Chapter 7 substance use

1. Define ‘tolerance.”

the need for increasing doses of a substance to produce desirable effects

Define “withdrawal.

the unpleasant and sometimes dangerous reactions (cramping, shaking, vomiting, nausea, sweating, high anxiety.......) that occur when an individual stops taking or cuts back on a substance they have been taking for a period of time

Define “Substance Dependence.”

maladaptive pattern of substance use characterized by the need for increasing amounts to achieve the desired effect, negative physical effects when the substance is withdrawn, unsuccessful efforts to control its use, and substantial effort expended to seek the substance orrecover from its effects.  Also known as “addiction”

2. Describe the effects of a “depressant,”

A psychoactive substance that results in behavioral sedation ( including “relaxation”) ; includes alcohol, sedatives, hypnotic, anxiolytic drugs, opioids

a “stimulant,”

A psychoactive substance that results in elevated mood, activity or alertness: includes amphetamines, caffeine, cocaine, nicotine.

and a “hallucinogen.”

Hallucinogen” Any psychoactive substance such as LSD or marijuana that can produce delusions, hallucinations, paranoia and/or altered sensory perception

3. What are the DSM-V criteria for “Substance Use Disorder”?

1. A maladaptive pattern of substance use leading to significant

impairment or distress.

2. Presence of two or more of the following symptoms within a 12- month period:

(a) Substance is often taken in larger amounts or over a longer period than intended.

(b) Persistent desire or unsuccessful efforts to reduce or control substance use.

(c) Excessive time spent trying to obtain, use, or recover from the effects of substance.

(d) Failure to fulfill major role obligations at work, school, or home as a result of recurrent substance use.

(e) Continued use of substance despite persistent social or interpersonal problems caused by it.

(f) Cessation or reduction of important social, occupational, or recreational activities because of substance use.

(g) Recurrent substance use in situations where use poses physical hazards.

(h) Continued substance use despite awareness that it is causing or exacerbating a physical or psychological problem.

(i) Tolerance effects.

(i) Withdrawal reactions.

k) Craving or strong desire or urge to use substance.

4. What % of people in the US qualify for this disorder?

9%

5. Define “Binge-Drinking?”

Binge-drinking defined as 5+ drinks consumed on a single occasion. For men and 4 for wemon bc they don’t process it as well bc of a stomach ensime

24% of people (over age 11) in US binge-drink at least once each month.

Do people who binge drink qualify for a diagnosis of Substance Use disorder?

Yes

what is glutamate

The primary exhibitor

Alchol blocks glutamate receptors to decrese neuron firing

7. How does alcohol affect the liver?

travels to the liver and is broken down to carbon dioxide and water. This reaction causes an inflammatory reaction which leads to cell death in the liver.

8. How does alcohol affect GABA ( the primary inhibitory neurotransmitter in the CNS) 

Alcohol increases the effects at the GABA receptor making the neuron less likely to fire. Increased GABA (the same effect that occurs with anti-anxity drugs) quiets the nervous system.

With prolonged consumption, how does the body respond?

They will have less gabba receptors and incressed glutamate

9. Does alcohol have a bigger effect on small or large people?

men or women? why?

Smaller

women become more intoxicated on a equal dose of alcohol vs. a man of the same weight.

10. What is the legal limit for blood alcohol levels in drivers?

(over 21 and below 21)

over is 0.08 and below is .02

11. Lifetime prevalence for Alcohol Use Disorder?

.55%

12. Describe ancestral patterns of alcohol use in the US

Prevalence of alcoholism in a given year (7-9%) is about equal among Caucasian Americans, Hispanic Americans and African Americans.

13. Withdrawal symptoms after excessive alcohol use?

symptoms include shaking, weakness, nausea/vomiting, sweating, rapid heart beat, increased blood pressure, anxiety, depression, insomnia, irritability, death

14. Describe the symptoms of DT’s.

a severe withdrawal reaction to alcohol.visual hallucinations (may be visions of insects, rats, snakes), auditory hallucinations or tactile hallucination (the feeling that something is crawling on the patient’s skin), fever, high blood pressure, sweating, confusion, disorientation, racing heart rate. Extreme feelings of impending doom. Sever anxiety, panic attacks, paranoia, and feelings of impending death, seizures.

How are DT’s treated

Because the alcohol is increasing the response at GABA receptors, the GABA neurons become less sensitive to GABA. With the withdrawal of alcohol, there is not enough GABA activity as it has been down-regulated - so you suddenly have a lack of inhibitory neurotransmitter.

•Alcohol inhibits glutamate (the excitatory NT) so the body up-regulates the glutamate activity. With the withdrawal of alcohol, you now have this glutamate up regulation and sudden increased glutamate (excitatory) activity.

•So, lots of glutamate activity and less GABA activity with alcohol withdrawal makes an over

What % of alcoholic develop DT’s?

5% of the 50% of alcoholics who develop withdrawal symptoms)

15. Features of Fetal Alcohol Syndrome (FAS).  

Under development Small head, Low nasal bridge, flat mid face, smooth philtrum, thin upper lip, small eye openings

Symptoms of FAS and FASD.Fetal Alcohol Spectrum Disorders (FASD)

caused by maternal alcohol consumption. estimated at 1/100 births (estimates up to 2-5/100)

nFASD- impairments in learning, memory, language and attention

How are these disorders believed to develop.

you know that alcohol is a glutamate blocker and a GABA stimulator, so it blocks the main excitatory NT and stimulates the main inhibitory NT. Developing neurons need neurotransmitter to develop correctly

Leading known cause of cognitive imparment

16. What is the safe level of alcohol intake during pregnancy.

None

17. Describe the lingering effects that binge drinking can have .

effects on mood, memory, learning, heart functioning

18. What % of college academic problems are linked to alcohol?

40%

19. Describe the effects of Anxiolytic drugs at low and high doses

at low doses, relaxing effect.  At higher doses, sleep inducers (hypnotics)

•Two classes we will study - Barbiturates and Benzodiazephines

20. How do benzodiazepines work?

Largely replaced by benzodiazepines

•Increase activity at GABA synapses so increased sedation.

•At high levels stop breathing. Lethal dose remains the same as tolerance to the drug occurs

Name 3 benzodiazepines.

Benzodiazepines - Xanax, Ativan, Valium

What % of people in the US have disorders related to benzodiazepines?

1%

21. Whats the difference between morphine and heroin. 

You get morohie from the flowers to make Herion morphine was the first isolate of a natural plant Isolated in 1804. First widely used in civil war. addictive properties discovered.

•1874 - chemist added 2 molecular groups on to morphine and created heroin. (diacetlymorphine) Available for medicinal use in some european countries (UK). more fat soluble and therefore easier to get into the brain. very effective and very addictive.

What receptors do these drugs work at?

opiate receptors that normally receive endorphins, natural neurotransmitters that normally relieve pain and reduce tension.

22. What is methadone?

Methadone (1937 Germany - because Germany needed an internally sourced opioid)

•used for severe chronic pain - long duration of action

•primary use is in treatment of opioid dependence and withdrawal.  Also can block the euphoric effects of other opiates

23. Describe withdrawal symptoms associated with opioid use disorder

anxiety, restlessness, sweating, rapid breathing, fever, vomiting, loss of appetite, high blood pressure. These symptoms peak at about day 3 and subside by about day 8-9]

24. At what part of the brain do opioids suppress respiration

Narcotics attach to opiate receptors that normally receive endorphins, natural neurotransmitters that normally relieve pain and reduce tension

Medulla - just above the spinal cord

•controls vital reflexes - breathing, heart rate, vomiting, coughing, sneezing

•damage may result in death

•opiate receptors present. opiates suppress the medulla, suppress respiration

25. Describe the dangers of opioid use.

Tolerance for the drug occurs relatively rapidly as does withdrawal reactions when one stops taking it.

•withdrawal symptoms include anxiety, restlessness, sweating, rapid breathing, fever, vomiting, loss of appetite, high blood pressure. These symptoms peak at about day 3 and subside by about day 8-9.

•to avoid withdrawal, addicts end up needing to increase their doses.

26. Describe Fentanyl - compare to morphine/Heroine. What is this doing to death rates from opioids?

Made in labs - when used medically, effective and safe for pain and anesthesia in combination with other drugs

•About 75-100 times more potent than morphine and many times more potent than heroine.

•Readily passes into brain where it attaches strongly to the opiate receptors. Makes Narcan treatment more difficult.

•Addicts don’t know when fentanyl is mixed with heroine or how much and OD. Purity? Measurements?

•2016 - more than 20,000 deaths in the US from fentanyl OD (>500% increase since 2013)

28. Name the area of the brain that is very important for perceiving pleasure

nucleus accumbens.

29. What is a common pathway for perceiving pleasure

( dopamine neurons releasing the DA onto the nucleus accumbens)

30. How do Amphetamines and Cocaine effect reuptake proteins at synapses?

Both drugs ultimately result in an increase in the levels of certain neurotransmitters in the synapse, leading to heightened stimulation of the postsynaptic neuron and intense feelings of pleasure, though the exact mechanisms differ.

31. Most powerful natural stimulant known?

Caffeine

Effects of Cocaine?  

euphoria, increased confidence, excitation, talkativeness, increased heart rate, respiratory rate, and blood pressure, arousal and wakefulness.

33. Why is there a depression - like letdown after the use of stimulants? What are the symptoms associated with this?

Due to a depletion of the neurotransmitters in the pre-synaptic neuron (remember, it hasn’t been taken back up into the pre-synaptic cell so the cell literally runs out)

Cocaine

It increases serotonin and norepinephrine

Increases the concentration of dopamine in the synapses

34. Problems that can occur with cocaine use?

Addictive.

•Increased blood pressure and heart rate can lead to heart attacks, strokes, CARDIAC ARRHYTHMIAS, cardiac arrest, seizures

•Snorting - nosebleeds, chronic runny nose, decreased sense of smell

•Ingesting can cause bowel problems due to constriction of the blood vessels

•miscarriage, birth defects

35. What are amphetamines?

CNS stimulant drugs made in a lab. First produced in the 1930’s and used for weight loss and anyone wanting a “boost” of energy (people trying to avoid sleep like pilots and students)In small doses, increase energy and alertness and decrease appetite. Intoxication and psychosis in high doses.

Describe the effects of this drug on the user?

increasing DA, 5HT and NE in the synapses by blocking their reuptake into the presynaptic neuron. (Amphetamines have more effect at the serotonin and NE transport proteins vs cocaine so somewhat different responses)

What are the effects of this drug at the synapse?

You don't need to know what drugs have stronger effects at which specific receptors.Increases DA in the synapse of axons synapsing in the nucleus accumbens

36. Describe the problems associated with methamphetamine use.neurotoxic to DA neurons -

increases risk of parkinson’s dz, cognitive deficits, impaired attention/memory. 20% of meth users experience psychosis (similar to schizophrenia) that is difficult to treat

long-term problems also include depression, suicide,serious heart dz, “meth mouth” (tooth decay,  grind their teeth and have poor hygiene, nutrition,) skin sores.......

Severe structural and functional changes in areas of the brain associated with emotion and memoryleading to long term emotional (anxiety, paranoia, insomnia, mood disturbances) and cognitive/learning/memory disorders. Increased risk of stroke.

37. Describe the withdrawal symptoms associated with meth

useinclude extreme fatigue, (but sleep problems,) irritability, anxiety, can last weeks-months

38. How does caffeine work (RELEASE of NT vs. blocking reuptake!)

Causes RELEASE of excitatory neurotransmitters (DA, 5HT, NE)

39. Problems with high caffeine consumption. withdrawal symptoms

3 cups of coffee (about 250mg of caffeine) can start seeing restlessness, anxiety, stomach problems, twitching, increased heart rate.

•Withdrawal symptoms include headaches, depressive symptoms, anxiety and fatigue

40. Some of the problems with tobacco consumption

Behavioral therapy = aversion therapy. people smoke as much as a puff every 6 seconds until they feel ill. Feelings of illness become associated with smoking

•Nicotine Gum (or patch) - Meant to ease withdrawal.

•Both have been shown to help with smoking cessation.

•Former smokers risk of disease decreases the longer they are away from smoking.

41. Tolerance associated with nicotine? withdrawal symptoms associated with Nicotine

regular smokers develop a tolerance to nicotine requiring more for the same effect

•withdrawal symptoms include irritability, weight gain (increased appetite and decreased metabolic rate,) sleep problems, cognitive difficulties....

42. Describe Aversion Therapy.

based on classical conditioning. Patients take a drug and it’s paired with something unpleasant ( a shock, something that makes them vomit, imagining a horrible scene or how their family would react to their death...)

43. What is a hallucinogen? Describe Hallucinogen intoxication.

Within two hours of being swallowed, LSD brings on a state of hallucinogen intoxication marked by increased visual perceptions

•may focus intently on small details or perceive more intense colors, objects may appear distorted or moving. May see objects or people not present (hallucinate.) May cause senses to “cross” - for example they may feel that they “hear” colors

•may induce strong emotions + and - joy, anxiety, depression

What is one of the primary dangers with LSD use?

One of the primary dangers with LSD for both first time and long-term users is the unpredictableperceptual, emotional and/or behavioral reactions that can occur. Sometimes these reactions are very unpleasant and can result in users being injured

•Some users can develop psychosis or experience “flashbacks” a recurrence of the sensory or emotional changes after LSD has left the body. Can occur days or months after the last LSD consumed.

45. Many drugs that distort perception resemble what neurotransmitter?

any drugs that distort perception, such as hallucinogens, resemble the neurotransmitter serotonin. Drugs like LSD, psilocybin (found in certain mushrooms), and DMT often mimic serotonin's structure and interact with serotonin receptors in the brain, particularly the 5-HT2A receptor, leading to altered sensory experiences and perceptions.

46. At what receptors does MDMA interact (low doses and at higher doses) What receptor is MDMA known to damage? What might be the long term result of damage to this receptor?

Ecstasy (MDMA) at low doses releases DA -

•At higher doses it affects 5-HT receptors. Metabolites of MDMA destroy neurons. MDMA also causes increased body temperatures - sometimes life threatening. This also destroys neurons

•evidence suggests that MDMA use can cause long term loss of serotonin receptors, persistent depression, anxiety, impaired learning and memory

47. What is the chemical in Cannabis that is most responsible for it’s effects?

tetrahydrocannabinol (THC)cannabinoid that appears to be most responsible for psychological effects. The greater the THC, the more powerful the effect.

48. Effects of Cannabis?

When smoked, cannabis produces a mix of hallucinogenic, depressant and stimulant effects

Low dose- generally, see relaxation effects(but can have a completely different effect of causing people to become anxious, suspicious, irritable) May increase/change perceptions, time may seem to slow, distances and sizes may seem larger

•physical changes include reddened sclera, increased heart rate, increased blood pressure, appetite increases, dry mouth, dizziness, drowsiness

•high doses can cause odd visual perceptions, hallucinations, confusion, paranoia.

49. Does Cannabis impair driving?

Yes

50. For treatment of substance use disorder, can one treat only the underlying condition such as depression?

No

51. Describe Aversion Therapy for substance use.

Behavioral treatment - Aversion Therapy - based on classical conditioning. Patients take a drug and it’s paired with something unpleasant ( a shock, something that makes them vomit, imagining a horrible scene or how their family would react to their death...)

52. Describe Contingency Management of Substance abuse.

Management -makes incentives (cash, vouchers, privileges) contingent of clear urine specimens. seems to work (positive reinforcement)

•Behavioral treatments work best when combined with

Describe CBT for substance abuse.

help clients ID and change the behaviors and cognitions that contribute to their patterns of substance abuse

•help clients develop coping skills for dealing with stress in a healthy way.

54. Describe Relapse Prevention Training.

Clients taught to ID high risk situations, look at the range of options that confront them in these situations, change their choices to healthy ones. They are taught to learn from their mistakes.

55. Describe DetoxificationSystematic and medically supervised withdrawal from a drug.

Most often one gives the client a different medication to help with withdrawal symptoms (e.g., benzodiazipines - short term - for alcohol withdrawal). Most people need follow-up treatment

56. Describe the use of Antagonist drugs. What is Antibuse?

An antagonist is a drug that blocks the effect of another substance (drug or neurotransmitter) at the receptor site.  Antabuse is a drug given to people who are trying to stay away from alcohol.  

•Alone, it has few effects. If one drinks while on a low dose of this drug, they experience intense nausea, vomiting, increased heart rate, dizziness.

57. Describe a “drug maintenance program”

Example, Methadone for Heroine addicts. Avoids the lifestyle issues, dirty needles (taken orally). Methadone can be dangerous itself - withdrawal symptoms tend to last longer.

58. Is there a major difference in outcome between inpatient residential treatment programs and good quality outpatient programs?

designed to help people get through the initial withdrawal period and provide psychotherapy.

•$$$

•# of studies show no major difference in outcome between inpatient residentialtreatment and good quality outpatient care for alcoholism or drug addiction.

What is the medulla

Located above the spinal cord and controls vital reflexes

Opiate receptors present, opiates suppress the medulla

What are 4 stimulants

Cocaine

Amphetamines

Caffeine

Nicotine