Substance Abuse

Question 1

Features of Addiction

Answer 1

A chronic mental health condition, where someone compulsively participates in an activity despite adverse health effects (this could include drug use, but it can also include behavioral addictions like sex addictions)

Question 2

4 C’s of addiction

Answer 2

(1) Compulsion
(2) Cravings
(3) Consequences
(4) Control

Question 3

Someone may experience one or more of the following:

Answer 3

(1) Dependence
(2) Abuse
(3) Intoxication
(4) Withdrawal
(5) Tolerance
(6) Difficulties controlling intake
(7) Consuming large amounts over time

Question 4

Features of Dependence

Answer 4

● May be aware of the dangers of using, but continues to use the substance
● Extreme efforts to obtain substance
● Decreased interest and participation in other activities
● Impacts daily life

Question 5

Substance Use/Abuse

Answer 5

● Substance use- using a substance (can be illegal if it is an illicit drug)
● Substance abuse- using a substance in a way that is not healthy for the way that substance is intended for use (this can include drinking in excess rather than 1 glass, misusing a prescription drug like Adderall, etc.)

Question 6

Withdrawal

Answer 6

● Often dangerous symptoms stopping use of
substance
● Can result in restlessness, anxiety, cramps, and even death depending on the substance/amount consumed

Question 7

Brain Response to Addiction

Answer 7

● Substances create a surge of dopamine, which creates a high feeling, and something the brain will continue to seek out for a higher level of reward/happiness
● Brain circuits adapt to this surge in dopamine, and eventually decrease their response to the substances, requiring someone to use more of a substance to create the same reward
● Long-term use can impact how the brain is able to locally respond (memory in the hippocampus area is affected, frontal lobe executive functioning is impacted, learning new information/working memory is impacted, etc.)

Question 8

Alcohol Use Disorder (AUD) Types

Answer 8

● Type I
○ Late-onset drinking that happens later in life
○ People are more prone to anxiety and other comorbid health diagnoses
● Type II
○ Drinking occurs during adolescence
○ Drink for euphoria, but not as frequently for mental health conditions

Question 9

Delirium Tremens (DTs)

Answer 9

Blood alcohol levels drop suddenly, resulting in:
● Deliriousness
● Tremulousness
● Hallucinations
○ Primarily visual; may be tactile

Question 10

Process of Metabolizing Alcohol

Answer 10

● Enters the system and is metabolized in the liver by special enzymes
● Once it reaches the brain, alcohol reduces the functioning of glutamate (excitatory neurotransmitter), and increases the functioning GABA (impacts anxiety levels, slows down neural excitability)
● Temporarily increases dopamine levels in the brain

Question 11

Long Term Impact of Alcohol Abuse

Answer 11

● Serious medical complications (malnutrition, liver damage, etc.)
● Long-term decreases in dopamine centers of the brain
● Cognitive difficulties
○ Destruction of brain cells

Question 12

The Disease Model

Answer 12

● Alcoholism previously viewed as form of moral degeneracy
● Current perspectives emphasize the concept of alcoholism as a disease-like process
● A progressive illness (gets worse and worse over time) with death as the end result
● There is no “cure” – only remission. One drink begins an inevitable slide back into disease.
● A heritable “allergy” and those who have it are biologically different
from those who do not

Question 13

E. Morton Jellinek

Answer 13

● Conducted surveys with a small group of men attending AA meetings.
● Concluded that alcoholic is a progressive illness (aligned with disease model)

Question 14

Jellinek Stages of Alcoholism

Answer 14

● (1) Pre-alcoholic phase
○ Drink occasionally
○ Social drinking/relieving tension
● (2) Prodromal phase
○ Heavier drinking than before
○ Few signs of alcoholism, but will sometimes be done in secrecy
● (3) Crucial phase
○ Loses control during drinking
○ Blackouts can happen after someone starts with one drink, social lives can be impacted, and binge drinking is more frequent
● (4) Chronic phase
○ Daily drinking
○ Physical intolerance, withdrawal if not drinking, and nutrition deficits

Question 15

Polydrug abuse

Answer 15

● Use of multiple substances
● Many users abuse multiple substances
○ Ex. Cigarettes, cocaine, marijuana
● 85% of people who misuse alcohol smoke as well

Question 16

Marijuana

Answer 16

● Drug derived from dried and ground leaves and stems of the female hemp plant (Cannabis sativa)
● Hashish
○ Stronger than marijuana
○ Produced by drying the resin exudate of the tops of plants
● THC activates nervous system and stimulates production of dopamine

Question 17

Marijuana Side Effects

Answer 17

● Relaxation and sociability
● Rapid shifts of emotion
● Interferes with attention, memory, and thinking
● Hallucinations and panic
● Reduced pressure within the eye
● Increased blood pressure, heart rate abnormalities
● Can aggravate pre-existing cardiovascular problems
● Damage to lungs

Question 18

Therapeutic Use

Answer 18

● Reduces nausea and loss of appetite caused by chemotherapy
● Relieves discomfort of AIDS
● Analgesic effects due to ability to block pain
signals from reaching the brain
● CBD does not create “high” feeling

Question 19

Heroin

Answer 19

● Opioid made from morphine
● Can be injected, sniffed, snorted, or smoked
● Slows down the overall nervous system, depressant
● Results in the following:
○ Euphoria, sleepiness, loss of self-control, increased confidence, rush
○ Intense feelings of warmth and ecstasy following injection
● Overdosing can cause breathing to stop, leading to death

Question 20

Amphetamines (Stimulants)

Answer 20

● Typically prescribed for treatment of attention deficit hyperactivity disorder (ADHD) or narcolepsy, but can be highly addictive
○ Speeds up communication between the brain and the body
● Stimulant drugs that have their strongest effects on dopamine levels
○ With continued use, body becomes dependent on substance to feel happy/experience dopamine effect

Question 21

Methamphetamine

Answer 21

● Stimulates production of Dopamine, and blocks reuptake of dopamine in reward centers of the brain
● An amphetamine
● First used in World War II to keep soldiers awake for long hours
● Kamikaze pilots used this to help them sustain the nerve for their suicide missions

Question 22

Short-Term Effects of Meth

Answer 22

● Feelings of energy, pleasure, euphoria, hypervigilance, restlessness, irritability, increased aggressiveness, attention, and alertness
● Tolerance can develop after only a few days of use

Question 23

Long-Term Effects of Meth

Answer 23

● Cardiovascular issues
● Reduction in hippocampus size in brain
● Irregular heartbeat
● Teeth loss
● “Crash states” when drug wears off
● Repeated use users no longer be able to experience pleasure (with or without the drug)

Question 24

Cocaine

Answer 24

● Produces a short, very intense, euphoric high
● High not as long-lasting as methamphetamine, but crash still very severe crash
● Reduces pain, produces euphoria, heightens sexual desire, increases self-confidence, blocks reuptake of dopamine in mesolimbic areas of the brain
● Involved in 23% of overdose deaths in 2021

Question 25

Hallucinogens

Answer 25

● Also known as psychedelics ● Strongest effect on serotonin system, which leads to a disruption in sensory information and leads to hallucinations ● Common hallucinogens: LSD and Mescaline ● Others hallucinogens: ○ Psilocybin ○ Ketamine ○ Ecstasy ○ PCP (phencyclidine) ■ Angel dust ■ Animal tranquilizer

Question 26

Short-Term Effects of Hallucinogens

Answer 26

● Hallucinogen effects include: ○ Colorful visual hallucinations ○ Synesthesias (information that goes to one area of the brain goes to several sensory systems) ○ Alterations in time perception ○ Fluctuating mood ○ Anxiety ○ Paranoia

Question 27

Long-Term Effects of Hallucinogens

Answer 27

● Hallucinations, both visual and tactile ● Paranoid thinking, extreme lability in mood, and depersonalization ● Behavior that is erratic and dangerous

Question 28

Recovery Options

Answer 28

● Contingency management ○ A type of CBT used for substance recovery (most often for stimulant use disorder) ○ Includes abstinence reinforcement and/or community reinforcement ● Marital and family therapy ○ Can address dynamics at home, such as codependency, conflict management, communication, and skill building to support individual experiencing addiction and for other family members ● Behavioral treatments ○ Aversion therapy through taking antabuse, that makes alcohol nauseating ■ Limited success ○ Community reinforcement ■ Social and environmental adaptations to maintain sobriety ● Beneficial for helping someone find alternative activities and strategies to avoid substances ● Relapse prevention ○ Prevent and solve problems to stop a return to substances ○ Often more helpful than controlled drinking treatment, where someone tries to have a smaller amount of a substance like alcohol

Question 29

Medications for Recovery

Answer 29

● Benzodiazepines are helpful for many people with substance use disorder ○ However, these also have high incidences of misuse, so caution may be applied ○ Can help with side effects of anxiety, if this is leading to alcohol use ● Detox medications for opioid use ○ Lofexidine can be helpful short-term ● Naltrexone can be helpful for alcohol or opioid recovery ○ Blocks euphoric/sedative effects of substances ○ Prevents feeling of getting high, so makes relapse less desirable ● Methadone for opioid use ○ A synthetic opioid agonist ○ Changes response of brain to pain ○ A painkiller, and some people will use this to get high