Addictions Part 2 Cocaine and Tobacco

Amphetamines/Cocaine intoxication effects

Initial increase in euphoria, alertness, and insomnia

Hallucinations, anxiety, vomiting, weight loss, seizures, coma

Cocaine withdrawal effects

Apathy, boredom, depression, increased sleep, irritability

NOTICE: The withdrawal effects are often the opposite of the intoxication effects.

Why do people try cocaine?

Usually because they have a tough time sleeping or not hanging out enough with their friends

What makes cocaine dangerous?

Because it is illegal, it has other substances in it, such as rat poison.

Cocaine in and of itself, isn’t super dangerous, it’s often the other things associated with it.

Etiological factors of amphetamines/cocaine part 1

Increase of norepinephrine and (especially) dopamine

Reverse tolerance/sensitization—the next time you take the drug, it hits you stronger than the previous time

What causes the schizophrenic-like hallucinations in cocaine use?

The increased dopamine

Etiological factors of amphetamines/cocaine part 2

Apathy and boredom prompt re-use

Impulsivity linked to sensitization

Apathy and boredom prompt re-use

The lack of joy in day to day life can cause people to want amphetamines and cocaine

Impulsivity linked to sensitisation

People who are impulsive seem to be able to focus more with amphetamines/cocaine, but we aren’t really sure why

Treatment for cocaine

NOTE: no medication can kill the desire for cocaine

Propranolol

Modafinil

ADHD medications

Propranolol

A beta-blocker, most commonly used for heart disease, but it helps reduce anxiety caused by withdrawal effects of cocaine.

Beta blockers used to be used for anxiety disorders

Modafinil

A medication for hyersommnia and narcolepsy, because people with those conditions often take cocaine to help them stay awake

ADHD medications

Sometimes people with ADHD take cocaine as it helps them concentrate

Cocaine treatment part 1

Cocaine anonymous

Harm reduction

Cocaine treatment part 2

CBT – contingency management

CBT – community reinforcement

Cocaine anonymous

Similar to AA. Somewhat effective, though there is little research.

Harm reduction

Talking to the client about the harmful effects of using drugs, as they may have mixed/contradictory feelings about it

It could also include giving the person more things to do in life, such as helping them get a job, go back to school, and engage in recreation activities

CBT Contingency Management

Focusing on the benefits of abstaining from the drug by setting up a contingency with rewards for completing goals

E.g. if you save money not spending on drugs, you can buy a new video game.

CBT Community reinforcement

Finding a community of (typically) non-using family members and friends.

It also involves distancing yourself from problem-causing people, such as friends who are also using drugs

Tobacco/nicotine intoxication effects

Typically smoking helps people relieve stress and improve mood, although some researchers think that it’s because it’s a social thing that allows you to take a break from work.

If you have tons of smokes in a row, that can cause blurred vision, confusion, convulsions.

Does nicotine effect cognitive processes?

Some research shows that nicotine improves cognitive processes, such as the ability to focus,and (very slightly) dementia and Alzheimer.

Nicotine, as a pure chemical, may not actually be that bad, it’s often the other stuff in cigarettes that’s toxic

Withdrawal effects of tobacco/nicotine

Depressed mood, insomnia, anxiety, difficulty concentrating, restlessness, increased appetite/weight gain

What are the hardest drugs to quit?

People at addiction centres say that cigarettes and alcohol

It might be because it’s easier to say “I can have just one more cigarette” compared to “one more injection of heroine,” which sounds more serious

Smoking in men vs. women

Men tend to smoke at a younger age than women, but in college, women rapidly catch up

Sometimes women will smoke because it decreases appetite, which will help them eat less in the dorms, as there can be lots of pressures to eat in dorms.

Etiological factors of smoking part 1

Nicotinic acetylcholine receptors

Genetic predisposition

Etiological factors of smoking part 2

Depression/anxiety prompt relapse

Motivations for use

Environmental stimuli

Nicotinic acetylcholine receptors

In your limbic system, and they are associated with the pleasure centres of the brain

When these receptors are stimulated, dopamine's effects are also enhanced

Genetic disposition

If your parents smoke, you’re more likely to.

But, there is a correlation between smoking and depression, so maybe it’s the depression that’s genetic and the cigarettes a byproduct (I think I infered this, it wasn’t exactly what Alex said)

Depression/anxiety prompt relapse

Often when people are bored and lonely, they smoke

Partly they see smoking as a social thing, and sometimes in the military, only smokers were given breaks

Motivations for use

No notes

Environmental Stimuli

What are the environmental factors that trigger you to smoke?

Ex. If the idea is that you always walk through the door that smells of cigarettes, exit through a different door

Treatment for smoking

Nicotine replacement therapy

Wellbutrin/Zyban

Champix

Silver acetate

CBT

Nicotine replacement therapy

Such as nicotine gum or nicotine lozenges, but they are much more effective if you add on additional treatments such as therapy or exercise

They work for about 30% of people

Quitting cold turkey only works for about 5% of people

Wellbutrin/Zyban

An antidepressant called NDRI, norephinephinre and dopamine re-uptake inhibitor.

One theory is that it blocks (antagonises) the receptor cites of nicotine.

However, 10% of people will hallucinate while on them, so people often quit the medication

Champix

Mimics the effects of tabacco, as it’s an agonist for nicotine receptor cites.

It thus takes away the pleasurable effects of smoking, because the receptor cite is blocked by the agonist.

Upon follow ups, a lot of people go back to smoking

Silver acetate

A gum or a lozenge that acts as an antabuse for smoking

CBT and harm reduction therapy

Few people go to therapy for smoking

There is hardly ever any harm reduction in therapy, for everyone knows the adverse effects of smoking, and you always encourage the individual to fully quit, rather than smoke in moderation