Addiction Flashcards
(20 cards)
Name three areas of the brain associated with reward pathways
- Nucleus accumbens
- Ventral tegmental area
- Joined by medial forebrain bundle
In terms of positive and negative reinforcement, describe the process of addiction from start to dependence
- First, there is a positively rewarding experience
- Then tolerance increases, demanding higher amounts of the substance to achieve same effect
- Then, going without the substance feels worse and worse
- This leads to running from negative reinforcement (feelings of withdrawal) rather than running towards
In the later stages of addiction, the sufferer is running from pain, not towards pleasure. Describe the neurobiology of this
- CRF (=CRH) hormone receptors (CRF1) are stimulated during activation of the stress response
- CRF1 on the amygdala, which are stimulated in response to stress of drug withdrawal, cause negative emotion
- This is the emotion that the addicted person runs away from by using again
Genetic factors may determine risk for developing addiction through modulation of…
- Neurotransmitter function
- Reward pathways
- Sensitivity and response to substances
What are some social risk factors for depression?
- Poor social supports
- Cultural traditions
- Health literacy/access
- Socioeconomic status
Effect of biopsychosocial factors on progression/not of addiction in the case of drugs like opioids or alcohol
- Risks predispose to initial exposure/sensitivity
- Risks then increase the risk that it moves to premorbid phase (repeated use; reward pathways begin adjusting)
- Then, they predispose to progression to full addiction
Biological, psychological, and social factors that influence addiction
- Bio: genetics, pharmacology, reward system/neurotransmitters
- Psycho: personality, mental comorbidities, trauma, coping mechanisms
- Social: support, culture, and finances
Three tiers of addiction treatment
- First: prevention
- Second: brief counselling/self-directed change
- Third: Behavioural and medication therapy
Logic behind/pharmacological management of addiction in settings of opioids, alcohol, tobacco
Give drugs to adjust brain chemistry and prevent straight withdrawal.
- Opioids: methadone
- Alcohol: naltrexone
- Smoking: nicotine patches/spray/gum
______ of people with substance use disorder have a coexisting mental health condition
1 in 3 (no surprise)
Acute complications arising from substance use disorder include…
- Acute intoxication (injury, violence, toxicity/overdose)
- Withdrawal symptoms
Alcohol substance use medical comorbidities
- Liver disease
- Cardiovascular disease
- Dementia
Amphetamines substance use medical comorbidities
- Cardiovascular disease
- Movement disorders
- Dental disease (methhead with no teeth)
Opioid substance use medical comorbidites
- Hyperalgesia
- Metabolic syndrome
- Osteoporosis
- Hypoandrogenism (how we know Peter Attia quit)
IVDU medical comorbidities
- Bloodborne viruses
- Infective endocarditis
What are some different ways that medical problems can become substance use issues?
- Iatrogenic dependence to prescribed meds
- Misuse/self-escalation
- Use of substances (alcohol, cannabis, illicit drugs) to manage one’s own pain
Acute psychiatric issues of substance use
- Psychosis
- Suicidality/self-harm
Chronic psychiatric complications of substance use
Predisposed to:
- Depression
- Anxiety
- Personality disorders
- Schizophrenia
- ADHD
- Bipolar
What are two classes of drugs that people can become dependent on in the setting of psychiatric morbidity
- Stimulants (low energy, unmotivated)
- Sedatives (people who want to numb extreme distress)
