M2s1 Substance Use Disorder

Question 1

Opioid crisis

Answer 1

-brought light to the impact and prevalence of substance use disorders (SUD)
-from Jan 2016 to sept 2020, 19,355 Canadians died of apparent opioid overdose (so every 2 hours Canadian life lost, 94% of these deaths accidental)

Question 2

What is SUD criteria

Answer 2

-defined and diagnosed by number of criteria
-once individual meet a minimum of 2 criterias = mild SUD
-more criteria an individual meets, the more severe the SUD
-various criteria can be generalized into subgroups

Social Impairments
-the individual fails to fulfill major roles (e.g. in work, school, home) and/or has persistent social or interpersonal problems. Additionally, social, occupational, or recreational activities may be given up or reduced

Risky Use
-individual may use the substance in physically hazardous situations or use the substance despite physiological or psychological problem caused by them

Impaired control
-the individual may have persistent craving for the substance ( I.e. addiction)

Withdrawal
-the individual may Experince a withdrawal syndrome after stopping use of the substance

Tolerance
-the individual may develop tolerance to the substance

Question 3

Syndrome definition

Answer 3

A group of signs and symptoms occurring together that characterize a particular abnormality or condition

Question 4

Addition

Answer 4

-one component of a complex disorder
-emotional and mental preoccupation with the drug’s effects and by a persistent craving for the drug, regardless of the consequences
-state in which stopping or abruptly reducing the dose of a given drug produces non-physical symptoms
-can occur not only to drugs, but other stimuli as well (e.g. gambling, shopping, video games, etc.)

Question 5

The Dopamine Hypothesis

Answer 5

Predominant hypothesis to explain addition is called the dopamine hypothesis. 2 main components

Effects on reward systems
-this hypothesis suggests commonly misused drugs increase dopamine in the reward systems of the brain (I.e. the limbic system)
-other neurotransmitter systems are involved in substance misuse, but the increase in dopamine appears to be a key component of the brain’s reward system

Dopamine increase
-these dopaminergic systems are also responsible for natural rewards such as food and sex as well as for stimulus-related rewards such as video games and gambling
-drugs associated with addiction (such as cocaine) caused an exaggerated increase in dopamine, altering communication in the brain

*look at good notes for photos

Question 6

Characteristics of Addictive Drugs

Answer 6

-categorized based off effect produce

Increase Dopamine - some substances lead to increase in dopamine in brain reward systems
Ex. Central nervous system (CNS) stimulates - cocaine, amphetamines, nicotine, caffeine
Opioids - morphine, heroin, oxycodone
And other drugs like alcohol and cannabis

Produce novelty - have novel feeling in person taking drug
Exs, lysergic acid diethylamide (LSD) and ecstasy also known as MDMA (3,4-Methylenodioxymethamphetamine)

Reduce anxiety - addictive as reduce anxiety in person taking them
Ex. CHS depressants like benzodiazepines and barbiturates

Question 7

Drug withdrawal

Answer 7

-abnormal physiological state produced by repeated administration of drugs which leads to appearance of a withdrawal syndrome when drug administration is discontinued or dose is decreased
-severity of withdrawal syndrome increases with speed of drug withdrawal as biological processes that accommodated to the presence of drug do not have time to reverse themselves
-fear of withdrawal is one factor that contributes to the continuing of the drug- taking behaviour

Question 8

Withdrawal symptoms

Answer 8

-usually opposite it the effects of the drugs ‘

Stimulants
Ex. Cocaine and amphetamines
-sleepiness
-muscle pain
-anxiety
-tremors
-low mood
-suicidal ideations (in some cases)
-cardiovascular problems ( in some cases)

Opioids
Ex. Heroin, morphine, and prescription medication like oxycodone
-sweating
-muscle aches
-agitation
-diarrhea
-abdominal cramping
-vomiting

Question 9

Drug tolerance definition

Answer 9

-repeated administration of a given dose of a drug has progressively less pharmacological effect OR a state in which the dose of a drug must be increased to obtain the same magnitude of pharmacological effect as was produced by original drug dose

Question 10

How would dose-response curve change after drug tolerance has developed

Answer 10

The graph would Experince a right word shift (more stretched that way) in order to receive as high of a percent response the drug dose must be increased

Question 11

Drug tolerance and dose-response curve

Answer 11

• check goodnotes for image of graph
  -usually expressed as a shortened duration of action and a decrease magnitude of effect
  -extent and rate of development of tolerance is specific for each drug
  Ex. Tolerance develops to the euphoria caused by morphine, but not to consitpating eggects caused by morphine

Note that tolerance does not develop to all drugs or all aspects of a drugs action

Drug tolerance is reversible upon drug discontinuation

Question 12

Cross tolerance

Answer 12

• refer to goodnotes for graph
  -can occur between pharmacologically similar drugs
  -defined as resistance or tolerance to one drug because of the resistance or tolerance to a pharmacologically similar drug

Ex. If person tolerant to the CNS depressant alcohol, they would also be tolerant to the CHS depressant benzodiazepines, even if they have never taken a benzodiazepine before in their life

Question 13

SUD

Answer 13

Substance use disorder

Question 14

Factors influencing SUD

Answer 14

Genetic factors
-can predispose an individual to SUD
-ex. Genetic mutations in dopaminergic pathways in the brain, which are associated with addiction confer an increased risk of SUD

Pre-existing disorders
-individuals with major affective disorder (ex. Depression or bipolar disorder), anxiety disorder or schizophrenia are at higher risk for SUD than general population

Environmental factors
-exposures to environments that promote drug use, family dynamics, trauma, engaging in specific social/work groups all alter risk of SUD
-even when considering genetic factors, spouses and siblings of those with SUD are higher risk of developing SUD

Developmental factors
-individuals more vulnerable during certain developmental timeframes
-ex. Adolescence and early adulthood are at age groups primarily associated with initiation of SUD
-smoking usually begins before age 18, 80% of those with alcohol disorder being problematic use alcohol before age 30, illicit drug use often begins between 15 and 18 years of age

Question 15

Stigma of SUD

Answer 15

-by society and medical professionals
-can lead to isolation and low self esteem
-consequence of this is individuals not receiving the medical or social help they need
-can help reduce stigma by changing language use ( instead of abuser, addict, druggie, or junkies -> use person with SUD, instead if abuse -> use use/misuse, instead of clean -> use in recovery/not currently using)

Question 16

Harm reduction

Answer 16

-approach that seeks to reduce and prevent negative consequences of substance use and improve health without judgement, coercion, or discrimination and without necessarily requiring the person to stop using the substances
Goals:

Health harms - decrease morbidity (transmission of blood bone diseases like HIV/AIDS, hepatitis, infections such as skin and heart infections) and mortality (from overdoses and secondary to associated morbidity)

Societal harms - decrease lost productivity, apprehension of children and criminal activity

Question 17

Prescription use verse misuse of substance

Answer 17

-SUD can occur with medications used as prescribed or with misuse of substances
-misuse defined as using drug in ways or amounts or their than what as prescribed, or against social norms
Ex. Individual prescribed opioids for long period of time (says for chronic pain) will develop withdrawal and tolerance as these are physiological processes that occur due to drug presence
-occurrence of tolerance and withdraw alone not sufficient for diagnosis of SUD however if an indictable also meets some of the other criteria, then classified as having SUD
-therefore, SUD can occur with prescription use of drug

-SUD can also develop after misuse substance
-individual using drug in ways or amounts other than what was prescribed, or against social norms
-potential for misuse of drug varies, and influenced by a number of factors

Question 18

Potential for misuse of drug

Answer 18

-tendency of drug to be misused varies from drug to drug as well as from individual to individual

Nature of drug
-most if not all drugs are natural reinforcers like food and sex
-pleasurable effects produced by drug increases the probability that drug will be taken again
Ex. Heroin and cocaine produce intensely pleasurable effects and therefore have a high intrinsic misuse potential

Route of administration
-can be administered by routes that give rapid absorption meaning rapid effects, have grater potential for misuse
Ex. Drugs administered by sniffing, inhalation or intravenous injection are usually more prone to misuse than those taken orally

Amount/ frequency of use
-greater the dose and frequency of use the greatest the potential for development of tolerance, withdraw and addiction, therefore continued misuse
Ex. Occasional use of alcohol in moderation (social drinking) will rarely lead to tolerance, withdrawal and addiction but frequent, high dose use of alcohol is more likely to lead to development

Availability
-more widespread a drug, more likely misused
Ex. Alcohol has only moderate intrinsic misuse potential but most misused psychoactive substance in society, largely cause readily available
-heroin high intrinsic misuse potential but lower overall risk in North America as availability is controlled by law and cost

Inherent harmfulness

-refers to potential of drug to cause harm
-if drug perceived to be serious risk to life and harm, not be used even if widely available
Ex. Methyl alcohol (wood alcohol or methanol) is widely available, and when consumed it produces inebriating effects similar to those produced by ethyl alcohol (beverage alcohol)
-in small doses, methyl alcohol can be used to cause blindness and death, therefore not commonly misused, even though widely available

Question 19

Drug classes: tolerance withdrawal and addiction

Answer 19

Drug Class. Tolerance. Withdrawal. Addiction
Opioids (e.g. morphine, codeine, heroin) Yes. Yes. Yes
CNS Depressants (e.g. ethanol, sedative-hypnotics) Yes. Yes. Yes
CNS Stimulants (e.g. amphetamines, cocaine). Yes. Yes. Yes
Hallucinogens (e.g. LSD). Yes. NO. Yes
Cannabis (I.e. THC) Yes Yes Yes

Question 20

Substance misuse case study example

Answer 20

Charlie binge drinks once a month. They will often drink so much that they “black out” and cannot remember events from the night before, and are sick the following day. Other than their big night out once a month, Charlie does not drink

Question 21

Substance withdrawal

Answer 21

Luisa has been drinking 4 large black coffees a day since she started her undergrad. If she doesn’t drink coffee immediately upon waking up, she experiences headaches, is irritable and doesn’t feel awake

Question 22

Substance misuse definiton

Answer 22

Using drug in ways or amounts other than what was prescribed, or against social norms

Question 23

Substance withdrawal

Answer 23

-withdrawal symptoms and effects opposite to the primary effect