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Psych Addictions > Midterm 1 Lecture > Flashcards

Midterm 1 Lecture Flashcards

1
Q

What are a few of the social determinants of health

A
  • Income
  • Education
  • Housing
  • Indigenous status
  • Gender
  • Race
  • Disability
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2
Q

The lower your income, the ______ your health

A

lower

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3
Q

What are the indirect impacts of SUDs on social costs (dollars lost due to SUDs)

A
  • loss of wages due to death
  • disability
  • being absent from work
  • being present at work but not able to function
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4
Q

Which drug has the highest social cost ($)

A

Alcohol

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5
Q

What are the top 4 substances that have the highest social cost ($)

A
  1. Alcohol
  2. Tobacco
  3. Opioids
  4. Cannabis
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6
Q

Are most healthcare providers prepared to work with patients who have SUD?

A

No, many lack the training and often patients aren’t asked about their drug habits

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7
Q

What is often implicated in many suicides

A

Alcohol and other drugs

> either SUDs or substances in their systems

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8
Q

Do most people with an addiction receive treatment?

A

Not, most do not

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9
Q

Why do words and labels matter?

A

Language can stigmatize and impact behaviour

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10
Q

Stigma

A

Negative attitudes and beliefs about a person that creates prejudice, and leads to negative actions

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11
Q

Self stigma

A

Internalization of negative beliefs and attitudes, and applying them to the self

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12
Q

5 levels of the substance use continuum

A 
Level 0:  Total abstinence 
Level Rare to social use 
Heavy social use 
Heavy problem use/early addiction 
Middle to late stage addiction
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13
Q

“Addiction” is used to refer to which end of the continuum of substance use?

A

The extreme end

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14
Q

4 criteria for having an Addiction

A
  • Loss of control over the use of a substance
  • Use substance under risky circumstances
  • Experience social impairment due to substance use
  • Developed physical dependence on the substance as evidenced by tolerance and withdrawal
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15
Q

T/F Many people who could be categorized at experiencing an Alcohol Use Disorder recovered on their own without treatment within 4 years (according to one study)

A

True

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16
Q

What is the most common drug of abuse

A

Alcohol

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17
Q

Are people stuck at one stage on the addiction continuum?

A

No, it is fluid and you can move between stages

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18
Q

Screening

A

determining who needs further assessment

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19
Q

Who gets screened?

A

ppl we think are at higher risk for a disease than the general population

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20
Q

Assessment

A

Defines the nature and the severity of the problem

> Do they meet diagnostic criteria

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21
Q

What are the 4 things you are aiming to do in the first contact with a client

A
  • Build relationship
  • Increase person’s motivation for change
  • Assess the person’s strengths
  • Identify supports to help the person through the change process
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22
Q

5 characteristics of screening tools

A
  • short
  • quick to administer and score
  • quickly detect possibility of a problem
  • can be used in a variety of settings
  • not precise
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23
Q

What types of questions should be asked in screenings?

A

Open-ended questions

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24
Q

TWEAK screening acronym

A 
Tolerance 
Worried 
Eye-opener
Amnesia
Kut down
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25
Q

What are benefits and draw backs of using online or paper screening tools

A
  • inexpensive
  • less threatening than face to face
  • Vulnerable to deception
  • require literacy
  • must be valid on pop of interest
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26
Q

6 steps to a diagnostic assessment

A
  1. Referral question
  2. Clinical interview
  3. Substance use evaluation
  4. MSE, Mental Status Exam
  5. Formal testing
  6. Summary and diagnosis
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27
Q

During a diagnostic assessment, what things do you want to pay attention to while they are speaking

A
  1. The “what” of the speech (content)

2. The “how” of the speech (speed, body language)

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28
Q

Referral question

A
  • how the client finds their why to the practitioner

- what is the question the practitioner is being expected to be answered

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29
Q

What is the first thing you do in a clinical interview

A

Getting informed consent

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30
Q

What is a semi-structured interview

A

There is certain info we try to gather from everybody, but you want to have flexibility to pursue the necessary leads

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31
Q

6 general areas that the MSE screens for

A
  • Appearance, behaviour and attitude
  • speech and communication
  • mood and affect
  • ideation and thought content, hallucination
  • orientation and memory
  • intelligence, judgement and insight
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32
Q

Phase 1 in the substance use evaluation

A
  1. Extent and severity of use
    - type, amount, frequency, tolerance, family history
  2. Problems associated with substance use (life problems)
    - social, family, work, consequences, legal
  3. Past military service
  4. Treatment
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33
Q

Phase 2 in the substance use evaluation

A
  1. Determine the appropriate level of care
  2. Client treatment goals
  3. Treatment readiness and motivation
  4. Client’s strength
  5. Recovery capital
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34
Q

3 types of tests in formal testing

A 
Objective tests (MMPI)
Projective tests (TAT)
Intelligence tests (WAIS)
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35
Q

Validity

A

How well the test accurately measures the construct of interest

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36
Q

Reliability

A

The test’s ability to measure the construct of interest consistently and in a stable manner

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37
Q

______ make a decision based on one piece of data /souce

A

NEVER

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38
Q

What has been shown to increase increase the accuracy of the information that the client gives

A
  • Alcohol free
  • given assurance of confidentiality
  • in a clinical or research setting
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39
Q

4 key concepts in DSM5 diagnosing

A

Disability
Distress
Impairment
Functioning

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40
Q

2 of the following 11 criteria need to be met for 12 months to be diagnosed with an Alcohol Use Disorder (AUD)

A
  1. Alcohol taken in larger amounts or over a longer period then intended
  2. Persistent desire or unsuccessful efforts to cut down or control use
  3. Spend lots of time getting, using, or recovering from alcohol’s effects
  4. Craving or strong urge to use
  5. Recurrent use results in failure to fulfill major role fulfillment
  6. Continued use despite continued problems
  7. Important activities given up or reduced because of alcohol use
  8. Recurrent use in situations where it’s physically hazardous
  9. Continued use despite knowledge of a problem what was caused or exacerbated by alcohol
  10. Tolerance (behavioural tolerance = practiced at masking impairment)
  11. Withdrawal or alcohol or benzo taken to avoid withdrawal symptoms
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41
Q

Number of criteria met and corresponding severity for an alcohol use disorder

A

2 -3 mild
4-5 moderate
6+ severe

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42
Q

What other drug is very often taken with alcohol use?

A

Smoking cigarettes

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43
Q

Issues you need to be aware of when people are using multiple substances

A
  • Cross tolerance
  • Pharmocological synergism
  • Cigarette use
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44
Q

Pharmocological synergism

A

Interactions that amplifies both effects

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45
Q

What two psychological illnesses often go hand in hand with SUD

A

Anxiety and depression

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46
Q

Bi-directional model of dial diagnosis

A

the SUD and psychiatric illness both cause each other

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47
Q

Common factor model of dial diagnosis

A

Overlapping diathesis for SUD and psychiatric conditions

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48
Q

What is a major problem when people have a psychiatric illness as well as a SUD

A

the SUD may mask the mental illness symptoms or be misdiagnosed as an MI symptom

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49
Q

Can most people with an SUD benefit from treatment?

A

Yes, regardless of the severity

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50
Q

ASAM levels of care

A

Level 0.5: Early intervention
Level 1: Outpatient treatment
Level 2: Intensive outpatient treatment/partial hospitalization
Level 3: Residential/inpatient treatment
Level 4: Medically managed intensive inpatient treatment

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51
Q

Client-treatment matching

A

Matching the level of treatment with the severity of the problem. The least intensive treatment possible

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52
Q

Transtheoretical model of change 6 stages

A 
Pre-contemplation 
Contemplation 
Preparation 
Action 
Maintenance 
Relapse
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53
Q

Recovery capital

A

Any resource in the person’s world that can be tapped to initiate and sustain recovery from alcohol and other drug problems

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54
Q

What are ways that drugs are classified?

A

Grouped by similarity:

  • Therapeutic use
  • Mechanism of action
  • Mode of action
  • Chemical structure
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55
Q

Psychoactive

A

Substances that act on the mind and impacts mental status

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56
Q

Three main categories of drugs

A

Stimulants
Depressants and opioids/narcotics
Hallucinogens

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57
Q

Addictive drugs hijack the ________ centre in the brain

A

reward/pleasure

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58
Q

Physiological effects of stimulants

A

Increased: heart rate, blood pressure, bod temp, metabolic rate, pupils
Decreased: appetite, salavation

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59
Q

NT that are effected by stimulants

A

Norepinephrine
Dopamine
Serotonin

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60
Q

Some examples of stimulants (5)

A 
Cocaine 
Amphetamines 
Methylphenidate 
Tobacco 
Caffeine
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61
Q

What does it mean to say that stimulants are sympatho mimetic

A

They mimic the effects of the sympathetic nervous system

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62
Q

Do people overdose from stimulants?

A

Not really

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63
Q

How do people die when taking stimulants

A

heart attacks

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64
Q

Desired effects of stimulants (4)

A
  • More awake
  • Elevated mood
  • More dopamine activity
  • Behavioural excitement
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65
Q

Undesired effects of stimulants (4)

A
  • Anxiety
  • Reduced self control
  • Irritability
  • Psychosis at high doses
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66
Q

What are bath salts? What makes them so deadly?

A

Mixture of drugs (cocaine and amphetamine-like)

>lethal because we don’t know what is in it

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67
Q

Symptoms of bath salts (7)

A
  • Shortness of breath
  • blurred vision
  • tremors
  • seizures
  • convulsion
  • psychosis
  • high BP
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68
Q

What is psychoactive in tobaco

A

Nicotine

69
Q

How quickly does nicotine hit the blood?

A

Very quickly, within ~20 seconds

70
Q

What is dangerous in cigarettes?

A

The tar in it, not the nicotine

71
Q

What does nicotine do for you?

A

Increases: psychomotor performance and alertness
Decreases: stress

72
Q

Why is smoking more reinforcing than wearing a nicotine patch?

A

Because nicotine enters the blood stream faster when inhaled than through the skin, so there is a more instantaneous reward

73
Q

What is the “gentle stimulant”?

A

Caffeine

74
Q

Symptoms of caffeine (3)

A
  • Elevates mood
  • Decreases fatigue
  • Inhibits sleep
75
Q

Amphetamines are ______ that lead to a ______

A

Uppers

Down (crash)

76
Q

Symptoms of amphetamines (3)

A

Reduced:

  • appetite
  • weight
  • fatigue
77
Q

Symptoms of cocaine (3)

A
  • Increases alertness
  • Increases blood pressure
  • Causes insomnia
78
Q

Why is cocaine dangerous

A

Increases blood pressure and constricts arteries so it can result in respiratory and cardiovascular collapse

79
Q

What can cause death with depressants

A

Because they are a CNS inhibitor, they can slow down respiration and heart rate too much and cause death

80
Q

What do sedative hypnotics do? (what are the effects)

A 
Sedative =  calming (anxiolytic)
Hypnotic = sleep inducing
81
Q

When are you are particularly high risk for over dose with sedative hypnotics?

A

When combined with alcohol

82
Q

Drugs that end with “al” are usually what type?

A

Barbiturates

83
Q

What are the long term effects of sedative hypnotics

A

Cross tolerance
Withdrawal
- shakes, anxiety, insomnia

84
Q

What are minor tranquilizers and what are the major tranquilizers

A

Minor: benzodiazepines
Major: anti-psychotics

85
Q

How long can you safely take benzodiazepines? Why?

A

Short period (like a week)

Why: because they are quite addictive and can cause death when mixed with alcohol

86
Q

What are the effects of date rape drugs?

A
  • Weaken resistance of individual, resulting in apparent consent
  • Inhibits memory formation after
87
Q

What are the effects of benzodiazepines?

A
  • Increase mood
  • Increase sociability
  • reduce anxiety and depression
88
Q

What receptor cites to depressants work on?

A

GABA

89
Q

What do Hallucinogens/Psychedelics do

A

Act on NT to produce visual hallucinations and out of body experiences

90
Q

What is the primary psycho-biological action of hallucinogens

A

Marked alterations in cortical functioning including cognition, perception and mood

91
Q

“psychotomimetic”

A

Mimics psychotic states

92
Q

3 types of hallucinogens drugs

A

LSD
Psilocybin
Cannabis

93
Q

hallucinogens stimulate which part of the autonomic nervous system

A

sympathetic

94
Q

Hallucinogens can cause synesthesia, what is that?

A

a cross in sensation modalities (like hearing colours)

95
Q

Is there a risk of over dose or withdrawal with hallucinogens?

A

No

96
Q

How can there be no withdrawal with hallucinogens

A

because it does not activate the dopamine system

97
Q

Reverse tolerance

A

When there are more effects after repeated use

–> sensitization

98
Q

Different effects of THC and CBD

A

THC is the psychoactive part

CBD has no psychoactive properties

99
Q

What drug does reverse tolerance happen with

A

Cannabis

100
Q

Overdose risk with cannabis?

A

Not really but behaviours while impaired can cause personal harm

101
Q

Opioids are under which drug class

A

Depressants

102
Q

Opioids are analgesics/narcotics, what do they do?

A

Reduce pain and induce sleep

103
Q

Characteristics of opioids (4)

A
  • Pain killers
  • Mimic analgesic actions of endorphins
  • Inhibit release of pain-inducing NT
  • Highly addictive
104
Q

What are the physiological effects of opiates, what body system are implicated

A

CNS and PNS are depressed

105
Q

What are the fatal effects of opioids

A

Respiratory and cardiac depression

106
Q

Tolerance and withdrawal of opioids severity

A

Rapid and dramatic tolerance

Severe flu like symptoms of withdrawal

107
Q

Drug effects are influences by 3 things:

A
  1. Baseline state (genetics, gender, weight)
  2. Pharmacokinetics: how time impacts a drug moving through your body
  3. Routes of administration
108
Q

A drug’s primary intended and side effects are affected by the:

A

method of administration

109
Q

What are enteral forms of administration

A

through the gastrointestinal tract

110
Q

2 types of enteral administration

A

Orally

Rectally

111
Q

What route of administration is both the easiest but also the slowest

A

Orally

112
Q

What is the advantage of slow release drugs?

A

If you are having an adverse reaction, there is time to intervene

113
Q

Draw back of oral route of administration

A

The acidic environment of the stomach. Can interfere with the drug or cause build up of drug and cause upset stomach

114
Q

Why are most drugs absorbed through the small intestine

A

Because then the blood is then filtered through the liver

115
Q

What can be a danger of the slow release of oral drugs

A

It takes a while for people to feel the effects so they take another does

116
Q

Parenteral forms of administration

A

Injecting drugs using a needle

117
Q

what is the advantage with injection drugs (2)

A

Rapid absorption and effects

Bypasses absorption barriers

118
Q

3 types of injection administration

A

Intravenous (IV)
Intramuscular (IM)
Subcutaneous (SC)

119
Q

Disadvantages of parenteral drug administration (4)

A
  • possibility of infection
  • Drug levels peaks almost instantly
  • Rapid onset or “rush” increases addiction potential
  • skin and veins scar after repeated injection
120
Q

3 types of transdermal drug administration

A

Intranasal (snorting)
Sublingual - under the tongue
Transdermal

121
Q

Advantages of transdermal administration

A
  • Ease of administration
  • Rapid absorption (bypasses gut)
    -
122
Q

Disadvantages of transdermal administration

A
  • Tissue damage at site of administration

- Not many drugs can be administrated this way

123
Q

What method is the fastest route of administration

>Why

A

Inhalation

> Because lung tissue has a rich blood supply

124
Q

The faster the rate of drug effect onset, the _____ addictive the substance

A

More

125
Q

What is a disadvantage when volatilization is achieved for inhaling by burning (like cigarrettes)

A

There are carcinogenic by-products

126
Q

Why is vaping safer?

A

Because there is no burning that results in carcinogens

127
Q

Therapeutic window

A

MeaA ratio of the effective does and lethal dose

128
Q

Is a high or low therapeutic window better?

A

High, because then there is more of a range where the drug works before there are bad side effects

129
Q

Adulterants

A

Substances that are used to “cut” other drugs

> fentanyl used to cut cocaine

130
Q

Alcohol is subject to what when it goes through the liver

A

First pass metabolism

131
Q

What has an impact on rate of absorption for alcohol

A
  • Food in stomach
132
Q

What has an impact on rate of absorption for alcohol

A

Food in stomach

133
Q

Why is alcohol called a “dity” drug for the mechanism of action?

A

Because it affects many different systems

134
Q

How does alcohol being “dirty’ effect with prescribed medication

A

Since alcohol has an effect on a regular basis, chances are that it will interact with your medication

135
Q

Biotransformation of alcohol

A
  • Some of the alcohol is absorbed straight through the mouth tissue
  • Then it is metabolized by ADH in the stomach and liver
136
Q

One of the ingredients in making ADH (alcohol enzyme) is testosterone. What gender effects does that result in?

A

Men have more testosterone, so they have more ADH and can metabolize alcohol better

137
Q

Alcohol-flush reaction. What is it, what causes it?

A

Red face, dizziness, heart palpitations from drinking alcohol
Caused by a build up of a toxic metabolite of alcohol

138
Q

How long does it take to metabolize one serving of alcohol?

A

One hour

139
Q

Concentration of alcohol in your blood is _______ to the amount of alcohol in your exhales breath

A

proportional, the same

140
Q

What do you use to treat delirium tremens? Why?

A

Benzodiazepines

They are in the same drug class (cross tolerance)

141
Q

of drinks for binge drinking for men and women

A

women: more than 4
men: more than 5

142
Q

3 high risk drinking issues

A
  1. Alcohol induced blackouts (assault, risky sex, injury)
  2. Pre-drinking
  3. Drinking to cope
143
Q

Low risk drinking guide lines for men and women

A

Women: 2/day, 10/week
men: 3/day, 15/week

144
Q

What is a working definition of social drinking

A

They do not experience negative side effects/consequences that heavy drinkers do

145
Q

What is straight edge culture?

A

A punk subculture who take a “vow” to substance abstinence, safe sex, and commitment to anti-racism

146
Q

The framework from which you practice in a clinical setting drives what?

A

Treatment

147
Q

What was the moral model (old) of addiction (4)

A
  • Addiction was a sin
  • It was a character flaw
  • It was self inflicted
  • Thought that people should be punished
148
Q

Criticisms of the moral model of addiction

A

Only punitive and no theoretical foundation that helps people

149
Q

The traditional disease model of addiction (4)

A
  • People are considered sick
  • It is beyond people’s control
  • No continuum, addiction is either present or it is not
  • There is no cure, only remission through total abstinence
150
Q

Which of the early perspectives of addiction is de-stigmatizing

A

traditional disease model

151
Q

How does Jellinek frame addiction?

A

Framed it as a disease like cancer

152
Q

Advantages of the disease model of addiction (4)

A
  • Addiction becomes a health rather than a moral issue
  • Provides an explanation that is easy to understand
  • Offers a treatment approach that works for some people
  • De-stigmatizes
153
Q

Disadvantages of the disease model of addiction

A
  • removes responsibility from the user
  • only 1 course of treatment
    Not supported by research
154
Q

What is the view of the cause of addiction today?

A

Equifinality = there are many potential causes

155
Q

What is the bio-psycho-social plus model

A

It sees that biology, psychology, social plus cultural and spiritual factors all work together and interact to create a problem

156
Q

In the neuroscience perspective, what are the 3 main factors that contribute to addiction

A
  • Genetics
  • Environment
  • Human development
157
Q

In the biological approach to the bio-psycho-social model, what is the focus

A

the brain is the centre of addiction

158
Q

The architecture of the brain develops in interaction with what?

A

The environment

159
Q

What happens to brain development during trauma

A

Brain circuits don’t develop in a healthy, optimal way

160
Q

What NT is released when a drug is taken that is a reinforcer?

A

Dopamine

161
Q

Learning and dopamine in addiction

A

When you do something rewarding, dopamine is released to notify the brain that it was a good thing to do and increases memory of the event so they will do it again

162
Q

The social learning model of addiction

A

Addiction is a learned behaviour that results from conditioning
> when something is pleasurable we do it more
> stop doing something when the costs outweigh the benefits

163
Q

Cognitive perspective of addiction

A

Thoughts and beliefs shape our behaviours and emotions

Our causal attributions influence behaviour

164
Q

Negative cognitive triad

A

Pessimistic view of the self, the world, and the future

165
Q

What is the relationship between ACE and substance use

A

People who score high on the ACE scale due to trauma and abuse are more likely to suffer from SUDs

166
Q

When thinking of the social/cultural aspects of the bio-psycho-social model, what should we think of?

A

The social determinants of mental health

167
Q

What is a very important macro-level social factor of substance use?

A

Social-economic disadvantage: poverty

168
Q

What is the spiritual aspect of the bio psycho social model?

A

It is a focus on self-awareness and its relationship with self-determination and responsibility for one’s own choices

169
Q

Whats is the role of spirituality and religion in addiction

A

See there is something bigger than ourselves and is life affirming, part of a community

Psych Addictions (2 decks)

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