Chapter 11: Substance Use/Addictive Disorders Flashcards
(81 cards)
1
Q
what is a drug?
A
any substance other than food that affects our bodies or minds
2
Q
do we use the word substance or drug?
A
substance
3
Q
______% of teens and adults in the US display a substance abuse disorder (over 11 y/o)
A
16.5%
4
Q
male to female ratio for substance use disorder
A
4:3
5
Q
racial and ethnic groups picture
A
6
Q
for substance use disorder, what substances are listed?
A
alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco, and other/unknown
7
Q
SUD are long term problems due to the maladaptive use of any substance WITH THE EXCEPTION OF _________
A
caffeine
8
Q
SUD are usually more temporary and include:
A
- INTOXICATION
- withdrawal
- substance/medication-induced mental disorders (e.g. substance induced psychosis)
9
Q
intoxication def
A
cluster of changes in behavior, emotions, and thought caused by substances
10
Q
some substances can lead to…….
A
long-term problems involving maladaptive behavior patterns and reactions
11
Q
what is the layman’s term for SUD
A
addiction
12
Q
SUD Dx Checklist
A
mild: 2-3 Sx
moderate: 4-5 Sx
severe: 6+ Sx
13
Q
tolerance
A
the adjustment that the brain and the body make to the regular use of certain drugs so that LARGER DOSES ARE NEEDED TO ACHIEVE THE ORIGINAL EFFECTS (may be due to the fact that the brain reduces its neurotransmitter production after habitual use of the substance)
14
Q
withdrawal
A
unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly stop taking or reduce their dosage of the drug; withdrawal effects are typically the opposite of the intoxication effects
15
Q
withdrawal has ________ of the drug
A
symptoms that are the reverse of the drug’s effects
16
Q
four categories of substances
A
depressants
stimulants
hallucinogens
cannabis
17
Q
what do depressants do?
A
they slow the activity of the central nervous system
- reduce tension and inhibition
- may interfere with judgment, motor activity, and concentration
18
Q
three most widely used depressants
A
alcohol #1
sedative-hypnotic drugs (AKA anxiolytics- Valium, Xanax)
opioids
19
Q
alcohol (depressants)
A
alcoholic beverages contain ethyl alcohol:
- which is absorbed into the blood through the stomach lining and takes effect in the blood stream and CNS
- alcohol helps GABA (an inhibitory messengers) shut down neurons and relax the drinker
20
Q
how are anxiety and GABA linked
A
anxiety is linked to lower GABA activity, so people with anxiety tend to have issues with alcohol use
21
Q
women vs men alcohol differences
A
women tend to have less alcohol dehydrogenase than men (which helps the body metabolize alcohol)
22
Q
what are predictors of a positive recovery from alcohol use disorder
A
- strong neg experiences related to use
- substitute dependency
- new social supports
- joining an inspirational group (religious, AA)
23
Q
how does race play a role in alcohol (effects)
A
a lot of Asian American less alcohol dehydrogenase (hence the Asian flush)
24
Q
BAC levels
A
0.06 (relaxed, comfort)
0.09 (intoxication)
>0.55 (death)
DUI in CA is anything above a .08 (most people lose consciousness before they can drink this much)
25
when do the effects of alcohol subside
only after alcohol is metabolized
- the avg rate is 25% of an ounce per hour (you can NOT increase this speed)
26
binge drinking USED to be a Dx
female: 4+ drinks
male: 5+ drinks
**now there are NO gendered differences
27
personal and social impact of alcoholism
- plays a role in suicides, homicides, assaults, rapes, and accidents
- can cause cirrhosis (liver damage)
- can cause major nutritional problems (e.g. Korsakoff's)
- pregnant women have an increased risk of FAS and miscarriage
28
Korsakoff's Syndrome (alcohol use disorder)
vitamin B1 deficiency
- causes memory loss
- the alcohol depletes B1, driving memory issues
BUT... once they get sober, their B1 replenishes and their cognitive function returns
29
men vs women differences (mental health and alcohol use)
MEN:
typically experience alcoholism FIRST and depression SECOND
WOMEN:
depression FIRST and alcoholism SECOND (most self-medicate)
30
sedative-hypnotic (anxiolytic) drugs
produce feelings of relaxation and drowsiness - at low doses: calming
- at high doses: function as sleep inducers or hypnotics
31
what were barbiturates prescribed for (and why are they less prescribed)
prescribed for anxiety and sleep, less safe than benzodiazepines
easier to overdose on (respiratory depression)
32
what are examples of sedative-hypnotic drugs
barbiturates and benzodiazepines
33
what were benzodiazepines prescribed for (and why are they less prescribed)
anxiety, safer than barbs (include Xanax, Valium, Ativan)
- potentially addictive, leading to sedative hypnotic use disorder
- can cause cog impairments with long term use (esp in older adults)
34
what receptors do benzos and barbs work on
GABA
35
opioids
INCLUDES NATURAL:
opium, heroin, morphine, codeine
AND SYNTHETIC:
methadone, oxycodone, fentanyl
- each has a different strength, speed of action, and tolerance level
- used for pain relief
- bind to endorphin receptor sites
- cause CNS depression
36
opioid use disorder
37
stimulants
- increase the activity of CNS
- can cause increase in blood pressure, heart rate, and alertness
- cause rapid behavior and thinking
38
four most common stimulants
cocaine
amphetamines
caffeine
nicotine
39
cocaine (general info)
- most powerful natural stimulant known (from the coca plant)
- produces a euphoric rush of well-being followed by a crash
- largely increases DOPAMINE, NOREPINEPHRINE, and SEROTONIN
- can be snorted, injected, or smoked
40
cocaine (intoxication and crashing)
high doses can produce cocaine intoxication (Sx: mania, paranoia, and impaired judgment)
- some also experience hallucinations/delusions
as the effects wear off, users experience crashing (depression-like)
41
what are the dangers of cocaine
risk of overdose
excessive doses depress the brain's function (respiratory failure)
can cause heart failure/seizures, leading to death
pregnant women who use have an increased likelihood of miscarriage and birth defects/complications
42
cocaine use disorder (p rate)
0.5%
43
amphetamines
manufactured in a lab
- usually pill form
- prescribed for weight loss, ADHD, and narcolepsy
- increases DOPAMINE, NOREPINEPHRINE, and SEROTONIN
Sx:
- increased energy and alertness, reduced appetite
- produces a rush, intoxication, and psychosis in high doses
- crash when they leave the body
44
meth use disorder (p rate)
0.6%
45
other amphetamine disorder (p rate)
0.5%
46
caffeine
most used stimulant (90% of the pop consumes it daily)
- usually in the form of coffee, tea, soda, energy drinks, chocolate, and over-the-counter
99% of ingested caffeine reaches its peak within an hour
47
caffeine acts as what kind of drug?
stimulant (dopamine, serotonin, norepinephrine)
- 2-3+ cups of coffee can cause caffeine intoxication
- seizures and respiratory failure can occur in doses over 10 grams (~100 cups of coffee)
48
is there a caffeine use disorder?
no
49
what happens when people try to stop or cut back their usual intake experience (for caffeine)
withdrawal symptoms such as...
- headaches
- depression
- anxiety
- fatigue
studies suggest correlations between high doses of caffeine and hearty rhythm irregularities, high cholesterol levels, and risk of heart attack
- high doses during pregnancy increase risk of miscarriage
50
hallucinogens (def)
produce delusions, hallucinations, and other sensory changes
e.g. LSD, PCP, Mescaline (psychedelic extracted from cacti), Psilocybin, MDMA (ecstasy)
51
cannabis substances (def)
produce sensory changes and stimulant effects
52
LSD
- one of the most powerful hallucinogens (brings on a state of hallucinogen intoxication, or hallucinosis)
- hallucinations/synesthesia
- effects wear off after 6 hours
- binds to serotonin receptors (help control visual info and emotions)
53
hallucinogens (clinical info)
- 10.5% of Americans have tried them at least once
- tolerance and withdrawal are rare
- may experience a bad trip
- another risk: flashbacks (can occur days/months after use)
54
MDMA
produces hallucinogenic effects (energy boost and strong feelings of connectedness)
DOPAMINE and SEROTONIN
e.g. ecstasy, molly
dangers:
immediate psychological probs, cog impairments, unpleasant/potentially dangerous physical Sx
- longer use can cause mood issues like depression
55
cannabis
produced from varieties of hemp plant, which are:
hashish- the solidified resin of the plant
marijuana- a mixture of buds, crushed leaves, and flowering tops
major active ingredient: THC
- the greater the content, the more powerful the drug
56
why is THC addictive now, but wasn't before?
THC content is 7X more powerful than that from the 70s
57
is marijuana dangerous
as the strength has increased, so has the side effects
- may cause panic attacks
- use has been linked to poor concentration and impaired memory
long term use has other dangers:
- may cause respiratory problems and lung cancer
- may affect reproduction:
men: lower sperm count
women: irregular ovulation
58
polysubstance use
taking more than one drug at once
- synergistic effects (similar actions)
- opposite (antagonistic) actions
thousands of people are hospitalized yearly for polysubstance use (accidental or intentional)
59
what is the best explanation of causes for SUD
a combination of factors
60
sociocultural (causes of SUD)
- people are more likely to develop substance abuse/dependence patterns when living in stressful conditions
- others believe it is more likely to appear in families and social environments where substance use is valued/accepted
61
psychodynamic (causes of SUD)
- believe people who abuse substances can have powerful dependency, tracing back to early years (caused by lack of parental nurturing; some may develop substance abuse personality)
oral fixation- part of the Freudian psychosexual stages of development, says that the pt is stuck and substance use is a result of oral fixation
limited research links early impulsivities to substance use (BUT findings are correlational and researchers cannot conclude that any one personality trait/group of traits stand out in substance use disorders
62
cog behav (causes of SUD)
operant conditioning:
- reduction of tension is rewarding (neg reinforcement)
- rewarding effects may also lead to try higher does
- classical conditioning (certain cues are associated with the substance)
- cog theorists believe that users develop an expectancy that substances will be rewarding, driving use
63
bio- genetic predisposition (causes of SUD)
- twin studies reveal that people may inherit a
predisposition (id: 50%, frat: 30%)
adoption studies:
- those with bio parents who were dependent, showed higher rates of alc use
genetic linkage studies: possible inheritance of the atypical form of the D2 dopamine receptor gene (in people w SUD)
64
bio- NT (causes of SUD)
alcohol and benzos: GABA
opioids: endorphins
cocaine/amphetamines: dopamine
marijuana: anandamide
as more of a substance is ingested, LESS of the NT is produced by the brain, pushing user to ingest more and more to achieve the same pleasurable effect
as the user experiences withdrawal, using the substance can provide relief from Sx
65
bio- brain circuit (causes of SUD)
brain imaging studies: drugs eventually activate a reward center or pleasure pathway in the brain (involving dopamine)
the reward center:
extends from the VENTRAL TEGMENTAL AREA to the NUCLEUS ACCUMBENS to the FRONTAL CORTEX
66
brain imaging pic (control vs drug abuser)
67
bio- biochemical factors (causes of SUD)
incentive-sensitization theory:
when substances repeatedly stimulate the reward center, the center develops a hypersensitivity to the substances in which neurons fire more readily driving a greater craving for the substance
SUBSTANCE HIJACKS THE PLEASURE PATHWAY
reward-deficiency syndrome:
the reward center is not readily activated (because of a lack of D2 receptors) by typical life events, so they turn to drugs to stimulate this pleasure pathway
LACK OF D2 RECEPTORS CAUSES INEFFICIENT PLEASURE PATHWAY
68
comorbidity with SUD and other disorders
20% of ppl w other psych Dx are also Dx w SUD (which is secondary- they self medicated)
over half of pt w bipolar I also have alcohol use disorder
depression and SUD (gender difference in terms of order)
schizophrenia and tobacco use disorder
eating disorders and alcohol use disorder/stimulants
anxiety disorders and alcohol use disorder
69
developmental psychopathology (causes of SUD)
- genetically inherited predisposition (externalizing or internalizing temperament- look at pic)
- numerous stressors throughout childhood
- inadequate parenting
- rewarding substance use experience
- relationships with peers who use drugs
70
how are SUD treated
Tx are typically used in combination (both in and outpatient)
- most are not helpful alone
71
CBT therapies (how are SUD treated)
aversion therapy
contingency management (short term)
relapse prevention training
ACT- acceptance and commitment therapy
72
aversion therapies (CB Tx)
- indiv presented w stimulus at the moment of taking drug (e.g. drinking paired with drug-induced nausea and vomiting)
- after repeated pairings, they are expected to have a neg reaction and lose their craving
73
contingency management (CB Tx)
- makes incentive contingent on submission of drug-free urine; they receive the reward if they're clean
74
relapse prevention training (CB Tx)
goal: for clients to gain control over their substance-related behav
- clients are taught to identify and plan ahead for high risk situations and learn from mistakes and lapses
(e.g. planning to drink 2 drinks MAX- particularly used for alcohol but also weed and cocaine)
structure:
1. identify cues of use
2. teach skills to avoid
3. plan for known event
75
ACT- acceptance and commitment therapy (CB Tx)
mindfulness-based
pt becomes aware of and accepts their thoughts regarding the substance, their cravings, etc. rather than eliminating their thoughts
76
bio Tx (detoxification)
detoxification- systematically, medically-supervised withdrawal (cold turkey can be dangerous)
two strategies:
- gradual withdrawal by tapering doses
- induce withdrawal but give addtl meds to block Sx
detoxification seems to help motivate people withdraw (but relapse rates are high if they do not receive therapy after)
77
bio Tx (antagonist drugs)
an aid to resist falling back into pattern- they block or change the Sx of drug
e.g. Antabuse- if they drink alcohol, they will be very sick
e.g. Naloxone for opioids- this blocks the endorphin receptor sites and does not allow the drug to have the same effect or high
78
bio Tx (drug maintenance therapy)
Methadone clinics- designed to provide a safe, legal, and medically supervised substitute for heroin
- administered by health professional, so OD is virtually impossible
Buprenorphine- similar to Methadone, but less addictive and PCP can prescribe pill form
79
sociocultural therapies (Tx for SUD)
self-help programs
culture and gender sensitive programs
community prevention programs
80
self-help and residential programs (sociocultural therapies)
most common: AA
- offers peer support and moral/spiritual guidelines to help overcome alcoholism
- higher power, alcoholism is a disease, abstinence model, 24-hour peer support (sponsor)
****the abstinence goal of AA directly opposes the controlled-drinking goal of relapse prevention training and several other interventions for substance misuse; this has been debated for decades
residential treatment centers/therapeutic communities
- former addicts live, work, and socialize in a drug-free environment while undergoing indiv, group, and family therapy
81
is the abstinence model or relapse prevention/controlled drinking more effective
depends on the individual
- for long-standing Dx, abstinence is more effective
- younger drinkers who have not developed a tolerance and withdrawal reactions may do well with relapse prevention/controlled drinking
