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Z YEAR 2 BRS PSYCH > Substance use and Addiction > Flashcards

Substance use and Addiction Flashcards

1
Q

What are categories of drugs?

A
  • Depressant
  • Stimulant
  • Hallucinogenic
  • Cannabinoid
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2
Q

What is experimental/recreational use?

A

causing no/limited difficulties

majority of population

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3
Q

What are positive reinforcement for drugs?

A
  • escapism
  • Get high
  • Like it
  • stay awake
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4
Q

What are negative reinforcement for drugs?

A
  • boredom
  • get to sleep
  • reduce anxiety
  • feel better
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5
Q

Why do you need to know why someone takes drugs?

A

-informs treatment
-A pattern of substance use that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others
Eg depression, anxiety, liver problems, high blood pressure, aggression

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6
Q

What is the process of using drugs?

A

Like, want to need and then regular sue (harmful) when period of loss, grieve, pandemic

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7
Q

What is harmful substance use?

A

•Actual damage should have been caused to the mental or physical health of the user in the absence of diagnosis of dependence syndrome.
–(as a Dr, the fact that they are seeing you may mean that many people will fulfill criteria for this diagnosis)
e.g. common chest cough if smoker or got in fight form drinking

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8
Q

What is hazardous substance abuse?

A

likely to cause harm if continues at this level)

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9
Q

What is the need criteria?

A

spiralling dependence

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10
Q

What happens in the like want need process?

A

neuroadaptions

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11
Q

What is the ICD-10 diagnostic criteria foe dependence syndrome?

A
  1. a strong desire or sense of compulsion to take the substance
  2. difficulties in controlling substance taking behaviour in terms of its onset, termination, or levels of use
    - who has control, you or ‘the drug/behaviour’?
    - when did you last have a drink/drug?
  3. a physiological withdrawal state when substance use has stopped or been reduced
  4. evidence of tolerance: need to take more to get same effect
  5. progressive neglect of alternative interests
  6. persisting with substance use despite clear evidence of overtly harmful consequences
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12
Q

What is a physiological withdrawal state when substance use has stopped or been reduced?

A

a ‘negative’ state (from uncomfortable to intolerable) so user takes drug/alcohol to gertrelief from it or ‘treat’ it

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13
Q

What is the prevalence of alcohol dependence?

A

–595, 000 estimated prevalence
–103,471 in treatment
-~82% of adults in need of specialist treatment for alcohol not receiving it

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14
Q

What is the impact of COVID-19 on alcohol dependence?

A

Over 8.4 million people are now (September) drinking at higher risk, up from 4.8 million in February

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15
Q

What is the prevalence of opiate dependence?

A

257,476 estimated prevalence
170,032 in treatment
~46% of adults in need of specialist treatment for opiates not receiving it.
-Death rates rising from opiates and from cocaine

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16
Q

What is the impact of Covid-19 on opiate dependence?

A

3,459 new adult cases in April 2020 - up 20% from 2,947 in April 2019 - the highest numbers in April since 2015

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17
Q

What is important to see for drugs and alcohol?

A

harm to others and harm to users (alcohol most harm to others as violence)

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18
Q

What is addiction?

A

compulsive drug use despite harmful consequences, characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, (depending on the drug) tolerance and withdrawal

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19
Q

What dependence?

A

In biology/pharmacology, dependence refers to a physical adaptation to a substance
–Tolerance/withdrawal
-Eg opioid, benzodiazepine, alcohol
-So can be dependent and not addicted
-Not seeking etc or taking more than prescription

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20
Q

Why is the way people use the words addiction of dependence important?

A
  • When people use the term “dependence,” they are usually referring to a physical dependence on a substance
  • Dependence is characterized by the symptoms of tolerance and withdrawal
  • While it is possible to have a physical dependence without being addicted, addiction is usually right around the corner.
  • Part of the reason for the change was the confusion surrounding the word ‘dependence.’
  • The hope is that defining an addiction as a substance use disorder was a more inclusive way to identify people who need help, but may not have a debilitating addiction.
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21
Q

What is gambling disorder?

A

-Behavioural addiction
•Many similarities in aetiology, neurobiology and treatment approaches, as well as comorbidity, with substance dependence
•Reclassified as behavioural addiction in DSM-5/ICD-11 from an ‘impulse control disorder’ previously.

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22
Q

What is internet gaming disorder?

A

-Behavioural addiction
•added to ICD-11 under addictive disorders
•in the DSM-5 is under “Conditions for Further Study

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23
Q

Why do people want to speed up brain entry?

A

more “rush” more addiction

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24
Q

What are the elements involved in alcohol/drug use and addiction?

A
  1. Social, environmental factors
  2. Personal factors eg genetic, personality traits
  3. Drug factors
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25
Q

How does the brain work from use to addiction?

A
  1. Pre-existing vulnerability (e.g. family history / age)
  2. Drug exposure (compensatory neuroadaptions to maintain brain function / resilience)
  3. Recovery: sustained or cycles of remission and relapse
26
Q

Are the exposure become chronic what does your brain do?

A

neuroadaptions

27
Q

What happens the earlier you use drugs?

A

more likely to be dependent

28
Q

Why do people drink?

A
  • Get sleep
  • reduce anxiety
  • Then get tolerant so carry on to avoid withdrawal
29
Q

What excitatory system does alcohol affect?

A
  • Glutamate system

- NMDA receptor

30
Q

What inhibitory system does alcohol affect?

A
  • GABA-benzodiazepine (GABA-A) system

- GABA receptor

31
Q

What happens to the excitatory system with acute alcohol?

A
  • blocked

- Impaired memory (alcoholic blackouts)

32
Q

What happens to the inhbiotyr system with acute alcohol?

A
  • boosted
  • anxiolysis
  • sedation
33
Q

What happens with chronic alcohol exposure that results in neuroadaptations so that GABA and glutamate remain in balance in presence of alcohol?

A
  1. Upregulation of excitatory system

2. Reduced function in inhibitory system - tolerance

34
Q

How does the GABA receptor respond to chronic alcohol neuroadaption?

A

Switch in subunits to make less sensitive to alcohol

35
Q

What happens in the withdrawal state?

A

Chronic alcohol exposure results in neuroadaptations: in absence of alcohol GABA & glutamate are no longer in balance

36
Q

Why do you need to treat in alcohol withdrawal? How do you treat?

A
  1. Upregulation of excitatory system means that NMDA receptor:increase in Ca2+
    - toxic leading to hyperexcitability (seizures) and cell death (atrophy)
  2. Treat with benzodiazepines to boost GABA function
37
Q

What are some other treatments for alcohol withdrawal?

A
  • Inpatients
  • Treated with lorazepam / diazepam (benzodiazepines)
  • MRS on d1 (EW)

–Increased glutamate

•MRS on d14 (SA)
–Glutamate levels reduced closer to healthy controls (HC)

38
Q

What can help people remain abstinent?

A
  • Acamprostate

- Reduction in MRS glutamate in acamprosate treated group - potentially neuroprotective

39
Q

What are some models of addiction?

A
  1. Reward deficiency (positive reinforcement)
  2. Impulsivity / compulsivity
  3. Overcoming adverse state e.g. withdrawal, anxiety (negative reinforcement)
40
Q

What do rewards lead to?

A

Increase levels of dopamine in ventral striatum

41
Q

What sort of system is the dopamine pathway?

A

‘pleasure-reward-motivation’

42
Q

What is a modulator of dopamine system?

A

-opioid system
-particularly mu opioid that
mediates pleasurable effects (eg
of alcohol, ‘endorphin ‘rush’)
-others include GABA-B, cannabinoids,
glutamate etc that are targets
for treatment

43
Q

What state is addiction thought to be?

A

‘reward deficient’ state

44
Q

How does substance abuse affect dopamine system?

A
  1. Dopamine released and cocaine, amphetamine block reuptake, so lots of dopamine in synapse
  2. Amphetamine enhances release of dopamine - directly target dopamine synapse
  3. Other drugs of abuse eg alcohol, opiates, nicotine increase dopamine neuron firing in ventral tenemental area - indirect effect.
45
Q

What may predispose people to drugs?

A

low levels of D2 receptors predispose subjects to use drugs, as high levels of D2 did not like the feeling of stimulant

46
Q

What is activated in the anticipation of winning?

A

ventral striatum

47
Q

What could cause people to use drugs in future?

A

had blunted reward to getting money years before - reward system not working as well

48
Q

When is there a blunted reward system?

A
  • Abstinent addicts compared with controls
  • In absitent addicts those with blunted response to anticipation of reward are more likely to relapse which is consistent with ‘reward deficiency’ theories of addiction
  • So maybe if can reverse blunted reward system less likely to relapse
49
Q

Is it a given to have a blunted reward system?

A

no

50
Q

What areas of the brain involved in addiction?

A
  • binge/intoxication
  • withdrawal/negative affect
  • preoccupation/anticipation /craving
51
Q

What are of the brain is involved in withdrawal/negative affect?

A

amygdala

52
Q

What happens as addiction/dependence develops?

A

change from positive to negative reinforcement

53
Q

How does this change happen?

A
  • Get drug, positive effect and then negative withdrawal but over time neuroadpatation, high gets less, but withdrawal gets greater
  • Positive reinforcement goes and so carry on taking to avoid negative so negative reinforcement, so fearful if not drug.
54
Q

What happens to the reward system with withdrawal and negative emotional states in addiction?

A

reduced dopamine and mu opoid function

55
Q

What happens to the stress system with withdrawal and negative emotional states in addiction?

A

increased activity in many including kappa opioid (dynorphin), noradrenaline (arousal system) CRF (stress) etc

56
Q

What happens to the amygdala with withdrawal and negative emotional states in addiction?

A

Dysregulation

57
Q

What happens to amygdala when shown adverse and normal image?

A

Not heightened in normal picture with normal volunteers but normal. picture heightened for abstinent polydrug users (not for alcoholics)

58
Q

What does change from voluntary drug use to more habitual and compulsive drug use involve?

A

-transition from:
•prefrontal to striatal control over drug taking (i.e. prefrontal ‘top-down’ control is diminished with greater striatal reward drive
•overt time go from ventral (limbic or emotional) to dorsal (habit) striatum.
-Role for ‘memory’ (eg hippocampus) in craving

59
Q

How do you asses neurocircuitry in inhibitory control with fMRI?

A

go-nogo task

60
Q

What happens in the go-nogo task?

A
  • Lights up putamen (dorsal striatum) and inferior frontal gyrus
  • Alocholics more activity in frontal cortex - longer absence the greater activity so greater activity during inhibitory control may facilitate in staying sober
  • Polydrug less likely to stay absence
61
Q

What was the result like for abstinent alcoholics in go-nogo task?

A
  • Greater response in frontal pole/inferior frontal gyrus during inhibiting response in abstinent alcoholics
  • Greater response associated with longer abstinence

Z YEAR 2 BRS PSYCH (4 decks)

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