Substance Use and Addiciton

Question 1

What are the 2 main ways drugs work?

Answer 1

They can be stimulants or depressants

Question 2

What is negative reinforcement

Answer 2

When people take drugs to overcome bad states

Question 3

What is positive reinforcement

Answer 3

When people take drugs to gain positive states

Question 4

How do we figure out wether there is positive or negative reinforcement or neither?

Answer 4

Ask why they are taking the drug

Question 5

What qualifies as harmful substance use?

Answer 5

When actual damage has been caused to the mental or physical health of the user in the absence of diagnosis of dependence syndrome

Question 6

What qualifies as hazardous substance use?

Answer 6

When harm is likely to be caused if the user continues at the current level

Question 7

What are the criteria for dependence syndrome?

Answer 7

A strong desire or compulsion to take the substance, there is difficulty controlling usage, there is physiological withdrawal state when substance use stops, there is evidence of tolerance, persisting usage despite harmful consequences, progressive neglect of alternate interests

Question 8

How many criteria must be met to qualify as dependant?

Answer 8

3 criteria for dependance

Question 9

What are the criteria for addiction?

Answer 9

Compulsive drug use despite harmful consequences, inability to stop using the drug, failure to meet work/social/family obligations and sometimes tolerance and withdrawal

Question 10

What is the difference between dependance and addiction?

Answer 10

Dependance refers to a physical adaptation to a substance, it is therefore possible to be dependant and not addicted

Question 11

What makes a drug more addictive?

Answer 11

If it can reach the brain faster

Question 12

What balance does alcohol disrupt? In which direct

Answer 12

Balance between the inhibitory and excitatory systems, it increases the effectiveness of the inhibitory system

Question 13

What is the bodies inhibitory and excitatory system in reference to alcohol? Include the names of the neurotransmitters and receptors

Answer 13

Inhibitory: GABA-A system, GABA-A receptor
Excitatory: Glutamate system, NMDA receptor

Question 14

What happens during alcohol withdrawal?

Answer 14

The alcohol is no longer making the inhibitory system more effective, so the excitatory system becomes unregulated in compensation

Question 15

What medication is given to help alcohol withdrawal?

Answer 15

Acamprosate

Question 16

How does acamprosate work?

Answer 16

It reduces NMDA function so there is redcued compensatory upregulation of the excitatory system and withdrawal is reduced

Question 17

How are some ways addiction develops?

Answer 17

Due to positive reinforcement
Due to overcoming an adverse state (negative reinforcement)
Impulsivity

Question 18

What neurotransmitter is highly involved with addiction?

Answer 18

Dopamine- drugs often increase levels of dopamine in the brain

Question 19

How does dopamine work as addiction worsens?

Answer 19

It becomes more about motivation to get the drug rather than feelings of reward

Question 20

What system is a key modulator of dopamine?

Answer 20

Mu opioid

Question 21

How may drugs increase levels of dopamine?

Answer 21

Block reuptake, enhance release, indirectly by increasing firing dopamine neurons

Question 22

Which drugs block dopamine reuptake?

Answer 22

Cocaine and amphetamine

Question 23

Which drug enhances dopamine release?

Answer 23

Amphetamine

Question 24

Which drugs work indirectly by increasing dopamine neurone firing?

Answer 24

Alcohol, opiates, nicotine

Question 25

What are dopamine receptors called?

Answer 25

D2 receptors

Question 26

What happens when someone has fewer D2 receptors?

Answer 26

They are likely to be more responsive to stimulants as they already have lower levels of dopamine functioning in their brain

Question 27

What brain region is associated with binge/intoxication?

Answer 27

Thalamus

Question 28

What brain region is associated with withdrawal/negative effect?

Answer 28

Hypothalamus, brainstem effectors, amygdala

Question 29

What brain region is associated with pre-occupation/anticipation/craving?

Answer 29

Hippocampus

Question 30

Which out of positive and negative reinforcement develops as addiction gets worse?

Answer 30

Goes from positive reinforcement to addiction developing and turns into negative reinforcement

Question 31

What happens to motivation as addiction develops and why?

Answer 31

Motivation increases because the addiction is present due to negative reinforcement so there is a lot of motivation/anxiety to acquire the drug

Question 32

Where is dysregulation most apparent during addiction?

Answer 32

Amygdala

Question 33

What system is the stress system?

Answer 33

Kappa opioid system

Question 34

What lights up the amygdala on an fMRI?

Answer 34

Showing a normal image then an aversive one

Question 35

How may units is a bottle of beer?

Answer 35

1.6 units

Question 36

How many units is a pint of beer?

Answer 36

2.3 units

Question 37

How many units is a pint of cider?

Answer 37

2.6 units

Question 38

How many units is a shot?

Answer 38

1 unit

Question 39

How many units is a medium glass of wine?

Answer 39

2.3 units

Question 40

How many units is a bottle of wine?

Answer 40

9.8 units

Question 41

How many units of alcohol is the limit for one week?

Answer 41

14 for both men and women

Question 42

What acronym is used to assess alcoholics and what does it stand for?

Answer 42

CAGE Cut down- have you ever felt you need to cut down on your drinking? Angry- has anyone annoyed you and made you angry by talking about your drinking? Guilty- have you ever felt guilty about drinking? Eye opener- have you ever felt you need a drink first thing in the morning?

Question 43

What are some symptoms of alcohol withdrawal?

Answer 43

Hot, sweaty, tremor of hands, retching/belching, abdominal pain

Question 44

What are some symptoms of opiate withdrawal?

Answer 44

Tachycardia, sweating, breathlessness, restlessness, dilated pupils, bone aches, runny nose, GI upset, tremor, yawning, anxiety, irritability, gooseflesh skin

Question 45

What terms are used when talking about conditions where people are addicted to alcohol or opiates? What terms used to be used?

Answer 45

Used to use abuse and dependence, we how use alcohol use disorder and opiate use disorder

Question 46

What is the name of the criteria used for opiate and alcohol use disorder?

Answer 46

DM5 criteria- the words alcohol and opiates can be used interchangeably depending on which youre assessing

Question 47

What does a history for someone who is addicted include?

Answer 47

``` Presenting complaint History of presenting complaint (onset, time frame etc) Substance misuse history Family history Past psych history Social and personal history ```

Question 48

In a history taking for addiction, what must be included in the substance misuse history?

Answer 48

Length of current use and when last used. Current amount (units/grammes per day) and for how long at this level. Total length of use, max use, and any periods of abstinence Mode/method of use Evidence of withdrawals and severity (e.g. seizures, admissions) Any previous treatments - medication, psychotherapy, detox, rehab. Any previous substance overdoses (accidental vs deliberate)

Question 49

Out of alcohol and opiate withdrawal, which is worse and why?

Answer 49

Alcohol withdrawal as it an cause seizures whereas opiate withdrawal doesn't

Question 50

What should you examine for in alcohol use disorder?

Answer 50

Clubbing, anaemia, DVT, cyanosis, jaundice, collapsed veins, track marks

Question 51

What are the 2 ways opiates work?

Answer 51

``` Reducing pain (analgesia) Euphoric feelings ```

Question 52

What is the difference between opiates and opioids?

Answer 52

Opiates are natural (e.g. opium, morphine) | Opioids are all natural, semisynthetic, synthetic or natural

Question 53

What are signs of opiate overdose?

Answer 53

``` Tiny pupils Slow or no breathing Choking/snorling/gurgling sounds No moving, cant be woken Clammy/cold skin Cyanosis ```

Question 54

What do you do when you find someone who has overdosed?

Answer 54

Inject naloxone into upper arm or thigh, if no response repeat after 3 mins Provide airway support and put them in the recovery position