Week Seven - Substance Related & Addictive Disorders Flashcards
Psychoactive substance
Any chemical compound which passes through the blood-brain barrier and alters mood and/or behaviour
Substance use
ingestion (inhalation/injection/transdermal) of a substance
Intoxication
Physiological reaction to the substance
Tolerance
Need larger doses for same effect
Withdrawal
A strong, negative physiological (and often
psychological) reaction which occurs when a psychoactive
substance is removed
Substance use disorder
Problematic pattern of use that impairs functioning, with two or more of the following within 12 months:
1. The substance is taken in larger amount or for a longer period than planned
2. Persistent desire and/or failed attempts to reduce/control use
3. A large amount of time is spent either trying to attain the substance, or to recover from it’s use
4. Cravings/strong desire
5. Use is resulting in inability to fulfil obligations at work/home
6. Continued use despite ongoing exacerbation of psycho-social problems
7. Social, hobbies, or work activities are given up or reduced
8. Recurrent use in situation which may be dangerous
9. Continued use despite knowing the problems caused by the substance
10. Tolerance – an increasing need to use more of the substance to gain the same effects, AND/OR a marked diminished effect whenusing the same amount
11. Withdrawal – as manifested by a severe negative physiological
response to cessation, or the need to continue use to avoid
negative symptoms
Substance use disorder is specified by?
Type and severity
types of substances
- Alcohol
- Sedative/hypnotic/anxiolytic
- Stimulant
- Tobacco
- Caffeine
- Opioid
- Cannabis
- Other Hallucinogens
- Inhalant
Severity of SUD
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6 + symptoms
Drug categories
- Depressants – increase physiological arousal. Eg Alcohol and barbiturates
- Stimulants – increase physiological arousal. Eg cocaine and nicotine
- Opiates – pain relief. Eg morphine and heroin
• Hallucinogens/Psychedelics – alter sensation and perception.
Eg cannabis and LSD
How much do Aus spend pa on illicit drugs?
7 billion, more on legal
Alcohol Use Disorder?
Alcohol is classed as a depressant
• Diagnosed if physiologically dependent or heavy user
Consequences of AUD
Delirium tremens (DTs) can occur when blood alcohol levels
drop suddenly. Results in:
• Deliriousness
• Tremulousness
• Hallucinations - Primarily visual; may be tactile
Polydrug abuse
– Many users abuse multiple substances
• e.g., cigarettes, cocaine, marijuana
• 85% of alcohol abusers are smokers
Prevalence of Alcohol Abuse
Lifetime prevalence: 8.6%
• Binge drinking
– 5 drinks in short period (e.g., within an hour)
– 43.5% prevalence among college/university students
• Heavy use drinking
– 5 drinks, 5 or more times in a 30-day period
• 16% prevalence among college students
Short-term effects of alcohol on brain?
Interacts with several neural systems:
– Stimulates GABA receptors (GABA is a key inhibitory neurotransmitter)
• Reduces tension
– Increases dopamine and serotonin
• Produces pleasurable effects
– Inhibits glutamate receptors (glutamate is a key neurotransmitter in a
range of functions, notably memory and learning)
• Produces cognitive difficulties
Long-term effects of alcohol
- Malnutrition
* Cirrhosis of the liver
Marijuana/Cannabis
Marijuana is classed as a hallucinogen
• Hashish
– Stronger than marijuana
Marijuana: Prevalence
• Most frequently used illicit drug in Australia.
• Greater use by men than women
• Ongoing debate about legalisation and medical use –
medical cannabis legalised at a federal level in 2016
Effects of Marijuana
Major psychoactive ingredient is THC (delta-9 tetrahydrocannabinol)
Psychological Effects:
– Feelings of relaxation and sociability
– Rapid shifts of emotion
– Interferes with attention, memory, and thinking
• Decline in IQ over time
– Heavy doses can induce hallucinations and panic
Marijuana and the Brain
Two cannabinoid brain receptors - CB1 and CB2 – High concentration in hippocampus Increased blood flow to emotion regions – Amygdala and anterior cingulate Habitual use leads to tolerance – Withdrawal symptoms also observed
Marijuana and Mental Health
Evidence that cannabis use increases risk of psychosis for some people with a genetic predisposition for psychosis
Heavy use associated with:
• Chronic memory problems
Synthetic Cannabis
AKA Spice, Kronic
• Early days, but evidence of more severe sideeffects as compared to cannabis
• More frequent admission to A&E for drug-related events
Opiates/Analgesics
Group of addictive sedatives that in moderate doses relieve pain and induce sleep: – Opium – Morphine – Heroin – Codeine
Opiates legally prescribed as pain medications
Prevalence of Opiate Use
Heroin
• Used by .1% of Australians in 12 month period (2013)
Psychological and Physical Effects of Opiates
• Produces euphoria, drowsiness, and lack of coordination
– Severe letdown after about 4 to 6 hours
- Stimulates receptors (nucleus accumbent - reward) of the body’s opioid system
Heroin and OxyContin
– Rush: Intense feelings of warmth and ecstasy following
injection
Tolerance develops and withdrawal occurs
- W lasts 72 hours
Meth/Amphetamines
Amphetamines are classed as stimulants.
Increase alertness and motor activity; reduce fatigue
– Trigger release of and block reuptake of norepinephrine and
dopamine
– Produce high levels of energy, sleeplessness
– Reduce appetite, increase HR, constrict blood vessels in skin and mucous membranes
Tolerance with Meth/Amphetamines
after only 6 days of use
Chronic use of Meth/Amphetamines
damages brain
– Impacts dopamine and serotonin systems
– Reduction in hippocampus volume
Ecstasy
also sometimes classed as a hallucinogen, but is a type of
amphetamine
Induces a sense of wellbeing, feeling close to others,
increased tactile sensation.
Ecstasy users experience what in the following days
depression
Cocaine and what does it do
Cocaine and crack cocaine are stimulants – Reduces pain – Produces euphoria – Heightens sexual desire – Increases self-confidence and self-worth
Cocaine and brain
• Blocks reuptake of dopamine in mesolimbic areas of brain
- Not all users develop tolerance – Some become more sensitive
- May increase risk of OD
Dissociative Anaesthetics (2)
Phencyclidine
Ketamine
Phencyclidine (PCP)
• Initially used as an anaesthetic but stopped in 1965 due to negative after-effects, mainly severe hallucinations.
• Was considered a relatively popular recreational drug
but has been steadily declining
• Animal tranquilizer
• Causes severe paranoia, violence, self harm,
depersonalisation.
Ketamine
Used in surgical and veterinary procedures –
anaesthetic and analgesic properties
• Used as a party drug
PCP and Ketamine in the brain
• Both Ketamine and PCP block the action of NMDA
receptors (one of the receptors which binds to the
neurotransmitter glutamate)
• Both increase the availability of serotonin, dopamine
and norepinephrine, by reducing re-uptake
LSD
LSD is a hallucinogen
– Colorful visual hallucinations
– Psychedelic trip: expansion of consciousness
- experience of flashbacks (HPPD)
Etiology of Substance-Related Disorders: Genetic Factors
Relatives and children of problem drinkers have higher-than expected rates of alcohol abuse or dependence
Greater concordance in MZ than DZ twins
Ability to tolerate large quantities of alcohol may be an inherited diathesis
Some evidence that people dependent on drugs or alcohol
have a deficiency in the dopamine receptor DRD2
Etiology of Substance-Related Disorders: Neurobiological Factors
Nearly all drugs, including alcohol, stimulate the dopamine
system in the brain, particularly the mesolimbic pathway
– Produce rewarding or pleasurable feelings
Etiology of Substance-Related Disorders: Psychological Factors
People take drugs to avoid the bad feelings associated with withdrawal
– Explains frequency of relapse
Incentive-sensitization theory
Distinguish Wanting (craving for drug) from Liking (pleasure obtained by taking the drug)
Dopamine system becomes sensitive to the drug and the cues associated with drug (e.g., needles, rolling papers, etc.)
Sensitivity to cues induces and strengthens wanting
Etiology of Substance-Use Disorders: Sociocultural Factors
Men consume more alcohol than women but differences vary by country
• Availability
– Usage is higher when alcohol and drugs are easily available
Etiology of Substance-Use Disorders: Sociocultural Factors (family factors)
– Parental alcohol use
– Marital discord, psychiatric or legal problems in the
family linked to substance use
– Lack of emotional support from parents increases use
of cigarettes, marijuana, and alcohol
– Lack of parental monitoring linked to higher drug usage
Etiology of Substance-Use Disorders: Sociocultural Factors (social network/media)
Social network
• Having peers who drink influences drinking behavior (social influence) but individuals also choose friends with drinking patterns similar to their own (social selection)
Advertising and media
– Countries that ban ads have 16% less consumption than
those that don’t
A Biopsychosocial Model of Addiction
Social Influences
• Family
• Media
• Peer etc
Psychological Influences
• Incentive Sensitisation Theory
• Expectancies
Biological Influences
• Genetic predisposition
• Sensitivity
• Other disorders
Biological Treatment for heroin
Agonist Treatment
- narcotics (used to wean heroin users from dependence)
Biological Treatment for opiates
Antagonist Treatment
- Naltrexone
• Prevents feeling high
Biological Treatment for alcohol
Aversive Treatment
- Antabuse (disulfiram)
• Produces nausea and vomiting if alcohol is
consumed
Psychosocial Treatment
Inpatient hospital treatment
– Detoxification
• Withdrawal from alcohol under medical supervision
• The therapeutic results of hospital treatment are not
superior to those of outpatient treatment
• May be necessary for those without social support or
with other serious psychological problems
Psychological Treatment
Alcoholics Anonymous (AA)
Motivational interventions
– Emphasises empathy and understanding in the client counsellor relationship
Cognitive and Behavioral Treatments
Cognitive and Behavioral Treatments for drinking
– Contingency-Management Therapy
• Patient and family reinforce behaviors inconsistent with
drinking e.g., avoiding places associated with drinking
• Teach how to say no
– Relapse prevention
• Strategies to prevent relapse
Marlatt and Gordon’s Relapse Prevention Model
coping vs no coping response
Combination therapy – CBT and Medication
– Desipramine (antidepressant) and CBT showed
effectiveness for cocaine use
• CBT especially helpful for users with high dependence
levels
