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PAS_Week 1 > Week 6_Intro to addiction > Flashcards

Week 6_Intro to addiction Flashcards

1
Q

Discuss why the term “substance use disorder” is the preferred term when discussing addiction?

A

The term “Substance use disorder”:

  • overnormalises addiction
  • doesn’t stigmatise person
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2
Q

The term dependence refers to the physiological effects that are felt and medicalises it. What behaviours does this term not address?

A

“Dependence” does not address behavioural issues or problems such as gambling. It does give us measurements we can work with.

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3
Q

Why is there negativity around the word “addiction”

A

The term “addiction” is associated with stigma. There is a big difference between saying someone has an addiction and saying they are an addict: using term incorrectly is part of the problem.

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4
Q

Discuss “Abuse”

A
  • Abuse: more potential to cause harm.
  • too high a dose on purpose to see if you can have an increased effect.
    eg. mixing with alcohol
  • also includes deliberate diversion of drugs then going and selling drugs on street. ARen’t addicted but are using the money as source.
  • Speaks to legal harms as well as physical harms.
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5
Q

Term “use”.
Who prefers us using this term?
How does it differ from the term “misuse”

A

Drug community wants us to use “drug use” because they are choosing to “use” rather than “misusing”.
Misuse: using a drug in they way it was not intended to be used: different to dosing, selling it, demanding brand etc…
When we see abhorrent prescription behaviours that’s when we start using “misuse”, used in interim while we work out what’s going on. Could be due to stress.

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6
Q

How do we know what drugs are being used in the community?

A

Monitoring schemes:

  • IDRS: illicit drug reporting system
  • EDRS: ecstasy and related drug reporting system
  • Household drug surveys
  • Needle syringe program
  • Forensic capture (people and also capture of drug stores)
  • Sewerage monitoring: not great on a community level: too diluted. Mostly used in institutions.ie. prison: monitor likely type of substances used and how much. NEGATIVE: can’t necessarily separate prescribed vs illicit.
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7
Q

What is being used?

A

Last 12 months:
- tobacco 12.2% decreasing (60% people never smoked)
- alcohol 80.5% (stable)
- Illicit 12% (variable)
-cannabis 10.4%(stable, age shifting(users getting older)
-cocaine 2.5% (increasing)
- Amphetamines 1.4% (decreasing) (Frequency of use: goes up. amphetamines don’t last long so people use at higher amounts more frequently.
-Heroin 0.2% (stable)
- IVDU 0.4% (stable)
Pharmaceuticals (misuse) 5% (increasing)

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8
Q

What are the drug trends in Townsville?

A
  • alcohol & tobacco
  • steroids (recent change)
  • IVDU- 50:50 opiate/amphetamine
  • opiate use is 90% + PRESCRIPTION- oxycodone, oxycontin (long acting), fentanyl
  • Amphetamines- mixed picture (IV use drops when the proportion of “ICE” increases.
  • Benzodiazepines: Drs began prescribing barbituates before understanding side effects, this then changed to benzos and the use was transferred to the community. : over 1% of pop.
  • OTC misuse: too early to see impact of changes.
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9
Q

What factors influence drug use?

A
  • social factors
  • environmental factors
  • biomedical/neurochemical factors
  • genetic factors : not modifiable
  • other
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10
Q

What role does genetics play in addiction?

A
  • there appears to be some genetic predisposition to addction
  • some genetic factors in response to some drugs that may enhance or alter their effects and their addictive liability. eg. codeine metabolism to morphine, alcohol dehydrogenase expression
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11
Q

Do social or environmental factors play a large role in addiction?

A

SES status a BIG factor.

  • eduction
  • family history
  • social acceptability of individual drugs : caffeine, alcohol, smoking
  • incarceration- one of largest grooming grounds
  • exposure
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12
Q

The reward centre was originally the part of the brain that drove us to eat, drink, have sex and to nurture our offspring. Our brains have grown beyond this: discuss how the reward pathway changed over time and how drugs affect the reward centr.

A
  • We started to make choices, preferring one thing over another. So our brain started to reward us for the things that it liked or wanted. Now, it has a life of it’s own. There is a hierarchy.

Drugs hijac reward pathway and push themselves on top. They become the first thing the brain tells you it needs every morning, if you don’t have them, the reward centre goes into a cycle, driving the person to look for the drug to the exclusion of everything else (food, water, sex, nurturing, self-care…etc)

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13
Q

How is a habit formed?

A

Habit: building of neuroplasticity between 2 events. Cut or impulse driven.

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14
Q

What type of personalities are more likely to experiment with drugs?

A

People who like taking risks are more likely to try drugs.

People who like to be in control, who tend to take less risk or like being less challenged, usually will be less likely to experiment.

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15
Q

Has the use of heavy drugs changed over the years?

A

No. The subproportion of people using heavy drugs has not changed, only what they are using changes.

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16
Q

What is the National drug strategy framework and who is largely responsible for each initiative?

A

Demand reduction: Prevention
- falls to community organisations and gov’t policy
Supply reduction: policing
- falls to forensics (apart from prescription meds, not much Drs can do.)
- Harm Reduction: Management
- drs

17
Q

In managing acute effects of a drug, what 4 factors might we be considering?

A

USE: Has used occurred?

  • saliva
  • drug testing for driving
  • urine drug screening in athletes
  • occupations
  • court

INTOXICATION: impaired ability to function? Blood alcohol (BAL) in driving or for consent in hospital.

ADVERSE EVENTS: Has there been an acute harm eg. injection injury, overdose, accident or other injury, social harms including forensic harm (ie.possession)

OVERDOSE: subcategory of harm (poisoning)

18
Q

What drug is responsible for 50% of drug deaths?

How many deaths per year from drinking and tobacco use?

A

opioids- 50%

  • 75% total deaths deemed accidental
  • majority acute

alcohol= 5500 deaths per year (30% acute)

tobacco- 15,000 deaths per year (0% acute)

19
Q

List routes of administration:

A

Drop it: oral
Boot it: IV
Chase it: inhalation/smoke
Shaft it: rectal

20
Q

What stages are seen in patterns of drug use?

A 
experimental 
 > occasional
  > recreational
   > regular
    > dependent
21
Q

List some social harms of drug use:

A

forensic, child safety issue, unplanned pregnancy/STIs, broken relationships, depletion of finances, employment issues

22
Q

What are the physiological steps of dependence?

A
  1. Exposure to substance with abuse potential (can cross BBB, can activate reward pathway)
  2. Positive aspects of neurochemical activation outweigh negative aspects in the individual.
  3. Environmental context is conducive to repeated use.
  4. Repeated use results in receptor adaptation (function or number)
  5. downstream neurological function alters to adjust for receptor adaptation (homeostasis)
23
Q

Describe the psychological aspects of dependence:

A
  1. psychological factors involved in the likelihood of trying the drug
  2. psychological factors involved in resistance to social forces (eg. peer pressure)
  3. Those with poorer coping strategies are more likely to seek out dissociation from their reality
    - a. internal - resilience, sense of control, identity
    - b. external- supports, role models, opportunities
  4. Psychological factors in the resistance to adverse experiences in stopping if desired.
24
Q

List DSM-% criteria : Substance Use Disorder

A

Problematic Patter of use leading to clinically significant impairment or distress, manifesting at least 2 of (in 12 months)
1. Increasing dosage ove rtime
2. persistent desire and unsuccessful efforts to cut down
3. Time spent obtaining, using and recovering from use.
4. craving or strong desire to use.
5. Recurrent use leading to failure to fulfill obligations
6. Continued use despite persistent or recurrent social or interpersonal problems caused by overuse.
7. Important social, occupational or recreational activities given up on or reduced (due to use)
8. recurrent use in situations that may be hazardous
9. use is continued despite knowledge of harm
10. Tolerance
11. Withdrawal syndrome on cessation or reduction
2-3= mild . 4-5= moderate 6+= severe

25
Q

Can withdrawal occur without physiological adaptations?

A

No, it is only due to these physiological adaptations that withdrawal occurs.

26
Q

List some general features of withdrawal of CNS stimulants/depressants.

A
  • sweating
  • nausea, vomiting, appetite disturbances
  • restless, irritability, cranky, angry, violent reactions
  • loss of self-control
  • anxiety, panic attack
  • depression
  • headaches
  • muscles/abdo cramps, aches and pain
    IN ADDITION TO SPECIFIC FEATURES OF THE DRUG
27
Q 
WITHDRAWal MANAGEMENT
List factors concerning:
The client
The drug
The environment
A

Client:

  • co-morbidity
  • severity of dependence
  • stage of change
  • safety

Drug:

  • what are the risks
  • what to expect

Environment
- where will withdrawal take place?

28
Q

Give some examples of alcohol screening tools:

A

CAGE- questionnaire based on 4 questions
The CAGE questionnaire asks the following questions:

  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

AUDIT-C
AUDIT

29
Q

What can health professionals do about drug addictions?

A
  • prevention
  • assessment
  • early intervention
  • withdrawal management
  • brief interventions
  • motivational interviewing
  • counseling-psychotherapy
  • pharmacotherapy
  • co-morbidities and complications
  • Addiction as as specialty

PAS_Week 1 (8 decks)

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