Substance-Related, Addictive, and Impulse-Control Disorders

Question 1

substance-related disorders

Answer 1

• problems associated with using/abusing drugs that later patterns of thinking, feeling and behaving
• DSM substance-related disorders encompass 10 separate classes of drugs
• include problems with used of depressants, stimulants, opiates, hallucinogens, gambling (specific diagnoses further categorized for any given drug)
• can have substance dependence, abuse, intoxication, withdrawal
• involve both physiological dependence (tolerance and withdrawal) as well as psychological dependence

Question 2

illicit drugs

Answer 2

• taken in excess and have common activation of the brain reward processes, which are somehow involved with reinforcement of behaviour and can be implicated in production or repression of memory
• produce such intense activation of reward systems that normal behaviours become neglected (instead of achieving reward system activation thr adaptive behaviours like hard work, drugs of abuse directly activate those systems)

Question 3

the high

Answer 3

-pharmacological mechanisms by which each class of drug produces rewards that are different, but typically activate the system and produce feelings of pleasure often referred to as a high

Question 4

substance use disorders

Answer 4

• indv with lower levels of self-control may be particularly predisposed
• interesting, bc it’s among this very class of individuals that the acute and intoxicating effects of substances are magnified, because of their predisposition
• suggests the roots of SUDs can be seen in behaviours that well precede diagnosis

Question 5

addiction

Answer 5

two views:

1. addiction is essentially a physiological dependence, and operates based on the presence of either tolerance or withdrawal
2. drug seeking behaviours themselves are a measure of psychological dependence
   - substance dependence is usually described as an addiction, but as seen above, there’s considerable disagreement on how to define it

Question 6

diagnostic issues in substance/addictive disorders

Answer 6

• substance use might be comorbid with other disorders
• drug intoxication and withdrawal cause increase risk-taking
• mental health disorders may cause or at least contribute to SUD

Question 7

depressants

Answer 7

• primarily decrease CNS activity, reducing arousal and helping you to relax (a positive pleasurable benefit)
• include alcohol, sedatives (reinforcing, calming effects), hypnotics (sleep-inducing), anxiolytics (anxiety-reducing) (all of which produce physical dependence, tolerance and withdrawal)

Question 8

alcohol-related disorders

Answer 8

• inhibitory centers in the brain are depressed/slowed; continued drinking depresses more areas of the brain leading to impaired motor coordination, which brings about reaction time, confused/poor judgments, and effects to vision and hearing
• use is continued despite knowledge of having persistent/recurrent physical/psychological problem likely to have been cause/exacerbated by alcohol
• more than half of ppl with alcohol disorders have a comorbid psychiatric disorder
• common to see a pattern of fluctuation btw heavy drinking and abstinence
• generally gets worse if untreated
• early consumption can predict dependence in later years
• linked with violent behaviour

Question 9

DSM-alcohol use disorder

Answer 9

problematic patter of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following occurring within a 12-month period:

• alcohol often taken in excess amts or over a longer period than intended
• persistent desire or unsuccessful efforts to cut down/control alcohol use
• great deal of time spent in activities necessary to obtain/use/recover to the effects of alcohol
• craving/strong desire/urge to use
• recurrent use resulting in failure to fulfill major role obligations at work/school/home
• important social/occupational/recreational activities given up/reduced because of use
• recurrent use in situations where it’s physically hazardous

Question 10

effects of depressants

Answer 10

• influences on neuroreceptor systems (can bring problems with information encoding leading to blackouts)
• release of natural analgesics (painkilling (or making things seem less painful))
• delirium tremens/DTs (frightening hallucinations and/or tremors that usually occur with fairly long-lasting alcohol use, particularly around the time of withdrawal)
• fetal alcohol syndrome/FAS (irreversible damage to the child related to neuronal connections that don’t form properly for which the indv cannot compensate)

Question 11

statistics on alcohol use and abuse

Answer 11

• 23% of canadians exceed low-risk guidelines for alcohol consumption (for women, 10 drinks/wk with no more than 2/day; for men, 15 drinks/wk with no more than 3/day)
• binge consumption frequent among college students
• men drink more than women, and single males are the most likely to be heavy drinkers
• different cultures also have predispositions that give alcohol either profoundly reinforcing or aversive effects (variance in drug physiology)

Question 12

sedative, hypnotic, and anxiolytic-related disorders

Answer 12

• barbiturates relax muscles but also give a mild feeling of wellbeing that sets in quickly, which impacts the mind and causes all muscles to become relaxed (as a consequence, really easy to OD)
• benzodiazepines are calming and induce sleep; dependence and tolerance come quickly bc that instant relaxation is really reinforcing
• in terms of abuse, barbiturate use has declined while benzodiazepine use has increased over time
• higher rates of these disorders among women, seniors and smokers

Question 13

stimulants

Answer 13

-most widely used drug class including caffeine, cocaine, amphetamine and nicotine; increase alertness and energy

Question 14

amphetamines

Answer 14

• uppers, leading to a down or crash which people do not like
• reduce appetite, cause weight loss
• reduce fatigue
• stimulate central nervous system, enhancing the activity of norepinephrine and DA (which is in particular as’d with pleasure)

Question 15

cocaine

Answer 15

• derived from the leaves of the coca plant
• coca cola contained 60 mg of cocaine per 240 mL until 1903
• both cocaine and amphs cause increased alertness and attention to small details; not uncommon to see them fixated on being really clean
• BP can increase
• can lead to insomnia

Question 16

DSM - stimulant use disorder

Answer 16

pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

• stimulant often taken in larger amount/over longer period than intended
• persistent desire or unsuccessful efforts to cut down/control use
• great deal of time spent in activities necessary to obtain/use/recover from the effects of the stimulant
• craving or strong desire/urge to use
• recurrent use resulting in failure to fulfill major role obligations at work/school/home
• continued use despite having persistent/recurrent social/interpersonal problems cause/exacerbated by its effect
• important social/occupational/recreational effects given up/reduced because of use
• recurrent use in situations in which it’s physically hazardous
• use continued despite knowledge of having persistent/recurrent physical/psychological problem likely to have been caused/exacerbated by the stimulant

Question 17

tobacco-related disorders

Answer 17

• nicotine is the psychoactive substance in tobacco which produced dependence, tolerance and withdrawal
• inhaled nic enters the blood in 7-19 seconds, and absolutely stimulates pleasure pathways
• genetic vulnerability and life stresses combine vulnerability to nic use and depression
• less than 20% of canadians smoke

Question 18

caffeine-related disorders

Answer 18

• caffeine is a gentle stimulant found in tea, coffee, many soda drinks, cocoa products
• elevates mood and decreases fatigue
• can potentially cause insomnia, esp if abused
• can lead to tolerance and dependence with overuse, and oftentimes people don’t realize how addicted they are until they go without coffee for a couple days and get a whopping headache

Question 19

opioids

Answer 19

• opiates are natural chemicals found in opium poppies that have a narcotic (pain relieving) effect
• opioids are a family of substances including natural opiates and synthetic variants (some of which, like mathadone, are for treating addiction by giving physiological satisfaction w/o the high)
• have sleep-inducing and pain-relieving (analgesic) effects
• heroin is the most common
• often taken IV, hence high comorbidity with HIV
• high mortality rates

Question 20

DSM - opioid use disorder

Answer 20

problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested my at least two of the following, occurring within a 12-month period:

• opioids often taken in larger amounts or over longer period than was intended
• persistent desire or unsuccessful efforts to cut down/control use
• great deal of time is spent in activities necessary to obtain/use/recover from the effects of the opioid
• craving or strong desire/urge to use
• recurrent use resulting in failure to fulfill major role expectations at work, school or home
• continued use despite having persistent/recurrent social/interpersonal problems caused/exacerbated by the substance
• important social/occupational/recreational activities given up/reduced because of use
• recurrent use in situations in which it’s physically dangerous
• continued use despite knowledge of having persistent/recurrent physical/psychological problem likely to have been caused/exacerbated by the substance

Question 21

cannabis

Answer 21

• mild hallucinogen that alters perception
• causes mood swings
• impairs memory, concentration, motivation, self-esteem, relationships with others
• can see reverse tolerance with repeated use (actually needing less than you originally did to get high, likely bc of the high bioavailability and length duration (due to long half life) in the blood)
• THC (tetrahydrocannabinol) is the psychoactive ingredient
• evidence for tolerance and dependence is contradictory
• only microdata available on its utility for medicinal purposed

Question 22

DSM - cannabis use disorder

Answer 22

problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least two of the following occurring within a 12-month period:

• cannabis often taken in larger quantities or over a longer period than intended
• persistent desire/unsuccessful efforts to cut down/control cannabis use
• great deal of time spent in activities necessary to obtain/use/recover from effects of cannabis
• craving or strong desire/urge to use
• recurrent use resulting in failure to fulfill major role obligations at work/school/home
• continued use despite having persistent/recurrent social/interpersonal problems caused exacerbated by use
• recurrent use in situations in which it’s physically hazardous
• use continued despite knowledge of having persistent/recurrent physical/psychological problem likely to have been cause/exacerbated by use

Question 23

other assorted drugs of abuse

Answer 23

• inhalants (volatile substances like spray paint, paint thinner, amyl nitrate, which are breathed directly into the lungs)
• anabolic-androgenic steroids (mimic testosterone and if taken in excess can produce tolerance, dependence, and even psychotic effects at high enough doses)
• designer drugs (everything from drugs intentionally designed to mimic a current drug to something some dude made in his garage)
  problem: aren’t well studied, so you really don’t know what you’re getting yourself into, and hard to see the influences unless there’s behavioural evidence

Question 24

causes of substance-related disorders

Answer 24

• biological dimensions (twin/adoption/family studies to determine genetic predispositions, neurobiology (why areas light up in the brain when substances are involved?)
• psychological (positive and negative reinforcement, cognitive factors (instantaneously, all that stuff is in your mind))
• social dimensions (ex for liquid courage)
• cultural dimensions (and interestingly, some cultures that spend a lot of time drinking ostracize drunks)

Question 25

equifinality

Answer 25

• refers to the fact that disorders may arose from multiple paths and might seem particularly relevant to the substance related problems, but in the end, the pathway/finality/endpoint is pretty similar
• repeated drug use can certainly lead to biological and cognitive reactions that contribute to dependence (we can get to a similar outcome despite the pathway that led to the SUD)
• there’s also a massive false assumption that what caused the SUD is also what continues to perpetuate it

Question 26

biological treatments of substance-related disorders

Answer 26

• agonist substitution: providing the person with a safer drug that has a similar chemical composition to the one abused (ex methadone is used as a heroin substitute that satisfies the neurons without producing the high, allowing ppl to live fairly productive lives); argument as to whether that’s actually treatment or just substitution, but the net effect and safety lvls for that indv are quite significant
• antagonist treatments: using drugs that block or counteract the positive effects of a psychoactive drugs (ex naltrexone to combat opioids)
• aversive treatments (use of drugs to make the ingestion of abused substances extremely unpleasant via a pairing/classical conditioning effect, but high treatment dropout)

Question 27

psychosocial treatments for substance-related disorders

Answer 27

• inpatient facilities: used to help with acute withdrawal and provide assistance to get ppl back into the community; downside is that it’s really expensive
• alcoholics anonymous/AA: community based 12 step program that views alcoholism as a disease that ppl are powerless to overcome without help, but provides unbelievable support to people in the community (thought sometimes the wrong kind, as they may get the substances they’re seeking from former users)
• relapse prevention: analyzing behaviour chain that led to addiction to come up with a list of triggers (where am I most likely to drink? What emotions do I have? Who am I likely to be with? What day of the week? Time?) and we figure out how to handle each one

Question 28

other forms of treatment for substance-related disorders

Answer 28

• harm reduction: controlled drinking, safe injection sites (SISs) ((make the process safer by keeping ppl from using dirty needles, ensuring they’re safely disposed; often medically supervised too))
• prevention: all kinds of community based interventions and even grassroots organisations like MADD, say no to drugs campaigns, how to have a safe night out campaigns; seeing a shift from solely education based efforts to wider efforts (ex changing the law so that young drivers can’t have a BAC above 0.0 as opposed to needing to stay below 0.08)

Question 29

gambling disorder

Answer 29

• lifetype estimate of approx 2% of americans
• can lead to job loss, bankruptcy, arrest
• said to be similar to substance use disorders in many respects, and categorized as an addictive disorder under the DSM-V
• people with gambling disorder are often said to be in denial, impulsive, and continually optimistic despite the odds
• argued that problem gamblers display the same types of cravings and dependence as indvs with substance-related disorders but at the least we can say that similar brain systems (such as the reward centre) seem to be involved

Question 30

DSM - gambling disorder

Answer 30

persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress as indicated by the indv exhibiting four (or more) of the following in a 12-month period:

• need to gamble with increasing amounts of money to achieve desired excitement
• restless or irritable when attempting to cut down or stop gambling
• has made repeated unsuccessful efforts to control/cut back/stop gambling
• often preoccupied with gambling (having persistent thoughts or reliving past gambling experiences, handicapping or planning the next venture, thinking of way to get money with which to gamble)
• often gambles when felling distressed (helpless, guilty, anxious, depressed)
• after losing money gambling, often returns another day to get even (chasing one’s losses)
• lies to conceal extent of involvement with gambling
• has jeopardized/lost significant relationship/job or educational/career opportunity because of gambling
• relies on others to provide money to relieve desperate financial situations caused by gambling

gambling behaviour is not better explained by a manic episode (biol zips of elation leading to impulsive behaviour)

Question 31

impulse-control disorders

Answer 31

intermittent explosive disorder
-aggressive impulses that result in serious assault or the destruction of property
-lifetime prevalence argued to be 7%
kleptomania
-recurrent failure to resist urges to steal things (also often stigmatized, bc it’s illegal)
pyromania
-what seems like an irresistible urge to set fires
-really hard to integrate smn with arson on their record back into the community

treatment: cognitive-behavioural (looks like risk prevention and relapse-prevention types of strategies)