Substance Use Disorders Flashcards
- Define tolerance, sensitization, dependence, withdrawal, and craving.
i. tolerance: diminishing physiological response to repeated drug exposure
ii. sensitization: growing physiological response to drug with repeated exposure
iii. dependence: physiological state where drug is required for normal function
iv. withdrawal: response to absence of drug, often very unpleasant
v. craving: intense desire for particular goal, increased motivation to obtain a particular goal or a narrowing of focus such that one goal is pursued at the expense of others
- Define addiction, reinforcement, reward, impulsive behavior and compulsive behavior.
vi. addiction: loss of control of intake, despite negative consequences, narrowing of motivational and emotional repertoire, potential for relapse throughout life, despite tx.
vii. Reinforcement: behavior increases likelihood that behavior will be repeated
viii. Reward: emotional experience that can accompany positive reinforcement
ix. impulsive behavior: tendency to consistently choose immediate reinforcement over delayed gratification and impairment of ability to inhibit a course of action once initiated
x. compulsive behavior: perseveration in behavioral strategy even in the face of unsuccessful or adverse outcomes
- Describe the role of the dopaminergic system in the nucleus accumbens and related areas in reward and reinforcement.
elevated dopamine (produced in VTA) nucleus accumbens promotes cellular mechanisms of learning
dopamine in mesocorticolimbic projections (amygdala, hippocampus and PFC) play a crucial role in wanting and seeking and reward learning
liking refers to the subjective emotional experience of reward
- Describe the neuroanatomy of appetitive behavior, specifically the cortico-striatopallidal-thalamic loop.
Information is sent to the striatum, integrated with dopamine signals, sent to the pallidum, up to the thalamus where the highly processed information is funneled to the cortical motor-control regions
Acb (ventral striatum) receives inputs from regions thought to be particularly important for motivation and emotions, specifically the amygdala and hippocampus (limbic-motor interface) as well as info from the PFC (impulse control)
Medium spiny neurons of the Acb serve to integrate glutamate and dopamine inputs and promoting behavioral output
- Explain how reward, withdrawal, learning and impulse control may play a role in the development of addiction.
Reward-based theories: substance initiates euphoric state, ability to increase DA transmission, euphoria would lead to strong reinforcement
Withdrawal-based theories: motivating force in drug addiction is avoiding unpleasant withdrawal symptoms
Learning-based theories: explains the life-long propensity to relapse, even in individuals that have been rehabbed and drug-free
Incentive-sensitization: repeated drug use produced life-long sensitization of DA ability to code for incentive salience of drug-related cues (wanting increases, liking decreasing)
Reward-learning model: stimuli are tagged as being better than expected, producing a powerful overlearning of behaviors and stimuli associated with drugs
Impulse-control: addicted individuals exhibits diminished function in frontal cortex that mediates executive control over impulsive and compulsive responses
- Name the three stages of addiction.
i. binge/intoxication: acute euphorigenic or reward of drug, DA release promotes cellular processes of learning and memory
ii. withdrawal/negative affect: motivation by the attempt to alleviate physical/emotional withdrawal symptoms
iii. preoccupation/anticipation: (can persist for a life time) strongly overlearned drug cues can promote relapse, frontal deficits promote impulsive and compulsive patterns in response to overlearned drug cues
- List the diagnostic criteria for substance intoxication, substance use disorder, and substance withdrawal.
Problematic pattern of use leading to clinically significant impairment of distress within the last 12mo
- Intake larger amounts than intended, or over longer period than intended
- Persistent desire or unsuccessful efforts to cut down or control intake
- Great deal of time spent in activities to obtain or recover from use
- Craving or a strong desire or urge to use
- Use results in failure to fulfill major role obligations at home or work
- Important social, occupational or recreational activities reduced
- Recurrent use in situations in which it physically hazardous
- Continued use despite knowledge of persistent or recurrent physical or psychological problems caused or exacerbated by alcohol
- Tolerance: requiring increased amounts for intoxication or diminished effects
- Withdrawal
- Recognize the symptoms of common intoxication and withdrawal syndromes of alcohol.
pleasant state, diminished coordination, impaired judgement; aggression, somnolence, slurring of words, loss of gag reflex, apnea
anxiety, nausea, tremors, sleeplessness, relentlessness, sweating, headaches, rapid pulse and high blood pressure (psychosis, delirium, seizures) usually subside in 72-96hrs, DT can last 10+ days; tx. with BZD, CIWA protocol
be aware of thiamine deficiency (Wernicke’s encephalopathy which goes to Korsakoff’s syndrome, low Mg (seizure risk) and macrobiotic anemia (folate difficency)
- Recognize the symptoms of common intoxication and withdraw.al syndromes of sedative-hypnotics.
withdrawal: anxiety, nausea, tremors, sleeplessness, restlessness, sweating, headaches, rapid pulse, high BP, seizures
duration related to half life of drug metabolites
- Recognize the symptoms of common intoxication and withdrawal syndromes of opioids.
euphoria followed by somnolence, miosis
somnolence, arena, death
NV, craving, rhinorrhea, diarrhea (dehydration), tearing muscle aches, cramps, gooseflesh, dilated pupils
- Recognize the symptoms of common intoxication and withdrawal syndromes of stimulants.
euphoria, insomnia, intense concentration, loss of appetite, anxiety, psychosis, agitation, seizures, cardiac/cerebral ischemia
tired, prolonged sleeping, motivational, depressed, overeating, craving; will leave to get more drug
cocaine is shorter than methamphetamine which has a longer half-life
- Recognize the symptoms of common intoxication and withdrawal syndromes of hallucinogens.
intense change in perceptual state: visual, auditory, and other sensory experiences; borders on psychosis with impulsive acts related to perceptions
- Describe the epidemiology and pathophysiology of alcohol use disorder.
8.7% of population of 12+ yo were diagnosed with substance use disorder, 5.9% for alcohol alone
marijuana was the illicit drug with highest rate of use disorder in 2010, followed by pain relievers and cocaine
use is highest beginning in early 20s and decline beginning by the lat 20s
pathology: over learned dopamine response to substance
- Describe the clinical presentation, and prognosis of alcohol use disorder.
clinical presentation is negative consequences due to excessive use of alcohol
prognosis relapse is common life-long, even in individuals that have undergone rehabilitation: relapse to (1mo-12mo most relapse prone time) use is frequent, frustrating and expectable, treatment aims to prevent relapse
- List treatments available for alcohol use disorder including medications and psychosocial interventions.
tx. of intoxication with supportive care, assess for trauma
naltrexone: can block the effects of opioids and make relapse and cravings less frequent or intense
acamprosate: acts on both GABA and glutamate, 5-HT and NE systems (reduces DA release in the nucleus accumbens)
disulfiram: can cause toxic buildup of aldehyde in patients who relapse, can decrease intake via fear
psychological therapies: coaching for relapse prevention and motivational enhancement, 12-step facilitation, even 10min conversations with PCP show improvement
