Week 11 - Substance Use/Addiction & Suicide

Question 1

What is tolerance?

Answer 1

When increased dosages are required to produce DESIRED effects

Question 2

What is dependence?

Answer 2

When regular use of a drug is necessary to maintain stable biophysiological functioning

Question 3

A substance or drug is any chemical that affects the ______/______, other than food

Answer 3

Body/mind

Food provides nutritional support, drugs don’t

Drugs can be pharmaceutical or recreational

Question 4

What is drug abuse VS addiction?

Answer 4

Drug abuse: use of drugs for unintended purposes

Drug addiction: disorder where people persistently use substances (despite medical or interpersonal use)

Question 5

What are pharmaceutical drugs?

“Over the counter drugs” vs “prescription medication”?

Answer 5

Medicine or medication

Alleviate medical symptoms/treating a medical disorder

——————————————————————————————————————

“Over the counter” medication, drugs that can be bought W/OUT a prescription
Ex) treats minor ailments, proven to be safe in low doses

VS

Prescription medication, require physician to prescribe them
Ex) classed in according to the system they affect

Question 6

What are “illicit” drugs?

Answer 6

Drugs ILLEGAL to buy or POSSESS w/out a perscription

High potential for addiction/dependency, overdose, severe side-effects etc…

Question 7

What are recreational drugs?

Answer 7

Drugs that people use for non-medical reasons (sociocultural meaning)

Alter one’s nervous system functioning (can be beneficial)

Some CAN be LEGALLY purchased

Others are pharmaceutical grade, acquired and taken for NON-medical reasons

Many are widespread legal and socially acceptable (Ex. Weed in Canada)

“Street-drugs” criminal enterprises

Question 8

True or false. Just because a drug is widespread, and legal does not mean its not harmless

Answer 8

True!

Ex) tobacco and lung cancer

Question 9

What is the moral framework perspective on drug use and addiction?

Answer 9

Drug use and addiction are an INDIVIDUAL choice and a moral FAILING

“Just say no”

Generally dismisses socioeconomic factors

DARE = “skill” training (not really effective)

Question 10

What is the disease framework perspective on drug use and addiction?

Answer 10

Addiction is a neurological dysfunction

TOLERANCE is a chronic decrease in neurotransmitter availability, drug enhances NT efficacy

WITHDRAWEL represents a sudden lack of NT availability

May be abnormal in the “reward circuit” in the brain

Question 11

What is the cognitive/developmental frameworks perspective on drug use and addiction?

Answer 11

Addiction is a kind of learning disorder cause by COPING, REINFORCEMENT and EXPECTATION

Maia Szalavitz

“Addiction is not brain damage or a pathology like Alzheimer’s. It really is misguided learning… With addiction, the vast majority of people do recover… Your brain isn’t broken. You’ve learned something that is problematic.” (2016)

Question 12

What is the civil liberties frameworks perspective on drug use and addiction?

Answer 12

Drugs are largely NEUTRAL/BENEFICIAL can be used responsibly, are compatible with everyday functioning, and should be accepted as a PERSONAL choice

Carl Hart: Neuroscience Professor at Columbia University who regularly uses heroin, amphetamines, cannabis, and other substances

• “I do not have a drug-use problem. Never have. Each day, I meet my parental, personal and professional responsibilities. I pay my taxes, serve as a volunteer in my community on a regular basis and contribute to the global community as an informed and engaged citizen. I am better for my drug use.” (2021)

• “It’s great to take MDMA with (my wife) and reconnect.”

Question 13

What are the 2 components to risk?

Answer 13

1) how LIKELY is an adverse event to occur?

2) how SEVERE are the consequences if it does occur?

Question 14

What is harm reduction?

Answer 14

Term seems to have been invented in 1987 by British researcher Russell Newcombe

Rather than advocating ABSTINENCE they advocated for “controlled use” of substances, involving “rational choice, care, and moderation”

Model involved needle exchange programs, opiate prescriptions, and educational materials

Question 15

What are the 3 arguments used in harm reduction?

Answer 15

1) people are likely to get HIGH, humankind unlikely to change their ways (pleasure, boredom etc…)

2) many illicit substances, used in moderation are less harmful than legal substances

3) when drug use in suppressed/criminalized, “underground” drugs emerge

Question 16

What is drug history in Canada? (Vancouver)

Answer 16

First unofficial needle exchange program was started by John Turvey, DTES activist 1988

In 1995, a group of drug users created an illegal injection site called Back Alley

The BC CDC provided clean needles and nursing visits, and VPD briefly tolerated it because it was indoors

In 1997, activists created a “union” of drug users called the Vancouver Area Network of Drug Users (VANDU), which still exists

Insite (safe injection) opened in 2003, Crosstown Clinic started offering prescription heroin in 2011

Question 17

Why is harm reduction favoured?

Answer 17

Among researches and doctors

Criminalization plainly does NOT keep drugs out of peoples hands

Unregulated drugs are unstandardized, unsafe and DONT meet market needs

Question 18

What are some contemporary harm reduction methods?

Answer 18

1) overdose reversal: drugs line opiates, other drugs can counteract their effects ex. Naxolone/Narcan

2) supervised use/safe consumption: facilities where people can use drugs under the supervision of medical staff

3) substitution (prescribed one drug as a substitute for another)

4) safe supply (someone taking the SAME does at the SAME time, may allow them to function more normally VS unsafe street drugs that are unpredictable)

Question 19

What are the issues with substitution/safe supply?

Answer 19

1) possibility of DIVERSION - people who acquire them may SELL them to other users

2) concerns that these programs normalize addiction (doctors argue if addiction is a brain disease, these services are denial of treatment)

3) substitution programs seem to ineffective in adolescents if they start using opioids (lack of retention/uptake)

Participant 12, who diverts their drugs: “Well it’s fucking necessary, because people need them, or else they’re going to take fentanyl and die.”

Question 20

Recovery-oriented programs (abstinence) can be ________ if the goals are _____

Answer 20

Effective; met

Ex) social support, extended care, integrated care

Question 21

True or false. Many recovery programs aren’t cognitive-behavioural or sociocultural in nature

Answer 21

False

Question 22

How is CBT used for substance use?

Answer 22

Relapse prevention: taught to IDENTIFY their substance use and recognize the situations which TRIGGER urges

Combined with coping strategies

Question 23

What is “detox”?

Answer 23

Aka rehab, medically supervised cessation of a drug

Typically requires on-going therapy and social support

Can be an in-patient or an out-patient basis

Typically 2-3 months

Question 24

What are some barriers to maintaining recovery?

Answer 24

Lack of programs or support

Being worried about what people would think

Lack of support for maintaining recovery etc…

Question 25

What are some warning signs of suicide?

What are some other signs that might mean someone is at risk of suicide?

Answer 25

WARNING:
Thinking/talking about suicide

Having a plan for suicide

——————————————————
RISK:
Withdrawal from family, friends or activities

Feeling you have no purpose in life

Increasing substance use

ETC…

Question 26

What is suicide?

Answer 26

The intentional ending of ones own life

Question 27

What is a “sub-intentional death”?

Answer 27

When people play an INDIRECT, or UNCONSCIOUS role in their own death

Ex) “death darers” people who do extremely risky things

Question 28

_____ people die by suicide each day

Answer 28

12

Question 29

Suicide rates are approx _____X ________among men compared to women

Answer 29

3X; higher

Question 30

What are some possible causes of suicide?

***INDIVIDUAL

Answer 30

1) Immediate stressors & chronic stressors

2) may be associated with impulsivity as a personality trait

3) that suicide is an impulsive decision (little thought beforehand)

Question 31

What are some possible causes of suicide?

***sociocultural

Answer 31

1) Emile Durkhheim argued that it depends on:
- social integration (strong attachments)
- social regulation (how society monitors)

Question 32

What are some possible causes of suicide?

***interpersonal

Answer 32

2) “interpersonal theory” people hold certain beliefs

3) “perceived burdensomeness” belief someone would be better off w/out them

4) “thwarted belongingness” want relationships, but feel incapable

Question 33

True or false. People are also likely to commit suicide in societies with extremely strong integration

Answer 33

True

People will SACRIFICE themselves for others

Ex) Aztecs

Question 34

To attempt suicide, the individual must hold ____________ ___________&___________ _____________as beliefs and then also have the “____________ _________” for suicide

Answer 34

Perceived burdensomeness; thwarted belongness

“Psychological capacity”

Question 35

True or false. Suicidal idealation/suicidal desires can’t be treated

Answer 35

False

People who survive a suicide attempt can benefit from TREATMENT to recover to a non-suicidal state, and REDUCE their risk of subsequent attempts

Question 36

How is CBT used in treatment for suicide?

Answer 36

1) acceptance and commitment therapy (ACT)
- encouraged to acknowledge and accept negative emotions
- increase resilience

2) dialectical behaviour therapy (DBT)
- skills training to regulate emotions
- variety of techniques

Question 37

What are some motives for seeking physician-assisted suicide?

Answer 37

1) self determination theory:
- people want autonomy, competence, relatedness

2) existential suffering:
- distress from realization that life has lost its meaning