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Pmcol 305 > Recovery + Harm Reduction > Flashcards

Recovery + Harm Reduction Flashcards

1
Q

cycle of addiction

A

initial drug use
acute drug experience
drug withdrawal
chronic drug experience

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2
Q

initial drug use

A

genetics - impulsivity
mood
environment

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3
Q

acute drug experience

A

euphoria
analgesia
anxiolytic
antidepressant

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4
Q

drug withdrawal

A

opposite of acute effects - dysphoria, pain, anxiety
unpleasant symptoms drive craving and relapse

certain drug withdrawals have lethal symptoms ex. alcohol

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5
Q

chronic drug experience

A

neurological adaptations (molecular, cellular, behavioural)
tolerance to positive effects of drug + natural rewards
loss of prefrontal cortical control of drug behaviours → compulsive drug seeking

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6
Q

biopsychosocial disease

A

biological factors can increase likelihood of developing an addiction and can promote continued use
also highly correlated with environmental factors

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7
Q

biological factors

A

Mu opioid receptors
neuroadaptations
concurrent mental illness

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8
Q

psychological + social factors

A

psychological:
- support services

social:
- interpersonal relationships
- treatment + drug-use settings
- SES

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9
Q

behavioural interventions

A

CBT
contingency management interventions/motivational incentives
counselling/therapeutic communities

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10
Q

CBT

A

psychosocial intervention administered by psychologist
develop non-drug coping strategies to triggers

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11
Q

contingency management
motivational incentives

A

individuals are rewarded for evidence of positive behavioural change
ex. get money for clean urine drug screens

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12
Q

counselling communities

A

alcoholics/narcotics anonymous

pros:
- connects people to community
- de-stigmatizes drug use
- free

cons:
- no medical interventions
- religious undertones
- abstinence only

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13
Q

systematic reviews and meta-analysis

A

reduce biases and random errors - combine results of many primary studies
highest quality of evidence
data expressed in forest plots

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14
Q

pharmacological interventions

A
  1. block positive effects of drug
  2. make withdrawal easier
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15
Q

drug withdrawal treatment

A

help maintain abstinence; safely + effectively stop drug use
involves treatment with a drug that targets the same receptor as the drug of abuse but has safer therapeutic profile

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16
Q

nicotine replacement therapy

A

provides nicotine by other means than tobacco
alleviates side effects of withdrawal; reduced cravings
increases success of quitting by 55%

side effects are similar to tobacco - dry mouth, headaches
long term use is better than tobacco but minimal studies

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17
Q

alcohol withdrawal

A

alcohol - PAM of GABAa receptor (inhibition)
chronic use upregulates excitatory glutamate signaling to balance excessive inhibition

cessation of alcohol use leads to over excitation - inhibitory balance is removed → can be lethal

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18
Q

alcohol withdrawal treatments

A

drugs that promote GABA signaling to restore inhibition
- benzodiazepines

19
Q

benzodiazepines

A

PAMs at GABAa receptors (like alcohol)
→ enhance GABA activity by binding to allosteric site
have no effects in absence of GABA
short term use

20
Q

opioid withdrawal

A

opposite symptoms of acute use
- anxiety, pain, dysphoria
symptoms last long term = vulnerable to relapse even years after use

21
Q

agonist replacement therapy

A

opioid withdrawal treatment
includes maintenance on opioid agonist + CBT
blunts symptoms of withdrawal
replacement agonists have longer half-lives to avoid repeated high/crash cycle
safe for long term use

methadone
buprenorphine

22
Q

methadone

A

half life = 24-42 hours
long acting full agonist of mu opioid receptor

overdose is still possible because it is a full agonist

23
Q

buprenorphine

A

partial agonist at mu opioid receptor
24 hr half-life

safer agonist profile
suboxone → combine buprenorphine with naloxone to prevent abuse

24
Q

advantages of agonist replacement therapy

A

reduces drug cravings
better participation in addiction treatment - no withdrawal symptoms
improved social functioning
reduce harms of illicit drug use

25
treatments to block drug effects
block positive effects of drugs of abuse removes reinforcing effects of drugs so it is no longer rewarding disulfiram naltrexone drug vaccines partial dopamine agonists
26
disulfiram
inhibits acetaldehyde dehydrogenase - ingestion of alcohol results in accumulation of acetaldehyde enhances the unpleasant effects of alcohol - tachycardia, nausea, vomiting must be taken daily to be effective; does not treat cravings
27
naltrexone
antagonist at mu opioid receptor blocks reinforcing properties of drugs of abuse - alcohol + opioids reduced drug craving and relapse rates requires daily dosing
28
drug vaccines
cocaine analog is conjugated to an antigenic protein evokes immune response to cocaine = antibodies will bind to cocaine and block transport into brain early phase II clinical trials
29
pros of drug vaccines
adherence is not an issue - no daily dosing vaccines don't enter brain - can be used in combination with other interventions
30
cons of drug vaccines
length of effect is unknown high doses might overcome immune response high drug specificity - only work against cocaine ethical concerns
31
partial dopamine agonist
full DA agonists and antagonist carry lots of side effects - tremors, ataxia, psychosis some evidence for partial dopamine agonists aripiprazole
32
aripiprazaole
partial DA agonist at D2 receptor good evidence to treat cocaine addiction; some evidence to treat opioid addiction less activation - competitive acts as antagonist to dopamine when DA absent - agonist → ease withdrawal phases
33
harm reduction
policies, programs, and practices that aim to minimize the negative health, social, and legal impacts associated with drug use, policies, and laws includes laws, resources, treatments
34
goals of harm reduction
keep people alive minimize harms of drug use improve laws, policies, and enforcement practices offer evidence-based interventions
35
alcohol prohibition
1920-1933 reduced alcohol use; less public intoxication over time, increased use
36
iron law of prohibition
potency of prohibited substances increases as law enforcement becomes more intense
37
war on drugs
aim of reducing drug abuse and illegal drug trade had little effect on drug use overall incarceration of users is expensive does not treat underlying addiction
38
decriminalization
harm reduction strategy non-criminal penalties are available for designated activities - fines
39
legalization
removes all penalties for possession and personal use of a drug regulations are maintained pros - drugs can be regulated cons - amplification of negative effects if larger population of users
40
drug education
provides information on risks and harms of drug use focused on abstinence effective drug education presents evidence-based information on risks and ways to mitigate those risks
41
supervised consumption sites
safe place to take drugs to reduce harm or overdose individuals bring own drug given clean needles; medical supervision free access
42
safe supply
legal and regulated supply of drugs programs check for contaminants
43
injectable opioid therapy
referral program must have failed all other addiction treatment prescribed specific doses of injectable opioids - self-administration at clinic monitored for adverse reactions
44
acute intoxication treatment
Narcan (naloxone) reverses overdose non-selective competitive opioid receptor antagonist works within minutes lasts about 30 min

Pmcol 305 (18 decks)

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