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Nervous System: Unit IV > Addiction I & II > Flashcards

Flashcards in Addiction I & II Deck (12)
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1

Definition of substance use disorders

  • 11 criteria including e.g.:
    • substance taken in large amounts/long period
    • unable to cut down/control substance use
    • ==> social/interpersonal problems
    • tolerance or withdrawal
  • mild: 2-3 sx
  • moderate: 4-5 sx
  • severe: 6+ sx

2

Neurobiology of substance abuse

  • multiple brain regions involved
  • motivational systems/reward:
    • ventral tegmental area ==>
    • nucleus accumbens
  • frontal regions/prefrontal cortex
    • learning, cognitive control, inhibition
  • mood and stress reactivity
  • all substances of abuse ==> dopamine release @ nucleus accumbens

3

Medications available to treat alcohol abuse

  • disulfiram (Antabuse)
    • inhibits acetaldehyde dehydrogenase
    • ==> antabuse rxn
  • Naltrexone
    • opiod antagonist
    • (possibly) blocks euphoria from alcohol
  • Acamprosate
    • enhances GABA transmission
    • interferes w/glutamate transmission
    • possible restoration of GABA/glutamate balance

4

Medications available to treat opioid abuse

  • methadone
    • long-acting opioid agonist
    • doesn't always lead to complete abstinence, but reduces harm and increases positive outcomes
  • buprenorphine
    • partial opioid agonist/naloxone
    • can precipitate w/drawal
  • naltrexone
    • blocks effects of heroin
    • can precipitate withdrawal

5

Medications available to treat tobacco abuse

  • NRT
    • can lead to rash, tachycardia
  • Buproprion
    • nicotinic receptor antagonist
    • dopamine reuptake inhibitor
    • doubles quit rates
  • Varenicline
    • partial alpha4beta2 agonist
    • some reports of depression/suicidal ideation

6

Psychosocial tx of substance abuse

1. Contingency management

2. Motivational interviewing

3. Cognitive behavioral therapy

4. Twelve step facilitation

7

Contraindications of Disulfram (Antabuse use)

  • Risk for MI
  • Risk for CVA
  • Cognitive dysfunction (can’t remember what will happen if drinks)
  • Pregnancy

8

"free-will" vs. biological disease in substance abuse disorders

  • All drugs of abuse share the final common pathway of increasing dopamine release in the nucleus accumbens; associated with the “high” (reward reinforcement)
  • Over time, dopamine circuitry compensates so that individuals now have to use drugs to create physiological normal levels of dopamine
  • Orbitofrontal cortex
    • SUD patients have decreased response-reversal learning, mediated by the OFC; i.e. they do not learn to alter their behavior when behavior that was previously rewarded/reinforced is now punished

9

Age impact on development of SUD

  • brain circuits involved:
    • dopamine-reward sytem ==> reinforcement of SUD
    • prefrontal cortex ==> resists development of SUD
  • circuits ==> susceptability of teenage development of SUD b/c reward system is fully developed while prefrontal cortex is not

10

Factors that impact SUD

  • Substance availability
  • Pharmacological reinforcement (e.g. withdrawal ==> reinforced substance use)
  • History of prior substance abuse
  • Genes
  • Gender (M>F by time young adulthood is reached)
  • Age (Teenagers = susceptible)
  • Risk-taking disposition
  • Stress
  • social punishment/reinforcement

11

Genetic impact on SUDs

  • ~ 50% heritability (based on twin and adoption studies)
  • First degree relatives w/SUD ==> higher rates of SUD
  • Rats can be bred to create lines that are highly susceptible to drug addiction

12

Important screening tools for SUDs

  • AUDIT (Alcohol Use Disorder Identification Test)
    • “At Risk Drinking”
    • Men: > 5 standard drinks in a day, or >14 per week
    • Women: > 4 in a day or >7 per week