EXAM 3 - Substance-Related, Addictive & Impulse-control Disorders

Question 1

Substance use

Answer 1

Taking moderate amounts of a substance in a way that doesn’t interfere with functioning

Question 2

Substance intoxication

Answer 2

Physical reaction to a substance (e.g., being drunk)

Often involves impaired judgment, mood changes, and lowered motor ability

Question 3

Substance abuse

Answer 3

Use in a way that is dangerous or causes substantial impairment in your life (e.g., affecting job or relationships)

Question 4

Substance dependence

Answer 4

May be defined by tolerance and withdrawal

Sometimes defined by drug-seeking behavior (e.g., spending too much money on substance)

Question 5

Tolerance

Answer 5

Needing more of a substance to get the same effect
Reduced effects from the same amount
A need for markedly increased amounts of the substance to achieve intoxication or desired effect
A markedly diminished effect with continued use of the same amount of the substance

Question 6

Withdrawal

Answer 6

Physical symptom reaction when substance is discontinued after regular use
The characteristic withdrawal syndrome for the substance
Another substance is taken to relieve or to avoid withdrawal symptoms

Question 7

Substance-Related Disorders in DSM-5: The 11 Criteria associated with substance use
There are no longer separate designations for intoxication, abuse, and dependence
Severity qualifiers are assigned:
Mild (2 or 3 of the 11 criteria are met)
Moderate (4 or 5 of the 11 criteria are met)
Severe (6 or more of the 11 criteria are met)

Answer 7

Taking more of the substance than intended or over a longer period of time than was intended
Persistent desire or unsuccessful efforts to cut down or to control use
Excessive time spent using substance, in activities to acquire substance or in recovering from the effects of the substance
Craving for or strong desire to use the substance
Failure to fulfill major role obligations at work, school, or home
Continued use despite persistent or recurrent social or Interpersonal problems caused by or exacerbated by substance use
Important social, occupational, or recreational activities are given up or reduced due to the substance use
Recurrent substance use in physically hazardous situations (e.g. driving)
Recurrent substance use despite knowing it is causing or exacerbating physical or psychological problems

Question 8

Depressants

Answer 8

Behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs)

Question 9

Stimulants

Answer 9

Increase alertness and elevate mood (e.g., cocaine, nicotine)

Question 10

Opiates

Answer 10

Produce analgesia and euphoria (e.g., heroin, morphine, codeine)

Question 11

Hallucinogens

Answer 11

Alter sensory perception (e.g., marijuana, LSD)

Question 12

Other drugs of abuse

Answer 12

Include inhalants, anabolic steroids, medications

Question 13

The Brain’s Pleasure Centers - The Limbic System

Answer 13

Hippocampus (memories)
Amygdala (emotions)
The Striatum

Question 14

Reward Circuits

Answer 14

Ventral Tegmental Area
Nucleus Accumbens
The Locus Coeruleus
The Prefrontal Cortex

Question 15

How do drugs produce their effects and lead to addiction?

Answer 15

Some Stimulate GABA receptors, major inhibitory neurotransmitters, and causes dopamine to be released
Reduces tension (benzodiapines)
Some Increase levels of dopamine and/or endorphins
Pleasurable feelings
Some reduce levels of serotonin, Others increase serotonin
Some inhibit glutamate receptors
Cognitive effects, such as slurred speech, impaired decisions, and memory loss

Question 16

Some Stimulate GABA receptors

Answer 16

major inhibitory neurotransmitters, and causes dopamine to be released
Reduces tension

Question 17

Some Increase levels of dopamine and/or endorphins

Answer 17

Pleasurable feelings

Question 18

Some reduce levels of serotonin, Others increase serotonin

Some inhibit glutamate receptors

Answer 18

Cognitive effects, such as slurred speech, impaired decisions, and memory loss

Question 19

Alcoholism

Answer 19

Jellinek’s (1946) sequence of behaviors associated with alcohol dependence:
Periodic, excessive drinking
Blackouts
Sneaking drinks
Loss of control over drinking (Key Sign)
Remorse and rationalization
Changing patterns
Morning Drinking
Benders
Defeat

Question 20

Incidence rates for Alcohol Dependence

Answer 20

men is over 20% and for women is over 8%

Native American youth have highest rates

Question 21

Alcohol Use: The Effects - Acts on multiple neurotransmitter systems

Answer 21

Major effects on GABA, an inhibitory neurotransmitter; inhibits firing of other neurons (e.g. anti-anxiety)
Effects glutamate system, excitatory (e.g. learning/memory)
Effects serotonin (e.g., mood, sleep, eating. Cravings)

At low blood alcohol levels (.03 to .06)
Disinhibitory Effect (ex., boisterous, aggressive, depressed)
Impaired Judgment
At higher blood concentrations (.06 up)
Psychomotor Incoordination 
More impaired Judgment

Question 22

At low blood alcohol levels (.03 to .06)

Answer 22

Disinhibitory Effect (ex., boisterous, aggressive, depressed)
Impaired Judgment

Question 23

At higher blood concentrations (.06 up)

Answer 23

Psychomotor Incoordination

More impaired Judgment

Question 24

Effects of Alcohol:

Hangovers

Answer 24

From the conginers added to alcohol to enhance the taste; These can be added chemicals or byproducts of the fermentation process.
Only ¼ to 1/3 of alcohol is metabolized in 1 hour

Question 25

Negative Physiological Effects of Alcohol Dependence

Answer 25

Hepatitis (Inflammation of the Liver) Treatable Cirrhosis of the Liver (Fat buildup along with fibrous tissue replacing liver cells) Nonreversable; eventually toxins destroy the liver Wernicke-Korsakoff’s Syndrome (Dementia) Memory impairment Flat Affect Blackouts Delirium Tremens After sudden cessation of drinking, when dependent for many years Can be fatal (Seizures, Hallucinations)

Question 26

Social Factors of Alcoholism

Answer 26

The more available, the higher the rates of alcoholism (ex., bartenders, liquor store owners) Alcohol use by parents increases risk of drinking in children Risk increases with Psychiatric problems, marital problems, lack of emotional support from parents, lack of parental monitoring of children’s behavior, or legal problems Media influences problems (Countries that ban alcohol ads had 16% less consumption) Cost of alcohol

Question 27

Psychological Factors | of Alcoholism

Answer 27

Alcohol abuse can be reinforced by altering mood states Alcohol-> Stress->Alcohol While alcohol is reported to reduce stress, it is not really a very potent stress reducer for most people The Exception: People with Anxiety Problems may find it more tension reducing

Question 28

Biological Factors | of Alcoholism

Answer 28

Concordance rates are higher in identical than fraternal twins The diathesis may be an inherited higher tolerance for alcohol Risk is low among Asians 3/4 of Asians have an inherited deficiency in an enzyme that metabolizes alcohol and drinking causes noxious effects

Question 29

Schuckit (1994, 1996) found 2 variables that predicted the development of alcohol abuse in a 10 year follow-up study of men

Answer 29

1)Self-report of low level of intoxication after a dose of alcohol 2)Less body sway after drinking Women with these indicators tend to have a positive family history of alcoholism (but not men)

Question 30

Swedish Adoption Studies

Answer 30

Offspring of alcoholic parents reared by nonalcoholic adoptive parents are more likely to develop alcoholism than people in general

Question 31

Treatment of Alcoholism

Answer 31

``` Alcoholics Anonymous 12 Step Program Abstinence Inpatient Treatment Detox (just the first step in treatment) Doesn’t appear superior to outpatient treatment, unless they have few sources of social support or if they have comorbid psychiatric disorders ```

Question 32

Treatment of Alcoholism: Controlled Drinking (Sobell & Sobell, 1993) (Now called “Guided Self-Change”)

Answer 32

Cognitive-Behavioral Approach Emphasizes personal responsibility & control Identify negative aspects of drinking (cost, behavior) Narrowing where drinking occurs Sipping instead of gulping Reinforce resisting the urge to drink Alternative coping skills developed

Question 33

Medications for Alcoholism

Answer 33

Disulfiram (Antabuse): Causes violent vomiting if ingested with alcohol Blocks the metabolism of alcohol Very high drop out rates Opiate Antagonists: Naltrexone (Revia) Blocks activity of endorphins stimulated by alcohol, reducing cravings Reduced relapse compared to placebo when combined with counseling Acamprosate (Campral) is the most recent medication approved by the FDA Used by individuals who are already abstaining from alcohol use to maintain sobriety People are 3 times more likely to abstain from alcohol use compared to a placebo Acts on the glutamate system to reduce withdrawal symptoms SSRI anti-depressants Improve treatment when depression is a comorbid diagnosis

Question 34

Narcotics

Answer 34

Sedative and analgesic-painreducing effects

Question 35

Barbiturates

Answer 35

Powerful sedatives and anticonvulsants

Question 36

Tranquilizers

Answer 36

Benodiazepines: Valium, Xanex; Rohypnol (“Roofies”) Can die of withdrawal Extremely addictive

Question 37

Effects of Narcotics:

Answer 37

Similar to the effects of alcohol (so very dangerous to take with alcohol Act on GABA, inhibitory neurotransmitter CNS depressants

Question 38

Stimulant Drugs

Answer 38

Amphetamines Nicotine Caffeine Cocaine

Question 39

Stimulant Drugs

Answer 39

Effect dopamine by blocking its reuptake in the synapse by binding to their sites on the dendrites; thus, stimulating the dopamine sites in the pleasure pathways of the brain Can be very addictive

Question 40

Opiates

Answer 40

Opium Morphine Heroin Oxycodone (other pain killers)

Question 41

The Opiates

Answer 41

Effects natural opioids in the brain: enkephalins and endorphins that produce narcotic effects Can be very addictive

Question 42

Hallucinogens

Answer 42

Distortions in Sensory Perception

Question 43

Hallucinogens

Answer 43

``` LSD Psilocybin (mushrooms) Mescoline (from peyote) PCP (Angel Dust) Ecstasy (also has properties of amphetamines) ```

Question 44

LSD

Answer 44

Seeds of the morning glory plant)and psilocybin certain mushrooms likely effect serotonin

Question 45

Mescoline

Answer 45

found in the peyote cactus plant) likely affects norepinephrine

Question 46

Ecstasy

Answer 46

likely affects serotonin and dopamine mixed hallucinogen/amphetamine Some may affect acetylcholine

Question 47

Cannabis (from the hemp plant)

Answer 47

Marijuana (leaves) Hashish (dried resin) Active ingredient is THC THC activates the same cannaboid receptors in the brain as the neurotransmitter, Anadamide, and has a pain relieving effect (in the limbic system, cortex, and cerebellum), but interferes with their normal functioning THC also effects dopamine Long-term use reduces hippocampal activity (Memory) Rarely can trigger psychosis that may be irreversible About 10% of people who use marijuana become dependent on it. It is the most commonly abused drug, except for alcohol and nicotine

Question 48

Principles of Effective Treatment for Substance Use Disorders (NIH, 2009)

Answer 48

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Question 49

Gambling Disorder

Answer 49

New disorder in DSM-5 Classified under “Addictive Disorders” Recurrent gambling leading to clinically significant distress or impairment

Question 50

DSM 5 Gambling Disorder Criteria

Answer 50

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Question 51

Gambling Disorder: Treatment

Answer 51

Psychosocial treatment similar to substance abuse Treatment is often ineffective Motivation to get better is critical; dropout is high Research is limited, but multipart CBT interventions are under investigation Scheduling alternative activities, setting financial limits, relapse prevention