Substance-Related and Addictive Disorders

Question 1

The leading cause of preventable neurodevelopmental disorders

Answer 1

Prenatal alcohol disorders

Question 2

The DSM uses two major categories of substance-related disorders:

Answer 2

• Substance use disorders: patterns of maladaptive behaviour involving the use of a psychoactive substance. Substance-use disorders include substance-abuse disorders and substance dependence disorders
• Substance-induced disorders: disorders induced by the use of psychoactive substances, including intoxication, withdrawal syndromes, mood disorders, delirium, and amnesia

Question 3

Gambling disorder

Answer 3

• used to be considered an impulse control disorder
• DSM 5: classified with other substance use disorders
• commonalities in expression, causes, comorbidity, and treatment with substance use disorders
• the broader category, though not formally mentioned in DSM is process addictions (partial exception is internet gaming disorder)

Question 4

Hallmarks of disordered substance use

Answer 4

• Tachycardia
• Delirium tremens
• Delirium
• Disorientation
• Physiological dependence (addiction) = tolerance and withdrawal
• Psychological dependence

Question 5

Top 3 commonly used drugs in North America

Answer 5

• tobacco (~25% of population)
• alcohol (~15% of population)
• marijuana (~5%)

Question 6

Pathways to drug dependence

Answer 6

• experimentation
  > most often in a social context
  > no loss of control
• routine use
  > alterations to lifestyle and personal values
  > borrowing, pawning, theft, lying, manipulation
  > may still believe they have control
• addiction or dependence
  > efforts center on avoiding withdrawal symptoms
  > life is centered on getting the drug

Question 7

Drugs of abuse (4)

Answer 7

• depressants = depress CNS activity (alcohol, barbiturates, opiates)
• stimulants = heighten CNS activity (amphetamines, cocaine, nicotine)
• hallucinogens = distort sensory perceptions (eg. synesthesia, colours, sounds, textures) (LSD, PCP, marijuana)
• inhalants = GABA effects (relaxing)

Question 8

Most commonly consumed intoxicant on Earth

Answer 8

Alcohol

Question 9

Risk factors for alcoholism

Answer 9

• gender = rates about equal, but women start later and progress faster
• age (starting before 40)
• antisocial personality disorder
• family history (both heritable and modelling effects)
• sociodemographic factors = lower SES and education , aboriginal > non-aboriginal; the damaging effects of alcohol abuse vary across ethnic groups in Canada, likely because of different cultural constraints and biological tolerance of alcohol

Question 10

Psychological effects of alcohol is…

Answer 10

circumstantially and dose dependent and is also different for everybody

Question 11

Alcohol can act as a ________ reinforcer

Answer 11

negative

use it to reduce unpleasant internal state; thus keep repeating if successful managing anxiety (or something else) through alcohol

Question 12

FASD - facial features arise if mom consumes alcohol on which days?

Answer 12

19, 20, 21 of pregnancy

Question 13

Facial features that arise from FASD

Answer 13

• philtrum (thinner, flat lips)
• shorter eyes and farther spaced apart
• microcephaly (shorter head)

Question 14

Korsakoff’s syndrome

Answer 14

Alcohol-induced persisting amnestic disorder
- looks like dementia and delirium (confusion, disorientation – idk… person, place, time)
Vitamin B12 injections reduce rather than completely eliminate it

Question 15

Synesthesia

Answer 15

crossing over of sensory experiences ; ; brain has lost ability to differentiate different sensory channels
Ex: taste colour

Question 16

Conceptions of alcohol

Answer 16

• moral defects
• behavioural pattern (bad habit)
• disease (genuine)

Question 17

Dimensions of orientation

Answer 17

person, place, time

Question 18

T or F. In FASD, a child can have neurological damage without physical/growth impairments

Answer 18

T

Question 19

T or F. Alcohol consumption has health benefits

Answer 19

T! MODERATION is key;

associated with high levels of HDL, slight decreased chance of developing clotting risk

Question 20

Maximum amounts of alcohol consumption recommended for men and women

Answer 20

M : <14/wk
F : <9/wk
no more than 2/day for either

Question 21

Alcohol plays a role in deaths due to:

Answer 21

• snowmobile accidents: 77% of cases
• homicides over 50% of cases
• traffic accidents: over 40%
• boating accidents: about 40%
• suicides: over 20%

Question 22

Sedatives

Answer 22

Barbiturates

• mostly among middle-aged adults (prescribed to help sleep)
• synergistic effect with alcohol (~4x)
• requires medically supervised withdrawal (hazardous to quit cold turkey; degree of dependence is super high!!)

Question 23

Intense rush

Answer 23

Opiates (a deep sense of euphoria; painkillers like morphine, heroin)

• narcotics
• analgesics
• endorphins
• —> rewarding effects are high enough that they will go through exhausting activity to get this rush

Question 24

Amphetamine psychosis

Answer 24

• doesn’t have to be a long period of time (risk factor even for individuals who are reasonably new to it)
• similar to acute schizophrenia spectrum psychosis

Question 25

Cocaine consumption

Answer 25

- snorted or ingested - often consumed in binges then crash - crack - for smoking, fast, concentrated rush - freebasing (heating with ether)

Question 26

Effects of cocaine

Answer 26

- birth defects: auditory info processing more than anything - sexual dysfunction for both M and W - sharp increases in body temp, respiratory distress, appetite suppression

Question 27

Mechanisms of overdose

Answer 27

1) Effective vs. Toxic doses (Primary physiological) - tolerance to intoxicating effects to a drug and the lethal dose both increase over time - tolerance builds more quickly **Although toxic dose may move slightly to right, tolerance will increase much more (as said earlier) In order to get high, they will actually administer closer to the toxic dose = OVERDOSE ** 2) Compensatory conditioning - over the course of conditioning, a CS may elicit physiological CRs that oppose the US (compensatory CRs). These CSs may include contextual cues present during conditioning - contributes to withdrawal symptoms and tolerance

Question 28

Heroin

Answer 28

Heroin = use for any period of time and HOOK on it, thus starting dose to lethal dose doesn’t take quick

Question 29

Neuroadaptation

Answer 29

Brain changes that take place overtime to compensate for the presence of foreign chemicals **explains tolerance**

Question 30

Factors that play a role in cigarette smoking in Canada:

Answer 30

- prevalence of smoking among adults is higher among Aboriginal than non-Aboriginal people, regardless of whether they live in rural or urban environments - smoking is becoming increasingly concentrated among the poorer and less well-educated segments of the population

Question 31

Angel dust

Answer 31

PCP (phenylcyclidine)

Question 32

Effective dose (ED50)

Answer 32

= point necessary to achieve a certain level of intoxication for 50% of the population

Question 33

Nucleus acumbens

Answer 33

Input pt to the prefrontal cortex - important esp in young ppl - all the structures leading up to nucleus acumbens tend to be matured much sooner than rest of cortex; ie, much of the inhibition and executive functioning that doesn’t fully solidify until early in to twenties is less active which is why sometimes we have less favourable decisions being made and more impulsive behaviour - see this in conduct disordered children

Question 34

Brain's reward centers

Answer 34

- neurotransmitters: dopamine - mesolimbic pathway - nucleus accumbens

Question 35

Abstinence violation effect

Answer 35

People believe they are a failure -> sometimes people will try half heartedly to quit and when they can't do it, they say "well im obvs a failure" when in REALITY, attempts at quitting increases with sincere and persistent attempts

Question 36

Self-efficacy

Answer 36

do people believe in themselves?

Question 37

What you believe is what you get

Answer 37

- amount consumed is influenced by the expectation of alcohol - actual alcohol content didn't matter

Question 38

Biological approaches to treating addiction

Answer 38

- detoxification (first step) - antabuse (disulfram) - antidepressants (SSRIs) - Nicotine replacement therapy - Methadone Maintenance Program (methadone not different from meth and heroin but not quite as severe either) - Naloxene & Naltrexone (block high from opiates; poor long-term compliance)

Question 39

Other approaches to treating addiction

Answer 39

- nonprofessional support groups (Ex: Al-Anon) - Residential approaches - Psychodynamic approaches (not very good) - Behavioural approaches (self-control strategies, aversive conditioning, social skills training)

Question 40

Relapse-Prevention Training

Answer 40

- Pattern/high risk factor recognition (predictability, behaviours/thoughts/feelings -- chains) - Specific coping strategies (escape/avoidance) - weekly "bring-backs" - SUDs (seemingly unimportant decisions -- tell tale sign if they become defensive about it) - Abstinence Violation Effect

Question 41

Controlled drinking

Answer 41

Closely related to harm reduction - controversial - done in 70's