PSYC 2161: Chapter 12 Substance Use Disorders SLIDES

Substance Abuse … person must experience one of the following (4)

1. Failure to fulfill major obligations

2. Exposure to physical dangers

3. Legal problems

4. Persistent social or interpersonal problems

DSM-5 update for Substance Related and Addictive Disorders

Eliminated “dependence” vs '“abuse”

—> Now a single broad category

1) Alcohol dependence lifetime prevalance, a yr prevalence

2) Highest among which group (3)

3) Comorbid with ___ and ___ disorders

1) 12.5% , 3.8%

2) White, men, younger cohorts

3) mood and anxiety disorders

What is high risk drinking defined as

More than 2 drinks per day

—> higher prevalence in males

____ students (uni/high school) report binge drinking usually once per week or in the last month

1 in 4

SHORT TERM EFFECTS OF ALCOHOL

1) What happens to it before it enters stomach

2) Where does it get absorbed in the blood

3) What breaks it down at the end

4) Biphasic effect: initial effects of alcohol

5) Biphasic effect: later effects of alcohol

6) What reduces tension

7) What gives the pleasureable effect

8) What causes cognitive effects like intoxication

9) Alcohol metabolism speed

1) Metabolized by enzymes

2) Small intestine

3) Liver

4) Acts as a stimulant

5) Acts as a depressant

6) GABA stimulation

7) Increased serotonin/dopamine

8) INHIBITion of glutamate

10) ~30 mL of 100-proof whisky/hour

LONG TERM EFFECTS OF ALCOHOLISM

• Malnutrition

• Deficiency of B complex vitamins (AMNESTIC SYNDROME)

• Cirrhosis of liver (fat/protein buildup —> inflammation —> scar tissue —> blocked blood flow)

• Damage to endocrine glands and pancreas

• HF, HTN, stroke, capillary hemorrhages

• Brain damage

Inhalant Use Disorders DSM5

1) What is it

2) Symptoms

3) Most common age group

4) Upper or downer

5) Short term effects

6) Long term effects linked to (3) things

1. Problematic use of hydrocarbon-based inhalants (e.g., glue, spray paint, gasoline) → ≥2 symptoms in 12 months, causing distress/impairment.

2. Symptoms: recurrent use, strong cravings.

3. Most common among 12-17 years old (peak 13-15)

4. Downer (depressant)

5. Euphoria, psychic numbing (nausea, headaches)

6. CNS damage —> Increase suicide rate, criminal behaviour, family problems

____ gets converted into morphine in brain and then binds to opioid receptors (downer/sedatives)

Heroin

Stimulants (uppers) act on the brain and the 1. ___ nervous system to increase alertness and motor activity

They produce effects by causing the release of 2. ___ and 3. ___ and blocking the reuptake of these neurotransmitters

1. Sympathetic

2. Dopamine

3. Norepinephrine

Conditioning / Feed-forward mechanisms

Your body prepares in anticipation of the drug because it’s learned to associate certain cues with its effects (biological + environmental stimuli)

1) Biological treatment for alcoholism that causes violent vomitting (blocks alcohol metabolism = toxic metabolites)

2) Best drug to use in combo with CBT

3) Dfrug that helps maintain abstinence

1) Disulfiram (Antabuse)

2) Naltrexone/Naloxone

3) Acamprosate

Aversion therapy

Goal is to make addictive substance or behaviour feel unpleasasnt

Covert sensitization

Instead of actually exposing the person to something gross or painful, the therapist has them imagine negative consequences (like getting sick or embarrassed) whenever they think about the addictive behaviour.

Contingent-Management Therapy (OPERANT CONDITIONING)

—> Usually involves: (3)

Puts the patient in control and rewards positive changes.

• Stimulus control → limit drinking to specific times/places

• Modification of the topography → Mixed drinks only, small sips only, etc

• Reinforcing abstinence → Give yourself a reward when you resist drinking

Prevalence of inhalant use in teens

17.3%

Conditioning Theory of Tolerance (Siegel)

Tolerance is learned via Pavlovian conditioning:

• Environmental cues present during substance use become conditioned stimuli.

• Example: If you always drink in your basement, the basement itself triggers body responses.

Implicit cognition

Thinking processes that happen automatically and outside of conscious awareness, where your brain quickly reacts to cues without deliberate control.

Delirium tremems (DTs)

An acute form of delirium caused by withdrawal from addictive substances (also called the shakes) mostly from alcohol

• Visual/tactile hallucinations

• Fever, disorientation, extreme fear, etc

Denormalization belief

A belief that reflects widespread social disapproval (e.g., society's current lack of approval of smoking).

Dependence susceptibility

The tendency for some people to be much more sensitive and prone to becoming addictive than are other people.

Drug-Stroop Task

A task to assess implicit cognitions believed to be involved in vulnerability to addiction. The task assesses whether people respond slower when provided with words that they must colour identify (e.g., the word is “blue”) but the word reflects drug-related content (e.g., “vodka”).

Explicit cognition

The controlled thought processes and beliefs that can be consciously deliberated upon in a person's awareness.

Class of synthetic sedatives that are addictive and in large doses can cause death by almost completely relaxing the diaphragm

—> originally developed to aid in sleeping and relaxation

Barbituates

The Developmental Model of Substance Dependence

A person generally goes through the following steps

1. Positive attitude toward the substance

2. Experiment with using it

3. Begin using it regularly

4. Use it heavily

5. Abuse/physically dependent on it

__ tolerance, which occurs with marijuana, is the direct opposite of the tolerance that occurs with an addicting drug such as heroin

Reverse

1) About ___% of people who use marijuana regularly go on tp use drugs like heroin or cocaine

2) IQ decreases by ____ points

3) Cannabinoid receptors are found in many areas in the brain, especially the ____ which explains short term memory loss after use

1) 60%

2) 4-6 points

3) Hippocampus

If a person is addicted to heroin, how soon after their last dose do they need t take more of the drug to avoid severe withdrawal symptoms of insomnia, vomiting, diarrhea

36 hours

Spanagels systems model of addiction suggests that chronic use of alcohol interacts with brain physiology to alter ___ and __

—> Addiction forms from interaction of: (3) things

1. gene expression

2. synaptic plasticity

_________

1. Genetics

2. Environmental stressors

3. Long term alcohol effects on brain physiology and gene expression

For a young binge drinker, the greatest risk that alcohol presents is

Hepatitis

Baby X has been born in a hospital in Canada. What is the probability that she will have a fetal alcohol syndrome disorder

1 in 100

Disease model

Addiction = Due to internal vulnerabilities (genes, brain chemistry)

—> No cure, abstinence needed! Focus on brain research

Moral model

Addiction = Personal failings / choices

—> Recovery framed as personal responsability

NICOTINE:

1) WITHOUT nicotine, how are women’s brains different?

2) WITH nicotine, is there difference in brain activity between males/females

1) Increased brain activity in prefrontal systems (attention & memory)

2) No. All differences disappear

Smoking = leading preventable cause of premature death

Causes 1. ___ % of deaths in Canada annually and 2. ___ deaths/day

3) Highest rates for demographic wise

4) Lowest province for smoking

5) Who gave the first official smoke warning in NA

6) Can addiction start after 1 puff?

17%, 100 deaths/day

3) 25-34 year old males

4) BC

5) Judy LaMarsh

6) Yes

Second hand smoke

1) ETS contains increased concentrations of ___, ____, ____, ___ than smoker-inhaled smoke

2) Blamed for ____ US Deaths/year

3) Linked to negative health effects and _____ _____ in kids

1) Ammonia, CO, nicotine, tar

2) >50,000

3) Behavioural issues