Substance Use disorder Flashcards
(17 cards)
OD trends
-opioids, meth, and coke have all been on the rise
-opioid worse
-most ppl who die of opioid OD are also on other drugs
-WV and midwest, northeast
-socioeconomic factors key drivers
Drug abuse
-harmful/hazardous use of psycho-active substances
-includes alcohol and illicit drugs
Drug Misuse
-use of drug for a purpose not consistent w legal or medical guidelines
Drug dependence
-inability of individual to function normally in absence of drug
-physical and psychological
Substance use disorder
-uncontrolled use of substance despite harmful consequences
Tolerance
-adapt to drug effect over time
-larger dose required for same effect
Withdrawal
-sx from abrupt d/c of drug
DSM-5 criteria for substance use disorder
-2 or more
-severe is 6+
-hazardous use
-social probs related to use
-neglected major roles to use
-legal probs (been removed)
-withdrawal
-tolerance
-repeated attempts to quit/control
-much time
-physical/psych probs
-activities given up
-craving (been added)
-but think in context, controlled use
Addiction
-state of habitual drug use
-chronic, relapsing
-compulsive drug seeking despite consequences
-brain vs complex disease?
Theories on drivers of drug use
-self-medication hypothesis
-brain disease model
-acculturation model
-social contagion model
-development/learning model
-not mutually exclusive
self-medication hypothesis
-feelings of distress
=drug experimentation
=relief/comfort
=continued use
-BUT is there a relationship between DSM dx and specific SUD? No
-drug use is cumulative
Role of mesolimbic dopamine system in sustaining substance use
-ventral tegmental area DA projections go into nucleus accumbens (reward) and prefrontal cortex (judgement)
-nicotine, opiates, alcohol work in ventral tegmental area to inc GABAergic activity
Role of Glutamate in sustaining substance use
-can inc DA activity in nucleus accumbens
-Glu projection to VTA
-destruction of pathway dec cocaine/morphine reward
-NMDA antagonist blocks acquisition of reinforcement learning
-intra NAcc AMOA inj causes relapse
-DA controls glutamate in amygdala
Short-coming of DA reward hypothesis
-lack of relationship between DA release and addiction liability
-DA modulators can’t tx addiction
-DA reward for all who use drugs but few get addicted
-addictive behavior can be observed w drugs NOT associated w euphoria (nasal spray)
Rhinitis medicamentosa
-afrin addiction
Acculturation Process
-most ppl who use drugs stop
1. start (peer pressure, curiosity, access) = stop for adverse effects, legal, maturity
2. Sustaining (social, escapism, more access) = stop for legal, maturity, cost
3. Surrendering (compulsion, withdrawal, helplessness) = legal repurcussion, health event, social cost = stop
Why acculturation model is good
-why addiction develops in only minority of users
-why med use can lead to addiction
-why ppl return
-why ppl can quit w/o tx
-why external rewards can motivate ppl to quit (cash rewards lmao)
-ppl w highly disordered life find it harder to stop
