PSY 183 Substance Abuse/Dependance

How do moral and medical views explain addiction?

moral views: addicts are morally weak; they freely choose self-destructive behavior and must exercise willpower and “make better choices”

What is the distinction between “use” and “abuse” of a substance

use: ingestion within a cultures accepted norm (ex. ceremonial wine)

abuse: use that violates norms and causes social or personal harm

How does intoxication, abuse, and dependence differ?

intoxication: temporary, usually reversible impairment after ingestion

abuse: harmful or hazardous pattern of use with social of health consequences

dependence: habitual abuse plus craving, tolerance, and withdrawal signs 

What increases risk for alcohol use disorder (ETOH)?

early drinking: starting before age 15

family history: 4x higher risk even hen reared by non-drinking parents

sex: males overall higher risk but females more medical harm

personality: impulsive, sensation-seeking traits; concept of antisocial PD

social factors: peer pressure, easy availability, fraternity/sorority culture

How does “level of response” to alcohol relate to risk?

people needing larger amounts of alcohol to feel “buzzed: have a low level of response and are more prone to later dependence

What are major withdrawal symptoms of ETOH and how are they related?

symptoms: tremors (“shakes”), sweating,. nausea, seizures, hallucinations, and delirium tremens (confusion, agitation, vivid visual hallucinations)

management: must be medically supervised (hospital or detox unit); often uses cross-tolerant sedatives, antipsychotics, or anticonvulsants to prevent death

What factors created the modern opioid epidemic?

over-prescription of painkillers and poor physician training in pain control

marketing and diversion of prescription opioids

surge of illicit fentanyl and stronger analogs in street drugs

use spread to younger, middle-class adults

What strategies are used to reduce opioid misuse and deaths? 

education: stricter limits on prescription duration and patient awareness 

substation therapy: daily-low-potency opioids (ex. methadone)

abuse-deterrent formulations such as buprenorphine + naloxone

rapid-response programs: wider distribution of naloxone (Narcan) 

research: psychedelic-assisted therapy and new non-addictive painkillers 

What are the two main treatment phases for an addiction?

acute (detox): manage withdrawal medically, stabilize patient, initiate group/family therapy

rehabilitation: outpatient therapy, education, relapse prevention, addressing co-occurring disorders

What is the philosophy behind 12-step recovery groups?

based on a medical view of cause but a moral view of recovery

core principles: admit the problem, accept powerlessness, rely on a higher power, make amends, help others

emphasizes abstinence “one day at a time”

evidence: higher abstinence rates than many other treatments

What trends characterize modern addiction treatment? 

continued reliance on 12-step and abstinence programs

greater attention to co-occuring mental illness (“detox first” still common)

early prevention in schools and communities

medication-assisted approaches: antagonists (block euphoria), maintenance with safer substitutes (ex. methadone, nicotine gum), and abuse-deterrent formulations that resist misuse

How effective are current treatments for common addictions?

most show low long-term abstention rates but can reduce relapse frequency and health risks

success depends heavily on motivation, social support, and continued follow-up

What is the rationale for abuse-deterrent formulations?

reduce misuse by making drugs harder to crush, inject, or rapidly absorb

ADFs release medication only through normal digestion, lowering the “rush”

aim is harm reduction-not elimination-of substance abuse

According to the text, “Does Marijuana Cause Mental Disorders,” what are the mental health risks associated with the use of marijuana? 

impaired driving (equal or worse than alcohol)

depends with withdrawal (irritiability, anxiety, insomnia)

long term cognitive impairment and lower IQ in adolescents

increased risk of anxiety, depression, and especially psychosis in vulnerable individuals

earlier onset of psychotic disorders among users

According to the text, “Does Marijuana Cause Mental Disorders,” why has marijuana use become much riskier?

THC concentrations have quadrupled from 1970s level

CBD levels have dropped sharply, eliminating a protective factor against psychosis

THC:CBD ratios are now 10:1 up to 100:1 instead of 1:1

highly engineered strains of vaping methods expose users to far higher THC doses

vaping has introduced new respiratory risks

According to the text, “Does Marijuana Cause Mental Disorders,” what medical uses of marijuana are well established?

reduction of seizures in severe pediatric epilepsy (CBD)

relief of neuropathic pain (ex. HIV neuropathy)

reduction of chemotherapy-related nausea/vomiting

(evidence for treating mental disorders remains inconclusive)

According to the text, “Fetal Alcohol Spectrum Disorder,” what are common signs of FASD and what factors increase its likelihood?

signs: abonormal facial features (ex. wide-spaced eyes), small brain, malformations, misaligned cortical cells, intellectual disability and learning problems, hyperactivity, attention problems, poor social judgement, high risk of later incarceration of behavioral issues

factors: maternal alcohol use before and during pregnancy, binge drinking (spikes blood alcohol), poor maternal nutrition, use of other drugs (including nicotine), lack of prenatal care, alcohol use by either parent before conception can alter gene methylation

According to the text, “Fetal Alcohol Spectrum Disorder,” what amount of alcohol is safe to drink in pregnancy?

none, even one drink per day as been associated with reduced child IQ

complete abstinence before and during pregnancy is recommended

According to the text, “Korsakoff Syndrome,” what is the cause of Korsakoff Syndrome?

thiamine (vitamin B1) deficiency due to severe and prolonged alcoholism and malnutrition

leads to damage in the mammilary bodies, thalamus, and widespread cortical atrophy (especially in frontal lobe)

According to the text, “Korsakoff Syndrome,” what is the nature of amnesia in Kosakoff’s?

anterograde and retrograde amnesia

confabulation: making up plausible stories to fill memory gaps

poor insight into memory problems, apathetic behavior

usually little recovery once syndrome develops