substance use disorders

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28 Terms

1
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Substance Use Disorder

  • combines abuse + dependence

  • different severities

    • mild 2-3sx

    • moderate 4-5sx

    • severe 6+ sx

2
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alcohol prevalence

general

  • 10% of 18-25 meet criteria

    • more men than women

  • lifetime = 29%

racial

  • more common in Native Americans and Hispanics

    • less in Black

  • Asian is lower than white

3
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Alcohol physical effects

  • depresses the CNS

    • impairs judgement and inhibition

    • impaired fine motor skills

    • incoherent speech

  • effects on brain

    • stimulates GABA receptors (like benzos)

      • relax

    • increases serotonin and dopamine

      • pleasure

    • inhibits glutamine receptors

      • cognitive effects

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long term alcohol use

  • impairment

    • social

    • occupational

  • liver cirrhosis

  • malnutrition

  • korsakoff’s

    • amnestic syndrome

    • deficiency in b-complex vitamins

  • damage to other organs (heart, pancreas, etc.)

  • erectile dysfunction

  • stroke

  • hypertension

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nicotine prevalence

  • lifetime 18%

  • higher for

    • Native Americans

    • less education

    • lower SES

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Nicotine effects

  • stimulates the sympathetic NS

    • release of NE and DOP

      • activates the CNS

        • activates the reward system

  • feeling of relaxation

    • use removes withdrawl sx

    • accompanying activities are relaxing

      • time with friends, being outside

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nicotine dangers

  • health risks

    • lung cancer, bronchitis, stroke, heart disease, etc.

  • don’t know how much is really in e-cigarettes

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marijuana prevalence

  • most widely used illegal drug in the US

  • 8% of the population over 12 use

    • 20% of 18-25

    • 6.5% of over 25

  • no gender difference

  • ~ equal across racial and ethnic groups

  • THC content is increasing

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marijuana dangers

  • increases risk of EVALI = e-cigarette or vaping use associated lung injury

    • THC concentrations are increasing A LOT esp in vaping products

    • large increase in highschoolers vaping it

  • cognitive decificts

    • esp loss of short term memory

  • impaired motor skills needed for driving

  • impairs lungs

    • reduced ability to expel air

  • affects reproduction

    • for chronic users

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marijuana effects - low dose

  • joy

  • relaxation

  • possible anxiety, suspicion, or irritability

  • sharpened perceptions (sights and sounds)

  • increase heart rate and BP

  • increased appetite

  • dry mouth

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marijuana effects - high doses

  • visual distortions

  • hallucinations

  • confusion

  • paranoid delusions

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marijuana benefits

  • reduced nausea and vomiting in cancer pts

  • improves appetite in AIDS pts

  • treat glaucoma

    • reduces intraocular pressure therefore prevents optic nerve damage

  • decrease seizures

  • decrease migraines

  • slows down plaque development in Alzheimer’s

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opioid prevalence

  • 0.3% of adults used heroid

  • 1-1.5% misused prescription pain meds

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opioid dangers

  • overdoses

  • used to be marketed as not addictive

  • leads to Heroin use when starting with prescription pain meds

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opioid effects

  • pain relief

  • euphoria

  • drowsiness

  • slowed breathing

  • ecstasy

  • high lasts 4-6hrs, feel with drawl within 8hrs

  • build up a tolerance

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methamphetamine prevalence

  • 0.6%

  • more men

  • emerging as a major drug in the last 2 decades

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methamphetamine effects

  • increased DOP

  • longer high than cocaine and cheaper than other drugs

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methamphetamine dangers

  • destruction of tissues and blood vessels

    • decreased ability to heal

    • skin loses elasticity

  • meth mouth

    • rotted teach due to dried out salivary glands

  • problems with learning and memory

    • damage to hippocampus and limbic system

  • paranoid thinking and hallucinations

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etiology - genetics

  • runs in families (esp alcohol)

  • high concordance rates

  • more likely to get addiction if

    • low response to alcohol

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etiology - neurobiological factors

Mesocorticolimbic Dopamine Pathway (MCLP)

  • in the ventral tegmental area connected to the nucleus accumbens and the prefrontal cortex

  • rewards increase DOP here

    • involved in emotions, memory, and gratification

  • drugs overstimulate it by flooding it with DOP

Role of DOP

  • too few receptors increases vulnerability

  • toxic effect model: problems in the DOP system due to drug use damaging it

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etiology - psychological

expectancies

  • if you believe that drugs are dangerous you are less likely to use them

  • get attitudes from

    • parents

    • society

    • friends

    • media

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etiology - sociocultural factors

  • alcohol use is normalized leads to increased prevalence

2 theories

  1. social influence model

    • social network can be used to predict how early and how much they will do drugs

  2. social selection

    • people who are inclined to use select social networks that conform to their pattern of use

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inpatient hospital treatment

  • starts with detox

    • can provide a safe space and decrease negative effects such as nausea

  • isn’t more effective than outpatient

    • provided you have good social support

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CBT

3 goals

  1. contingency management

    • reinforce behaviors inconsistent with drinking and avoid situations associated with drinking

  2. community reinforcement

    • address multiple areas as there is more than one reason someone uses

      • coping skills

      • relationship therapy

      • replace substance use with new activities

      • identify antecedents and consequence of drug use

  3. relapse prevention

    • view relapse as a failure of cognitive and behavioral skills

    • identify high risk situations and change mindset about drug use and view relapse as learning experienceal

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alcoholics anonymous

  • 12 step program where you make amends and admit you are powerless to alcohol

  • attend regular meetings (Esp at the beginning) and work with a sponsor

    • isn’t more effective than other treatments

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controlled drinking vs abstinence

  • what is best for everyone varies on the type of drinker you are

    • older = abstinence

    • younger = moderation

  • some say abstinence leads to relapse bc with one drink you all ready blew it

  • others say that moderation isn’t possible for addicts

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treatment - medication

antagonist drugs

  • block the effects of an addictive drug

  • antabuse → alcohol

  • naltrexone → opioids

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treatment - drug maintenance program

  • lifestyle is worse than the drugs themselves

  • methadone programs

    • give heroin users methadone (synthetic opioid) and a safe space to use it

  • suboxone

    • buprenorphine (agonist) + naloxone/narcan (antagonist)

    • doesn’t produce a strong high but is mildly addictive

    • used to help transition to being clean

  • pretty effective! esp when combined with other therapies