Week 5

Question 1

What is the history of alcohol? (3)

Answer 1

It has been around for a long time

We’ve been fermenting fruits throughout history

Even animals can recognize fermented fruits for their intoxicating properties

Question 2

What is the prevalence of alcohol consumption in Canada? (5)

Answer 2

We consume a lot of alcohol, specifically in the Western world

In 2015, there was an 80% prevalence of alcohol consumption over the last year for people 15+

25-34 age group and males most prevalent

Almost 50% of those 15-18 have consumed it in the past year

Number 1 substance consumed in the past year by Canadians

Question 3

What is the overall trend with alcohol consumption for youth?

Answer 3

There is an overall downward trend in alcohol consumption among grades 7-12 and it is lower than adults (but still high)

Question 4

What is the AUDIT? (2) What are the 3 subscales of questions? What does your score mean?

Answer 4

Alcohol use disorder identification test

10 questions, typically used in a clinical setting as it is a short test that is easy to give to a lot of people

3 subscales of questions:

Hazardous alcohol consumption (frequency and amount)
Dependence symptoms (control)
Harmful alcohol use (psychological and physiological harm)

The score you receive determines whether you are engaging in drinking in any of the three categories and are at risk of AUD

Question 5

What is the prevalence of AUD in Canada? (4)

Answer 5

18.1% of the general population has met the criteria for an AUD sometime in their life (6.3 million people)

3.2% for the past 12 months (1 million people)

So a lot of people qualify for an AUD

Known sex difference in that men have a significantly higher prevalence

Question 6

What is the cost of AU in Canada? (2)

Answer 6

From a public health POV, AUD costs society billions in indirect costs (productivity loss), healthcare costs from health problems resulting, law enforcement costs from crime resulting and other direct costs

39.8 billion for SUDs in 2002, even more now with inflation

Question 7

What did the Nutt study on conceptualizing, identifying and categorizing harms resulting from addictive substances do? (6)

Answer 7

Looked at how different substances weigh into perpetuating different kinds of harm

Addiction professionals identified 16 harm criteria and categorized types of harm

9 were related to physical, psychological and social harm to the self (mortality, dependence, impairment of mental functioning, loss of relationships)

7 related to physical, psychological and social harms to others (injury, crime, family adversities)

Rated 20 drugs on a 100 point scale based on each harm criteria

Also assessed relative importance of the criteria within each cluster and across clusters

Question 8

What did the Nutt study on conceptualizing, identifying and categorizing harms resulting from addictive substances find? (4) what can it be used for?

Answer 8

Found that alcohol ranks highest as most harmful overall, both to self and others

Due to it being so accessible, normalized and so widely/frequently used

Found that certain drugs like meth cause mostly harm to self while drugs like alcohol cause more harm to others (high for both kinds of harm but on another level for harm to others)

Most frequent AUD harms are economic cost and injury to others

Can inform the use of interventions to prevent AUDs and regulate the sale and consumption of alcohol

Question 9

According to the BPS model, why do people drink alcohol?

Answer 9

Combination of biology (genes, nutrition), psychological (emotions, behaviors) and social (stress, trauma, environmental)

Question 10

According to positive reinforcement theory, why do people drink alcohol?

Answer 10

Because it is exciting and enhances your life

To get a high

Question 11

According to negative reinforcement model, why do people drink alcohol?

Answer 11

To forget/remove painful memories

To stop me from feeling negative feelings associated with anxiety and depression

To reduce anxiety and forget worries

Question 12

According to social theory, why do people drink alcohol? According to conformity theory, why do people drink alcohol?

Answer 12

As a way to celebrate and be sociable

Due to peer pressure and so I won’t feel left out

Question 13

How does personality impact AUD severity? (3)

Answer 13

Certain personality traits (neuroticism, impulsivity, etc.) can lead to alcohol consumption at increased levels

This is because they lead to certain drinking motives that lead to addiction

These motives connect with risk factors (biopsychosocial) to form susceptibility and risk for addiction

Question 14

How does alcohol impact the brain? (6)

Answer 14

Inhibitory neurotransmitters (GABA) are active throughout the brain to control neural activity and decrease communication between cells in the brain, making them less likely to fire

Another neurotransmitter in another area of the brain, glutamate, does the opposite as a general-purpose excitatory neurotransmitter than increases communication between the cells

When alcohol enters the brain, it binds to GABA receptors and makes the inhibitory signal of GABA even stronger, making us more relaxed and sedated

It activates opioid receptors that induce the release of endorphins, which then bind to receptors and on dopamine neurons in the reward centers to trigger dopamine release and pleasure/reward

Alcohol also binds to the glutamate receptors to block glutamate from exciting the cell, resulting in functioning problems like slurred speech, coordination and reaction issues

The more alcohol you drink over time, your brain will need more and more alcohol for the same effects because it will kill the receptors

Question 15

What are the consequences of alcohol concerning neurodegeneration? (4)

Answer 15

Reduction and mutations in the production of new neurons as alcohol exposure continues

Reduction in brain systems (which can be somewhat reversed with even a short time abstaining)

Changes in the volume of brain areas associated with executive functioning and decision-making

Deficits in decision-making impairs the inhibition of impulsive behavior, contributing to further drug seeking behavior

Question 16

What are the consequences of alcohol concerning withdrawal? (4)

Answer 16

Withdrawal is painful and people can die from it

Symptoms can appear within days of stopping and the physical ones usually stop within the week but the psychological ones last way longer

Physiological symptoms include sweating, seizures, fever and tremors

Delirium tremens is an extreme form of withdrawal that often results in hospitalization due to confusion, hallucinations, disorientation, fever, tremors, death

Question 17

What are the consequences of alcohol concerning death from acute alcohol intoxication? (4)

Answer 17

Younger and older people are at greater risk

Alcohol poisoning results from drinking more alcohol than our bodies can handle, shutting it down

It is metabolized by the liver at a rate of about 1 drink per hour and consuming more creates intoxication

Consuming more than the body can metabolize creates alcohol poisoning, passing out and other physiological harms

Question 18

What are the consequences of alcohol concerning alcohol liver disease? (2)

Answer 18

Mortality related

Fatty liver, alcoholic hepatitis, and cirrhosis

Question 19

What are the consequences of alcohol concerning Alcoholic Korsakoff syndrome? (5)

Answer 19

Chronic memory disorder

Severe thiamine deficiency in the brain due to alcohol consumption

Problems learning new information

Inability to remember recent events

Long term memory gaps

Question 20

What is the Low-Risk Alcohol Drinking Guidelines?

Answer 20

Guidelines for how much one should consume, risk factors to look out for, and other AUD factors based on research

Question 21

What is the origin of cocaine use? (4)

Answer 21

German chemist Albert Nieman was the first to isolate cocaine extracted from cocoa leaves in 1860 (even though indigenous people had been chewing on the leaves for centuries)

It became popular in the 1880s in the medical community as an anesthetic for cataract surgery

Freud was fascinated with and addicted to cocaine and promoted it in papers as a “magical substance”

Cocaine was readily available, non-regulated and accessible, even in Coca Cola (which was so popular only whites could drink it)

Question 22

What is the American Crack Epidemic of the 1980s? (5)

Answer 22

Cocaine was no longer readily available and it was highly regulated

This resulted in crack cocaine, which is crystallized cocaine mixed with baking soda as a way of making more money by selling cocaine without using as much actual coke

When boiled, the vapor was pure cocaine that resulted in an intense but short-lived high

Increase of CC use in major cities across the US in the 80s and 90s, resulting in an increase in crime and violence

Lead to “tough on crime” policies and the “war on drugs” led by the Kennedys

Question 23

What is the legal status of cocaine in Canada? (4)

Answer 23

Schedule I drug under the Canadian Controlled Drugs and Substances Act (CCDSA)

Possession can result in 7 years imprisonment

Trafficking and production can result in life imprisonment

DUI of cocaine is a criminal offense

Question 24

What is the prevalence of cocaine consumption and addiction? (6)

Answer 24

3 substances used in the past year by Canadians

In 2015, 1.3% of Canadians had used in the past year

This is much lower internationally (0.4%)

More than 2% in US and Australia

Overall decline in past-year cocaine use in Canada, especially for youths

Use is most prevalent among high risk populations (homeless, street-involved youth, younger, trauma, mental health, other drug use)

Question 25

What is the study on the risk and protective factors for drug use and abuse? (3)

Answer 25

A study found risk and protective factors in the context of addiction from an epidemiological perspective

Tracked youths over time to see what substances they were using, how much and how often to examine factors that may be associated with drug use over time

Found that scores for both risk and protective indexes correlated with the frequency and quantity of drug use (protective negatively correlated with use, risk negatively correlated with use)

Question 26

What are protective factors according to the Protective Factor Index? (7)

Answer 26

High GPA

Low depression

Having supportive relationships at home

Perceiving many sanctions for drug use

High religiosity

High self-acceptance

High law abidance

Question 27

What are risk factors according to the Risk Factor Index? (7)

Answer 27

Low educational aspirations

High perceived adult drug use

High perceived peer drug use

Many deviant behaviors

High perception of community support for drug use

Easy availability of drugs

Low perceived opportunity

Question 28

What is the multiple risk and protective factors model demonstrate? (8)

Answer 28

Risk factors are additive and combine to create heightened risk but they also interact with protective factors

RFI and PFI interaction was not predictive of concurrent outcomes

It was predictive of hard drug frequency for everyone and cocaine/cigarette use for women

Found a buffering effect, where high risk and low protection was linked to high drug use and low risk and high protection was linked to low drug use

Predicted greater cocaine and cannabis use 4 years later and alcohol problems 8 years later

In youth, high risk factors were not mediated by protective factors

Cannot attribute addiction to one or even a few causes/factors since we are all so different

Drug use and addiction increase as numbers of vulnerability conditions to which a person is exposed and with which they must cope increase

Question 29

What is the neurobiology of cocaine consumption and addiction? (3)

Answer 29

fMRI studies show that the longer one uses cocaine, the less dopamine D2 receptors there are

This may contribute to the loss of control and impulsivity in cocaine users

There is evidence that the effect can reverse slightly due to abstinence

Question 30

How else does cocaine affect the brain? (2)

Answer 30

Cocaine enters the brain and block the uptake and recycling of dopamine by blocking the dopamine transporters at the synapse at the end of each cell

Means dopamine builds between the cells, giving you the high of release

Question 31

What are the health consequences of cocaine? (6)

Answer 31

Cocaine intoxication can produce a wide variety of psychiatric symptoms that can persist for months, even for months following the termination of cocaine use

Delusions, paranoia, hallucinations, severe anxiety

Psychosis and psychotic disorders

Suicidality

Withdrawal (which has sleep impacts, psych effects, craving, cardiovascular problems)

Overdose (seizures, hypertension, shaking, rapid heartbeat, coma and death)

Question 32

What is the history of tobacco use? (6)

Answer 32

James Bonsack invented the cigarette making machine in 1881, which could make 120,000 cigarettes a day

This industrialized smoking and made it easily accessible and mainstream, mostly for men

During and after WWII, women were entering the workforce which resulted in them taking up smoking

Ads for smoking were everywhere, like by Camel

Smoking wasn’t seen as dangerous because companies would hire actors to pose as doctors in ads and say they smoke them too and are doctor approved

When people started to realize the risk, companies then sold devices to moderate risk

Question 33

What is the prevalence of tobacco smoking in Canada? (3)

Answer 33

In 2016, people who smoke the most are males in the 20-34 category (1 in 4 having smoked that year)

Known sex different across all age groups, with males more at risk

Negative relationship between smoking and household income (the more income you have, the less likely you are to smoke) which speaks to the socio-structural aspects of smoking addiction

Question 34

What is the prevalence of tobacco smoking and other substance use in Canada for youth? (6)

Answer 34

See they are more vulnerable to risky behavior because their brains are still developing and they are more impulsive

Over a quarter were using tobacco in the past year

Tobacco is associated with more frequent use of alcohol, cannabis and other illicit drugs relative to non-smoking youth and adults regardless of smoking

This impact is seen the most by teens and youth (loses its effect after 20)

Cannot necessarily say tobacco is a gateway drug to other drug use and addiction but it is correlated and it is an indicator of other risky behaviors in youth

It is also self-report which could be a limitation due to bias

Question 35

What is nicotine dependence? (5)

Answer 35

Nicotine dependence is the most common SUD and it is known at the chameleon drug

It acts as a sedative when the smoker is anxious and as a stimulant when they are fatigued

Reaches the brain within seconds

On average, a smoke takes about 200 puffs a day, which is a lot and very different from cocaine addicts who would die if they did that

Similar to slot machine playing, which is fast action anticipating a reward

Question 36

How do you measure nicotine addiction? (3)

Answer 36

The Fagerstrom Test for Nicotine Dependence

Test asks 6 questions, it is highly reliable and valid for screening for nicotine dependence

Very short and can be administered quickly to a lot of people

Question 37

What is the neurobiology of nicotine addiction? (2) non scientifically

Answer 37

Dopamine theory had been the prevailing narrative but recent evidence suggests a more nuanced understanding

In the nucleus accumbens, nicotine pushes the accelerator (dopamine) and disables the breaks (GABA) and this ratio increases the release of dopamine

Question 38

What is nicotine’s double effect on DA release? (4)

Answer 38

Nicotine affects two neurons that modulate DA level in the nucleus accumbens

It stimulates the release of glutamate, which triggers additional dopamine

It blocks the release of GABA, which sustains DA level

It increases the ratio of glutamate to GABA in the ventral tegmental area (VTA), which amplifies the rewarding properties of nicotine

Question 39

What are the health consequences of tobacco smoking? (5)

Answer 39

Impotence

Strokes

Cancer (lung especially deadly)

Environmental impacts

There are chemicals like PAINT, methanol and arsenic in there which can kill you

Question 40

What is nicotine withdrawal? (3)

Answer 40

Characterized by fatigue, irritability, gastrointestinal upset and cravings

Acute withdrawal resolves in about 5 days but cravings can last months

Relapse rates are high and many people spend years and decades of their lives trying to overcome addiction