WEEK 9 Substance Use Disorders

Question 1

What are depressants and give examples?

Answer 1

Induce behavioural sedation and relaxation

Examples include Alcohol, Sedatives, anxiolytics

Question 2

What are stimulants and give examples?

Answer 2

Increase alertness, mood, and activity

Examples include Caffeine, Tobacco, Amphetamines, crystal meth, cocaine, nicotine

Question 3

What are opiates and give examples?

Answer 3

Produce analgesia and euphoria

analgesia = inability to feel pain

Examples include Heroin, opium, codeine, morphine

Question 4

What are hallucinogens and give examples?

Answer 4

Alter sensory perception

Examples include Cannabis, LSD, MDMA (also a stimulant)

Question 5

What are inhalants and give examples?

Answer 5

Produce intoxicating chemical vapors

Examples include nitrous oxide, spray paint, glues, cleaning fluids

Question 6

List the diagnostic criteria for substance use disorder.

Answer 6

• Take in larger amounts or for longer than intended
• Unsuccessful efforts to reduce use or quit
• Spending a lot of time getting, using, or recovering
• Cravings and urges to use
• Role disruption at work, home, or school
• Continued use despite social/interpersonal problems
• Reduction in social, occupational, or recreational activities
• Using in physically hazardous situations
• Continued use despite physical or psychological problems
• Tolerance
• Withdrawal

caffeine is not included in DSM5 substance use disorders - it is noted as a condition for further study

Question 7

What are the severity specifiers for substance use disorder?

Answer 7

• Mild (2-3 sx)
• Moderate (4-5 sxs)
• Severe (6+ sxs)

Question 8

Define substance intoxication.
What substance does the DSM-5 exclude for intoxication.

Answer 8

Development of reversible substance-specific problematic behavior due to the acute ingestion of a substance.

The DSM-5 does not recognise tobacco intoxication –> because review of the literature has determined that tobacco does not lead to an acute impairing syndrome that’s significant to the same level as the other ones (could be lack of research though)

Question 9

Can intoxication occur without a substance-use disorder?

Answer 9

Yes

Question 10

Define withdrawal.
What substances are not recognised in the DSM for withdrawal.

Answer 10

Development of a substance-specific problematic behavioural change, with physiological and cognitive components, due to cessation of or reduction in heavy and prolonged use.

DSM doesnt recognise hallucinogen-related withdrawal and inhalant withdrawal because these are often not used in heavy or prolonged situations.

Question 11

What are the acute effects of alcohol on neuroreceptor systems?

Answer 11

• GABA - Increased
• Glutamate - Decreased
• Serotonin - Increased

Question 12

What might increased GABA levels be responsible for?

Answer 12

Anti-anxiety properties

Question 13

What might decreased Glutamate levels be responsible for?

Answer 13

Cognitive dysfunction

Question 14

What might increased Serotonin levels be responsible for?

Answer 14

Improved mood and alcohol cravings

Question 15

List some long-term effects of alcohol.

Answer 15

• Withdrawal (e.g. Delirium tremens)
• Liver disease
• Pancreatitis
• Cardiovascular disorders
• Brain damage (e.g. Dementia, Wernicke-Korsakoff Syndrome)

delirium tremens = characterised by profound confusion, the shakes (often hand), agitation and hallucinations

Question 16

What are the predictors of alcohol abuse?

Answer 16

Drinking at an early age
* Low level of response to alcohol
* Family history of alcohol use disorder
* Increased positive alcohol expectancies
* High impulsivity
* High novelty seeking

Question 17

What are the predictors of nicotine dependence?

Answer 17

Smoking at an early age
* Mood disorders
* Anxiety disorders
* Personality disorders
* Illicit substance use disorders
* Being unmarried
* Low education attainment
* Low SES

Question 18

What are the predictors of illicit drug dependence?

Answer 18

• Severe and chronic early life stress
• Using drugs before adulthood
• Drinking alcohol early
• Cigarette use
• Depression
• Being male
• Low education attainment
• High neuroticism
• Conduct disorder

Question 19

What is the role of dopamine and the reward system?

Answer 19

Increased DA in NA –> more rewarding behaviour
Repeated experience –> release DA –> strengthens learning Engaging in repeated experiences of the behaviour –> releases dopamine –> stronger the learning

Question 20

How has the view of dopamine as a neurotransmitter evolved?

Answer 20

Seen as the learning neurotransmitter instead of pleasure neurotransmitter.

Dopamine helps you learn associations with contextual cues before engaging with substance and pleasurable outcomes –> so now thought DA is associated with assigning importance to stimulus associated with rewards and increasing reward seeking behaviours

Question 21

What are the main neural pathways involved in reward?

Answer 21

Mesolimbic dopamine pathway: projections from VTA to NA (which is assoc with motivation and reward)
-considered main structure of the reward system.

Mesocortical dopamine pathway:
projections from VTA to frontal cortex which is also activated during rewarding experiences.

Question 22

What are the three main types of infleunce for SUDs

Answer 22

Biological, psychological, sociocultural.

Question 23

Biological causes of SUDs

Answer 23

*Genetic component (identical twins > fraternal twin concordence w SUDs)
*Genetic factors play a similar role for all drug abuse
*Drugs reduce bad feelings assoc w reward
*Drugs affect the reward pathway
*Incentive sensitisation theory
*Value of immediate over delayed reward

Question 24

What is incentive sensitisation theory?

Answer 24

The theory that poses the biological changes in the brain from repeated use of substances. There is a shift from liking to wanting (craving) as an addiction forms. Triggered by cues.

Question 25

Psychological causes of SUDs

Answer 25

*Mood alteration -increase positive feelings and limit negative ones neg affect and life events predict drug use -ability to reduce negative affect is influenced by abstinence and distraction *Outcome expectancies - you expect positive changes to your mood --> predicts greater use and greater problems placebo effects *Personality -high neuroticism --> negative reinforcement as it removes feelings of anxiousness -heightens disinhibitory personality traits --> positive reinforcement as we feel more free and less tense

Question 26

Sociocultural causes of SUDs

Answer 26

*Exposure to drugs is a prerequisite for drug use -Taxing alc and cigs is hence protective *Family -Parental support, involvement, modelling, monitoring, good quality relo= assoc with less alc and drug use -Teens whose parents supply them with alcohol are more likely to experience alc harms *Peers - Peers use more --> likely for individual to use more *Societal attitudes

Question 27

Which countries have higher rates of drug use per capita?

Answer 27

- Australia, Europe, Argentina

Question 28

Which countries have moderate rates of drug use per capita?

Answer 28

North and South America

Question 29

Which countries have lower rates of drug use per capita?

Answer 29

Africa and Asia

Question 30

Outline the integrative model for SUDs

Answer 30

Genetic, neurobiological, associative learning, cognitive and environmental factors all work to create unique pathways to get to problems with drugs and alcohol. *see image on slide 68

Question 31

What is the principle of equifinality?

Answer 31

A disorder may arise from multiple and different paths (multiple pathways to same outcomes).

Question 32

Outline risk factors for gambling (strap in there's a lot)

Answer 32

-Male -Living alone -Engaging in continuous forms of gambling -Being young -Having financial difficulties -Number of gambling activities -Being single -Alcohol and other substance use Family members are programbling or have gambling problems -Sensation seeking Poor academic performance -Under controlled temperament -Impulsivity -Engaging in gambling to make money -High stress -Social problems -Engaging in gambling to regulate emotions -Depressive symptoms

Question 33

Based on the integrated risk and protective factors model of gambling types, what are the three types of gamblers? (Hearn et al. 2021)

Answer 33

1. Social gamblers 2.Affect regulation gamblers 3.Antisocial gamblers

Question 34

Outline social gamblers

Answer 34

*Motivated by social and recreational reasons *No additional psychopathology *Least severe *Decreased risk of problem gambling *low-moderate cognitive distortions *high levels of protective factors

Question 35

Outline affect regulation gamblers

Answer 35

*Preexisting and current emotional problems *History of negative life experiences *Emotionally unstable *Gamble to cope with negative affective states *Increased risk of problem gambling *low-moderate protective factors

Question 36

Outline Antisocial gamblers

Answer 36

*Lots of impulsivity and antisocial tendencies *Leads to harmful behaviours *More severe gambling related cognitive distortions (e.g. the odds are rigged but im an exception) *To escape negative emotions, but also for excitement and positive emotions *Increased risk of problem gambling *low protective factors

Question 37

Outline the three kinds of substance use **prevention** programmes.

Answer 37

1. Universal programs - most effective because more cost effective - small effects: helps few people - more effective when target young audience, but this is a problem cause gov doesnt want children exposed to drugs and alc 2.Selective programs - often more costly because extensive screening needed 3.Indicated programs - basically treatment for young people

Question 38

what are psychoactive substances

Answer 38

alters mood, behaviour or both

Question 39

what is substance use

Answer 39

taking MODERATE amount of substance in a way that DOESNT interfere with functioning

Question 40

problematic drug seeking behaviour is characterised by... (3 things)

Answer 40

- behaviour is excessive - causes significantly significant distress or impairment - persists despite neg consequences and little reward

Question 41

changes in substance use disorder conceptualisation from DSM4 to DSM5

Answer 41

DSM 4 had two terms 1. substance abuse = 1+ sxs 2. substance dependence = 3+ sxs DSM5 = substance use disorder - mild (2-3 sxs) - Moderate (4-5 sxs) - Severe (6+ sxs) and added craving and removed legal problems as specifiers

Question 42

what are the top 3 categories of drug use for AUS 2022-2023

Answer 42

1. risky alcohol consumption 2. cannabis 3. smoking daily

Question 43

what are the acute effects of nicotine?

Answer 43

- reaches brain in 7-19 seconds making it highly rewarding and addictive - influences nicotinic acetylcholine receptors --> increases energy and improves mood - influences glutamate --> increases desire to keep using it because we remember it makes us feel good

Question 44

long term effects of nicotine?

Answer 44

- withdrawal --> It not only goes to the brain quickly but also leaves the brain quickly so then they need to keep smoking to keep a steady amount of nictotine in their system - loss of taste and smell - yellow teeth, tooth decay, and bad breath - premature ageing - decreased immune response - respiraratory disorders - cardiovascular disorders - gastrointestinal disorders - cancer - resistance to chemo and radio therapeutric agents bruh

Question 45

List all the substance use disorders (there are 8)

Answer 45

- Alcohol use disorder - Cannabis use disorder - Hallucinogen-Related use disorder (PCP or other) - Inhalant use disorder - Opiod use disorder - Sedative/Hypnotic/Anxiolytic use disorder - Stimulant use disorder - Tobacco use disorder

Question 46

acute effects of illicit drugs

Answer 46

* Sedative, Hypnotic, and Anxiolytic Drugs --> Acts on GABA receptors to produce tranquilising effects * Amphetamines --> Acts on norepinephrine to influence arousal, attention, and mood * Opioids --> Acts on enkephalins and endorphins to produce pain relief and induce euphoria * Cannabis --> Acts on cannabinoid receptors to influence pleasure, memory, thinking, concentration, movement, coordination, and sensory and time perception

Question 47

Long term effects of Illicit Drugs

Answer 47

* Sedative, Hypnotic, and Anxiolytic Drugs --> Memory problems (maybe dementia) and depression * Amphetamines --> Paranoia, hallucinations, malnutrition, reduced immunity, mood swings, heart and kidney problems * Opioids --> Constipation, sleep-disordered breathing, fractures, hypothalamicpituitary-adrenal dysregulation * Cannabis --> Psychosis, Chronic coughing, wheezing, sputum production, and acute bronchitis, Using regularly as a teen may impair thinking, memory, and learning functions

Question 48

criteria for gambling disorder what are the severity specifiers

Answer 48

- need to gamble with increasingly amount of money to achieve excitement - restless or irritable when try to stop - unsuccessful efforts to stop - often preoccupied with gambling thoughts - often gambles when distressed - after losing money, returns to get even - lies to conceal extent of gambling involvement - had jeapardized relationships, educational, or career oppurtuniies - relies on others for money to relieve desparate fincancial situation - rule out mania mild = 4-5 moderate = 6-7 severe = 8-9

Question 49

what are substance use **treatments**

Answer 49

- agonist substitution: safe drug with similar chemical composition to reduce harmful side effects e.g. methadone for heroin and nicotine gum/patch for tobacco - antagonist substitution: drugs that counteract or block the pos effects of substances e.g. naltrexone for opiates and alcohol (reduces DA) - aversive treatment: drugs that make use of substance extremely unpleasant e.g. antabuse and silver acetate --> will get very sick, can be dangerous though if they continue to drink so need to be certain they will stop

Question 50

what does cognitive behavioural approach target for substance use and gambling treatment? And what is the problem of CBT for gambling?

Answer 50

teaches behaviours that make relapse less likely - distorted cognitions - identify neg consequences - increase motivation to change - identify high-risk situations - reframe relapse (not a failure of the person, failure of coping skills) problem for gambling: seems to more target anxiety and depression rather than the gambling, individuals likely to drop out, not very successful