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abnormal psych > Ch10 (lesson 12) substance use > Flashcards

Ch10 (lesson 12) substance use Flashcards

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1
Q

types of substance use disorders

A

a) alcohol and tobacco
b) Marijuana
c) Opiates
d) stimulants
e) hallucinogens
f) gambling

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2
Q

prevalence substance use

A

alcohol: 51.9 %
cigarettes: 27.7
marajuana: 6.6%

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3
Q

subtance use disorder DSM- IV-TR

A

pathological use of substances divided into two categories

  • substance abuse
  • substance dependence
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4
Q

DSM-5 substance use disorder category

A

one category-
substance use disorder
categorized by substance:
- alcohol
- amphetamine
- cannabis
- cocaine
- hallucinogen
- inhalant
- opiod
- phenocyclidine
- sedative/hypnotic/anxiolytic
- tobacco

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5
Q

Substance use disorder DSM-5 criteria

A

problematic pattern of use that impairs func.

two or more symptoms within a 1 year period

  • failure to meet obligations
  • repeated use in situations where use is physically dangerous
  • repeated relationship problems
  • tolerance
  • withdrawel
  • substance taken longer time or greater amounts than intended
  • efforts to reduce/control use don’t work
  • much time trying to obtain substance
  • social/hobbies/work given up or reduced
  • strong craving to use substance
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6
Q

severity ratings

A

mild: 2-3 criteria
moderate: 4-5 criteria
severe: 6 or more-

  • with physiological dependence: presence of tolerance or withdrawal
  • without physiological dependence: absence of tolerance or withdrawal
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7
Q

tolerence

A

indicated by either

1) larger doses needed to produce desired effect

2) effects of substance becomes markedly less if usual amount taken

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8
Q

withdrawal

A

negative physical and psychological effects when stopping substance/ reduces amount

symptoms c an include:
- muscle pains/ twitching
- sweats
- vomiting
- diarrhea
- insomnia

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9
Q

alcohol use disorder- alcoholic

A

physiologically dependent or heavy user

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10
Q

Delirium tremens (DT’s)

A

alcohol use disorder symptom

  • can occur when blood alcohol levels drop suddenly

results in:
- deliriousness
- tremulousness
- hallucinations (primary visual, sometimes tactile)

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11
Q

polydrug abuse

A

many users abuse multiple substances

  • 85% alcohol abusers also smokers
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12
Q

prevalence of alcohol abuse

A

alcohol abuse: 17%

Binge drinking: 5 drinks in short period
43.5% among college students

heavy use drinking:
- 5 drinks, 5 or more times in 30 days
- 16% among college students

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13
Q

alcohol use disorder comorbidity

A

comorbid w borderline and antisocial personality disorders

21.3% w alcohol abuse also have atleast 1 mental disorder

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14
Q

prevalence of alcohol abuse- ethnic differences

A

white and hispanic more than african americans
also Indigenous people

binge and heavy use drinking lowest among asian americans

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15
Q

short term effects of alcohol

A

enters bloodstream quickly through small intestine
- metabolized by liver slowly at 1 ounce of 100 proof per hour

effects vary by concentration
- concentration varies by gender, height, weight, liver effeciency, food in stomach

size of drink defined by alcohol content
- 12 oz glass beer = 5 oz glass wine = 1.5 oz of hard liquor

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16
Q

short term effects of alcohol - neural systems (neurotransmitters, cog effects)

A

once in your blood, interacts w several neural systems
- stimulates GABA receptors
- reduces tension
- increases dopamine and sertonin
- produces pleasurable effects
- inhibits glutamate receptors
- produces cog difficulties (slow thinking, memory loss)

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17
Q

short term effects of large amounts of alcohol

A

effect of large amounts:
- significant motor impairment
- poor decision making
- poor awareness of errors made

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18
Q

Longterm effects of alcohol

A
  • malnutrition
  • cirrhosis of the liver
  • damage to endocrine glands
  • heart failure
    -e erectile dysfunction
  • hypertension
  • stroke
  • capillary hemorrhages ( facial swelling and redness especially in nose
  • destruction of brain cells (esp. areas important to memory)
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19
Q

malnutrition due to alcohol

A
  • calories from alc lack nutrition
  • interferes with digestion and absorption of vitamins
  • deficiency of B-complex vitamins cause AMNESTIC SYNDROME
    • severe loss of memory (short and longterm)
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20
Q

Cirrhosis of liver - longterm alc effect

A
  • liver cells engorged w fat and protein, impede function
  • cells die triggering scar tissue, obstructs blood flow
  • liver diseas and cirrhosis rank 12th cause death
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21
Q

Fetal Alcohol Syndrome

A

Heavy alcohol intake during pregnancy

  • leading cause of intellectual developmental disorder
  • fetal growth slowed
    -cranial, facial, limb anomalies

total abstinence by pregnant women

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22
Q

Tobacco use disorder

A

Nicotine
- addicting agent of tobacco
- stimulates dopamine neurons in mesolimbic area
-involved in reinforcing effect

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23
Q

prevalence of tobacco

A
  • about 440,000 americans die prematurely each year
  • cigarettes kill 1,100 ppl every day (1 of 6 deaths related to tobacco use)
  • more prevalent among white and hispanic youth than PoC
    • PoC less likely to quit and more likely to get lung cancer (metabolize it slowly, smoke menthols)
  • more prevalent among men than women (except 12-17)
  • secondhand smoke (ETS, environmental tobacco smoke)
    • higher levels of ammonia, CO2, nicotine, tar
    • causes 40,000 deaths per year
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24
Q

health consequences of tobacco

A

lung cancer most common cancer
- 87% caused by smoking

Cigarettes also cause or exacerbate:
- emphysema, cancer of larynx, esophagus, pancreas, bladder, cervix, stomach, cardiovascular disease
- sudden infant death syndrome and pregnancy complications

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25
Q

Marijuana

A
  • drug derived from dried and ground leaves and stems of female hemp plant (cannibis sativa)

Major active ingrediant: THC (delta-9 tetrahydrocannibinol)

  • hashish
    • stronger
    • produced by drying resin exudate of tops of plant
  • in DSM-5, called Cannabis use disorder
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26
Q

Marijuana prevalence

A

most freq. used illicit drug
- 17,000,000 used in 2010, 22 mil in 2015

  • greater use by men than women
  • more common among white and indigenous people
  • heavier use is US and Australia than europe, africa or canada
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27
Q

Effects of Marijuana - psychological

A

Psychological:
- relaxation and sociability
- rapid shifts of emotion
- interferes w attention, memory, thinking (decline in IQ over time)
- heavy doses can induce hallucination, panic
- interferes w cog functioning (memory, complex motor skills)

difficult to regulate dosage
- effects take 30 mins to appear
- smoke more than intended waiting for effects

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28
Q

effects of marijuana- physiological

A
  • bloodshot and itchy eyes
  • dry mouth and throat
  • increased appetite
  • reduced pressure w/in eye
  • increased blood pressure
  • damage to lung structure and function long-term users
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29
Q

Marijuana use- medical, recreational

A

medical use
- legal in 33 states and district of columbia
- 14 more allow w/ limited THC content
- reduces nausea and loss of appetite caused by chemotherapy
- relieves discomfort of aids, chronic pain

recreational use
- legal in 11 states
- 15 states decriminalized recreational use

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30
Q

Marijuana and the Brain

A

two cannabinoid brain receptors
- CB1 and CB2
- high concentration in hippocampus (time distortions)

increased blood flow to emotion regions
- amygdala and anterior cingulate

habitual use leads to tolerance
- withdrawal symptoms have been observed

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31
Q

Opiates

A

Group of addictive sedatives that in moderate doses relieve pain/induce sleep
- opium
- heroin
- codeine

synthetic sedatives
- separate category in DSM-5: sedative/hypnotic/anxiolytic use

Opiats legally prescribed as pain medication include:
- hydrocodone combined w other substances yields vicodin, zydone. lortab

  • oxycodone the basis for OxyContin, Percodan, Tylox
32
Q

Prevalence of Opiate use

A

heroine:
-estimated million addicted to heroin in US
- accounted for 62-82% of drug-related hospital admissions

5 million Pain med users
- oxyContin jumped 1800% btwn 96-2000
- hydrocodone increased from 4.5 to 5.7 million
- oxycodone abuse increased 43% in one year
- rates of abuse of pain meds remained stable since 2002

textbook says:
- 12 mill misused pain meds in 2015
- 2 mill opioid use disorder
- more women prescribed, more men abuse of pain meds
- misuse higher for whites

33
Q

Psychological and Physical Effects of Opiates

A

Produces euphoria, drowsiness, lack of coordination
- loss of inhibition, increased self-confidence
- severe letdown after 4-6 hrs

Heroin and OxyContin
- rush: intense feelings of warmth/ecstasy following injection

stimulate receptors of body’s opioid system
- stimulate nucleaus accumbens

tolerance develops and withdrawal occurs

34
Q

withdrawal of opiates

A
  • muscle soreness and twitching, tearfulness, yawning
  • becomes more severe, includes cramps, chills/ sweating, increase in heart rate + blood pressure, insomnia, vomiting
  • lasts about 72 hrs
35
Q

long-term effects of opiate usage

A

29 year follow up of 500 addicts
- 28% dead by age 40
- half by suicide, homicide, accident
- 1/3 by overdose

many users resort to illegal activities to obtain money for drugs
- theft, sex work, dealing

exposure to infectious diseases via shared needles
- HIV
- Evidence suggests free needles reduces infectious diseases

36
Q

Stimulants

A

increase alertness and motor activity; reduce fatigue

37
Q

Stimulants: amphetamines

A
  • synthetic stimulants
    • benzedrine, dexedrine, Methedrine
  • trigger release of and block reuptake of norepinephrine and dopamine
  • produce high levels of energy, sleeplessness
  • reduce appetite, increase heart rate, constrict blood vessels in skin and mucous membranes
  • tolerance can develop after 6 days
38
Q

high doses of amphetamines can lead to

A

nervousness, agitation, irritability, confusion, paranoia, hostility

39
Q

Methamphetamine (Crystal Meth)

A
  • amphetamine derivative
  • can be taken orally, intravenously, or intranasally
  • high levels off (the “shoulder”) then crashes (tweaking)
    • becomes agitated
40
Q

chronic use of methamphetamine (brain)

A

damages brain
- impacts dopamine + serotonin systems

  • reduction in hippocampus volume

textbook adds
- impacts areas of brain associated w reward + decision making ( insula, frontal and temporal cortex, sriatum) - unclear if it came before or after meth use

41
Q

methamphetamine prevalence

A
  • 5.4% reported use in 2015
  • men more likely to abuse , no gender difference for other amphetamines

-

42
Q

Stimulants: Cocaine

A

Crack
- form of cocaine, became popular in 80’s
- rock crystal heated, melted, smoked
- cheaper than cocaine

Alkaloid obtained from coca leaves
- reduces pain
- euphoria
- heightens sexual desire
- increases self-confidence and indefatigability

43
Q

Stimulants: cocaine - how does it work

A

blocks reuptake of dopamine in mesolimbic areas of brain

44
Q

cocaine overdose

A

chills, nausea, insomnia, paranoia, hallucinations; possibly heart attack and death

  • vasoconstrictor- blood vessels narrow, especially dangerous for pregnancy

not all users develop tolerance
- some become more sensitive, may increase risk of OD

45
Q

prevalence of Cocaine

A

cocaine use declined btwn 2002 and 2009- dropping to 1.4% to 2% ( 6.9- 5.4% from 2006-2015)

  • crack also declining
  • men more than women
46
Q

types of Hallucinogens

A
  • LSD (d-lysergic acid diethylamide)

others:
- mescaline (active ing. of peyote)
- Psilocybin (from mushroom psylocybe mexicana)
- ecstacy (MDMA)
- PCP (phencyclidine)
- angel dust
- animal tranquilizer
- causes severe paranoia and violence

47
Q

hallucinogen effects include

A
  • colorful visual hallucinations
  • psychedelic trip- expansion of consciousness
  • alter sense of time
  • sharp mood swings
  • may trigger anxiety
  • work through the serotonin system and 5-HT receptor
  • 1-2% regular users
    • PoC less likely
48
Q

Hallucinogen Persisting Perception Disorder (HPPD)

A

flashbacks - visual recurrences of perceptual experiences after the physiological effects of drug have worn off

  • DSM-5 defines HPPD as re-experiencing flashbacks that occured during use of the drug, when drug is not being used
  • most common during stress
49
Q

Ecstasy (MDMA)

A

methylenedioxymethamphetamine
contains compounds from hallucinogen and amphetamine families

-increase feelings of intimacy and enhances mood
- chemically similar to mescaline and amphetamines
- acts on serotonin
- may have neurotoxic effects on serotonin system by reducing availability of a transporter called SERT

  • use peaked in 2001, 1.8 mill users, may be rising again (2.5 mill in 2015)
50
Q

effects of MDMA

A
  • -increase feelings of intimacy and enhances mood
  • improves interpersonal relations
  • self-confidence
  • aesthetic awarness
  • muscle tension, rapid eye movements, jaw clenching, nausea, faintness, chills, sweating, anxiety, depression, depersonalization, confusion
51
Q

PCP (phencyclidine)

A

Angel dust
- animal tranquilizer
- causes severe paranoia and violence

-phencyclidine use disorder
- more men than women

52
Q

Gambling Disorder- DSM-IV-TR vs DSM 5 and why

A
  • included in DSM-5 chapter on Substance related and addictive disorders
  • was in the “impulse control disorders not elsewhere classified” in DSM-IV-TR

moved because it is addictive, behavior that elicits physiological changes that are similar to the changes shown in substance abuse disorders

53
Q

process of becoming a drug abuser

A

positive attitude (about substance) –> experimentation –> regular use –> heavy use –> dependence or abuse

54
Q

Etiology of Substance Use Disorder - Developmental Approach (alcohol, 2 paths)

A

two paths to alcohol abuse: (men more likely first path, women second path)

  1. first group began drinking in early adolescence, increased throughout highschool
  2. second group drank lesser amounts in early adolescence, increased drinking in middle school, increased again in high school

Developmental studies do not account for all cases
- not an inevitable progression through stages

55
Q

Etiology of Substance Use Disorder - genetic factors

A
  • relatives and children of problem drinkers have higher-than-expected rates of alcohol abuse/dependence
  • greater concordance in MZ than DZ twins
  • genetic and shared environmental risk factors for drug abuse/dependence appear to be nonspecific- (not tied to specific substance)
  • ability to tolerate large quantities of alcohol may be inherited diathesis
    • asians low rates alcohol abuse (deficient enzymes- ADH or alcohol dehydrogenases)
  • genes and smoking
    • people w SLC6AS gene less likely to smoke, more likely to quit
    • smokers w defect in CYP2A6 gene less likely to become dependent
56
Q

Etiology of Substance Use Disorder - Neurobiological Factors

A

Nearly all drugs (incl. alc) stimulate dopamine system in brain, particularly mesolimbic pathway
- produce rewarding/pleasurable feelings
- some evidence that people dependent on drugs/alc have deficiency in dopamine receptor DRD2
- vulnerability model vs toxic effect model
- vulnerability in dopamine system leads to substance use or vice versa

people take drugs to avoid bad feelings associated w withdrawal (neg reinforcement)
- explains frequency of relapse

57
Q

incentive-sensitization theory (neuorbiological factor of substance abuse)

A
  • distinguish WANTING (craving drug) from LIKING (pleasure from taking drug)
  • dopamine system becomes sensative to drug AND CUES associated w drug
    • sensitivity to cues induces/strengthens wanting

-Brain imaging studies shoe cues for drug activate reward and pleasure areas of brain involved in drug use

58
Q

Psychological Factors- etiology of substance use disorders

A

mood alteration
- tension reduction maybe due to “alcohol myopia”
- user focuses reduced cog capacity on immediate distraction
- less attention focused on tension-producing thoughts
- similar effects for smoking
- however alc and nicotine may increase tension why no distractions present

expectancies about drug effects
- people who expect alc to reduce stress and anxiety most likely to drink
- drinking and positive expectancies influence each other positively

59
Q

Personality - psychological factors of substance-use disorder

A

personality factors that can predict onset of substance-related disorders:
- negative emotionality or neg affect
- desire for increased arousal and pos affect
- low constraint
- less likely for people that have: harm avoidance, conservative moral values, and cautious behavior

kindergarten children rated high in anxiety and more novelty seeking more likely to drink, smoke, use drugs in adolescence

60
Q

sociocultural factors- etiology of substance abuse

A

alc most common abused substance worldwide
- highest consumption in france, spain, italy where consumption is accepted (less abuse)

men consume more alc than women but differences vary by country
- israel: men 3x as women
- netherlands: men 1.5x

availability
- usage higher when alc and drugs easily available
- 2003- drug use among youths approached by drug dealers was 35%, under 7% where youths not approached

61
Q

family factors- sociocultural factors - etiology of substance abuse

A

family factors
- parental alc use
- marital discord, psychiatric or legal problems in family linked to substance use
- lack of emotional support from parents increases use of cigarettes, weed, alc
- lack of parental monitoring linked to higher drug usage

62
Q

social network- sociocultural factors - etiology of substance abuse

A

social network
- social influence or social selection?
- Bullers et al (2001) found evidence for both
- social influence: having peers who drink influences drinking behavior
- ppl chose friends w drinking patterns similar to their own

63
Q

media and advertising - sociocultural factors - etiology of substance abuse

A

countries that ban ads have 16% less consumption than those who don’t

64
Q

treatment of substance use disorders- alcohol use disorder- how many

A

in 2015 2.2 milll ppl over 12 received treatment
- over 16 mill in need of treatment and didn’t receive it
- I in 4 (24%) ppl who are physiologically dependent get treatment

65
Q

treatment of alcohol use disorder

A
  • inpatient hospital treatment
  • outpatient treatment (AA)
  • Cognitive and Behavioral Treatments
    • Contingency-Management Therapy
    • relapse prevention
      -Motivational Interventions
66
Q

inpatient hospital treatment for alcohol use disorder (rehab)

A

detoxification
- withdrawal from alc under medical supervision
- therapeutic results of hospital treatment not superior to outpatient treatment
- but may be necessary for those w/out social support or with other serious psychological problems

67
Q

Alcoholics Anonymous (AA)

A

outpatient treatment
- largest self-help group for problem drinkers
- regular meetings provide support, understanding, acceptance
- promotes complete abstinence
- believes it to be a disease, must always be vigilant to avoid alcohol
- 12 steps
- although some studies shown AA participation predicts better outcome, recent studies suggest AA no more effective than other forms of therapy

68
Q

Cognitive and Behavioral treatments- treatments of Alcohol Use Disorder

A

Contingency Management Therapy
- patient and family reinforce behaviors inconsistent w drinking
-eg avoiding places like bars
- teach problem drinker how to deal w uncomfortable situations
- eg refuse a drink

Relapse prevention
- strategies to prevent relapse

69
Q

Motivational Interventions -treatments of Alcohol Use Disorder

A
  • designed to curb heavy drinking in college
70
Q

Controlled drinking model - treatments of Alcohol Use Disorder

A
  • belief that problem drinkers can consume alcohol in moderation
  • learning principals can be used to control drinking
  • avoid total abstinence and inebriation
  • guided self-change
71
Q

Medications- treatments of Alcohol Use Disorder

A

antabuse (disulfiram)
- produces nausea and vomiting if alcohol is consumed

other medications include naltrexone, naloxone, and acamprosate
- most effective when combined w CBT

72
Q

treatments of Nicotine dependence

A

peer behavior important
- if others in social network stop smoking, increases likelihood to stop

physician’s advice
- by age 65 most smokers quit

scheduled smoking
- reduce nicotine intake gradually over a few weeks

nicotine replacement treatments
- gum, patches, inhalers
- reduce craving for nicotine
- combining patch with antidepressants (wellbutrin) improved success rate

73
Q

treatment of drug use disorders

A

detoxification is central to treatment

psychological treatments:

  • Despiramine and CBT showed effective for cocaine
    • CBT especially helpful for users w high dependence levels
  • Contingency management
    • vouchers that can be traded for desirable goods given to users who abstain
  • Motivational interviewing or Enhancement Therapy
    • CBT plus solution focus therapy effective for alcohol and drug use
  • Self-help residential homes
    • non-drug enviro
    • group therapy
    • guidance and support from former users
74
Q

Heroin substitutes - treatments of substance Use Disorder

A

Synthetic narcotics
- methadone, levomethadyl acetate, bupreophine
- used to wean heroin users from dependence

opiate antagonists
- naltrexone- prevents feeling high

75
Q

prevention of substance-use disorders

A

often aimed at adolescents

utilize some or all following elements:
- enhancing self-esteem
- social skills training
- peer pressure resistance training
- parental involvement in school programs
- warning labels on alcohol bottles
- education regarding alc impairment
- testing for drugs and alc at school or work
- correction of beliefs and expectations
- inoculation against mass media messages
- peer leadership

76
Q
A

abnormal psych (16 decks)

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