Physiology and Pharmacology

Question 1

Buprenorophine vs Methadone

Answer 1

Buprenorphine has advantages over methadone, including less associated stigma; fewer
regulations, which permit its use outside opioid treatment programs; and lower risk of overdose
(Albizu-Garcia et al., 2007). Its combination with naloxone reduces the likelihood of
intravenous abuse of the medication. Buprenorphine is safe and effective for alternate-day
dosing instead of daily dosing [Center for Substance Abuse Treatment (CSAT), 2004], which
may increase its patient adherence (Amass, Kamien, & Mikulich, 2000) and might make it less
likely to interfere with security procedures in a prison setting (Smith-Rohrberg et al., 2004). Finally, unlike methadone, which is ingested by swallowing under the observance of medical
staff, buprenorphine tablets are dissolved under the tongue.

Question 2

Addiction in terms of brain anomalies

Answer 2

1. A survival/reinforcement circuit involving an overactive “go” switch in the old brain
2. A damaged or underactive “stop” switch in the control circuit in the new brain
3. Impaired communication between these two circuitries
4. Damaged, stay-stopped brain areas that make recovery extremely difficult

Question 3

“Addiction comes from a combination of an obsession of the mind coupled with an allergy of the body.”

Answer 3

.

Question 4

Inhalation acts more quickly than any other method of use

Answer 4

.

Question 5

Stress can dramatically increase the ability of drugs to cross this barrier.

Answer 5

.

Question 6

The liver is the key metabolic organ - it breaks down or alters the chemical structure of drugs. Then the kidneys filter the metabolites, water and other waste from the blood and eliminate urine

Answer 6

.

Question 7

Old brain structure and function

Answer 7

Structure: brain stem, cerebellum, mid-brain, which contain the limbic system (emotional center).
Function: regulating physiological functions, experiencing basic emotions and cravings, imprinting survival memories. Acts four or five times more rapidly than the new brain – so action is usually well under way before common sense kicks in. Old brain simply reacts

Question 8

New brain (neocortex) structure and function

Answer 8

Structure: cerebrum and cerebral cortex
Function: processes information coming from the old brain and from the senses via peripheral nervous system. Allows us to speak, reason, create, remember, make decisions and then act.

Question 9

Memory and drug use

Answer 9

The more an activity is repeated, the more likely we are to repeat it when we run into a similar situation. The earlier in life a person begins using psychoactive drugs or practices addictive behaviors, the longer and stronger the memories remain in the brain. Brain tends to remember the positive memories more quickly and intensely than the negative ones (euphoric recall)

Question 10

The “go” switch’s three functions + stop switch

Answer 10

• tells us that what we are doing is necessary for survival
• tells us to remember what we did to survive
• tells us “do more of whatever you did- do it again and again until you are satisfied; it is necessary for your survival”
• when need has been satisfied, the pain relieved or the imbalance rectified, the “stop” switch shuts doewn the “go” switch and the “do it again” message ceases

Question 11

how the drug hijacks survival/reinforcement

Answer 11

“Go” switch more powerful than normal and the “stop” switch becomes dysfunctional. Essentially the individual is tricked into sensing that survival depends on their use.

With chronic heavy use, the “do it again” message becomes impossible to ignre– resulting in drug-seeking/using behavior regardless of the amount of pleasure the user experiences of the destruction the use ultimately causes. underlying message is “if you don’t do it again, you will die”

Question 12

Endogenous neurotransmitter correlates mean that..

Answer 12

psychoactive drugs cannot create sensations or feelings that do not already have a ntural counterpart in the body

Question 13

Down regulation

Answer 13

if the cell senses there are too many neurotransmitters (Which occurs with drug use), it retracts many of the receptor sites into the cell, causing a slowdown of message transmission. When drug use is stopped, most of the receptors will be restored. Excessive use, however, can cause a permanent decrease in receptor sites

Question 14

Possible drug effects on neurotransmitters

Answer 14

1. Block the release of neurotransmitters
2. Force the release of neurotransmitters
3. Prevent neurotransmitters from being reabsorbed
4. Inhibit an enzyme that helps synthesize or metabolize neurotransmitters
5. Interfere with the reuptake and storage

Question 15

Withdrawal definition

Answer 15

Withdrawal is defined as the body’s attempt to rebalance itself after cessation of prolonged use of a pschoactive drug or compulsive behavior. Withdrawal effects are often the opposite of the drug’s direct effects

Question 16

Major PAWS symptoms

Answer 16

• Unclear thinking and cognitive impairment
• Memory Problems
• Emotional overreaction and mood swings
• Sleep disturbances
• Motor coordination and dizziness problems
• Difficulty Managing stress

Question 17

Abuse vs Addiction

Answer 17

Abuse: the continued use of a drug despite negative consequences
Addiction: loss of control, compulsive use, cravings, continued use despite increasing catastrophic consequences

Question 18

“The development of addiction progresses from first the spiritual to then the emotional, and finally to the physical aspects of an addict’s existence. Treatment works best when it progresses by first addressing the physical, then the emotional and finally the spiritual aspects of the addict.”

Answer 18

.

Question 19

Diathesis-stress theory

Answer 19

A predisposition (diathesis) to addiction is the result of genetic and environmental influences (E.g. childhood abuse), which when further stressed by the use of psychoactive drugs or the practice of certain compulsive behaviors, alters neurochemistry, brain function, and even new epigenetic gene expressions to the point that a return to normal behavior is extremely difficult.

Question 20

Heredity vs environment in addiction

Answer 20

40-60% heredity, 40-60% environment. More than 89 genes have been correlated to a greater or lesser vulnerability to addictive behavior

Question 21

Stimulants force the release of the body’s own energy chemicals epinephrine and norepinephrine as well as other chemical, especially dopamine. Prolonged use, esp of stronger ones eventually depletes energy resources, disrupts brain chemistry, and induces exhaustion, depression, paranoia, anger, violence and intense craving.

Answer 21

.

Question 22

In the debate over which factor- genetics or environment - is more important, the consensus leans toward genetics.

Answer 22

.

Question 23

Occasional disagreements about treatment intervention or direction for a dual-diagnosis client can be resolved by using Minkoff’s Four-Quadrant Model

Answer 23

.

Question 24

Almost 15% of Americans will experience a major depressive disorder in their lifetime. 18.1% of adults (18-54) will experience an anxiety disorder in a given year.

Answer 24

.

Question 25

A study of the risk of SUDs in boys who were treated with ADHD drugs found a significant reduction in their risk of drug use problems as adults compared with patients who were not treated

Answer 25

.

Question 26

Of all people with a mental health diagnosis, about 1/3 also have a problem with alcohol and/or drugs. Of the 7-13 million people who have co-occurring disorders, 20% received MH, 10% received SUD, 10% both and 60% none.

Answer 26

.

Question 27

it is important during treatment to examine relationship history to determine the extent of family conflict and what impact that has on the individual with the co-occurring condition. urthermore, effective intreatment experiences may be reversed if the patient resumes
living among and interacting with a negative social support
network

Answer 27

.