Lecture 13 Flashcards
(44 cards)
1
Q
Acrophobia is the fear of ____, and trypanophobia is the fear of ______
A
- heights
- needles
2
Q
What does the word “addiction mean to you?
A
- surge of dopamine
- frequent cravings
- feeling relieved
- withdrawal symptoms
3
Q
What has drug trade contributed to?
A
- contributed to tremendous wealth and political influence of societies (commodities)
4
Q
define adiction
A
- repetitive consumption of a substance, or repetitive engagement in an activity that is considered to be problematic
- this definition has evolved, but the core concept is that the behaviour associated with the substance use is harmful for the individual and/or the people/community around that individual (both health and social problems)
5
Q
define psychoactive drugs
A
- defined as a substance capable of influencing brain systems linked to mood/emotion/perception, as well as reward and pleasure
6
Q
define PWUD
A
- people who use drugs
- person-first, descriptive, neutral
7
Q
define PWID
A
- people who inject drugs
- injection as mode of administration
8
Q
define “addict”
A
- lacks precision and clarity, can be pejorative and stigmatizing
9
Q
define “drug use”
A
- transparent, neutral, and free of judgement
10
Q
define illicit drugs
A
- controlled/prohibited substances (heroin, cocaine, etc.) and diverted pharmaceuticals (prescription opioids)
11
Q
define harmful use or problematic use (sometimes termed drug misuse)
A
- consumption that causes social, psychological or health problems/harms for individual or society
12
Q
define drug dependence
A
- psychobiological syndrome involving impaired control of use, increased tolerance, continued use despite negative consequences, and withdrawal symptoms
13
Q
what has replaced “drug addiction” in the ICD
A
- drug dependence
14
Q
define substance use vs. substance abuse
A
- subjective distinctions and value judgements based on particular understandings of physiology, psychology, law, and history
15
Q
What do some argue about terms like substance “abuse” and “abuser”
A
argue that those terms are stigmatizing
16
Q
What things began the process of medicalization of addiction to a wide variety of substances, and later to behaviours?
A
- in the 18th century, a distinction was made between “normal” drinking and “abnormal” drinking
— normal drinking included drunkenness - late 19th century : “inebriety” was a concept that likened abnormal drinking to a physical illness, and referred to “a disease of the nervous system characterized by morbid craving” for alcohol
- 1940s : term “alcoholism” used to refer to problem drinking and physiological dependence
17
Q
What are 2 parallel models of addiction developed in the 19th century
A
- disease model
- addiction related to the characteristics of the substance itself
18
Q
explain disease model
A
- addiction stemmed from physiological or psychological predispositions in some individuals
- this model contributed to theory of individual degeneracy (as inheritable) and solutions such as institutionalization and sterilization
19
Q
explain addiction related to the characteristics of the substance itself
A
- this model was associated with the “temperance movement” which identified the substance (alcohol) as the source of the problem and advocated for severe restrictions or prohibitions (laws making production and sales illegal) on the availability of alcohol
20
Q
review this about terminology and conceptualization
A
- the tension between a disease model focusing on the person with addiction and a focus on dangerous substances influenced our current responses to addiction
- if we see addiction as a disease, we are likely to favour medical responses to addiction
- if we see addiction as bad behaviour (moral view), we are likely to favour criminal justice responses to addiction as punishment and deterrent
- if we consider social determinants of health, we might look at systemic or social drivers (causes) of addiction
21
Q
The disease model may bring a more humane approach, but what are the consequences related to medicalization?
A
- arguably reduces individual responsibility and imperative to improve/reform
- decreases emphasis on social, economic, and cultural contexts in shaping substance use and outcomes, with a larger focus on biology and medications
- less attention to systemic and underlying issues, if we view it solely as medical problem; medical solutions are somewhat narrow
22
Q
define public health
A
- more focus on populations but also individuals in context and the role of socio-cultural influences in shaping behaviour and outcomes
23
Q
what affects public health
A
- social determinants of health and systemic factors
- ethnicity, neighbourhood characteristics, gender, sexual orientation, income (socioeconomic status), education: all influence mental health
- environment is centrally important and structures issues related to addiction
24
Q
give some related substances of the drug class opioids and its pharmacological effects
A
- heroin, opium, morphine, oxycodone, codeine, fentanyl, methadone, pethidine
- acts on nervous system (slows it dow) to relieve pain; have the capacity to produce high euphoria and induce respiratory depression, drowsiness, and impaired judgement
25
give some related substances of the drug class cannabis and its pharmacological effects
- hashish, THC, marijuana, bhang, ganja, hash oil
- intoxication produces feelings of euphoria, lightness of limbs, increased appetite, tachycardia, and impaired judgement
26
give some related substances of the drug class cocaine and its pharmacological effects
- crack
- feelings of elation (joy), exaggerated feelings of confidence. Acute toxic reactions include hypertension, cardiac arrhythmias, auditory and visual hallucinations, seizures
27
give some related substances of the drug class amphetamines/other stimulants and its pharmacological effects
- dexamphetamine, methamphetamine, methylphenidate, phenmetrazine, diethylpropion
- effects include euphoria, anorexia, nausea, vomiting, insomnia and abnormal behaviour such as aggression, grandiosity, hypervigilance, agitation, and impaired judgement
28
give some related substances of the drug class hypnotics/sedatives and its pharmacological effects
- benzodiazepines, barbiturates, buspirone, methaqualone, Rohypnol
- induce muscle relaxation, calmness, and sleep. Impair concentration, memory, and coordination. Other effects include slurred speech, drowsiness, unsteady gait
29
give some related substances of the drug class hallucinogens and its pharmacological effects
- lysergic acid diethylamide (LSD), dimethyltryptamine (DMT), psilocybin, mescaline, MDMA, phencyclidine (PCP)
- produce feelings of euphoria/dysphoria, mood changes, altered perceptions, and visual illusions. Adverse effects include panic reactions, flashbacks, and mood disorders
30
give some related substances of the drug class psychoactive inhalants and its pharmacological effects
- industrial solvents, glue, aerosol, paints, lacquer thinners, gasoline, cleaning fluids, amyl nitrite, nitrous oxide
- signs of intoxication include belligerences, hallucinations, lethargy, psychomotor impairment, euphoria, impaired judgement, dizziness, nystagmus, slurred speech, tremors, muscle weakness, unsteady gate, stupor, coma
31
Who was the term "addiction" abandoned by and why?
- abandoned by WHO in 1964
- due to imprecision
--- adopted dependence
* physiological syndrome involving tolerance and withdrawal as key components
32
define tolerance
- more of a substance is required to achieve same effect
33
define withdrawal
- unpleasant symptoms accompany cessation or reduction of consumption
34
review about medical models of addiction
- DSM-5 uses the term "addiction" and includes nonchemical, behavioural addictions in the relevant sections
- Section was to be titles "Addiction and related disorders" but became "Substance Use and Addictive Disorders"
35
Including non-chemical, what do behavioural addictions emphasize?
- emphasizes psychological aspects of dependence, rather than just physical/biological (substances)
36
What is the implication of the emphasis of non-chemical and behavioural addictions?
- this can lead to inclusion of "addictions" that do not involve physiological dependence (as substances do), but some biologically/brain focused researchers would say these problem behaviours similarly alter brain function/chemistry
37
Viewing behavioural addictions (ex. sex, shopping addictions, etc.) as similar to substance use disorders is founded upon view of addiction as involving what?
- compulsion
- loss of control
- continued use/behvaiour despite negative consequences
38
what do advocates for this model (behavioural addiction) point to?
- point to neurological research into the reward systems of the brain
- what was rewarding or pleasurable, becomes compulsive/addiction due to neurological changes in the brain (common between chemical and non-chemical dependencies)
--- also known as the "hijacked" brain model of addiction
39
some addictive behaviours are now thought to operate what?
- thought to operate psychologically and physiologically like substance dependence
* there are similar neurochemical changes in the brain when the behaviour is engaged in related to the reward system in the brain
40
What are the implications of this reconceptualization?
- addictions as progressive and fatal diseases
- downplays personal agency and fosters assumptions that those who are addicted will always continue to be
- de-emphasizes social factors shaping behaviour
- there's a need to re-examine the disease model, (ex. the assumption that addiction is always a chronic, relapsing condition and also progressive and fatal) - recovery happens!
41
What are the 3 criteria ICD-11 focuses on?
Any 2 qualify as a diagnosis of substance dependence
- impaired control over substance use
- substance use becoming an overriding priority in the user's life
- tolerance to or withdrawal symptoms from the drug
- DSM-V; dependence replaced with substance use disorder, diagnosed on presence of 2/11 criteria related to use...
42
How was "addiction" redefined from DSM-IV to DSM-5
- DSM-IV had 2 different diagnostics (Abuse and Dependence (Abuse+)) // DSM-5 has one diagnostic (Substance Use) and the severity for it
- in the symptoms, "recurrent legal problems due to use" got taken out and in the DSM-5, "craving or strong desire to use" was put in instead
43
For each, Abuse, Dependence (Abuse+), Substance Use, how many do you need of the symptoms?
Abuse: 1 or more of the 4
Dependence (Abuse+): 3 or more of the 11
Substance Use: 2 or more of the 11
44
What are the different severities of addiction in DSM-5?
- mild (2-3 symptoms)
- moderate (4-5 symptoms)
- severe (6 or more symptoms)
