Week 9 - Substance and Addiction Disorders Flashcards
(24 cards)
Types of substance-related disorders
Alcohol, caffeine, cannabis, hallucinogen, inhalant, opioid, stimulant, tobacco, sedative/hypnotic/anxiolytic
Substances - terms and definitions
Psychoactive substance - alters mood and/or behaviour
Substance use - moderate use, doesn’t impede function
Polysubstance use - using multiple
Substance intoxication - physical reaction
Physiological dependence - tolerance and withdrawal
Addiction - defined by dependence or seeking behaviour (excessive, distress, persists)
Substance abuse - Pre DSM5 term (harmful use, 1 or more sx)
Substance dependence - Pre DSM5 term (harmful use, 3 or more sxs)
Substance use disorder - DSM5 (harmful use, 2 or more sxs)
Drug categories
Categories not completely mutually exclusive
Depressants - sedation (alcohol - stimulates initially, sedative anxiolytics)
Stimulants - alertness/activity (caffeine, tobacco, amphetamines, crystal meth, cocaine, nicotine)
Opiates - analgesia/euphoria (herion, opium, codeine, morphine)
Hallucinogens - alter perception (cannabis, LSD, MDMA - also stimulant)
Inhalants - intoxicating vapors (nitrous oxide, spray paint, glue, cleaning fluids)
Drug use - Australia
Drug strategy survey 22-23:
- risky alcohol (6.6 mil), recent cannabis (2.5 mil), smoke daily (1.8 mil), vape (1.5 mil)
- fewer people smoking tobacco, vaping had tripled (1/2 18-24 vaped in past 12 months)
- less males drinking, more females
- drink driving reduced
Changes in recent drug use
- Hallucinogens and ket increased
- Ecstasy and opioids decreased
- Weed, cocaine, inhalants stable
Drugs and mental health & wellbeing survey
Over 12 months - anxiety (17.2%), affective (7.5%), substance (3.3%)
- Alcohol highest substance, men more common in substance use, highest rates 16-24 (then steady decline)
Substances - DSM5 additions
Combined substance abuse and dependence into one
Severity - mild (2-3 criteria), moderate (4-5 criteria), severe (6+ criteria)
Added ‘craving’ and removed ‘legal problems’
Substance use disorder - diagnostic criteria
- Larger amounts/longer than intended
- Unsuccessful efforts to quit
- Lots of time involved
- Cravings
- Role disruption
- Continued use with social problems
- Reduced social, occupational, recreational activity
- Using in physically hazardous situations
- Continued use despite physical/psychological problems
- Tolerance
- Withdrawal
Severity - mild (2-3 criteria), moderate (4-5 criteria), severe (6+ criteria)
Use disorders
All drug types (alcohol, tobacco, etc.) have a use disorder EXCEPT for caffeine
Intoxication and withdrawal
Intoxication - reversible substance-specific problematic behaviour
- Tobacco only drug WITHOUT intoxication component
Withdrawal - substance-specific problematic change in behaviour due to drug cessation (physiological and cognitive)
- Inhalants and hallucinogens WITHOUT withdrawal component
Effects of alcohol
Acute
- GABA (inhibitory) - enhanced, leads to relaxation and anti-anxiety
- Glutamate (excitatory) - suppressed, leads to cog. dysfunction
- Serotonin - enhanced, improves mood and alcohol craving
Long-term
- Withdrawal (delirium tremens), liver disease, pancreatitis, heart disease, brain damage, dementia, Wernicke-Korsakoff
Effects of nicotine
Acute
- Reaches brain in 7-19 seconds
- Nicotine acetylcholine receptors - improves energy and mood
- Glutamate - remember that nicotine feels good
Long-term
- Withdrawal, loss of taste/smell, tooth decay, aging, worse immunity, respiratory disorders, heart disease, GI disorders, cancer, chemo resistance
Effects of illicit drugs
Acute
- Sedatives - acts on GABA to tranquillise
- Amphetamines - acts on norepinephrine for arousal, attention, mood
- Opioids - acts on enkephalins and endorphins to relieve pain and give euphoria
- Cannabis - acts on cannabinoid receptors to influence pleasure, memory, thinking, concentration, movement, coordination, perception
Long-term
- Sedatives - memory (dementia), depression
- Amphetamines - paranoia, hallucinations, malnutrition, poor immunity, mood swings, heart/kidney
- Opioids - constipation, sleep-disordered breathing, fractures, HPA dysregulation
- Cannabis - psychosis, coughing, wheezing, bronchitis, teens may impact thinking and learning
Gambling - terms and definitions
Pathological gambling/gambling disorder - DSM5, 5+ symptoms
Problem gambling - 3-4 sxs (not threshold)
Recreational/at-risk gambling - 2 or less sxs, more than 5x year gambling
Low-risk/non-gambling - less than 5x year
Gambling prevalence
85% of population had gambled once
Australia has highest gambling per capita (lose $1000 per year per person)
Since 2000, Australians lost $21.2 billion per year (NSW, QLD, VIC most)
Harm - gambling will harm 6 people in one’s life
Gambling - diagnostic criteria
Similar to substance
1. Increasing amounts of money
2. Irritable when trying to stop
3. Can’t stop
4. Preoccupied with gambling
5. Has jeopardised relationships, education, career
Different to substance
6. Gambles when distressed
7. Tries to get even
8. Lies to conceal extent
9. Relies on others financially
Must rule out mania
Severity - mild (4-5), moderate (6-7), severe (8-9)
Substance abuse predictors
Alcohol - early drinking, low response, family history, increased expectancy, impulsivity, novelty seeking
Nicotine - early smoking, mood/anxiety issues, PDs, substance use, unmarried, low SES/education
Illicit drugs - early life stress, early use, early drinking, smoking, depression, male, low education, high neuroticism, conduct disorder
Dopamine and reward system
All drugs of abuse increase DA in NA
Pathways - mesolimbic DA (VTA > NA), mesocorticial DA (VTA > frontal cortex)
DA doesn’t exactly correlate with pleasure (thought to associate more with learning)
Causes of substance use disorders
Positive attitude > experimentation > regular use > heavy use > addiction
Biological
- genetic component likely (twin studies)
- drugs taken to avoid withdrawal sxs
- incentive sensitisation theory (wanting & liking, drug cues and responses)
- valuing immediate rewards over delayed
Psychological
- mood alteration (drugs change affect, neg. life events increase drug use)
- outcome expectancies (placebo, positive expectancies predict use)
- personality (neuroticism, disinhibitory personality)
Sociocultural
- exposure to drugs (advertising, availability)
- family (parental endorsement, good parent/child relationship reduces chance)
- peers (big influence)
- societal attitudes (Aus/EU most, Africa/Asia least)
Integrative model
Multiple sources - genetics, neurobiology, associative learning, cognitive factors, environment
Equifinality - disorder can arise from multiple paths
Exposure > social expectations + psychological influences > drug use (if stressors and biological influences are added, can lead to disorder)
Predictors of gambling
Male, single, young, live alone, financial difficulties, substance use
Engaging in continuous/numerous gambling activities
Family history, sensation seeking, impulsivity
Social problems, poor academic performance
High stress, depressive symptoms
Integrative risk and protective factors model of gambling types
Motivation 1 - social gamblers
- Risks - low cog. distortions, pattern of habitual gambling
- Protective - social support, self-control, life satisfaction, resilience
— Decreased risk
Motivation 2 - affect-regulation gamblers
- Risks - neg. life events, anxiety/depression, high cog. distortions
- Low protective
— Increased risk
Motivation 3 - antisocial gamblers
- Risks - impulsivity, anxiety/depression, high cog. distortions, psychopathy, criminal versatility
- Low protective
— Increased risk
Substance use prevention
Universal programs (whole population) - small effect sizes, significant social cost savings
Selective programs (at-risk groups) - more costly due to screening
Indicated programs - treatment for those suffering
Substance use treatment
Agonist substitution - safe drug with similar composition (methadone, nicotine patches)
Antagonist treatment - drugs that block positive effects (naltrexone)
Aversive treatment - make substances unpleasant (antabuse, silver acetate)
CBT tries to reduce relapse behaviours (address distortions, consequences, motivation, risk situations, reframe relapse)
Effectiveness
- CBT no more effective than other treatments
- Controlled use may be just as effective as abstinence
- Contingency management helps short-term
- Community reinforcement helpful
Gambling treatment
Similar to CBT for substance use (high relapse, if family problems addressed outcomes may improve)
