Lecture 9 (Substance related disorders)

Question 1

Epidemiology

Answer 1

value of life lost to addiction = 48 billion
drug induced deaths = 1%
opioids death most common -> human made not natural
Fewer people are smoking, but vaping has tripled

low SES more likely to smoke and use vapes

Risky alc use >10 standards per week / >4 per day -> decreasing over the years
31% 14-17 have drank in past year, 42% (18-24) risky drinking in past year

In past few years more people using hallucinogens, decrease in S8s

Males much more likely

Average age of onset for sub use has increased over the years

24% alc disorder have mood disorder, 20% with anxiety

Question 2

DSM diagnoses

Answer 2

definest substance use disorders -> maladaptive pattern of behaviours related to continous use of drugs
Tolerance -> need for more amounts
Withdrawal -> unpleasent physical effects when trying to stop taking the drug

Mild 2-3 symptoms, moderate 4-5, severe, 6+

criteria involves impaired control -> social impairment, or pharm -> tolerance / withdrawal

DSM 5 has fused previous abuse and dependence diagnosis and added cravings

Substance induced mental disorders-> develop in the context of intoxification and/or withdrawal from substances -> symptoms may be identical to the disorder -> but will disappear within a month -> with exception of neuro symptoms

Question 3

Aetiology -> genetics / bio

Answer 3

One of the most heritable diseases
polygenic

All drugs produce changes in neurotransmitters -> empathogens (increasing affect for people)
but lots of people are poly substance users so body is confused with feels and leads to poor withdrawal processes

Substance use disorder is where neural pathways become disordered and motivational processes become amplified as a result

Thinking of it as a disease may be a problem as it takes away the autonomy of trying to fix it, but having it as a disease may reduce the stigma

increase in reward brain areas, and some drugs block GABA

Question 4

Aetiology -> social determinants, personality theories, and learning theory

Answer 4

Social determinants -> structures which people grow, not just about how you and the brain works, it may be about the broader structures we live in

Personality theories -> impulsivity -> approach (approaching stuff without thinking about consequence), neuroticism -> avoidance (using drugs to cope)

Learning theory -> uses operant conditioning -> positive reinforcement increases use (prominent in early stages of alc use)

Negative reinforcement -> relief of stress/anxiety increases substance use
leads to compulsive and dependance

Question 5

Aetiology social cog theory, and biosocial cog model

Answer 5

Social cog theory model -> individuals learn from and influenced by social environment -> individuals status can have powerful effect
self-effiacy has a big role -> belief one has the ability to refuse offers
Expectancies -> e.g. shy person has expectation that using will allow to be more social

Expectancies decreases ability for refusal self-efficacy which in turn increase drug use

Biosocial cog model -> incorporates biology (e.g. reward sensitivity and impulsivity) into affecting drug expectancies and self-efficacy, but bio can also have direct effect on substance use

Question 6

Aetiology -> motivation/change dynamics, recent models, and protective factors

Answer 6

argue that motivation to change is dynamic and not circular -> e.g. wanting to change -> changing -> relapse -> maintenance
-> it does not always go in this order and different people can be affected in different ways

Addictive behaviour seen as motivated decision
-> immediate cost of reward seeking is low and there is high access
the environment has limited reward substance free alternatives
Individuals have greater tendency for immediate rewards than prolonged rewards

Recent models - addiction viewed as motivational problem with that being the target of a theraputic approach, try to increase non substance rewards and shift motivational focus to distant rewards

Protective factors -> culture, parental monitoring and modelling, responsible use, affect regulation, +ve family environment

Question 7

Treatment -> government approaches

Answer 7

Harm minimisation policy -> 3 pillars (Demand reduction, supply reduction, harm reduction)

Sharps programs

Drug diversion programs -> e.g. warnings if first use and focus on educating people when they have substance use

Drug checking

Question 8

Treatment -> psych models

Answer 8

Assessing alc use and depending on severity based on what treatment
low severity = primary health care providers, counsellors, online services
moderate = psych treatments, pharm, detox if needed (still only primary health care providers)
High severity = specialised care (detox, pharm, inpatient)

use the alc use disorders identification test (AUDIT) or (ASSIST) test
>7 is cutoff

QuickFix intervention -> three modules over 3-2 sessions using motivational interviewing and doing goal setting. targets coping skills, and giving strats to manage personality risks

Motivational interviewing uses set of principles to help engagement -> talking to person with intent on them telling you why they need to change, allowing better goal setting and building commitment to change

Coping skills training
looking at personality and giving different strategies based on an individuals personality e.g. anxiety prone, depression prone, sensation seeking, impulsivity

Pharm approach