ECON 546 Lecture Notes - Lecture 22: Attention Deficit Hyperactivity Disorder, Methadone, Hyperalgesia

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Lecture 22: Addiction and Alcoholism I Monday, April 4, 2018
Dr. K Gill
What Is Addiction?
- Withdrawal symptoms if they stop
- Difficult to stop even with knowledge of risks and negative consequences
Tobacco Smoking
- Single largest preventative cause of illness and mortality in the world
- Extremely high rates among patients with mental illness
- Nicotine
- Beta-carbolines (inhibit MAO)
- Acetaldehyde (affects NT release)
- Preservatives, pesticides, mould retardants, humectants, carcinogens (polycyclic
aromatic hydrocarbons)
- Why can’t they just stop when they know it’s incredibly harmful?
oBrings incredible pleasure  part of pharmacological profile of tobacco
oAddictions start when first experiences are positive (entices you)
Pleasure and Reward
- Primary effects of tobacco constituents: muscle relaxation, reduces hunger, reduces
depression, reduces anxiety, pleasure, arousal, enhanced attention, improved task
performance
- Stimulus complex: taste, smell, pharmacological effects, motion/ritual
oEvery drug
oThe more complex the stimulus, the more conditioning there is (fancy alcohol
bottles, sounds/lights of casino machines)
Physical Dependence/Withdrawal Discomfort
- Function of dose and time
- Some are more prone to dependence than others
- Tobacco withdrawal: irritability, restlessness, drowsiness, anxiety, hunger, weight gain,
sleep disturbance, headaches, cravings
Reinforcing Complex of Tobacco
- Pleasurable pharmacological effects of tobacco smoke (stimulant, anxiolytic)
- Relief from withdrawal (irritability, anxiety, fatigue)
- Conditioned cues: smell, taste, oral sensations, shape of cigarette, time out, taking a
break
- 10-15% capture rate of all drugs of abuse
oTobacco is the exception: 60-70%, highest of all drugs
oNot because nicotine is more addictive, but because of the stimulus complex and
availability
Total Opioid Consumption by Country
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- Huge increase in opiate consumption in many countries, most dramatic in Canada
- Epidemic of opioid overdose deaths in North America
oStarted climbing since the 1990s, started with over prescription of opioids
oIncreased 156% from 2010 to 2015
- Very good for acute surgical pain, but not good for chronic use
oStill trying to figure out what the indications are for long-term use, not many
people will benefit from it because the effects won’t be there anymore
Cases
- Substance use pattern at intake
- Salient signs and symptoms (signs are observed, symptoms are reported)
- Possible concurrent disorders
Case 1:
- Female aged 49, former artist, accident left her disabled
- Family physician referred to addictions unit detox, problems related to repeated dose
increases, unresolved pain, increasing cognitive and functional impairment, multiple
prior failed med trials
- At intake she reported night sweats, anxiety, poor memory, concentration and balance
issues, regular nausea, low libido, irritability, sadness, hopelessness
- Prior cocaine dependence, current high level of alcohol consumption (9+ drinks per day)
- Continued pain despite enormous doses of opioids (generalized although pain was
initially just in the shoulder)
oGeneralized pain indicates hyperalgesia and/or central effects
- Substance use pattern at intake:
oDaily use of HydroMorph Contin + Dilaudid, progressive intake of opioids over 4
years, alcohol intake, prior history
- Salient signs and symptoms:
oHigh negative affect = symptoms of depression
oNight sweats = minor withdrawal from addiction
oOther symptoms of withdrawal: irritability, insomnia
- Possible concurrent disorders:
oAlcohol, opioid dependence, substance-induced depression
- Additional info:
oNo prior addiction treatments, abused cocaine age 20-24, marital conflict,
obstructive sleep apnea, antidepressant, multiple failed med trials
oHasn’t sought treatment before  significant because it may mean high levels of
stigma in her life
oEntire process of socializing a patient to learn what addiction is and what
happens next in a non-stigmatic way
- DSM-5 sedative/hypnotic and anxiolytic withdrawal
oTwo (or more) of the following developing after cessation or prolonged alcohol
use
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Document Summary

Difficult to stop even with knowledge of risks and negative consequences. Single largest preventative cause of illness and mortality in the world. Extremely high rates among patients with mental illness. Preservatives, pesticides, mould retardants, humectants, carcinogens (polycyclic aromatic hydrocarbons) Why can"t they just stop when they know it"s incredibly harmful: brings incredible pleasure part of pharmacological profile of tobacco, addictions start when first experiences are positive (entices you) Primary effects of tobacco constituents: muscle relaxation, reduces hunger, reduces depression, reduces anxiety, pleasure, arousal, enhanced attention, improved task performance. Stimulus complex: taste, smell, pharmacological effects, motion/ritual: every drug, the more complex the stimulus, the more conditioning there is (fancy alcohol bottles, sounds/lights of casino machines) Some are more prone to dependence than others. Tobacco withdrawal: irritability, restlessness, drowsiness, anxiety, hunger, weight gain, sleep disturbance, headaches, cravings. Pleasurable pharmacological effects of tobacco smoke (stimulant, anxiolytic) Conditioned cues: smell, taste, oral sensations, shape of cigarette, time out, taking a break.

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