Lecture 4: Comorbidity in addiction Flashcards
prevalences of SUD
19.1% lifetime prevalence, 5.6% incidence
prevalentie comorbiditeit
- 50% of SUD clients has another mental disorder (dual diagnosis)
- 25% suffers from comorbid mood/anxiety disorders
welke disorders komen het vaakste samen voor
- mood disorders
- anxiety disorders
- adhd
- personality disorder
welke specifieke disorders komen het meeste voor
- dysthymia
- GAD
- agoraphobia
- adhd
waarom is comorbiditeit relevant
- more severe symptoms
- lower treatment compliance
- higher drop-out
- worse treatment outcome
- higher probability of relapse (want veel meer cues zoals stress of angst bij angststoornissen)
4 explanatory models of comorbidity
- self-medication hypothesis (CO -> SUD)
- susceptibility hypothesis & high-risk hypothesis (CO <- SUD)
- bidirectional hypothesis (CO <-> SUD)
- 3rd factor hypothesis (CO <-> SUD)
self-medication hypothesis=
mental disorder leads to excessive use of a substance, because substances are used to control emotional pain
high risk hypothesis =
by leading to behaviour that increases the risk for eg. trauma exposure
susceptibility hypothesis=
through biological processes induced by the substance use that render them more susceptible to developing ptsd following exposure to traumatic event
third-factor hypothesis=
there is no direct relationship, but the association occurs because the sud and the other mental disorder share the same cause (genetics, brain abnormalities, environmental risk factors)
bidirectional hypothesis =
Substance use and other mental disorders may also influence each other / have bidirectional interrelations
alcohol influence of psychological symptoms
- depressed mood
- fear
- confusion
- mood swings
- sleep problems
alcohol withdrawal symptoms
<8-12 hours:
- General bad/sick feeling
- Headache, nausea, vomiting
- Light shaking, fear, not eating
12-36 hours:
- Insomnia
- Restless, agitation
- Tremors
- Sweating, palpitations
48 hours:
- Withdrawal feeling / delirium
- Tremor
- Sweating
- Agitation
- Slight fever
- Hypertension
cannabis: influence on psychological symptoms
- Concentration issues
- Memory impairment
- Fear
- Suspicion / paranoia / psychosis
cannabis withdrawal symptoms
- insomnia
- depressed mood
- agitation
cocaïne symptoms
- lack of energy
- depressed mood
- insomnia
- fear and panic
- suspicion/paranoia
wat is belangrijk om te vragen als iemand zegt “i only drink in the weekend”
how long is your weekend?
voor sommige mensen een aantal dagen, en dan kan het een withdrawal zijn in die paar dagen voordat ze weer drinken
cannabis zit na … nog in bloed
6 weken
waarom kunnen mensen geirriteerd raken tijdens withdrawal
drugs numb the senses: als je stopt dan gaat deze blanket weg, en dan raak je opeens heel gestimuleerd door letterlijk alles. dus dan raken mensen geirriteerd.
wat is er met diagnoses en SUD
in order to be able to finalise a diagnosis, a client must always quit using a substance.
two exceptions; ADHD and PTSD
SUD and depression
- A lot of comorbidity addiction and depression, especially in the case of excessive alcohol consumption
- In about 80% of the clients, symptoms of depression disappear after quitting alcohol
- However, clients often perceive their substance use as self-medication!! -> timeline can be helpful
waar kan abstinence dus voor zorgen bij depressie
abstinence kan zorgen voor remission of depressive symptoms, al na 2 weken. zelf voor mensen zonder SUD: dus treatment voor depressie zou kunnen zijn om een verslaving te ontwikkelen en dan te stoppen (maar ofc niet ethisch)
substance use and anxiety
- symptoms can be the result of SUD: withdrawal and intoxication can lead to anxiety
- SUD may also have masked anxiety (drinken waardoor je minder sociale angst hebt)
- anxiety disorders can maintain SUD and cause relapses (veel anxiety -> middel gebruiken)
- anxiety decreases after alcohol abstinence, returns after relapse
SUD and PTSD: prevalentie
11-41% van mensen met SUD hebben ook PTSD