lecture 80 Flashcards
svensson -- pathophysi of SUD
what is the definition of drug abuse?
the harmful or hazardous use of psycho-active substances, including alcohol and illicit drugs
what is the definition of drug misuse?
the use of a drug for a purpose not consistent with legal or medical guidelines
what is the definition of drug dependence?
inability of the individual to function normally in the absence of the drug
can be both physical or psychological
what is the definition of substance use disorder?
complex condition in which there is uncontrolled use of a substance despite harmful consequences
what is the definition of addiction?
a state of habitual drug use associated with significant harm that is driven by complex interaction of behavioral, biological, cultural financial, moral, and social factors
what is the definition of tolerance?
the bodys ability to adapt or acclimate to the effects of a drug over time
a large dose is required to achieve the desired effect of the drug due to a progressively decreased responsiveness to the drug
what is the definition of withdrawal?
a constellation of symptoms that occur as a result of the abrupt d/c of a drug
what are the general drug trends over time
increasing exponentially since 1970s –> indicates that there is a general drug abuse crisis, not just an opioid one
the largest increased growth since 2015 is synthetic opioids other than methadone (like fentanyl)
what are the criterion of the DSM-5 for SUD?
hazardous use
social/interpersonal problems related to use
neglected major roles to use
withdrawal
tolerance
used larger amounts/longer
repeated attempts to quit/control use
much time spent using
physical/psychological problems related to use
activities given up to use
craving
must have 2+
what was the biggest change from DSM-4 to DSM-5 related to SUD?
remove legal problems and added craving to criterion list
what parts of the mesolimbic DA system play a role in sustaining drug use?
Nucleus Accumbens (NAcc) – reward center
Ventral Tegmental Area (VTA) – relays DA from both the prefrontal cortex and NAcc
what is the role of glutamate in sustaining drug use?
glutamate increases DA activity in the NAcc via projections from the VTA thus turning up the reward signaling
Glutamate tells the person that the drug is meaningful while DA is motivation behind it
what are the 4 short comings of the DA-reward hypothesis?
lack of relationship between DA release and addiction liability
lack of ability of DA modulators to treat addiction
while DA reward is operational for all who use drugs recreationally, few become addicted
addictive behavior observed with drugs not associated with euphoria
what is rhinitis medicamentosa?
prolonged use of topical nasal decongestants leads to persistent nasal congestion, even after ceasing med
what factors are more important in determining harmful drug use?
socioeconomic factors > biology
shown through marked geographical difference in drug OD deaths
what are the five theories for drivers of drug use called?
self-medication hypothesis
brain disease model
developmental or learning model
acculturation model
social contagion model
not mutually exclusive model
what are the two observations that argue against the self medication hypothesis?
over 90% of heroin addicts demonstrate the same accumulative drug use hx
there is no meaningful difference in drug of choice among addicts with different mental health diagnoses
for a person to be diagnosed with SUD, how many criterion do they have to meet?
2
severe is 6
