Chapter 10

Question 1

DSM-5 Criteria for Substance Use Disorder

Answer 1

*Problematic pattern of use that impairs functioning. Two or more symptoms within a 1-year period:

Failure to meet obligations
Repeated use in situations where it is physically dangerous
Repeated relationship problems
Continued use despite problems caused by the substance
Tolerance
Withdrawal
Substance taken for longer time or greater amounts than intended
Efforts to reduce or control use do not work
Much time is spent trying to obtain the substance
Social, hobbies, or work activities given up or reduced
Craving to use the substance is strong

Question 2

DSM-5 Criteria for Substance Use Disorder : time period

Answer 2

Two or more symptoms within a 1-year period

Question 3

Severity Ratings for Substance Use Disorders in DSM-5

Answer 3

mild: 2-3 criteria
moderate: 4-5 criteria
severe: 6 or more criteria

Question 4

Two symptoms often a part of severe substance use disorder:

Answer 4

*Tolerance
Larger doses of drug needed to produce desired effect
Effects of drug decrease if usual amount is taken

*Withdrawal
Negative physical and psychological effects from stopping substance use
E.g., muscle pain, twitching, sweats, vomiting, diarrhea, insomnia

Question 5

What is the time requirement for substance use disorder?

Answer 5

What is the time requirement for substance use disorder?

Within a year! This is different than other disorders

Question 6

T/F addiction usually starts out as self medicating

Answer 6

true !

*self medicating : addiction usually starts out as self medicating

Question 7

“Dependent” or addicted

Answer 7

People who develop tolerance or withdrawal

Question 8

Alcohol withdrawal

Answer 8

*Muscle tremors, elevated pulse, blood pressure, and temperature

*Delirium tremens
Rare withdrawal symptom when alcohol in blood drops suddenly
Delirium, tremulous, hallucinations
Can kill you

Question 9

Delirium tremens

Answer 9

Rare withdrawal symptom when alcohol in blood drops suddenly
Delirium, tremulous, hallucinations
Can kill you

Question 10

T/F alcohol withdrawal is really bad but it cant kill you

Answer 10

FALSE

I am pretty sure

Question 11

administered for the management alcohol withdrawal symptoms.

Answer 11

Benzodiazepine

Question 12

alcohol abuse disorder is associated with what other drug use

Answer 12

Associated with other drug use

80-85% smoke tobacco

Question 13

Alcohol use is especially frequent among ____
___ report binge drinking ( def?)
____% report heavy-use drinking (Def?)

Answer 13

Alcohol use is especially frequent among college-age adults

• 39.4% report binge drinking
• 5 drinks in a short period of time

*12.5% report heavy-use drinking
5 drinks on the same occasion 5 or more times in a 30-day period

Question 14

alcohol : Prevalence

Answer 14

Prevalence varies by gender, race, and education level
More common in men than woman
This gender difference continues to shrink
Rates higher for never married or divorced men and women

Question 15

Marti is a 24-year-old college student who started drinking heavily when he was 15. Marti drinks a moderate amount every night. In high school, he would become drunk after about four beers; now his tolerance has more than doubled. Marti claims alcohol relieves the pressures of college life. He once attempted to quit drinking, but he had chills, fever, diarrhea, nausea and vomiting, and body aches and pains.

Answer 15

alcohol use disorder

Question 16

Effects of Marijuana: Long-term Physiological

Answer 16

Damage to lung structure and function in long-term users

Cognitive problems linked to the effects of marijuana on CB1 and CB2 receptors in the brain (e.g., hippocampus)
Cannabanoid 1, cannabanoid 2

Different patterns of connectivity between amygdala and frontal cortex among users compared to non-users

Use can develop tolerance and withdrawal

Question 17

What NT’s are affected by alcohol and how?

Answer 17

What NT’s are affected by alcohol and how?
Gaba: more
Increased dopamine and serotonin
Less glutamate

Stimulates GABA receptors
Reduces tension
Increases dopamine and serotonin
Produces pleasurable effects
Inhibits glutamate receptors
Produces cognitive difficulties (e.g., slowed thinking, memory loss)

Question 18

What receptors does marijuana affect in the brain?

Answer 18

CB1 and CB2 (endocannabanoids)

Question 19

Lung cancer rates are lower with tobacco use among which ethnic group?

Answer 19

Asian Americans

Question 20

Short-term Effects of Alcohol

Answer 20

Enters the bloodstream quickly through small intestine
Metabolized by the liver slowly at 1 ounce of 100 proof per hour

Effects vary by concentration
Concentration varies by gender, height, weight, liver efficiency, food in stomach

Size of drink defined by alcohol content
12 oz. glass of beer, 5 oz. glass of wine, and 1.5 oz. of hard liquor are equal in alcohol content

• Interacts with several neurotransmitters
• *Stimulates GABA receptors: Reduces tension
• *Increases dopamine and serotonin: Produces pleasurable effects
• *Inhibits glutamate receptors: Produces cognitive difficulties (e.g., slowed thinking, memory loss)

Question 21

Short-term Effects of Alcohol and neurotransmitters

Answer 21

Interacts with several neurotransmitters
Stimulates GABA receptors
Reduces tension
Increases dopamine and serotonin
Produces pleasurable effects
Inhibits glutamate receptors
Produces cognitive difficulties (e.g., slowed thinking, memory loss)

Question 22

Opiate Withdrawal

Answer 22

May begin within 8 hours after high tolerance develops
Muscle pain, sneezing, sweating, tearfulness, yawning
Resembles influenza

Within 36 hours, becomes more severe:
Uncontrollable muscle twitching, cramps, chills, flushing/sweating, elevated heart rate/blood pressure, insomnia, vomiting, diarrhea
Withdrawal persists for about 72 hours – diminishing over 5-10 days

Question 23

T/F you can die from opiate withdrawal

Answer 23

FALSE but may feel like you want to

Question 24

Neurobiological Factors

Answer 24

Nearly all drugs stimulate the dopamine system, particularly the mesolimbic pathway
Linked to pleasure and reward

Vulnerability model vs. Toxic effect model
Vulnerability in the dopamine system leads to substance use or substance use leads to dopamine system problems

People also take drugs to avoid the bad feelings
Avoidance of withdrawal symptoms
Explains frequency of relapse

Incentive-sensitization theory
Distinguish wanting (craving for drug) from liking (pleasure obtained by taking the drug)
Dopamine system becomes sensitive to the drug and the cues associated with drug (e.g., needles, rolling papers, etc.)
Over time, liking for drugs decreases, but wanting remains intense
Craving (wanting) is associated with use

Brain imaging studies:
Cues for a drug (needle or a cigarette) activate the reward and pleasure areas of the brain involved in drug use

Question 25

Reward Pathways in the Brain Affected by Different Drugs

Answer 25

affecting the nucleus accumbens: amphetamines, cocaine, marijuna, opiates, phencyclidine affecting the ventral tegmental area: alcohol, opiates, barbiturates, benzodiazepines

Question 26

Reward Pathways in the Brain Affected by Different Drugs: affecting the ventral tegmental area:

Answer 26

affecting the ventral tegmental area: alcohol, opiates, barbiturates, benzodiazepines

Question 27

Reward Pathways in the Brain Affected by Different Drugs: affecting the nucleus accumbens

Answer 27

affecting the nucleus accumbens: amphetamines, cocaine, marijuna, opiates, phencyclidine

Question 28

Valuing Short Term Over the Long Term

Answer 28

Immediate (short-term) vs. delayed (long-term) rewards People dependent on substances discount delayed rewards more steeply than do people not dependent Valuing immediate vs. delayed rewards recruit different brain regions: Delayed reward = prefrontal cortex Immediate reward = amygdala, nucleus accumbens

Question 29

T/F People dependent on substances discount delayed rewards more steeply than do people not dependent

Answer 29

TRUE

Question 30

Nearly all drugs stimulate which system?

Answer 30

Nearly all drugs stimulate which system? Dopamine system ___people with substance use______ discount delayed rewards more steeply than people without a substance use How do expectations affect alcohol use? More likely to use that substance : if you expect it to do good Example: ben franklin quote

Question 31

______ discount delayed rewards more steeply than people _______

Answer 31

people with substance use disorder discount delayed rewards more steeply than people without a substance use How do expectations affect alcohol use? More likely to use that substance : if you expect it to do good Example: ben franklin quote

Question 32

How do expectations affect alcohol use?

Answer 32

More likely to use that substance : if you expect it to do good Example: ben franklin quote

Question 33

AA firmly states that controlled drinking does not work. What does the research say?

Answer 33

AA firmly states that controlled drinking does not work. What does the research say? There is some evidence that controlled drinking can work (probs better for early form ) What medications are used for opiate use? Naltrexone (and others that I missed!)

Question 34

What medications are used for opiate use?

Answer 34

naltrexone and buprenorphine (Suboxone)

Question 35

Treatment of Drug Use Disorders: Medications

Answer 35

Opioid substitutes and Opioid antagonists

Question 36

Opioid substitutes

Answer 36

Synthetic narcotics, methadone, buprenorphine (Suboxone) Used to wean off opioids Person does not experience euphoric high Dropout is high Side effects: insomnia, constipation, excessive sweating, diminished sexual functioning

Question 37

Opioid antagonists

Answer 37

Naltrexone Person is gradually weaned from heroin or pain medication Receives increasing dosages of Naltrexone to prevent feeling high should they later take other opioids

Question 38

addiction is purely psychological | T/F

Answer 38

- addiction: is not just psychological it is also social | - thus addiction should not just be from a psych standpoint (or pharmacoloigcal standpoint)

Question 39

Tobacco Use Disorder: Prevalence

Answer 39

*More prevalent among people in lower socioeconomic classes ``` *African American cigarette smokers Less likely to quit More likely to get lung cancer Nicotine is metabolized more slowly More likely to smoke menthol cigarettes Direct advertisement to this community People tend to inhale more deeply and hold the smoke for longer ``` *Chinese Americans Metabolize less nicotine from cigarettes than European American or Latino smokers Lung cancer rates are lower

Question 40

Marijuana: Prevalence - gender - race

Answer 40

``` Marijuana is considered an illicit drug Legal for all uses in 8 states Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, Washington Has gone up to 15 I think Growing Legal for medical uses in 29 states ``` *Higher among men than women No differences across racial and ethnic groups Rates of daily use are on the rise May be related to varying degrees of legal status by state

Question 41

Stimulants: Cocaine

Answer 41

Comes from leaves of coca shrub Can be snorted, smoked, swallowed, or injected Used predominantly in urban areas and by men Used less frequently today Crack Form of cocaine developed in the 1980s Rock crystal that is heated, melted, and smoked Cheaper than cocaine Acts rapidly on the brain Blocks reuptake of dopamine in mesolimbic areas Induces pleasurable states Increased sexual desire, self-confidence, stamina Overdose (OD) Chills, nausea, insomnia, paranoia, hallucinations, possibly heart attack and death Not all users develop tolerance May increase risk of OD

Question 42

Treatment of Drug Use Disorders

Answer 42

Substance use disorders are typically chronic, and relapse occurs often Detoxification central to treatment 90% of people who need treatment for substance use disorder do not get it

Question 43

Treatment of Drug Use Disorders: Psychological Treatments

Answer 43

CBT Learn how to avoid high-risk situations, recognize triggers, and develop alternatives to use Contingency management Vouchers that can be traded for desirable goods are given to users who abstain Motivational enhancement therapy CBT plus solution focus therapy effective for alcohol and drug use Self-help residential homes Non-drug environment Group therapy Guidance and support from former users

Question 44

Stimulants: Amphetamines

Answer 44

Synthetic stimulants: Dexedrine, Adderall Trigger release and block reuptake of norepinephrine and dopamine Taken orally or intravenously A person becomes alert, euphoric, outgoing, feels boundless energy and self-confidence High doses can lead to nervousness, agitation, confusion, suspiciousness, hostility Tolerance can develop after only 6 days of use

Question 45

Opioids

Answer 45

Includes: Opium, morphine, heroin, codeine Moderate doses relieve pain Prescription pain medications among the most abused of all drugs Vicodin, Zydone, Lortab, Percodan, Tylox, OxyContin 7% of US misused at least once

Question 46

Among those with schizophrenia who suffer from delusions, a large majority experience a) delusions of persecution. b) thought broadcast. c) delusions of impulses imposed by others. d) hallucinations with the delusions

Answer 46

a) delusions of persecution.

Question 47

Carlos has schizophrenia and is living with his parents. One of his symptoms is a difficulty initiating any activity, and once started, he is unable to finish. This is an example of a) akathisia. b) anhedonia. c) avolition. d) alogia.

Answer 47

c) avolition.

Question 48

1. Which of the following is not one of the sociocultural factors implicated in the etiology of substance use disorders? a. the media b. gender c. availability of a substance d. social networks

Answer 48

b. gender

Question 49

Anhedonia as a symptom of schizophrenia refers to lack of a) emotional expression. b) interest or pleasure. c) coherent speech. d) speech.

Answer 49

b) interest or pleasure.

Question 50

The symptom alogia refers to lack of a) intelligence. b) energy and interest. c) emotional response. d) speech.

Answer 50

d) speech.

Question 51

A major goal of inpatient hospital-based treatment for alcohol abuse is Question 7 options: a) to focus upon sobriety as a major criteria for discharge. b) helping the individual admit there is a problem. c) increasing nutrition and creating a behavior that inhibits alcohol consumption. d) detoxification.

Answer 51

d) detoxification.

Question 52

James is struggling with schizophrenia. He also finds it difficult to experience pleasure from activities that he enjoyed before his symptoms began. This is an example of a) alogia. b) anhedonia. c) avolition. d) asociality.

Answer 52

b) anhedonia.

Question 53

Mr. Hart spends long hours sitting in a chair with his arms behind his back and his left leg tucked under. No matter what is going on around him, he remains in this position. This is an example of which symptom of schizophrenia? a) somatic passivity b) anhedonia c) catatonic immobility d) inappropriate affect

Answer 53

c) catatonic immobility

Question 54

The term schizophrenia comes from the Greek word schizein meaning to split and phren meaning a) dissociation. b) mind. c) conscience. d) unconscious state.

Answer 54

b

Question 55

List four of the therapeutic benefits of marijuana.

Answer 55

pain relief, reduction of nausea, increased appetite, relief from the discomfort from AIDS

Question 56

The DSM-5 removed the subtype of schizophrenia called a) paranoid. b) disorganized. c) catatonic. d) all of the above.

Answer 56

d

Question 57

``` Match the treatment approach to the type of substance(s). Treatment 1. Suboxone 2. AA 3. couples therapy 4. opiate antagonist 5. antidepressant 6. patch 7. Matrix ``` Substance a. alcohol b. heroin c. cocaine d. nicotine e. methamphetamine

Answer 57

b, a, a, b, a/c/d, d, e

Question 58

Studies show that, of the schizophrenic symptoms, the ones with the greater genetic component are a) negative symptoms. b) delusions. c) positive symptoms. d) persecution delusions

Answer 58

a) negative symptoms.

Question 59

True or False: According to DSM criteria a diagnosis of a substance use disorder requires BOTH tolerance and withdrawal symptoms?

Answer 59

FALSE

Question 60

Which of the following sociocultural factors is NOT associated with schizophrenia a) Poverty. b) Child rearing practices. c) Urbancity. d) Migration.

Answer 60

b) Child rearing practices.

Question 61

Marijuana - derived from: - how consumed:

Answer 61

Drug derived from dried and crushed leaves and flowering tops of the hemp plant (Cannabis sativa) Most often smoked, but it can be chewed, prepared as a tea, or eaten in baked goods

Question 62

Hashish

Answer 62

Stronger than marijuana | Produced by drying the resin exudate of the tops of the plant

Question 63

Synthetic marijuana

Answer 63

Spice or K2

Question 64

alcohol comorbidity

Answer 64

Often comorbid with borderline and antisocial personality disorders, mood disorders, and anxiety disorders

Question 65

Dissociative Identity Disorder : gender prevelance

Answer 65

more common in women

Question 66

Hallucinogens

Answer 66

Used more often by men and European Americans LSD Popular in 1960s, but regular use has declined No evidence of withdrawal, but tolerance develops rapidly Effects serotonin system Effects take place within 30 minutes, last up to 12 hours Hallucinations, sense of time, mood swings, expanded consciousness Flashbacks – visual recurrences of perceptual experiences after effects of drug have worn off

Question 67

Ecstasy (molly)

Answer 67

Taken in a pill or powder form Average age of first use: 21 Acts primarily on the serotonin system Increases feelings of intimacy, insight, positive emotions, self-confidence Can also cause muscle tension, nausea, anxiety, depression, confusion, depersonalization

Question 68

PCP (phencyclidine)

Answer 68

``` PCP (phencyclidine) Angel dust Used more by men Causes severe paranoia and violence Coma and death are possible ```

Question 69

34. The "pleasure pathways" or internal reward centers in the human brain are primarily made up of a. dopamine-sensitive neurons. b. serotonin-sensitive neurons. c. both dopamine-sensitive and serotonin-sensitive neurons. d. none of these

Answer 69

a. dopamine-sensitive neurons.

Question 70

Alcohol Use Disorders : medications

Answer 70

Medications Antabuse (disulfiram) Produces nausea and vomiting if alcohol is consumed Dropout rates are high (80%) Other medications: naltrexone and acamprosate Most effective when combined with CBT

Question 71

Explain the frequency of relapse | neurobiological factors

Answer 71

People also take drugs to avoid the bad feelings Avoidance of withdrawal symptoms Explains frequency of relapse

Question 72

In a laboratory research study involving "drug addiction" in animals, it was demonstrated that the positive-reinforcing effect (i.e., pleasure) of drugs a. is a uniquely human weakness b. Primarily asocial and cultural phenomenon c. Existed even without social and cultural influences. d. biological, social, and cultural.

Answer 72

c. Existed even without social and cultural influences.

Question 73

Prevention of Substance Use

Answer 73

The measures that hold promise for persuading young people to resist smoking may also be useful in dissuading them from trying other drugs and alcohol Brief family interventions Associated with less initiation of alcohol use among teens

Question 74

Which of the following has been useful in discouraging teens from trying drugs and alcohol? a) DARE b) brief family interventions c) television commercials about the dangers of substance use d) all of the above

Answer 74

b) brief family interventions

Question 75

105. Which of these symptoms is not a criterion for Substance Use Disorder in the DSM-5? a. Continued use despite knowing the use causes problems. b. Efforts to control or stop use are unsuccessful. c. Craving to use is strong. d. Withdrawal is experienced when ceasing use.

Answer 75

a. Continued use despite knowing the use causes problems.

Question 76

8. Delirium tremens refers to a) a symptom of conversion disorder. b) the symptoms that accompany an overdose of heroin. c) the symptoms that may accompany withdrawal from alcohol. d) the hallucinations common in schizophrenia.

Answer 76

c) the symptoms that may accompany withdrawal from alcohol.

Question 77

Which neurotransmitter has been implicated in alcohol tolerance? a) serotonin b) dopamine c) norepinephrine d) GABA

Answer 77

d) GABA

Question 78

alcohol enters the bloodstream _[speed]__ through _____. It is metabolized by the ______ _[speed] at what rate?

Answer 78

Enters the bloodstream quickly through small intestine | Metabolized by the liver slowly at 1 ounce of 100 proof per hour

Question 79

17. Cirrhosis of the liver due to alcohol abuse is characterized by a) liver cells becoming engorged with fat and protein. b) an increased efficiency of alcohol absorption with a corresponding decrease in blood cell reproduction. c) a decreased efficiency in absorption due to liver atrophy. d) None of the above.

Answer 79

liver cells becoming engorged with fat and protein.

Question 80

``` Alcohol goes into the __________ and is absorbed into the blood, after which it is metabolized by the __________. a) small intestine; kidneys b) small intestine; liver c) stomach; liver d) stomach; kidneys ```

Answer 80

small intestine; liver

Question 81

``` 23. Nicotine ultimately stimulates __________, which are implicated in the reinforcing effects of smoking. a) muscarinic receptors b) dopamine receptors c) GABA receptors d) serotonin receptors ```

Answer 81

b) dopamine receptors