5. Addiction And Substance Misuse Flashcards
(71 cards)
1
Q
Addiction
A
• “Not having control over doing, taking, or using something to the point where it could be harmful to you or to others.”
2
Q
Substance misuse
A
• “A patterned use… in which the user consumes the substance in amounts or with methods which are harmful to themselves or others
3
Q
behavioural addiction
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• “A… pattern that is characterized by recurrent failure to control the behaviour, and continuation of the behaviour despite significant harmful consequences.”
4
Q
2 • Diagnositic materials, used to identify mental health disorder
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ICD-11
DSM – 5
5
Q
Icd-11
• Substance Dependence:
A
○ Repeated or continuous use leads to impaired control, increasing priority given to the substance, and physiological features indicative of neuroadaptation (tolerance, withdrawal, repeated use).
6
Q
Icd-11
• Harmful Patterns of Substance Use:
A
○ Repeated use of a substance that has directly damaged the user’s physical or mental health, or has resulted in behaviour which directly caused harm to others.
7
Q
Icd-11
• Hazardous Substance Use:
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○ Substance use is a risk factor. It has not yet caused harm, but the pattern of substance use has increased the risk of harm to the user and others.
8
Q
DSM-5 defines a single diagnosis
A
• Substance Abuse Disorder: The use of ten separate classes of substance; alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives and anxiolytics, stimulants, tobaccos, or ‘other’ substances that lead to a rewarding feeling that may be so profound that they neglect other normal activities
9
Q
DSM-5 Psychoactive substances
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- Alcohol
- Caffeine
- Cannabis
- Inhalants
- Hallucinogens
- Opiods
- Sedatives
- Stimulants
- Tobacco
- Oter = e.g. new drugs or discovered addictive substances
10
Q
Impaired control
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○ Wanting to stop using the substance or to cut down but not being able to
11
Q
Impaired priority
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○ Spending more time using the substance so that responsibilities are beginning to be neglected and social, occupational, or recreational activities are avoided or given up.
—> individual struggles to stop and gives more priority to the addiction
12
Q
Harmful outcomes
A
–> these can be co nsequences of given priority to addiction
Symptoms od withdrawl
Decisions due to impaired control
○ Substance use to a degree that interferes with major life obligations. Continued use despite legal/ social/ interpersonal issues. Recurrent abuse even when intoxication is dangerous. • For something to become a disorder it has to have a negative impact on uindividal and others
13
Q
Opiod crisis
A
- Started in america as pharmaceutical companies, marketed drugs incorrectly hiding addictive side effects
- These were then prescribed by medical proffessionals
- Public use of these opiods led to opiod crisis in america and similar crisis in the uk
14
Q
Medical risks of addiction
A
- Liver Damage
- Cardiovascular Disease
- Stroke
- Seven types of Cancer
- HIV/AIDs
- Hepatitis B and C
- Lung Disease
- Mental Disorders
- Physical Injuries from Risk Behaviour such as Driving
- Etc…
15
Q
Non medical risks of addiction
A
- Impaired Control Over Use
- Social Issues
- Legal Issues / Criminality
- Neglected Responsibilities
- Strained Finance
16
Q
The reward pathway - steps
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- Pleasurable/ rewarding stimulus
- Release of dopamine in the brain – ventral tegmnetal area in midbrain
- Dopamine is sent to several brain regions part of mesolimbic pathway
- These parts of brain have dopamine receptors and receive it
- Euphoric feeling – amygdala recognises as pleasurable
- Hippocampus records the situtation as a memory – so person can experience it again get the pleasurable stimulys again
- Nucleus accumulus – makes you repeat the behave get the feeling again e.g. have another bite of cake, it makes you lift hands
- Pre frontal cortex – makes you focus on pleasurable behaviour and intend on repeating it
- Next rewarding action = more release of dopamine = more feeling of pleasure
17
Q
Reward pathway - neurotransmitters
A
As dopamine levels go up in reward pathway – serotinin levels decrease
—> serotini = responsible for feeling satisfied, like yu have had enough of soemthing
* Felling more euphoric each time * But less content and satisfied ewach time
18
Q
Tolerance - steps
A
- Axon of presynaptic neuron sends dopamine to post synaptic neuron
- Post synaptic receptors recieev dopamine
- Addictions alter this brain chemistry
- Overstimuluation with too mcuh dopmaine – turns off some of these dopamine receptors
○ Same amount of stimuli doesn’t give same effect
19
Q
Tolerance - definition
A
• One becomes addicted to a substance and needs more to produce the same effect / reward.
20
Q
Withdrawal
A
—>One might not always have access to the substance, and that’s when withdrawal occurs.
1. Brain is used to the high level of dopamine 2. Stimuli with smaller effect won't produce the strong enough feeling of reward to account for missing stimulus
21
Q
Withdrawal symptoms
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- depression
- Anxiety
- shaking
- Sweating
22
Q
Strange addictions
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- Addictions to things seeming weird
- e.g. eating sofa cushions
- But actions of addictions can be seen in this situation
Just because one person finds something addictive – the substance can’t just be classified as addictive
23
Q
Categorising addiction is important because
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- Attributing behaviour as a disorder that isn’t actually a disorder
- Can lead to wrong treatment and diagnosis
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3 types of theories of addiction
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- Neuroscientific
- Psychological
- Sociocultural
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• Neuroscientific theory of addiction
○ Biological factors, brain processes, genetics, hereditary attributes
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• Psychological theory of addiction
○ Common factors with compulsive and obsessive disorders, models of learning, cognition, and behavioural tendencies
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• Sociocultural theory of addiction
○ Cultural influence, environmental factors,
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Brain disease model
• Idea of underlying changes in brain = cause of:
○ Repeated relapses
○ Intense cravings
○ Persistent requests requiring long term treamtnet
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Learning theory – behaviourism
Challenge to the concept that excessive behaviours represented illness
• Behaviour results from the interaction of the individuals and their environment
• Addiction → addictions (can be learned and unlearned)
• Treatment = learning more functional patterns of behaviours
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Classical conditoning - Pavlov
Pair unconditioned stimulus with conditioned stimulus so unconditoned stimulus pairs with unconditioned repsonse- conditioned stimulus is associated with unconditioned stimulus and elicits unconditioned response
addiction
• Drinking with friends
• Beer associated with relaxed and happy feelings
• In future person may drink alone wihtout being in a social environment
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Operant conditoning
Positive reinforcement
* Good things happen
| * e.g. social acceptance, confidence, control, etc
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Operant conditoning
Negative reinforcement
* Encourgaing behaviour by removing something negative
* e.g. Removal of negative emotions, etc
* Drinking to remove stress
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Social learning theory
• Learning from role models through observation
Bandura bobo doll study
1. See role model doing behaviour
2. We are more likely to mirror it
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Social learning theory – modelling
---> more significant during adolescence
“across adolescence and young adulthood, exposure to substance related media content was associated with increased alcohol use via perceived alcohol norms.
That is, the association observed in prior studies between media exposure and alcohol use may be explained, in part, by perceptions of peer alcohol use.
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3 main risk factors for addiction
Biological
• Genetics
• Reward pathway
• hereditary - e.g. metabolism activity
```
Psychological
• ptsd
• stres
• anxiety
• trauma
• homesickness
• fear
```
Environmental
• Hostile environement
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Most at risk of addiction
---> most at risk of addiction are those in deprived areas
• 56% of people in treatment for crack and/or opiates were living in areas ranked in the 30% most deprived areas in England
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Cessation
---> reach of end of something causing it to stop, e.g. stop addictive substance use or behaviour
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Cessation examples
• Fading / Replacement (changing brands, NRT)
○ Replacing addiction to control withdrawal while detoxing
• Aversion Therapies (making the experience unpleasant)
○ Medicine inducing nausea
• Contingency Contracting (punish addictions and reward abstinence)
○ Punishment and reward
• Cue exposure (unconditioning)
○ Classical conditioning = stop reinforcing behaviour
• Self-management (self-monitoring, raising awareness)
• Self-help
○ Responsib;e for own recovery e.g. CBT
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Intervention
• initaion
○ Beliefs : Susceptibility, Cognitions and Affect Costs / Benefits Expectancies
○ Social factors: Parental behaviour Parental beliefs Peer Group pressure
At point of intervation = therapeutic options begin = state of cessation is set in motion
• maintenance
• cessation
• Relapse
○ Important to give realistic expectation – prepare person for relapse: Coping Expectancies Attributions
○ Without preapring for relapse person may return to maintainign addicitve behaviour
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Replase
Effect of relapse
--> depends on how far they are into cessation process
May no longer be able to tolerate their usual doages of drug
Overdose is likely
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Reasons for relapse
• Stress '
○ negative emotion and pressure of recovery
• Drug Priming
○ Single-use leading to full-blown relapse
• Environmental Cues
○ Classical Conditioning – location may cause craving for heroin
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Managing relapse
Abstinence violation effect
* Tendency to engage in behaviour after violating personal goal to abstain
* Difference between lapse (just once) and relapse (repeated action of the behaviour)
* happens when individuals, see no step between lapse (one use) and relapse (full indulgemtn)
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Theory of planned behaviour
• Perceived behavioural; control: Behaviours are under our individual control, how easy it is to change
• Attitudes : beliefs and outcomes on behaviour
• Subjective norms: peers and society, social norms
• Percieved power = external factors
These all impact their intention and behaviour
• Combined motivationalf factors that influence behaviour
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Abstinence violation effect
Results in;
* More extreme behavior during a relapse
| * More negativity and pessimism about the meaning of a relapse
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Greater risk of AVE Abstinence violation effect
| when;
* High stakes for ‘getting clean’
* Drug is used as coping behaviour
* High expectations of positive outcome of behaviour change
* Low self-efficacy/percieved behavioural control
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Contingency management
--> consequence and reward based of oc
Treatment based-upon behaviourist models of addiction
• Using positive reinforcement for behaviour change
• Agreement between service user and service about goals, incentives (vouchers and thing) & screening
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Incentives
* – Vouchers for exchange, modest financial incentive, take home methadone doses
* Respect and trust
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Uses of contingency management
Could incentivise behaviours such as;
• Clean needle exchange = bring in old dirty needles and receive new ones so they can safely take drugs
• Taking part in immunisation program = e.g. hep b
• Taking part in disease screening= e.g. hiv screening
Protecting indivudals from harmful consequences of substance use
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CBT
---> treat range of addictions
Recommended for comorbidity in mental health
e.g. those with addiction are likely to have depression and anxiety – as they have common risk factors
• Some mental health issues can be a risk factor for subsequent substance misuse
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What is CBT - goal
• How we think feel and behaviour are all connected
○ The goal is to reveal and change false and distressing beliefs, because it is often not only the things and situations themselves that cause problems, but the importance that we attach to them too.
• Immediately drawing negative conclusions from an event and generalizing this to other situation
• Or catrastrophising
• Cognitive therapy helps people learn to replace these thought patterns with more realistic and less harmful thoughts.
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black and white thinking
• black and white thinking = no mid ground, in between
| ○ “I can either be sober or engage in uncontrolled alcohol consumption”
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Catastrophising
• catastrophising –think of worse possible outcome
| ○ “this event is going to put me down, I’d better drink to escape than cope with it”
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Confirmation bids
• confirmation bias – use examples that fit our narrative to prove our point
○ “I know people that have a few pints sometimes, I don’t see why I am different from them”
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Magical thinking
• magical thinking –some people belief outcomes that can be influenced by unrelated actions
“Just when I was feeling down I saw that beer commercial on TV, it must be a sign”
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Control bias
• control bias – person believes they have more control over their behaviour than they actually do
○ “I can control my behaviour, so this is going to be my last pint”
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Treatment is most successful when:
– Initial dependence is less severe
– Individual has no comorbid psychopatholoy
– Individual has greater self-efficacy and motivation
– Indiviudal has a treatment goal
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ABC model
Coaching and supporting changes in beliefs
1. Activation = strt of event or situation
2. Beliefs= what they thought
3. Consequences = response to situation
• What happens is determined by our perceptions
4. D = challenge false negative beliefes
5. E = effective new approach – plan a new effective consequence to an event, change their evaluations and planned consequences through coaching
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• Coaching = asking questions
| ABC model
○ A = what is the event ehat happened '
○ B = what is negative thought, what are the distorted ways of thinking, what interpretations
○ c = what am I feeling what was my behaviour
○ D = what is a more realistic statement, of the situation alternative way of realistic thinking
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4 Impact of addiction
* Crime increase
* Shortened life spans
* Associated costs
* Deaths
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Substance use – burden of disease
* Significant number of hospital admissions due to drug use
* Alcohol specific deaths increased
* Causes further costs for the NHS
* All figures are increasing – also due to impact of COVID and how it affected people's lives
• Different people are at different risks of developing addiction disorder
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Dependence
---> relying or or being controlled by something
• “a disorder of regulation of alcohol/ substance/ gambling use arising from repeated or continuous use… and consisting of a strong internal drive to use...
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Physical dependence
○ Physical symptoms, withdrawl symptoms
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Psychological control
○ Impaired control, not able to stop
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Diagnosisng dependence
Manuals continue listed criteria to determine dependence
Icd 11 criteria for substance dependance
A pattern of use evident over a period of at least 12 months.
• Harm to the health of the individual due to one or more of the following:
1. Behaviour related to intoxication
2. Direct or secondary toxic effects on body organs and systems
3. A harmful route of administration
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DSM-5 diagnostic criteria
1. Taking the substance in larger amounts or for longer than you're meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance
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Icd 11 gambling disorder
A pattern of persistent gambling behaviour manifested by:
1. Impaired control over gambling
2. Increasing priority to the point where gambling takes precedent
3. Continuation or escalation of gambling despite negative consequences
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Diagnosing
---> use these tools in clinical practice
Use info from diagnostic manuals and provide quick and easy ways to diagnose individual
• Tell you how at risk or likely someone is to have the addiction
• Helps you to refer them on to get help
AUDIT – alcohol use disorders identification test
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DUDIT
* Tool for substance use
| * Drug use disorder identification test
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PGSI
• Problem gambling severity index
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Risk factors: for addiction
---> everyone has capacity to become addicts but different factors can increase or decrease someone's level of risk
* Issues relating to family life: neglect, abuse, exposure
* Mental health: conditions such as depression, anxiety and attention deficit disorder are associated with addiction
* Employment and educational attainment: Unemployment and poor educational attainment are associated with increased risk
* Social groups: spending time and socialising with drug users
* Previous drug use: Using drugs early in life
* Biology: People who report positive effects from drug misuse are more likely to continue using drugs
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Major risk – adverse childhood experiences
* Childhood mistreatment
* Parental seperation
* Witnessing domestic violence
* Household member with addiction
* Family member with addiction
People with ACE's 66% more likely to use heroin and cocaine
4 or more ACE's
• More likely to be involved in risky behaviours and negative life outcomes
• Assess holistically past and present
