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Abnormal Psych Exam 3 > Addiction > Flashcards

Flashcards in Addiction Deck (46)
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1
Q

Alcohol Use Disorder

A

A. a problematic pattern of alcohol use leading to clinically significant impairment or distress, occurring in a 12 month period, at least two of the following:

  1. alcohol is often taken in larger amounts or over a longer period than was intended
    - I meant to have one glass, but I drank the whole bottle
  2. there is a persistent desire or unsuccessful efforts to cut down or control alcohol use
  3. a great deal of time spent dealing with consequences or getting alcohol
  4. craving to use
  5. repeated use results in failure to fulfill obligations
  6. use despite problems the substance causes
  7. quitting activities to spend time drinking
  8. continued use despite physical hazards
  9. keep drinking despite psychological or physical problems caused by it
    - depression sets in when drunk, liver problems
  10. tolerance
  11. withdrawal
2
Q

Criteria for a drug or alcohol use disorder are largely the same

A

=similar criteria for all the substance abuse disorders, just substitute alcohol with the other drugs
= not all substances have withdrawal profiles, however
-alcohol and cocaine have a clear set of symptoms that occur in withdrawal
- inhalants do not

3
Q

Severity

A

=mild: 2-3 symptoms
=moderate: 4-5 symptoms
=severe: 6+ symptoms

4
Q

Differences for substances

A

=criteria 1-10 are the same
-but refer to different substances
=criteria 11 (withdrawal) may or may not be present
-depending on if substance has an established withdrawal profile

5
Q

How do we become addicted?

A

=mesocorticolimbic dopamine pathway: MCLP

  • brain pathway indicated in all addictions, substance or not
  • ventral tegmental area –> nucleus accumbens –> prefrontal cortex
  • controls release of dopamine
  • the reward pathway
6
Q

Alcohol Use Disorder: quitting

A

=the hardest substance to quit
-freely available, harder to avoid
= nicotine is second hardest

7
Q

Alcohol Withdrawal

A

A. cessation of (or reduction in) alcohol use that have been heavy and prolonged.
B. two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use
1. autonomic hyperactivity - sweating or high pulse
2. increased hand tremor
3. insomnia
4. nausea or vomiting
5. transient visual, tactile, or auditory hallucinations or illusions
6. psychomotor agitation
7. anxiety
8. generalized tonic-clonic seizures
C. see txt book,

8
Q

Prevalence of Alcohol use disorder

A

=~7.3% of US population 12 and older
= cuts across racial and ethnic groups, SES
-slightly higher in american indian, and lower in asian (bc of asian flush)
= men > women, but the gap is narrowing
= 37% have at least one comorbid diagnosis

9
Q

Risks associated with alcohol use

A
=injury 
-ER visits 
-motor vehicle accidents 
=crime 
-homicides, assaults, rapes, arrests, violent encounters with police
10
Q

Alcohol is a stimulant and a depressant

A

Stimulant
=at low levels
=stimulate “pleasure centers” and release endogenous opioids
=warmth, self esteem, well being increases

Depressant
=at higher levels
=inhibits glutamate (excitatory NT), which shows brain activity
=impaired learning, judgement, coordination and balance, lowered self control, eventually respiration stops

11
Q

Blood Alcohol Level

A

=intoxication legally: .08%
-judgement and coordination are impaired before this point
= .5% unconscious, .55% is typically fatal
=BAL depends on food, duration of drinking, sex, physical condition
-women tend to be lighter and metabolize alcohol more slowly

12
Q

physical effects of chronic alcohol use

A
= cirrhosis 
-hardening of the liver 
-progression of states lead up to this 
-irreversible damage 
-heavy drinkers tend to get this
=weight gain 
=malnutrition
=reduced life span - 12 years 
=sleep disruption 
=brain shrinkage 
=alcohol withdrawal delerium - very strong visual hallucinations, rapid heart rate, terror about world
=alcohol amnestic disorder  - permanent memory loss, can't form new memories
13
Q

social effects of problematic alcohol use

A

=marital and relationship deterioration, divorce
=loss of job, home
=financial strain, bankruptcy

14
Q

Genetic influences on problematic alcohol use

A

=alcoholic parents raise risk for alcoholism
-one raises it, two raises it alot
=adoption studies: genes matter
=alcohol risk personality?
-impulsive, risk taker, less emotionally stable
-show a greater reduction in stress to alcohol
=pre alcoholic risk markers?

15
Q

Psychosocial influences on problematic alcohol use

A

=negative role models, family dysfunction, instability in early childhood
=childhood sexual abuse
=parental (esp paternal) alcohol misuse
=lack of parental monitoring (esp if parents abuse alcohol)

16
Q

psychological influences on problematic alcohol use

A
=emotional immaturity 
=impulsive and aggressive 
=low frustration tolerance 
=feelings of inadequacy 
=high expectations of the world 
=requiring much praise and appreciation
17
Q

Other influences of problematic alcohol use

A

=use for relaxation
=expectations for social success
-more common in younger people, high schools
=less intimate and supportive interpersonal relationships
=sociocultural factors
-societies where alcohol use is accepted as opposed to those where it is forbidden

18
Q

Treatment of alcohol abuse

A

=issue of insight
=most people will relapse at some point
=especially hard with alcohol because it is legal

19
Q

Medications for alcohol abuse

A

=meds should not be used alone
-used with self help or psychological treatment
=antabuse: causes you to get violently ill if you drink
-but the person has to be motivated enough to keep taking it
-best use is for someone who is always drunk to interrupt the cycle to get an intervention
=naltrexone and campral target cravings
=and sometimes benzodiazepines for withdrawal symptoms

20
Q

Psychological Approaches to treatment for alcohol abuse

A

=group therapy
=environmental interventions
=behavioral and cognitive behavioral therapy
=brief motivational interviews
-deal with ambivalence about whether or not they want to stop drinking

21
Q

Alcoholics Anonymous

A

=self help, peer led
=group testimonial format
=free, worldwide, anonymous
= “always in recovery”
=complete abstinence
=higher power - alcoholism is beyond you, god
=no empirical research
-some studies have incorporated AA type techniques and found they work for less heavy drinkers
-AA never participated in external studies

22
Q

Treatment Outcomes for alcohol abuse

A

=vary considerably
=best when individual has insight, access to adequate and modern treatment, attends treatment regularly, good relationship with provider
=success is higher for stopping drinking than preventing relapse

23
Q

Understanding Relapse of alcohol abuse

A

=understanding what your triggers are
=could be all of your friends, where you lived, the area near where you used to buy liquor, advertisements
-triggers happen all the time, very profuse, and hard to pin point

24
Q

substance abuse disorders

A
=see table 11.2 in textbook
-know it fairly well 
=sedatives 
=stimulants 
=other stuff
25
Q

Sedatives

A
=Alcohol
=Barbituates 
- nembutal, seconal, veronal, turinal 
=Effect: 
-reduce tension
- facilitate social interaction 
-blot out feelings or events
26
Q

Prevalence of Substance Use DIsorder

A

=about 3% of US population 12 or older
-includes people with other comorbid disorders
=most common in teens and early adulthood
=slightly more prevalent in economically depressed, minority communities
-still relatively equal opportunity

27
Q

Opiates: Treatment

A

=methadone in conjunction with a rehabilitation program often used
=methadone is a synthetic opioid
-not injected, no needle sharing
-controlled by government
-less psychological and medical impairment
=downsides to methadone
-just as addictive as other drugs
-people don’t like living near methadone clinics because of the people who come to get the methadone
-just substituting one addiction for another?

28
Q

Amphetamines

A
=suppress appetite 
-occasionally prescribed for weight loss 
=decrease need for sleep 
-occasionally prescribed for narcolepsy 
=calming effect on those with ADHD 
-used for treatment
29
Q

Methamphetamine

A

=highly addictive
-quick and especially long lasting high
=increases DA; prolonged use leads to
-structural changes in the brain
-cognitive problems: learning and memory impaired
-psychological problems
=withdrawal: weakness, lethargy, sleepiness, depression

30
Q

Geographic patterns for Meth

A

=can be cooked in very large quantities with substances that can be obtained legally
-set up lab in an out of the way area
=way more prevalent out west
-thats where big labs have been found

31
Q

Barbiturates (sedatives)

A

=provide relaxation, drowsiness
=most with addictions are middle aged or older
-likely prescribed as sleeping aids and become addicted
-not likely to have comorbidity with other substance abuse

32
Q

Cannabis

A
=marijuana - leaves of plant 
=hashish - gummy resin of plant 
=both are smoked 
=most commonly used illicit drug 
=decline in use in some populations 
-college students
33
Q

Marijuana: effects

A

=slight intoxication for 2-3 hours
-increased well-being, heightened perceptions and sensations, “stretched” sense of time, mild euphoria, pleasant relaxation, short-term memory disruption
=medical uses
-thc itself can have some therapeutic effects
-bad drug for schizophrenics
-legal issues with medical use
=withdrawal: established profile, much less severe than other drugs
-nervousness, sleep and appetite changes, lethargy

34
Q

tobacco (nicotine)

A

=one of the hardest substances to quit
=fewer and fewer people are smoking
=majority of people have never smoked
=rates of smoking are higher for people who are more disadvantaged than for those who are
-those who can least afford it, do it most
-stress
-targeted by advertisers
=cross cultural differences: US is about in the middle

35
Q

Nicotine Withdrawal

A
=craving 
=irritability, frustration, anger 
=anxiety 
=trouble concentrating 
=restlessness and tremors 
=headache 
=insomnia 
=decreased heart rate 
=increased appetite and weight gain 
-especially a problem for women who don't want the weight gain 
=symptoms peak in the first week and then decline
36
Q

Nicotine: treatment

A

=Nicotine Replacement therapy: some type of nicotine taken
-patch, gum
=and some social support or CBT is most effective
-group meetings

37
Q

Nicotine treatment outcomes

A

=success rates are modest ~25%
-but people try to quit so many times that this number is skewed. higher for people who try multiple times to quit
=bupropion (zyban) can improve outcomes
=NRT can reduce withdrawal symptoms
=highest quit rates are among people hospitalized for life threatening diseases caused by cigarettes.

38
Q

Gambling Disorder: new to DSM

A

=was a “condition for further study” in DSM-IV

=was new to DSM V

39
Q

Gambling Disorder DSM

A

A. need to keep gambling more and more to achieve desired excitement
B. made repeated attempts to stop and went back to it
C. is restless or irritable after stopping gambling
D. role impairment - can’t fulfill occupations and functions
=very close to description of symptoms for other substance abuse disorders

40
Q

Gambling DIsorder

A

=1-2% of adults worldwide
-elevated rates in certain populations
-on the increase in US
=men is equal to women

41
Q

Gambling Disorder Features

A

=comorbid with alcohol use disorder and personality disorders
=many commit crimes related to gambling, assault
=common profile: immature, rebellious, thrill seeking, superstitious, antisocial, compulsive

42
Q

what leads to Gambling Disorder

A

=many pathological gamblers won a large sum of money the first time they gambled
=operant conditioning
-variable ratio schedule of reinforcement
-rationalizations and misunderstandings

43
Q

Gambling Disorder: treatment

A
=CBT 
-high drop out 
-those who remain show improvement 
-jury is out on relapse: better at stopping behavior than preventing it from relapse 
=family relationship problems
44
Q

Internet Gaming Disorder

A

=currently listed as a “condition for further study” in DSM 5
=see moodle for DSM guide

45
Q

prevalence of Internet Gaming Disorder

A

=highest prevalence: asian countries, males 12-20

  • point prevalence: 8.4% males, 4.5% females
  • ID’d as an addiction by the Chinese government
  • most research is in Asian medical journals
46
Q

Clinical picture of Internet Gaming Disorder

A

=typically 8-10 hours or more per day, at least 30 hours per week
=go for long period of time without food or sleep
=possible associated with MDD, ADHD, OCD
=relief from boredom