Chapter 12: substance abuse and impulse control

why are substance hard to treat?

because the person denies the fact that they have a problem, which interferes with help seeking

why do abusive alcohol drinkers end up with diabetes?

because of the level of sugar found in alcohol

define “dependence”

thinking about consuming the substance as soon as you wake up, eventually becomes the main element of your life 

why is snorting drugs more dangerous than ingesting?

when you snort, the drug gets into contact with your tissues which goes directly into your bloodstream 

what are the drugs abused in adolescence? (4)

• alcohol

• nicotine

• cannabis

• prescription

why is the risk of substance abuse higher in adolescence higher today?

drugs are now more affordable 

why are First Nations more likely to abuse substances? (2)

• genetics: they genetically don’t handle drugs well

• when living in reserve communities, there isn’t a lot to look forward for

what are the physical consequences of substance abuse? (4)

• damage to vital organs (liver, heart, lungs, brain)

• increased risk of infectious diseases (HIV, hepatitis) for intravenous/needle drugs

• neurological impairments and cognitive deficits (thiamine deficiency)

• increased risk of overdose that can be fatal

true or false: dying from drugs is usually the result of suicide 

false: usually it comes from a miscalculation 

explain how people can accidentally die from substance abuse

• certain ways of consuming drugs are associated with a sense of rush: all the substance goes to the brain like you’re in heaven

• rush ≠ being high

• you might be already high, but you will continue to inject drugs to feel the rush

• eventually, you inject too much and you die

what are the psychological consequences of substance abuse? (4)

• anxiety, depression and other mood disorders

• mood swings and emotional instability

• impaired judgment and decision-making

• development or worsening of mental health problems

what are the social consequences of substance abuse? (4)

• strained or broken interpersonal relationships

• social isolation and withdrawal (get rejected)

• difficulties at work or school

• legal problems (thief, drink and drive)

what are the life impact consequences of substance abuse? (4)

• financial problems due to spending on substances 

• loss of employment or academic opportunities 

• incarceration 

• pregnancy

what are the levels of involvement of substance abuse (magnitude or severity)? (3)

1. use: ingestion of substances in moderate amounts that don’t interfere with functioning

2. intoxication: physiological reactions to becoming drunk or high

3. substance abuse: when you can no longer control yourself

define “tolerance”

using an increasingly greater amount of drug to experience the same effect

define “withdrawal”

negative physical response when the substance is not longer ingested 

what’s the difference between tolerance and withdrawal?

• tolerance: take more and more to have the desired effect

• withdrawal: negative physical response when the drug is not longer ingested

define “craving”

psychological intent to take the drug, need to have the substance

behind every [intention/behaviour], there is an [intention/behaviour]

behind every behaviour, there is an intention

what are the DSM5 diagnostic criteria for substance use disorder? (11)

*works for any substance: stimulants, opioids, alcohol, cannabis…

1. using larger amount or over a longer period than intended 

2. unsuccessful efforts to cut down or control usage 

3. significant time spent obtaining, using or recovering from substances

4. craving or strong desire to use 

5. failure to fulfill major role obligations 

6. continued use despite persistent social or interpersonal problems 

7. giving up activities in favour of use 

8. using in physically hazardous/dangerous situations 

9. continued use despite health problems 

10. tolerance 

11. withdrawal symptoms 

*at least 2 for 12 months

what are the major categories of abused substances? (5)

• depressants: alcohol, barbiturates, benzodiazepines → calm down, effect on GABA system

• stimulants: amphetamines, cocaine, nicotine, caffeine → effect on norepinephrine, dopamine

• opioids: heroin, morphine, oxycodone, codeine → make you numb

• hallucinogenes: LSD, psylocibin → affects perception, thoughts

• others: glue, steroids, nitrous oxide

associate the drugs to the category and effect:

• alcohol, barbiturates, benzodiazepines

• glue, steroids, nitrous oxide

• LSD, psylocibin

• amphetamines, cocaine, nicotine, caffeine

• heroin, morphine, oxycodone, codeine

• hallucinogens

• others

• depressants

• opioids

• stimulants

• effect on norepinephrine and dopamine

• makes you numb

• effect on GABA

• alters perception, thoughts

• depressants: alcohol, barbiturates, benzodiazepines → calm down, effect on GABA system

• stimulants: amphetamines, cocaine, nicotine, caffeine → effect on norepinephrine, dopamine

• opioids: heroin, morphine, oxycodone, codeine → make you numb

• hallucinogens: LSD, psylocibin → alters perception, thoughts

• others: glue, steroids, nitrous oxide

define “depressant”

drugs that decrease the central nervous system (GABA)

what are the steps of alcohol absorption? (5)

1. ingestion

2. stomach

3. small intestine

4. heart

5. liver

(heart and liver don’t like alcohol)

what’s the damage to the brain caused by alcohol? 

you lose your brain tissue which is not reversible 

what are the alcohol withdrawal delirium symptoms? (4)

• agitation

• insomnia

• disorientation to time and place

• hallucinations

define “wernicke-korsakeoff syndrome”

severe thiamine deficiency that will cause cognitive and physical problems

what are the characteristics of Wernicke-Korsakoff syndrome? (5)

• confusion 

• difficulty with planning, problem-solving and maintaining attention 

• loss of muscle coordination

• unintelligible speech 

• confabulation (making stuff up)

what are the characteristics of fetal alcohol syndrome? (5)

• occurs in babies whose mothers drank excessively during pregnancy

• fetal growth retardation

• cognitive deficits

• behaviour problems

• learning difficulties

what are the drugs used for sedative, hypnotic and anxiolytic related disorders? (3)

• sedative (calming)

• hypnotic (sleep inducing)

• anxiolytic (anxiety reducing)

_{please don’t hit your head when seeing this, i don’t know how to question this}

define “barbiturates”

central nervous system depressants that act as sedatives, hypnotics and anticonvulsants (pretty similar to benzodiazepines, but less safe)

what are the drugs considered as barbiturates? (4)

• phenobarbital

• pentobarbital

• amobarbital

• secobarbital

*anything ending with “barbital”

what was barbiturates initially used for? (3)

anesthesia, anxiety relief and seizures

what’s the risk of using barbiturates? (4)

• dependence 

• overdose 

• respiratory depression 

• withdrawal symptoms 

define “benzodiazepines”

depressants that act on the central nervous system to enhance GABA: calming, anxiolytic, muscle relaxant, anticonvulsants (similar to barbiturates, but safer)

what are the drugs considered as benzodiazepines? (5)

• diazepam (valium)

• alprazolam (xanax)

• lorazepam (atican)

• clonazepam (klonopin)

• temazepam (restoril)

*anything ending by “am”

true or false: sedative, hypnotic and anxiolytic can be used against tolerance and withdrawal

true

why have prescription rates for benzodiazepines and sleeping pills increased in the last years?

because people are more stressed than before

what are stimulants? (4)

• caffeine 

• nicotine 

• amphetamines 

• cocaine 

what are amphetamines used for? (5)

• first used for asthma and nasal decongestant

• weight loss drugs

• energy, remain awake/alert

• narcolepsy

• ADHD

*amphetamines = stimulants

what are the psychological consequences of amphetamine? (7)

1. anxiety, tension, anger

2. changes in sociability

3. euphoria

4. hallucinations

5. impaired judgment

6. impaired social or occupational functioning

7. stereotyped behaviours

what are physiological consequences of amphetamine? (8)

1. blood pressure changes 

2. coma 

3. increased heart rate 

4. nausea or vomiting

5. perspiration or chills 

6. respiratory depression 

7. seizures 

8. weight loss

how can cocaine be consumed? (3)

• snorted

• injected

• smoked (crack cocaine)

true or false: at first, addictive properties of cocaine were not recognized

true

what are the consequences of long term cocaine use? (8)

1. addiction and dependence 

2. cardiovascular damage

3. dental decay: tooth decay and gum disease 

4. effects on infants (when mom take during pregnancy)

5. gastrointestinal issues: decreased blood flow 

6. neurological effects: seizures, strokes and neurotoxicity 

7. psychological and cognitive impact: paranoia, hallucinations 

8. respiratory problems: chronic runny nose 

define “dopamine theory of addiction”

people who have a genetic predisposition will experience less satisfaction from a natural reward and are more likely to fall into amphetamine and cocaine

how does amphetamine affect dopamine and norepinerphrine?

it stimulates their release and block their reuptake

how does cocaine affect dopamine?

block the reuptake of dopamine

define “dopamine”

psychoactive substance that produces a pattern of dependence, tolerance and withdrawal

what are the withdrawal symptoms of nicotine? (8)

• depressed mood 

• insomnia 

• irritability

• anxiety 

• difficulty concentrating 

• restlessness 

• increased appetite 

• weight gain 

why is caffeine called the “gentle stimulant”

because it is thought to be the least harmful of all addictive drugs (found in coffee, tea, chocolate and energy drinks)

low doses of caffeine are associated with [agitation and sleep disturbance/elevated mood and decreased fatigue] while high doses are associated with [agitation and sleep disturbance/elevated mood and decreased fatigue]

• low: elevated mood and decreased fatigue

• high: agitation and sleep disturbance

define “opiates”

chemical compounds extracted or refined from natural plants (ex: opium, morphine, codeine, heroin)

define “opioids”

chemical compounds that are synthesized to mimic properties of opiates (ex: oxycontin, percoset, demerol, fentanyl)

define “narcotics”

group of drug that encompasses opiates and opioids

what’s the difference between opiates, opioids and narcotics?

• opiates: made from natural substances (ex: opium, morphine)

• opioids: synthetic version of opiates (ex: oxycontin, fentanyl)

• narcotics: group of drug that encompasses opiates and opioids 

define “LSD”

hallucinogenic drug

what are the hallucinogenic drugs? (5)

• psilocybin (magic mushroom)

• dimethyltryptamine 

• mescaline 

• LSD

• phencyclidine 

define “cannabis”

classified hallucinogen with depressant and stimulant effects

define “marijuana”

name given to the dried parts of the cannabis

what are the effects of cannabis? (5)

• humour inducing 

• dreamlike state 

• heightened sensory experiences

• seeing vivid colours 

• distorted time perception

what causes drug usage? (8)

1. cognitive expectancies: having positive expectations for drug usage 

2. conditioning: association of having a good time will become a trigger 

3. craving: always craving when you develop a dependence

4. denial: not aware that you have a problem until its too late

5. genetics: rate your experience more positively if your family uses drugs 

6. modelling: if your family uses drugs, you might learn from them 

7. psychological: use substances to deal with psychological issues 

8. social inclusion: to be part of a group, you feel like you need to drink

what are the influences of substance abuse? (3)

• biological: heritable component

• social: exposure by others

• psychological: mood related

explain the biological influence on substance abuse disorders

• heritability component to how certain people react to drugs

• if you have a family history of alcoholism and you drink alcohol, you will experience it more positively than someone who doesn’t have a family history 

• (biological risk to develop substance abuse disorder)

explain the social influence on substance abuse disorders (2)

• social expectations of friends

• if you come from a family that consumes, this will be a model for you:

  • you see them use alcohol as a way to cope with stress and so you do the same

  • on the contrary, if your family is against substance

explain the psychological influence on substance abuse disorders (2)

• self-medicate: alcohol has a numbing effect, if you experience significant distress, alcohol and substances will be used to self-medicate mental health struggles (works for short term only)

• positive expectancy: expect that taking substances will make you cool or likeable (not true)

explain how biological treatments for drug use work

• they are used to deal with cravings (to make the withdraw not too bad)

• as soon as you stop taking the drug, you will have withdrawal symptoms that will push you to seek out the substance

• we will give you another drug that isn’t as addictive and has better withdrawal symptom

associate the disorder and the drugs used for treatment:

• alcohol use disorder

• opioid use disorder

• tobacco use disorder

• methadone, buprenorphine, naltrexone

• […] replacement therapy, bupropion, varenicline

• disulfiram, naltrexone, acamprosate

• alcohol: disulfiram (antabuse), naltrexone, acamprosate

• opioid: methadone, buprenorphine, naltrexone

• tobacco: nicotine replacement therapy, bupropion, varenicline

associate the opioid treatment drug to its technique:

• buprenorphine 

• methadone

• naltrexone

• opioid antagonist that blocks the effects of opioids, reducing the risk of relapse

• partial opioid agonist that helps alleviate withdrawal and diminish cravings without producing the same high as other opioids

• long-acting opioid agonist that reduces cravings and withdrawal symptoms 

• methadone: long-acting opioid agonist that reduces cravings and withdrawal symptoms

• buprenorphine: partial opioid agonist that helps alleviate withdrawal and diminish cravings without producing the same high as other opioids

• naltrexone: opioid antagonist that blocks the effects of opioids, reducing the risk of relapse

associate the alcohol treatment drug to its technique:

• acamprosate

• disulfiram

• naltrexone

• causes unpleasant reactions when alcohol is consumed 

• helps reduce alcohol cravings and the rewarding effects of alcohol 

• helps normalize brain systems disrupted by chronic alcohol exposure and reduce symptoms of withdrawal 

• disulfiram (antabuse): causes unpleasant reactions when alcohol is consumed 

• naltrexone: helps reduce alcohol cravings and the rewarding effects of alcohol 

• acamprosate: helps normalize brain systems disrupted by chronic alcohol exposure and reduce symptoms of withdrawal 

associate the tobacco treatment drug to its technique:

• bupropion

• nicotine replacement therapy

• varenicline

• antidepressant that helps reduce nicotine cravings and withdrawal symptoms

• patches, gums, sprays, inhalers to reduce withdrawal symptoms

• reduces cravings and withdrawal symptoms by partially stimulating nicotine receptors in the brain

• nicotine replacement therapy: patches, gums, sprays, inhalers to reduce withdrawal symptoms

• bupropion: antidepressant that helps reduce nicotine cravings and withdrawal symptoms

• varenicline: reduces cravings and withdrawal symptoms by partially stimulating nicotine receptors in the brain

what are the drugs used against opioid use disorder? (3)

• methadone: reduces the cravings and withdrawal symptoms

• buprenorphine: partial opioid agonist that helps alleviate withdrawal and diminish cravings without producing the same high as other opioids

• naltrexone: opioid antagonist that blocks the effects of opioids, which reduces the risk of relapse

define “methadone” and for which substance abuse disorder it’s used against

• long-acting opioid agonist that reduces cravings and withdrawal symptoms 

• used against opioid use disorders

define “buprenorphine” and for which substance abuse disorder it’s used against

• partial opioid agonist that helps to alleviate withdrawal and diminish cravings without producing the same high as other opioids

• used against opioid use disorders

define “naltrexone” and for which substance abuse disorder it’s used against

• opioid antagonist that blocks the effects of opioids, which reduces the risks of relapse OR helps reduce alcohol cravings and the rewarding effects of alcohol

• used against opioid use disorders OR alcohol use disorder

what are the drugs used against alcohol use disorder? (3)

• disulfiram (antabuse): causes an unpleasant reaction when alcohol is consumed, which discourage alcohol consumption

• naltrexone: helps reduce alcohol cravings and the rewarding effects of alcohol

• acamptosate: help normalize brain systems that are disrupted by chronic alcohol exposure and reduce withdrawal symptoms

define “disulfiram/antabuse” and for which substance abuse disorder it’s used against

• causes unpleasant reactions when alcohol is consumed, which discourage its consumption

• used against alcohol use disorder

define “acamprosate” and for which substance abuse disorder it’s used against

• helps normalize brain systems that were disrupted by chronic alcohol exposure and reduces withdrawal symptoms

• used against alcohol use disorder

what are the drugs used against tobacco use disorder? (3)

• nicotine replacement therapy: patches, gums, sprays that reduce withdrawal symptoms

• bupropion (zyban): antidepressant that helps reduce nicotine cravings and withdrawal symptoms

• varenicline (chantix): reduces cravings and withdrawal symptoms by partially stimulating nicotine receptors in the brain

nicotine replacement therapy (gums, patches, sprays) still contain nicotine, how can they fight the addiction?

• we are trying to break the addiction by breaking the behavioural habit to smoke 

• another problem with smoking is the smoke that is inhaled 

define “bupropion/zyban” and for which substance abuse disorder it’s used against

• antidepressant that helps reduce nicotine cravings and withdrawal symptoms

• used against tobacco use disorder

define “varenicline/chantix” and for which substance abuse disorder it’s used against

• reduces cravings and withdrawal symptoms by partially stimulating nicotine receptors in the brain

• used against tobacco use disorder

how does CBT help with drug use? (2)

• helps the person recognize and change negative thought patterns and behaviours related to substance use

• focus on developing coping strategies to deal with stress and avoid triggers for drug use

what are the steps of CBT to solve substance abuse? (5)

1. improve self-control

2. development of coping strategies

3. avoidance of triggering environments

4. better emotional regulations: equip the person with strategies so that emotions won’t reach the intensity where they feel like they need to consume

5. increased self-awareness and accountability

explain how motivational interviewing is going to help someone with substance abuse disorder

• an addicted person is already reluctant to get help, so we need to hook them in

• client-centered approach: enhance the motivation to change by helping the person explore and resolve ambivalence about drug use (“do you want this lifestyle?” “no, i want to change”)

• encourages self-efficacy and commitment to change

define “12-step facilitation therapy”

• 12-step programs like “Alcoholics Anonymous” or “Narcotics Anonymous” 

• emphasizes on acceptance, surrender and active involvement in group support (meet people who face the same challenges as you and you give each other advices)

• we don’t know about the effectiveness, but it seems to help some people 

define “dialectical behaviour therapy”

• intervention approach where you get people to be more tolerant to negative emotions

• negative emotions will happen no matter what, but they will often go away on their own → learn to handle it while it’s there

• uses mindfulness practices 

what was dialectical behaviour therapy originally designed for?

bordeline personality disorder, but now used for substance abuse

what’s the role of drug rehabilitation centres?

it’s a highly structured program with medical supervision: they manage withdrawal symptoms and detoxification by removing the drug from the system in a medically supervised environment

what’s the sinclair method (TSM)? 

technique that uses naltrexone to help with alcoholism 

true or false: gambling disorders use the same systems as substance abuse disorders

true: they seem to display the same types of cravings dependance

what are the disorders under impulse-control disorder? (3)

• intermittent explosive disorder: act on impulse and destroy things

• kleptomania: urge to steal

• pyromania: urge to set on fire