence.
Such factors put some people at higher risk for substance dependence than others.
It is a mistake to consider substance-use disorders as somehow solely the result of moral failing or personal choice.

Question 7

What are some of the short-term effects of alcohol?

Answer 7

• Alcohol begins being metabolised by enzymes in the stomach & is absorbed in the blood stream.
• It is then broken down by the liver which can metabolise about 1 ounce of 100% proof (50% alcohol) liquor per hour.
• Alcohol interacts with several neural systems in the brain: it stimulates GABA receptors (reducing tension)
• Alcohol increases levels of serotonin & dopamine (pleasurable effects)
• Finally, alcohol inhibits glutamate receptors (cause cognitive effects: slowed thinking, memory loss).

Question 8

What are some of the long-term effects of alcohol?

Answer 8

Almost every tissue & organ in the body is adversely affected by prolonged consumption of alcohol

• due to the heavy calorie load a drinker may reduce their calorie intake from nutritional sources so can develop malnutrition.
• Alcohol impairs digestion & absorption of vitamins
• A lack in vitamin B complex can cause amnestic syndrome - severe memory loss
• Prolonged alcohol use & poor protein intake leads to liver cirrhosis
• Damage to endocrine gland, pancreas, heart failure, erectile dysfunction, hypertension, stroke, capillary hemorrhages.
• Pregnant women who drink heavily can produce babies with fetal alcohol syndrome

Question 9

Marijuana is the most frequently used illicit substance. What are some of the psychological effects of marijuana?

Answer 9

Effects of marijuana depend on the potency and size of the dose
Some of the Psychological effects:
*relaxed & sociable; *rapid emotional shifts
*dull attention; *Fragment thoughts; *Impair memory
*give the sense time is moving slowly
Extreme heavy users: extreme panic
*Impair cognitive functioning & psychomotor skills such as driving
*It is not known whether marijuana use impairs intellectual functioning.

Question 10

What are some of the physical effects of marijuana? & How does marijuana affect the brain?

Answer 10

Short term physical consequences:
*bloodshot & itchy eyes; dry mouth & throat; increased appetite; raised blood pressure

Long term physical consequences:
*1 ‘marijuana cigarette’ is the equivalent of 5 tobacco cigarettes in CO2; 4 cigarettes for tar & 10 for damage to the airways
There are 2 cannabinoid receptors in the brain: CB1 & CB2
CB1 receptors are found throughout the body & brain - large No. in hippocampus (learning & memory) as a result short term memory problems have been associated with cannabis use

Cannabis use results in:

• increased blood flow to the amygdala & the anterior cingulate (emotion regions)
• Decreased blood flow to temporal lobe (associated with auditory attention - leads to poor performance on listening tasks

Question 11

What are Opiates?

Answer 11

• Opiates are considered sedatives
• Opiates are a group of addictive drugs that in moderate doses relieve pain and induce sleep
• The Opiates include opium, & it’s derivatives: Morphine, heroin, codeine

Question 12

What is the prevalence of Opiate Abuse and Dependence?

Answer 12

More than 1 million people are thought to be addicted to heroin in the USA

• Heroin used to be a drug for low SES, however, in 1990’s it became popular with middle & upper-middle class students & professionals
• In 2009 over 5 million people in the USA used pain medications for nonmedicinal uses.
• The no. of people seeking treatment for dependence on pain medications increased 400% in just 10 years
• Because heroin is cheaper than OxyContin and has similar effects, health professionals are concerned people will turn to heroin instead

Question 13

What is the Psychological & Physical effects of Opiate Abuse and Dependence?

Answer 13

Opiates produce euphoria, drowsiness and sometimes a lack of coordination.

• Heroin & OxyContin produce a ‘rush’ a feeling of warm, suffusing ecstasy immediately after an intravenous injection
• The user has great self confidence, & sheds worries & fears for up to 4-6 hours.
• However, the user feels a severe comedown, bordering on stupor

Question 14

How do Opiates produce their effect?

Answer 14

Opiates produce their effect by stimulating neural receptors of the body’s own opioid system (endorphins & enkephalins)

• Heroin is converted into morphine in the brain & binds to the opioid receptors located throughout the brain.
• The pleasurable effects may come from a link between these receptors & the dopamine system or via the opioids action in the nucleus accumbens

Question 15

Opiates are clearly addictive. How quickly do users gain tolerances & show withdrawals?

Answer 15

*Withdrawal from heroin may begin up to 8 hours of the last injection once a high tolerance has built up.
During the next few hours after withdrawal begins the person experiences flu-like symptoms. Within 36 hours symptoms are more severe: uncontrollable chills, muscle cramps, flushing, sweating, a rise in heart rate & blood pressure. inability to sleep, vomiting & diarrhoea follow. Symptoms typically persist for about 72 hours & gradually diminish over 5-10 days

Question 16

What are Stimulants?

Answer 16

Stimulants such as caffeine & amphetamines, are substances that act on the brain & the sympathetic nervous system to increase motor activity & alertness.

Question 17

How do amphetamines work?

Answer 17

Amphetamines, such as benzedrine, dexedrine & methedrine produce their effects by causing the release of norepinephrine & dopamine, & blocking the reuptake of these neurotransmitters.
Amphetamines are taken orally or injected and can be addictive.

Question 18

What are the symptoms for someone using amphetamines?

Answer 18

• Heightened wakefulness
• inhibited intestinal functioning leading to reduced appetite (hence used in dieting)
• Heart rate quickens, blood vessels in skin & mucus membrane constricts
• The person becomes euphoric, alert, outgoing, with seemingly boundless energy & self-confidence
• Larger doses can led to nervousness, agitation, confusion, heart palpitations, headaches, dizziness, sleeplessness
• Heavy users can become suspicious & hostile - potentially dangerous to others (similar to the paranoia seen in schizophrenia)

Question 19

What type of tolerance is built up for someone using amphetamines?

Answer 19

Tolerance to amphetamines develops rapidly so more of the drug is needed to produce effects.

• As tolerance increases, some users might stop taking pills and begin injecting methedrine (a strong amphetamine).
• Users may repeatedly inject methedrine to maintain euphoria and energy for days, only to crash exhausted & depressed for several days, then start the cycle again.

Question 20

Aside from being an anesthetic (pain reduction agent), what other effects does cocaine have on the user?

Answer 20

Cocaine acts rapidly on the brain, blocking the reuptake of dopamine in mesolimbic areas.

• Cocaine yields pleasurable states because dopamine left in the synapse facilitates neural transmission.
• Cocaine can increase sexual desire & produce feelings of self-confidence, well-being,
• indefatigability.

Question 21

Do people develop a tolerance to cocaine? &

is it difficult to go through cocaine withdrawal?

Answer 21

Many cocaine users also develop a tolerance requiring larger doses to have same effect whilst others become very sensitive to small amounts of cocaine, sometimes leading to death.
*Stopping cocaine appears to cause severe withdrawal symptoms

Question 22

What does cocaine use have on physiology?

Answer 22

Cocaine is a vasoconstrictor causing the blood vessels to narrow.
As users take larger doses of purer forms of cocaine they are more often rushed to emergency due to overdose or heart attack
Cocaine also increases a persons risk of stroke & suffering cognitive impairment

Question 23

What is a hallucinogen?

Answer 23

Hallucinogen refers to the main effects of drugs such as LSD, Mescaline & Psilocybin.
Unlike the hallucinations in schizophrenia, however, these are usually recognised by the user as being caused by the drug
The use of LSD & other hallucinogens peaked in the 1960’s. By the 1980’s only 1-2% of people could be classified as regular users.
*There is no evidence of withdrawal symptoms during abstinence, but tolerance appears to develop rapidly

Question 24

What are some of the symptoms an LSD user will experience?

Answer 24

*Hallucinations
*Distorted sense of time (passing very slowly)
*expanded consciousness
*Heightened appreciation of sights & sounds (more vividly)
*mood swings
negative symptoms:
*some users experience intense anxiety after taking LSD in part because the perceptual experiences & hallucinations can provoke fears that they are ‘going crazy’.
*The anxiety can subside as the drug is metabolised.
*A minority of people will have a psychotic state requiring hospitalisation
*Flashbacks (hallucination persisting perception disorder)

Question 25

What will determine some of the effects of LSD on a user?

Answer 25

The effects of LSD hallucinations will depend on a number of psychological factors:

• A person’s set (attitudes, expectancies, & motivations with regard taking drugs) is widely held to be an important determinant of his/her reactions to hallucinations
• The context in which the drug is experienced is also important

Question 26

What do you know about the origins of Ecstasy & MDMA?

Answer 26

Ecstasy is a hallucinogen-like substance made from MDMA (methylenedioxymethamphetamine)
*MDMA was first synthesised in the early 1900’s & was an appetite suppressant for WWI soldiers
Ecstasy contains compounds from both hallucinogen & amphetamine families but is sufficiently different from each that they are regarded as ‘entactogens’

Question 27

What do you know about the physiological effects of using Ecstasy?

Answer 27

Ecstasy acts primarily by contributing to both the release and the subsequent re-uptake of serotonin

• At one time ecstasy was viewed as relatively harmless however research is suggesting it may have neurotoxic effects on the serotonin system.
• In animal studies a single dose has caused serotonin depletion & prolonged use can damage serotonin axons & nerve terminals

Question 28

What do you know about the use of Ecstasy & MDMA?

Answer 28

• Users report that ecstasy enhances intimacy & insight, improves interpersonal relationships, elevates mood and self-confidence, & promotes aesthetic awareness
• It can also cause muscle tension, rapid eye movements, jaw clenching, nausea, faintness, chills or sweating, anxiety, depression, depersonalisation, & confusion
• Some evidence suggests that the subjective and physiological effects of Ecstasy, both pleasurable and adverse, maybe stronger for women than men

Question 29

What do you know about PCP & Angel Dust?

Answer 29

PCP (phencyclidine) is often known as Angel Dust & like ecstasy, is not easy to classify

• It was developed as a horse tranquilizer and generally causes serious negative reactions, including severe paranoia and violence.
• Coma & Death are also possible

Question 30

What do you know about what PCP does to the neurotransmitter system?

Answer 30

PCP affects multiple neurotransmitters in the brain

• Chronic use is associated with a variety of neuropsychological deficits
• Many users of PCP are polydrug users so it’s difficult to separate the effects of PCP from the other drugs

Question 31

What is the process by which people become physiologically dependent on a substance?

Answer 31

They begin with a:

• positive attitude toward a substance,
• then begin experimentation
• move to regular use
• this turns to heavy use
• then become dependent on the substance

Question 32

When considering the development of substance use problems among adolescents what does our knowledge of the developing brain tell us?

Answer 32

• The Frontal Cortex is still developing and is linked to judgement & Decision making, novelty seeking and impulse control
• The neural systems believed to be important for reward, including dopaminergic, serotonergic, & glutamatergic pathways all pass through the still developing frontal cortex

Question 33

Why does the developmental approach not suffice as an explanation for all cases of substance abuse or dependence?

Answer 33

• A developmental approach fails to account for all cases:
  e. g. heavy tobacco or heroin use does not always lead to dependence
• It is not inevitable for a person to pass through all stages of dependence
  e. g. some people have periods of heavy use, then return to moderate use
• Still others do not require a heavy period of use to become dependent

Question 34

What have behavioural genetic studies shown us about illicit drug use disorders?

Answer 34

• That there is a great concordance in identical twins than in fraternal twins for alcohol use disorder, smoking, heavy use of marijuana, and drug use disorders in general
• Genetic and shared environmental risk factors appear to be the same no matter what the drug. This is true for both men and women

Question 35

Research has uncovered some gene-environment interactions in alcohol and drug use. What have they found?

Answer 35

Peers & parents appear to be particularly important:

• heritability for alcohol problems is higher among adolescents with large No.s of peers who drank
• similarly for smoking best friend who drinks and smokes
• heritability for smoking was greater for teens who went to school where the popular crowd smoked compared to when the popular crowd did not smoke.
• heritability was higher for teens with parents who were low monitors of their behaviour

Question 36

Why is it not surprising that dopamine is featured in all discussions about substance use?

Answer 36

• People take drugs to feel good & to feel less bad
• Dopamine pathways in the brain are importantly linked to pleasure and reward
• The mesolimbic pathway is particularly stimulated by drugs
• People dependent on drugs or alcohol are thought to have a deficiency in the dopamine receptor DRD2

Question 37

What are the two models put forward to explain drug interaction in the dopamine system?

Answer 37

*The vulnerability model
Suggests that problems within the dopamine system increase the vulnerability to become drug dependent alternatively
*The Toxic effects model
Suggests that problems in the dopamine system are the consequence of taking substances

For cocaine use there is evidence to support both theories

Question 38

Tell me about the neurobiological theory, referred to as the ‘incentive-sensitisation theory’ of substance use that considers both the craving (wanting) & the pleasure (liking).

Answer 38

The dopamine system linked to pleasure becomes super-sensitive to both the cues associated with taking the drug (needle, spoon, rolling paper) & the direct effects of the drug.
This sensitivity to cues induces craving (wanting) & people go to extreme lengths to seek & obtain drugs.
Over time the like of drugs decreases, but the wanting remains very intense
It is the transition from liking to powerful wanting maintains the addiction

Question 39

What evidence is there to support the neurobiological theory of substance use?

Answer 39

• Those who were dependent on cocaine showed changes in physiological arousal, increases in craving, & ‘high’ feelings, & increases in negative emotions in response to cues of cocaine which consisted of audio & videotape of people preparing to inject or snort cocaine, compared to those not dependent.
• Brain imaging studies have shown that cues for a drug (needle/cigarette) activate the reward & pleasure areas of the brain implicated in drug use

Question 40

Drugs are used to enhance positive moods or to diminish negative moods. Drugs can also be used to relieve boredom.
What psychological factors can contribute to different experiences of mood alteration?

Answer 40

*Drugs are often used to reduce tension
eg Stress might lead to increases in smoking
- however, this is dependent on both the circumstance and the drug user
-whether someone is a new smoker or a life long smoker makes a difference
-there is evidence to suggest the act of inhaling (rather than the tobacco itself) actually decreases stress
*Distraction can reduce cravings also

Question 41

What other expectancies influence our drug taking behaviour?

Answer 41

• the belief that a drug will stimulate aggression & increase sexual responsiveness predicts increased drug use
• people who falsely believe that alcohol will make them seen more socially skilled are likely to drink more than those who accurately predict it can interfere with social interactions
• positive expectancies predict alcohol use and alcohol use helps to maintain & strength positive expectancies
• In general, the greater the perceived risk of a drug, the less likely it will be used.

Question 42

Which personality factors been shown to influence our drug taking behaviours?

Answer 42

• High levels of negative affect (or negative emotionality)
• a persistent desire for arousal,
• increased positive affect
• constraint (cautious behaviour)
• Harm avoidance
• conservative moral standards

Question 43

Which personality factors been shown to indicate likely drug taking behaviours?

Answer 43

Low constraint & High negative affect
have predicted onset for alcohol, nicotine, and illicit drug use in both men and women

Anxiety & novelty seeking have predicted the onset of getting drunk, using drugs & smoking

Depression has not been found as a factor in starting smoking

Question 44

How have sociocultural factors been shown to influence our drug taking behaviours?

Answer 44

People’s interest in and access to drugs are influenced by peers, parents, the media, and cultural norms about acceptable behaviour

Question 45

What are some of the sociocultural findings regarding substance use

Answer 45

• Cultural attitudes & patterns of drinking influence the likelihood of drinking alcohol
• In most cultures men drink more than women though the cultural norms about drinking influence the amount
• availability of the substance makes a huge difference to rates of abuse: liquor store owners, bartenders have higher rates of alcohol use
• exposure to alcohol use by parents increases children’s likelihood of drinking
• a lack of parental monitoring leads to increased drug-abuse

Question 46

What is deemed by many as the first step towards treatment?

Answer 46

The user admitting there is a problem followed by detoxification which is central & the first step to rehabilitation. It may also be the easiest step

• Enabling the drug user to function without drugs after detoxification is extremely difficult as the craving for the substance often remains even after the substance has been removed via detoxification
• Psychological treatments, drug substitution treatments and medications are part of this journey

Question 47

What are some alternatives to abstinence?

Answer 47

• Relapse prevention
• controlled drinking
• guided self-change

Question 48

Which medications are used for the treatment of alcohol use disorder?

Answer 48

Antabuse - it discourages drinking by causing violent vomiting if alcohol is ingested.
However dropout rates are as high as 80%
*Acamprosate (Campral) reduces cravings associated with withdrawal - it is thought to do this by impacting the glutamate and GABA neurotransmitters
*There are arguments against using drug therapy for substance abuse (dependence on one drug to stop using another)

Question 49

How effective are some of the treatments aimed at helping people give up smoking?

Answer 49

Gum can be as habit forming as cigarettes, though it is still thought to be less harmful than cigarettes

• Patches have been found to be superior to placebo *however, for all NRT abstinence rates are only 50% at 12 month follow up
• NRT & anti-depressants can be an effective treatment
• Clonidine & silver acetate are pharmacological treatments that show benefit also

Question 50

What did the findings of this study indicate with regard the usefulness of CBT to treat substance use disorder?

Answer 50

People receiving CBT learnt:
*how to avoid high risk situations. *recognise the lure of the drug for them, *& to develop alternatives to using cocaine & *strategies for coping with craving & resisting urges to use

NB: Regular substance abuse counselling has been found to be as effective as CBT

Question 51

What are some of the other psychological treatments of drug use disorders?

Answer 51

• Contingency management (with or without food/clothing vouchers) has shown promise for cocaine, heroin and marijuana use disorders
• Motivational interviewing or enhancement therapy which combines CBT to help clients identify their own solutions has also shown great promise
• Self-help residential homes are also effective treatments

Question 52

What are some of the drug replacement & medication treatments of drug use disorders?

Answer 52

• Heroin substitutes
• Methadone, levomethadyl acetate, & buprenorphine - chemically similar to heroin to replace body’s craving
• these are cross-dependent with heroin
• Opiate antagonists - Naltrexone - drugs that prevent the user from experiencing the heroin high
• 1st people are gradually weaned from heroin, then increasing doses of naltrexone are administered
• this drug binds to the opiate receptors without stimulating them

*Buprenorphine (AKA Suboxone) contains both buprenorphine & naloxone
It is a partial opiate agonist so it does not produce such an intense high as heroin & is only mildly addictive
Suboxone is effective at relieving heroin withdrawal symptoms & it seems relapse is less likely

Question 53

Is drug replacement an effective treatment for cocaine & methamphetamine abuse and dependence?

Answer 53

No, there are very few effective treatments for methamphetamine abuse.
Matrix treatment approaches are most effective for methamphetamine (Multiple interventions)

Question 54

What do prevention programs focus on?

Answer 54

• Raising self-esteem
• Teaching social skills
• Saying no to peer pressure

these have shown promise:

• two family treatment programs
• delaying alcohol use as long as possible seems to be an effective preventative intervention also