week 5 Substance-related, addictive, and impulse-control disorders. Flashcards
describe the clinical features of substance use disorders in DSM-5;
Defines the disorder by level of impairment resulting: may be mild (2 symptoms of interfering with life in past year) moderate(4-5 symptoms in past year) or severe (6+ symptoms in past year). Often described as an addiction although this term is arguable.
Symptoms include physiological dependence, drug seeking behaviours. DSM-4 had substance abuse and substance dependence as 2 distinct diagnoses, but dsm-5 has as same.
TERMS;
Psychoactive substance;alters mood, behaviour or both.Includes hard drugs, but also nicotine, caffeine, chocolate etc etc.
Substance use=take psychoactive substances in amount which does not significantly interfere with social, educational, occupational fn.
Intoxication=physiological reaction to psychoactive substance, to point of impairment such as impaired judgement, mood change, lowered motor ability etc.
Physiological dependence=need drug in greater amount to have effect, (tolerance), adverse physical reaction when substance withdrawn
outline the short-term effects and long-term consequences of alcohol use;
Short term;antianxiety, increase sociability (mild doses). Increased consumption leads to cognitive impairment, incoordination, passing out, loss of memory etc.
May have headache or tender liver day after etc as body recovers from a binge.
Long term liver cirrhosis, alcoholic dementia, and or Wernicke-Korsakoff syndrome (confsion, incoordination, from thiamine deficiency) from frequent binges.
Foetal alcohol syndrome can affect offspring of mother’s who drank when pregnant. affected osspring may have skin folds at eyes, short nose, lack of median lip groove, reduced growth, cognitive disabilities and behavioural issues.
Withdrawal from heavy drinking can actually be fatal. Typically have hand tremors, nausea, v+, anxiety, transient hallucinations, insomnia. At extreme level will have withdrawal delirium (or delirium tremens=dt’s) with whole body tremors.
Alcohol is often present during violent incidences also.
Whilst initialing may be stimulating, alcohol is classed as a depressant as more brain systems become depressed with further intake.Depressants cause relaxtion, sedation.
define the other depressant substances (sedatives, hypnotics, and anxiolytics) and the features (i.e., effects) of their use;
Sedatives cause calming.
Hypnotic causes sleep.
BARBITURATES include amytal, seconal, nembutal. Sedatives. Muscle relaxation, increased dose incoordination and slurred speech, very high doses relax diaphragm and death by suffocation. Overdose common means of suicide.
BENZODIAZEPENES include valium, rohypnol. Antianxiety. Considered “safer”than barbiturates.Induces calming, muscle relaxant and antiseizure.
define stimulants and describe the features of amphetamine and cocaine use disorders;
STIMULANTS;cause increased activity and alertness. May elevate mood. Includes amphetamines, cocaine, nicotine, caffeine.
AMPHETAMINES;manufactured. induces feelings of elation and reduced fatigue, but when come back down, “crash” with depression and tiredness.Sometimes taken ton lose weight. suppresses appetite.Prescribed for narcolepsy. Related drugs include ritalin and aderolwhich are used in children with adhd.
DSM CRITERIA FOR AMPHETAMINE USE DISORDER;euphoria or affective blunting,sociability changes,tension, anxiety, anger, impaired judgement, impaired fn,. Changes after ingesting amphetamines include heart rate change, blood pressure change, perspuration and chills, nausea, muscle weakness, weight loss, .
Severe intoxication may cause panic, agitation, paranoid delusions.
Tolerance occurs rapidly. Withdrawal results in apathy, drowsiness, irritability.
MDMA (methylene-dioxymethamphetamine) (ëcstasy”) is descibed as making one feel happy and love everyone.long term causes memory loss issues
“crystal meth”is taken via smoking and causes marked aggression.
Amphetamines enhance activity of norepinephrine and dopamine.
COCAINE;from coca leaves (South America), to ward off hunger and fatigue. Cococola originally had small amounts of cocaine.Increases alertness, produces uephoria. Is quite short lived. frequently results in paranoia. “crack babies”born to mothers who used cocaine during pregnancy, may have decreased birth weight, reduced head circumference, increased irritability and ongoing behavioural issues.
Crack cocaine is crystallised form, and is smoked.cocaine blocks re-uptake of dopamine
define and describe the features of opioid use disorders;
OPIOIDS;naturally found in poppy flowers. Synthetics include heroin, methadone, hydroconone, oxyconone. Also naturally occuring enkephalins, beta-endorphins in the brain. Causes euphoria and drowsiness and slowed breathing.High doses cause respiratory arrest.
Withdrawal causes yawning, nausea, chills, muscle aches, insomnia. Withdrawal can be completed within 1 week or less.Usually taken i/v, so increased risk of other iv issues such as hepatitis and hiv.
Opiate addict has a 6-20% increaed mortality rate cf general population.
define hallucinogens and describe the features of the use of marijuana and LSD and other hallucinogens;
HALLUCINOGENS;alter sensory perception, can cause hallucinations, paranoia and delusions. includes cannabis (when dried, = marijuana). and lsd
Cannabis makes normal experiences seem very funny, or to have a dream like quality, senses may be heightened and colours appear very vivid.Individual responses are quite varied and 1st time users often report no effect. Some users, if suffciently motivated can exert control to “turn off”the effect of being high.
Long term cannabis use leads to impairments of memory,concentration and social relations. Synthetic marijuana eg “k2”can cause seizures, hallucinations and heart palpitations.Withdrawal is not major, but still has irritability, restlessness, difficulty sleeping.
LSD (d-lysergic acid diethlamide)(acid) is synthetic., although occurs naturally in ergot (grain fungus)
Other hallucinogens include psilocybin(from mushrooms), and mescaline (from peyote cactus).
Intoxication from hallucinogens often includes dilated puils, sweating, blurred vision, tachycardia and hallucinations.Some report mystical experience which may years later still be claimed as revelatory. Mood may be altered to joy, happiness, fear or anxiety.
discuss biological, psychological, cognitive, social and cultural factors in the aetiology of substance use and how these contribute to an integrative model of substance related disorders;
“lack of willpower” suggests the victim is to blame, whereas seeing substance use disorder as a disease enables tx. BUT is not always helpful to suggest that a person is helpless to do anything about it. Possibly a combination of the 2?
Genetics play a role in susceptibility to substance use disorder, and also possibly in how one will respond or not to tx. eg naltrexone (opiod antagonist) used to treat alcohol use disorder, is more effective in those with a particulat genetic variation re opiod receptors (OPRM1 gene).
Environment, social influence, and cultural belief/accessability also plays a part.
generally, psychoactive substances are able to activate our reward or pleasure pathway.
There are individual levels of sensitivity to substances. One study found sons of alcoholics are more sensitive to the initial euphoria of alcohol, and less sensitive to the later depression effect, making them more likely to develop substance use disorder.
Another study has found that the brain activity spike which occurs 300miliseconds after a tone (the P300) as the brain processes this, is lower in those with alcoholism in their family, and it is lower in opiod substance use disorder, schizophrenia and depression. Significance of this is unknown.
Substances may be used becuase they are pleasurable (positive reinforcement) or because remove unpleasant feelings of anxiety, lonliness etc (netaive reinforcement). Those who have seen combat or experienced sexual abuse more likely to develop alcohol use disorder. Children with higher reports of lonliness or tension, more likely to use drugs.
OPPONENT-PROCESS-THEORY-states that an increase in positive feelings, will be followed by an increase in negative feelings. For those with substance use disorder, they increasingly seek the positive, experience the negative, but pursue the positive again as a means of overcoming the negative. vicious cycle.
Many use substances as a way of “self medicating” or alleviating anxiety, stress, fatigue, loneliness etc etc.
EXPECTANCY EFFECT-differs for each person, but before taking drugs, have an expectation of what will happen, and this influences how one reacts eg placebo caused disinhibition because thought took alcohol and thought would cause disinhibition.
describe and evaluate the various biological, psychosocial, and sociocultural interventions for alcoholism and other substance related disorders.
BIOLOGICAL/MEDICAL TX: primarily used to alter how substance is experienced.
eg. Agonist substitution is where substance is replaced with a similar but “safer” substance. eg Methadone often given as a substitute for heroin.
eg Antagonist substitution used so substance is counteracted eg naltrexone to counter effects of opioids.
eg Aversive tx such as take disulfram (“antabuse”) which prevents breakdown of acetaldehyde (by product of alcohol), therefore feel ill, therefore hopefully avoid drinking in future.
eg medications to ease the withdrawal symptoms eg benzodiazepines to aid withdrawal from alcohol.
None of these are greatly successful, but have improved success if combined with psychosocial or other tx.
PSYCHOSOCIAL TX;
eg Inpatient facility; expensive. Really only geared for the initial withdrawal period. Cheaper outpatient may be as effective.
eg Alcoholics Anonymous-proven helpful for those motivated to change and who adhere to the policies. Does not suit all. Emphasises that whilst is a dz, patient needs to acknowledge their dependence upon it. There are now programs that follow the same basic recommendations but without the religiosity. The social group and mentorship aspects are likely very important.
eg Controlled Use-a controversial method which encourages smaller, controlled use. Neither this nor complete abstinence programs are successful for 70-80% of patients long term.
eg Component treatment-combining tx. eg biological with psychosocial.
Contingency management is one component of a combo, which, decides on positive reinforcements eg cash for negative urine drug test etc
Community reinforcement is another component. This enlists the aid of a friend/spouse who does not have substance use disorder, to help the patient to work on relationships etc as part of addressing other contributing factors such as stress, anxiety etc.
eg Motivational enhancement therapy focuses on person’s beliefs, why change is necessary and the good things that can come of it.
eg Cognitive Behavioural therapy addresses a person’s
cues to substance use to try to avoid them. In cbt, relapse is best addressed as a response to stress etc and does not mean failure or that change cannot still occur.
One of the hardest obstacles to successful tx is patient admitting there is a problem.
