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PYB306 Psychopathology > 9. Substance-related disorders > Flashcards

9. Substance-related disorders Flashcards

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1
Q

how many Australians use substances daily?

A

4/10 Australians daily smokers, risky drinkers, or used illicit drugs in last 12 months

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2
Q

percentage of Risky alcohol use in Australians > 14 years

A

18% drinking > 2 SD / day

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3
Q

percentage of Tobacco use in Australians > 14 years

A

12% daily smokers

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4
Q

percentage of Cannabis use in Australians > 14 years

A

10.4% national average (use in last 12 months)

Most common illicit drug (36% of drug users report cannabis use)

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5
Q

percentage of Metham use in Australians > 14 years in last 12 months

A 
Ice (80% pure metham)
Speed (10-20% pure)
1.4% national average (last 12 months)
6.3% ever used
Drops in NSW
Higher rates in WA (2.7%), Tasmania (2.1%) and SA (1.9%)
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6
Q

percentage of Ecstacy use in Australians > 14 years in last 12 months

A

2% national average

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7
Q

percentage of Pain killers / opiate misuse (excl OTC) use in Australians > 14 years in last 12 months

A

4.8% opioids
Over the counter / prescribed codeine products most commonly misused.
Pharmas second most commonly misused illicit
drug
Highest users in their 20s and 40s

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8
Q

public perception of illicit drug use according to the NDSHS

A

 Public perception – treatment/education program best for all drugs except cannabis (warning)
 Most people support harm reduction for injectors
 Great majority of people support medicinal cannabis (87%)
 One third Australians support cannabis legalisation

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9
Q

Low risk drinking

A

– 2SDs/5 days per week, 4 SDS on a single occasion increases risk of injury

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10
Q

At what age does alcohol have bad affects?

A

under 15s, no alcohol, delay as long as possible after 15

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11
Q

Tobacco, alcohol and illicit drugs as a killer

A

Tobacco still the biggest killer (18000K per year), followed by alcohol (6000K per year), followed by illicit drugs (1800 per year))

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12
Q

Drug use in disadvantaged communities

A

 2.7x smoking
 1.7x alcohol abstinence
 Less cocaine/ecstasy (1.2% compared to 3%)

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13
Q

Drug use in unemployed people

A

 1.8x smoking
 1.5x cannabis
 3.1x meth/amphetamine

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14
Q

Drug use in Homosexual or bisexial people

A

5.8x use of ecstasy and meth/amphetamine

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15
Q

Drug use in people living in urban and regional regions

A

Smoking under 10% in inner city areas, around 20% in regional areas

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16
Q

What are the basic criteria of substance use disorder

A

 impaired control (craving, larger amounts than intended, persistent desire to cut down, excessive time to obtain)
 social impairment (failure to fulfil obligations, continued use despite problems)
 risky use (use in hazardous situations)
 tolerance/withdrawal
 Number of symptoms present determines severity

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17
Q

Severity of of substance use disorder

A

Number of symptoms present determines severity
 2-3 mild
 4-5 moderate
 6+ severe

Key feature of presentation: Ambivalence

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18
Q

Tolerance of drugs

A

Milder symptom, somewhat normative, varies greatly over comparatively few years

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19
Q

Withdrawal

A

Rare for adolescents

Confused with hangover

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20
Q

Normative aspects may mean..?

A

over-diagnosis -

stigmatisation

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21
Q

useful assessment measures of substance use disorder

A

 Screening – AUDIT, Fagerstrom
 Patterns, context, baseline - Timeline follow-back
 Motivational factors - Expectancies/efficacy

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22
Q

What items are involved in an AUDIT as a measure of SUD

A 
 Hazardous alcohol use (3 items)
 Dependence symptoms (3 items)
 Harmful alcohol use (4 items:
guilt/blackouts/injuries/others concerned about
drinking)
 Scores and treatment (tentative)
- 8-15: brief advice/education
- 16-19 brief counselling and monitoring
- 20+ further diagnosis
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23
Q

Timeline follow back as a measure for SUD

A

 1-3 months (up to yesterday), marked in standard days, mark in personal holidays special events, best estimate, something written in each box
 Last drink? How much? Where were you?
 Max drink? When? (How much)? Where were you?
 Least amount? When? Where were you?
 Abstinence days? Where were you?
 Then work back from today..
 Work around anchors

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24
Q

Expectancies of alcohol according to the alcohol expectancy questionnaire and the drinking expectancy profile?
(Young & Knight, 1991)

A
  • Transforms experience
  • Enhances social/physical pleasure
  • Sexual experience and performance
  • Power and aggression
  • Social assertiveness
  • Reduces tension
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25
What are the expectancies of alcohol according to the Negative alcohol expectancy questionnaire? (McMahon & Jones, 1993)
* same day * next day * long term
26
Expectancies of cannabis according to the Marijuana Effect Expectancy Questionnaire - brief (Torrealday et al., 2008)
* Cognitive and behavioural impairment (heavily weighted negative) * Relaxation and tension reduction (heavily weighted positive) * Social and sexual facilitation (very heavily weighted positive) * Perceptual and cognitive enhancement (very heavily weighted) * Global negative effect (heavily weighted negative expectancy) * Craving and physical effects (modestly weighted negative)
27
Tobacco expectancies according to Smoking abstinence (Abrams et al., 2011; 28 items four scales)
* Negative mood (“I would feel agitated”) * Somatic symptoms (“my hands would shake”) * Feeling physically awful (“I would feel like I’m going to die”) * Feeling calm
28
Efficacy and drug use
```  Situational confidence/drug use control self-efficacy  Common high risk situations: - interpersonal conflict - negative emotional states - testing personal control - feeling urges or temptations ```
29
Cannabis products - contents of the cannabis leaf
 Cannabinoids – some 80 chemicals in the cannabis sativa plant  Cannabidiol – 40% of cannabis extracts – has antipsychotic effects (for anxiety, bipolar managing seizures)  Delta-9-tetrahydrocannabinol (THC) – major active ingredient (euphoria, pain relief)
30
Cannabis products - contents of cannabis candies, cookies and infusions
 More ED admissions |  Child poisoning
31
Cannabis concentrates
 70% - 90% THC Content |  Vapourisers and e-cigarettes
32
Adverse acute effects of cannabis according to early research
 Anxiety, dysphoria, paranoia (especially when naive users)  Attention and memory impairment  Psychomotor impairment  Risk of psychotic symptoms, partic where family history of psychosis  Increased risk of low birthweight babies when used during pregnancy
33
Cannabis as a cause of car accidents
 Cannabis impairs reaction time, information processing, attention and tracking, motor performance, and tracking behaviour  Often not clear whether cannabis impairment present at time of accident  More recently – cannabis doubles – triples risk of crashes (Gerberich et al)  High but not as high as alcohol, where 6-15 higher risk of crash
34
Fatalities of cannabis?
Fatal overdose – very unlikely – still holds | Case reports of cardiovascular fatalities in otherwise healthy men
35
Neurological impacts of cannabis
Imaging studies show Reduced activity in brain regions related to memory and attention (hippocampus, prefrontal cortex, cerebellum)
36
Cannabis and its association with other drug use
More likely to use other drugs, particularly when start cannabis at a young age. Why?  Exposure through suppliers  Early users use cannabis because of other issues (e.g., sensation seeking)  Cannabis increases propensity to use other illicit drug use (Gateway theory) .
37
Cannabis as a reverse gateway
Cannabis use increases tobacco use
38
Cannabis dependence
```  Impaired control  Difficulties ceasing use despite harms  1-2% adults affected in past year  4-8% adults in their lifetime  Among those who have ever used, 9% report lifetime risk of dependence (compared to 32% for nicotine) ```
39
cognitive impairment as a result of chronic cannabis use
 Few studies control for intellectual functioning before cannabis use  Available studies indicate frequent long term cannabis use produces unique negative impairments  Verbal learning, memory, attention  Unclear whether the brain fully recovers – probably not  Some evidence that effects significant for adolescents, but not for adults
40
Cannabis withdrawal according to the DSM 5
 Anxiety / Irritability / agitation  Insomnia  Mood swings / tremor / nausea / anorexia  Poor concentration / headache  Perspiration / cravings  Unlike alcohol withdrawal, THC rarely requires in-patient care  Use diazepam, sometimes anti-psychotics
41
What is the medicinal cannabis?
Sativex®
42
Sativex®
 Only medicinal cannabis product registered by the TGA  Can be prescribed without state approval if you are a patient class subscriber, or GPs can apply to DG Health  Price set by overseas suppliers
43
How is Sativex® accessible?
 Authorised Prescriber Scheme  Special Access Scheme (severe illnesses)  Clinical trials
44
CBT as treatment for cannabis dependence
 Coping with relapse vulnerabilities  Building social/group support for change  Motivational interviewing (client centred, reflective)  Goal setting (3-4 prioritised problems)  Resource identification  Clear plan with specified steps  Progress measures – diverse, use of cannabinoid-positive urine testing
45
Steinberg et al: Marijuana Treatment Program as treatment for cannabis dependence
 Included a case management module – addressing any issue affecting durability (relationship problems, housing, employment/financial, psychiatric, transportational, parenting/medical)  Case manager a mentor/guide
46
Analglesics - opioids
(e.g., Morphine, codeine, fentanyl, oxycodone)  Very common treatment  Effective in the treatment of acute pain  Not recommended as a long term treatment for chronic non-cancer pain  Safety and efficacy concerns (State health departments in Australia)  Short acting opioids more dangerous than longer acting ones
47
Opioid use in Australia
In Australia, there has been a 600% increase in opioid prescriptions in the last 10 years
48
Side effects of opioid use
Side effects – lots, constipation, decreased alertness, disassociation. However, side effects are manageable most of the time
49
Risks of dependence of opioids compared to other substances
High risk of dependence, particularly in those with Hx of dependence on a substance
50
Motivational interviewing
- A conversation about change - Foster internal confrontation - Bring together uncomfortable realities with empathy - Roll with resistance - Look for change statements - Strengths-based – support efficacy
51
What is a behavioural indicator of motivational change?
Do i have a problem? --> What can i do?
52
Acceptance and commitment therapy
‘Feeling good’ versus living a rich and meaningful life
53
What is happiness in Acceptance and commitment therapy?
Happiness (pleasure, gratification elation) is - not normal but we crave and strive for it - Great but doesn’t last - Pursuing it is unsatisfying - THIS IS THE TRAP
54
what is a rich and meaningful life in acceptance and commitment therapy?
- Take action based on what we consider valuable and meaningful - When we know what we stand for - Not fleeting, sometimes uncomfortable
55
How is pain seen in acceptance and commitment therapy?
- ‘Life involves pain – cannot be avoided but we FIGHT IT, ARGUE, TAKE DRUGS TO STOP IT - We all struggle with being fused to our thoughts
56
Psychological flexibility in acceptance and commitment therapy
- being present here and now - Being fully aware - Choosing actions that are guided by your values - Moving towards what is important
57
How does ACT allow us to live meaningfully?
Drains the power of chronic and overwhelming | troublesome thoughts and frees us to live meaningfully. Can change your life’s trajectory
58
Troublesome/uncomfortable thoughts
> Most people have them.. Called stories, that run all the time > They expand [+++++, xxxxxx, no subtraction] > Same old stories running and rerunning – self concept --Ï am hopeless - I am unlikeable -I am a fraud
59
How does CBT overcome troublesome/uncomfortable thoughts?
seeks to challenge írrational’ thoughts,
60
How does ACT overcome troublesome/uncomfortable thoughts?
thoughts are only a problem if you fuse with them
61
Defusing as a treatment of addiction
- Wisdom traditions, not problem solving traditions - Endless ways of creating distance from thoughts ``` - Ten deep breaths > Slow > Focus on air moment, chest, shoulders > Empty your lungs, breath in > If a thought comes by, acknowledge it, then turn back to your breath - Name your stories > The ‘I can’t do this’ story.. > Don’t have to challenge, or push away - Let it come and go then do things you value. ``` - I’m having the thought that….
62
Delusion as treatment for addiction
Not a control strategy – if its an attempt to change, avoid, get rid of.. Its not defusion Is an acceptance strategy Can stop struggling with troublesome thoughts (the happiness trap), struggling takes you away from what you value.
63
What happens with the struggle switch is on?
‘should have.. Could have…. This must…. This has to be… this can’t…’ troublesome feelings snowball – anxiety causes anger.. Acting inconsistent with values - alcohol/drugs to distract…
64
What happens when the struggle switch is off?
- Anxiety comes, rises, goes.. | - Observe, don’t waste time and energy struggling
65
Urges as a treatment for addiction
 Seem overwhelming, rate them (scale 0-10)  Urges like waves that one can learn to surf  What are urges to like? - Body scanning: What do they feel like from head to toe? Where are they located?  Awareness of them, rate them (scale 0-10)  Acknowledge them – I’m having the urge to… My brain is telling me to..  Breathe into it, make room for it, observe it crest and fall..  Response: Can act or not act.. If act, will I be acting like the person I want to be?  Take action
66
Does ACT work?
Lee et al. (2015). An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders. Drug and Alcohol Dependence. Meta-analysis of 10 trials of ACT compared to CBT, pharmacotherapy, 12-step, treatment as usual. Small to medium effect size favouring ACT. Promising approach to the addictions

PYB306 Psychopathology (13 decks)

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