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Flashcards in Psych - Substance Use Disorders Deck (16):
1

Defining Addiction

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry

NOT the result of something else, but a primary disease -- it is CHRONIC not recurrent too

NOT to be confused with DEPENDENCE --> physical dependence can develop from use of substances that are NOT addictive

SPEED OF ADMINISTRATION is what determines addiction most --> SMOKING is the fastest way!!!

2

TOBACCO

Morality due to tobacco = 400,000/year is MORE than the mortality due to alcohol and ALL OTHER DRUGS combined

Use is declining in the US (down from 40% to 20% in the past 50 years), but there are ~3,000 new smokers each day with an average starting age of 16 years old

Genetic influences --> component of tobacco, ACETALDEHYDE, synergistically interacts with nicotine to make BOTH more reinforcing and addictive

Use of tobacco by addicts of OTHER substances is ~70%

3

ALCOHOL

65% of adults in the US drank in the past year

Used to think of alcoholism as a disease of middle age, but in reality it is a disorder of YOUNG ADULTS (18-30 y.o.)

Alcohol use disorder doesn't become very diagnosable until ages 25-40

The majority of those with alcohol use disorder DO have stable jobs and DO NOT abuse other drugs

****TOLERANCE lends itself to addiction --> 0.40 mg% is technically the LETHAL level of BAC, but many alcoholics can reach this level EASILY!

Alcoholics who's BAC is 0.2 mg% (2.5 times the limit) can show no impairment whatsoever

****Alcoholics also have DECREASED INTERNAL CONTROL --> alcoholic has trouble stopping themselves from drinking

4

Marijuana

Most frequently used illicit drug in the US -- peaked in the 1960s and 1970s, rising again now

Because the use of marijuana is becoming more and more legal, it is possible that the PERCEIVED DANGER IS DECREASING and thus illicit use is increasing

Marijuana is perceived as harmless, but there are SIDE EFFECTS, including impaired judgment, amotivational syndrome, reduced IQ in those who begin early, pulmonary problems, and possible withdrawal

5

Opioids

Obviously are useful and provide effective relief from pain, coughing, anxiety and depression, but can cause a lot of problems when they become addictive!!!

Older, street heroin users common

Middle-class younger demographic is ON THE RISE! These guys use PRESCRIPTION PAIN PILLS, though as their tolerance builds up, they may switch to heroin

DEATHS from PRESCRIPTIONS are more common than those from heroin!

Prescription use has leveled off, but heroin use has started to rise again (cheaper)

Opioid system resensitizes (receptor population changes) during a period of abstinence --> thus RELAPSE can be PARTICULARLY FATAL

More prescriptions written in the past decade, so we are perpetuating the addiction!

6

Stimulants

Less common

Cocaine use is actually down, amphetamines are rising
This has to do with the increased use of crystal meth in the past decade or so (MDMA - ecstasy) is also increasing

People generally DONT use stimulants on the daily; more of a BINGE and CRASH cycle

Stimulants are HIGHLY REINFORCING AND ADDICTIVE, but there is NO SIGNIFICANT WITHDRAWAL from them

7

Caffeine

Can have excess amounts of caffeine and can get withdrawal headaches, but there is no real dependence diagnosis for caffeine abuse

8

Genetics and Addiction

Genes can be protective!! The ABSENCE of ACETALDEHYDE DEHYDROGENASE in some Asian populations can be protective against becoming an alcoholic

Genetic influences can also be bad! Alcoholism in biological parents can lead to HIGHER TOLERANCE in children; those with high tolerance tend to become alcoholics; CHILDREN OF ALCOHOLIC PARENTS WILL HAVE A QUANTITATIVE HIGHER TOLERANCE (decreased sensitivity) BUT ALSO A QUALITATIVE INCREASED SENSITIVITY TO ALCOHOL

9

OPRM1


OPRM1 --> encodes the mu opioid receptor; particular allele of the gene will make the mu receptor more sensitive in a subset of children with alcoholic patients; MORE LIKELY TO BECOME ALCOHOLIC BEFORE AGE 25!

"G" allele --> more positive reinforcing effect when they drink, via a greater beta endorphin release and spike. Large endorphin spike hits a more sensitive receptor, so these patients experience alcohol in a more pleasurable way. QUALITATIVE increased sensitivity to alcohol

Consider this mutation if you have an alcoholic patient < 25 with alcoholic parents

10

CNS changes that result in heavy use

Decreased activity of the prefrontal cortex

Morphological changes in dendrites in the nucleus accumbens

Brain stress system changes

Decreased executive function, impaired learning and memory, impaired inhibition

When a person's alcohol intake is chronically elevated, their glutamate levels are also elevated in a compensatory mechanism called ALLOSTASIS --> when we remove alcohol, there will be a persistently high level of glutamate --> this contributes to post-acute withdrawal symptoms and relapse!

11

Summary of Addictive Behavior

Neurobiological changes seen in addiction and substance use disorders is a SHIFT IN THE BALANCE BETWEEN REFLECTIVE AND IMPULSIVE PARTS OF OUR BRAIN

Our inhibitory functions and functions of the FRONTAL CORTEX are REDUCED, and our LIMBIC SYSTEM IS ENHANCED --> leads to addictive behaviors!

Genetic differences in sensitivities to certain substances combined with environmental circumstances contribute to this change and should be considered when dealing with patients that have substance use disorders.

12

What is "safe drinking"

Men --> 2-14-5: No more than 2 drinks per day, 14 drinks per week, or 5 drinks per occasion

Women = 1-7-4; no more than 1 drink per day, 7 drinks per week, 4 drinks per occasion

13

AUDIT Questionnaire

When evaluating a patient's alcohol use, ask "how many times in the past year have you had 5 (4 for women) or more drinks in a day?"

If they answer one or more times, follow up with the AUDIT (Alcohol Use Disorder Identification Test) questionnaire --> help to elucidate whether a problem exists, and if it does, what the severity of the problem is

It is a series of 10 questions, takes 5 minutes to administer, and can help detect any alcohol problems within the past year

AUDIT-C is a shortened version that takes about 3 minutes to administer and assesses hazardous use of alcohol

14

Operational Diagnosis of Substance Disorders

Continued use of alcohol and/or drugs despite a pattern of adverse consequences

Therefore, diagnosis is made based upon the CONSEQUENCES of drinking or drug use, as opposed to the AMOUNT or FREQUENCY.

15

Treating Substance Abuse Disorders

Diagnosed addict is ALWAYS an addict! Goal of treatment is RECOVERY, not CURE!

BEcause thy are always an addict, abstinence is recommended over moderation and the addiction must be monitored over time

Patient should be separate from the substance and placed in a healing environment that includes family, friends and community support

Support groups are also key for managing substance abuse disorders

16

Smoking Cessation

70% of smokers have tried to quit with only 5% being successful in quitting in a given attempt

It typically takes 5-7 unsuccessful attempts before an individual is able to quit smoking

Currently, medication has been the mainstay of treatment, but combination therapy with talking is more effective