Week 6 - Substance and addictive disorders

Question 1

What has changed from DSM-IV to DSM-V substance use considerations?

Answer 1

• combines substance abuse and substance dependence into one substance-related disordr (describes them as mild, moderate or severe based on no. of symptoms)
• added ‘craving’, removed ‘ legal problems’

Question 2

What is the DSM-V criteria for substance-use disorders

Answer 2

• take in larger amounts of alcohol than what was intended
• unsuccessful efforts to reduce intake
• spending a lot of time getting, using or recovering
• cravings and urges to use
• continued use despite physical or psychological problems
• role disruption at work, home or school
• reduction in social, occupational or recreational activities
• using in physically hazardous situations
• tolerance and or withdrawal

Question 3

What are the specific substance use disorders?

Answer 3

• alcohol use disorder
• cannabis
• caffeine
• hallucinogen - related disorder
• inhalant use disorder
• opioid use disorder
• sedative/anxiolytic use disorder
• stimulant use disorder
• other substance use disorder

Question 4

What are factors which have been demonstrated to contribute to substance use disorders?

Answer 4

• genetics
• the brain
• cognitive factors
• stress
• environment

Question 5

What is the integrative model of substance use disorders?

Answer 5

• Posits that substance use disorders arise due to multiple sources including genetics, the brain/ neurobiology, associative learning, cognitive factors and environmental factors.
• a disorder may arise from multiple and different paths

Question 6

What is the best way to assess for a substance-use disorder?

Answer 6

• KNOW YOUR PURPOSE (screening, diagnosis, functional assessment or treatment outcome)
• DIFFERENT MODALITIES (interview, self-report, biochemical measures)

Question 7

How do we screen for substance use disorders?

Answer 7

• Alcohol Use Disorders Identification Test (AUDIT): Adults, interview or self-report
• Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD): Adolescents, adults, self-report or interview

Question 8

How do we diagnose substance-use disorders?

Answer 8

• Structured Clinical Interview for DSM-5 diagnoses
• WHO-WMH-CIDI
• Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS): 6-18 years

Question 9

How do we do a functional assessment for assessing substance-use disorders?

Answer 9

• ANTECEDENT (what makes the behaviour more likely to occur; identify contexts and cues)
• BEHAVIOUR (describe intensity, duration and frequency)
• CONSEQUENCES (both within and outside of the person)

Question 10

How do we assess treatment outcomes?

Answer 10

• timeline followback interview
• inventory of drug taking situations
• drug taking confidence questionnaire
• alcohol dependence scale
• severity of dependence scale
• urine testing

Question 11

How do we know that genetics play a part in developing substance - use disorders?

Answer 11

• twin and adoption studies show heritability at:
• 51-73% alcohol
• 0-60% smoking
• 30-80% cannabis
• 30-50% psychedelics

Question 12

How do we know that the brain plays a part in developing substance - use disorders?

Answer 12

• All addictive drugs cause SHARP INCREASES IN DOPAMINE RELEASE
• Dopamine RESPONSE WITH GREATER AMPLITUDE IS A RISK FACTOR
• Dopamine increases elicit a reward signal that triggers ASSOCIATIVE LEARNING
• REPEATED EXPERIENCES OF REWARD BECAME ASSOCIATED WITH STIMULI THAT PRECEDE THEM
• With repeated use dopamine cells stop firing in response the drug and instead fire in response to the conditioned stimuli

Question 13

How do COGNITIVE FACTORS plays a part in developing substance - use disorders?

Answer 13

• positive and negative reinforcement effects learned directly and indirectly
• these expectancies influence both substance use behaviour and substance use effects
• lower self-efficacy about one’s ability to cope without using substances is a risk factor