Addiction Medicine/Substance Abuse

What are some commonly abused drugs?opioids, heroin, cocaine, methamphetamine, alcohol, marijuana, and many others.

What is addiction?Compulsive drive to take a drug or engage in a behavior despite serious adverse consequences.

What system does addiction use?Utilizes the mesolimbic dopaminergic system to promote particular behaviors.

What do addictive drugs and behaviors increase?the release of dopamine from the presynaptic VTA that targets the postsynaptic neurons in the NA.

What does dopamine stimulate?feelings of reward and pleasure that are quickly associated with the behavior that prompted it (addictive behavior and drugs)

What is the rate hypothesis?If drugs (or behaviors) can increase dopamine in the VTA-NA faster than the homeostatic mechanisms can adjust to keep up, then the euphoria is more intense.

Why is the speed of dopamine release important?It will be faster than homeostatic mechanisms. Example, Smoked, inhaled, IV, etc... are all very rapid in dopamine release and dangerous. This is why ADHD medication is orally ingested as a pill absorbed more slowly over time.

How are humans prone to addiction?Once the brain decides this is a necessary substance, it gets folded into the seeking system and the entire PNEI (psycho-neuro-endo-immune) homeostatic system gets harnessed to regulate it.

The continuum of drug use encompasses various stages that individuals may experience when using or abusing substances, what are they?(1) Initiation/intoxication, (2) Harmful use/abuse, (3) Dependence/withdrawal, (4) Relapse and craving, (5) Recovery and persisting deficits.

What is the seeking system comprised of?Motivational Salience, Hedonic Tone, and Other Factors.

What is the seeking system?Motivates behavior through seeking out items critical for survival: includes things like food, water, shelter, sex, relationships.

What does addictive substances hikack?The seeking system to produce aberrant drives that can inherently decrease survival.

What is motivational Salience?extent to which a given object, event, thought, belief, or physical/emotional sensation, captures one’s attention and drives goal-directed behavior.

What is the Hedonic Tone?Sense of wellbeing, contentment, pleasure, and happiness. Established by the mesolimbic dopaminergic system (pleasure, reward, survival). Emotions can range from intense euphoria to intense dysphoria.

What is George F. Koob Model of Addiction?Addiction represents dramatic dysregulation of motivational circuits that is caused by a combination of: Exaggerated incentive salience, habit formation, reward deficits, excess stress, and compromised executive functioning.

What are the 3 main stages of addiction?Binge/Intoxication Stage,Withdrawal/Negative Affect Stage, Preoccupation/Anticipation Stage.

What is the Binge/Intoxication Stage? Rewarding effects of drug abuse, Development of incentive salience, Development of drug seeking habits (previously neutral stimuli become reward associated).

What is the Withdrawal/Negative Affect Stage?If use becomes regular, brain develops mechanisms to maintain new equilibrium which will result in negative emotional states and dysphoric stress

What is the Preoccupation/Anticipation Stage?Compromised executive functioning and heightened drug cue-induced incentive salience. New baselines for low reward system functioning and excessive stress system functioning. All combine to form a power combination of positive and negative reinforcement process that drive pathologic compulsive drug seeking.

What are the risk factors for addiction?Family history & genetic factors, Psychological risk factors, Peer related factors, Parental risk factors, Psychiatric Factors, Environmental Factors.

What are some Family history & genetic factors?40-60% of vulnerability to addiction can be attributed to heritable factors

What are some Psychological risk factors?High sensation/novelty seeking, low harm avoidance, high reward dependence, high aggression/irritability, affect dysregulation, impulsivity, low self esteem, trauma/stressful events, executive cognitive dysfunction, attention, judgment, etc...

What are some Peer related factors?(strong predictor of adolescent substance use). Peer substance use, positive peer attitude re substance use, strong attachment to peers, peer rejection

What are some Parental risk factors?Parental/sibling substance use/psychopathology, parental beliefs/attitudes re substance use, lack of closeness with parents, lack of appropriate supervision/discipline, rejection or absence of parental authority, lacking clear family rules

What are some Psychiatric Factors?Depression, Anxiety/social anxiety disorder, ADHD, schizophrenia, bipolar disorder, personality disorders

What are some Environmental Factors?Availability, homelessness/poverty, urban life, school’s lax policies or enforcement, media promotion

**What are some Protective Factors?**Being female, higher SES, high academic aspirations/achievement/self-esteem, clear family rules prohibiting drug use, higher intelligence/problem-solving ability, positive role models, affiliation with religious institutions/spirituality, better affect regulation, high perception of risk from drug use, optimistic and risk avoidant.

What are some treatments for addiction? SBIRT, Detoxification, Relapse prevention, and Maintenance of recovery.

What are some Identification and Engagement treatments?SBIRT: Screening, Brief Intervention, Referral to Treatment.

What are some Detoxification treatments?Elimination of substances from the body by the liver. Can be both inpatient and outpatient depending on severity of symptoms. Dealing with withdrawal symptoms

What are some Relapse prevention and Maintenance of recovery treatments?Non-hospital inpatient, residential, and outpatient treatment programs. Self-help and social support programs help facilitate healthy behaviors and provide support to prevent relapse Can utilize both psychotherapeutic and pharmacological treatment avenues.

What are some Psychotherapeutic examples?group and individual therapy, cognitive-behavioral therapy (CBT), contingency management interventions and vouchers, motivational enhancement therapy.

What are some Pharmacological treatment examples for Opioid Use disorder?Methadone, Buprenrophine/Naloxone.

What are some Pharmacological treatment examples for Alcohol Use disorder?Acamprosate, Naltrexone, Disulfiram(in specific circumstances)

What are some Pharmacological treatment examples for Nicotine Use disorder?Varenicline, Bupropion, Nicotine replacement therapy(patch, gum, lozenge)

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