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substance related and addictive disorders.docx

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Tufts University
Jackquelyn Mascher

Substance Related & Addictive Disorders 04/15/2014 Diagnoses Substance Use Disorder Substance­Induced Disorders Gambling Substance Use Disorder Must specify which substance(s) Pattern of use that impairs functioning 2 or more within 1 year: Putting things aside in order to use Having difficulties/problems in life but continue to use Give up other pleasures and substance replaces them Have tried to reduce/control to no avail (cravings) Built up tolerance  Greater dose needed to produce desired effect Diminished effect of same dose of substance Experience withdrawal  Physiological, psychological consequences when substance reduced Same/similar substance taken to reduce withdrawal symptoms Substance Induced Disorder Intoxication Withdrawal Delirium Persisting Dementia Persisting Amnesia Psychotic Disorder Mood Disorder Anxiety Disorder Sexual Dysfunction Sleep Disorder  Non­Substance Addictive Disorder Gambling Disorder Note: other behavioral addictions/repetitive behaviors are NOT included in the DSM (e.g. sex, gaming,  exercise)  Major Neurotransmitters Dopamine  Serotonin GABA – inhibiter throughout system  Glutamate – excites (motor movement, thought, etc.) Alcohol What is it? Ethyl alcohol  Mechanism: Agonist for GABA (GABA inhibits), so increases effect of GABA Also increases dopamine and serotonin activity Antagonist for glutamate (glutamate excites) Short term effects: Impairs impulse, reason, judgment, speech, motor, coordination, reaction time, decision making, memory  Nausea, vomiting, lack of physical control, loss of consciousness, death Long term effects: Malnutrition Alcohol lacks nutrients  Interferes with vitamin digestion & absorption Deficiency of B­complex vitamins  Cirrhosis of the liver Liver cells engorged with fat impeding functioning Cell death leaves scar tissue which obstructs blood flow  Damage to glands and pancreas Heart failure Erectile dysfunction Hypertension Stroke Capillary hemorrhages Facial swelling and redness, especially in nose Severe LTM, STM loss Additional information Enters bloodstream via small intestine Metabolized by the liver Effects vary by gender, height, weight, liver, efficiency Biphasic effect (considered depressant) Initially stimulates Later depresses  Alcohol withdrawal Anxiety Depression Weakness Restlessness Difficulty sleeping Muscle tremors Elevated BP, pulse, temperature Delirium tremens (DTs): when blood alcohol level drops suddenly & causes deliriousness, tremulousness,  and hallucinations Fetal Alcohol Syndrome (FAS) Heavy alcohol intake during pregnancy Fetal growth slowed Cranial, facial, limb anomalies Moderate alcohol intake during pregnancy Learning and memory impairments Growth deficits Tobacco What is it? Dried leaves of plant that have nicotine Mechanism: stimulates dopaminergic systems Short term effects:  Nicotine acts as stimulant or sedative Cravings, irritability, sleep disturbance Long term effects: Tobacco causes or exacerbates: Emphysema Chronic bronchitis Cancer  Related to 30% of cancer cases, 90% of lung cancer cases  Common cancers: larynx, esophagus, pancreas bladder, cervix, & stomach  Sudden Infant Death Syndrome (SIDS) and pregnancy complications Cardiovascular and heart disease Stroke Secondhand smoke Higher levels of ammonia, carbon monoxide, nicotine, tar compared to directly smoking Contributes to 40,000 deaths per year in US Marijuana What is it? Derived from dried, ground leaves of hemp plant (Cannabis); “Hashish” is dried resin from plant  tops and stronger Mechanism: THC mimics anandamide (natural cannabinoid) Cannabinoids block dopamine­inhibiting neurotransmitter Result is an increase in dopamine Short term effects: Peace, euphoria, sleepiness, paranoia, low mood Impairs memory, attention span, balance, reaction time, coordination  Other effects: Relaxation and sociability Rapid emotion shifts Interferes with attention, memory, and thinking Heavy dose can cause hallucinations and panic Impaired driving skills Bloodshot, itchy eyes Dry mouth and throat Increased appetite Reduced intraocular pressure Reduced BP Abnormal heart rate (may exacerbate preexisting cardiovascular problems) Damage to lung structure and functions Impairment present for several hours after ‘high’ worn off Analgesic effects THC blocks pain signals Relieves discomfort of AIDS Reduces nausea & loss of appetite caused by chemotherapy Heroin What is it? Derived from poppy plant Mechanism: Natural opioids block dopamine­inhibiting neurotransmitter Heroin mimics natural opioids, blocking dopamine inhibition Neurons with opioid receptors deal with pain, stress, emotional attachment Allows free flow of dopamine in these areas Short term effects: Euphoria, reverie, lack of coordination followed by hours of drowsiness Loss of inhibition, increased self­confidence Nausea, vomiting, itching Severe letdown after about 4­6 hours Muscle soreness and twitching Sweats, chills, yawning Increased BP & HR Long term effects (focus on research findings): Withdrawal Restlessness, pain, insomnia, diarrhea, vomiting, cold flash 500 addicts at 29 year follow­up 28% dead by age 40 OD, suicide, homicide, accident Illegal activities to obtain money Theft, prostitution, dealing Exposure to infectious disease via shared needles (e.g. HIV) Methamphetamine Mechanism:  Meth mimics dopamine (better than anything else)  Taken into presynaptic cell by dopamine transporters Meth taken into dopamine vesicles, forces dopamine out Excess dopamine released into cleft by transporters  Blocks reuptake of dopamine  Stays in your system for a long time so mechanism is complex, there is a huge  burst of dopamine  Short term effects: Increases alertness, energy, motor activity Reduces fatigue and appetite Increases HR and simultaneously constricts blood vessels in skin and mucous membranes (dangerous  combination) Long term effects: Abuse Elevates body temperature, causes convulsions Chronic use Violence, anxiety, insomnia, paranoia, delusions, agitation, irritability, confusion, paranoia, hostility Reduction in hippocampus volume “Meth mouth” (can occur in matter of months) Oral hygiene affected (salivary glands, blood vessels in mouth) Grind teeth Eat sweets  Don’t care about oral hygiene  Cocaine What is it? Alkaloid obtained from cocoa leaves Mechanism: blocks reuptake of dopamine in mesolimbic areas Short terms effects: Reduces pain  Produces euphoria Heightens sexual desire Increases self­confidence and indefatigability Increased energy Decreased appetite, mental alertness  Long term effects: Altered heart rate, respiratory failure Stroke, seizure Overdose Chills, nausea, insomnia Paranoia, hallucinations, other psychosis Not all users develop tolerance (some become more sensitive which increases risk of OD) Within a few months, whole brain metabolism decreases in cocaine addicts  Crack Form of cocaine (popular in 80s) Rock crystal that is heated, melted, & smoked Increased popularity, cheaper than coke  Hallucinogens Examples: Shrooms LSD: acid, blotter, dots, sugar, window pane Mescaline: buttons, cactus PCP: angel dust, peace pill Ketmine (horse tranquilizer): Special K, ket, kitkat, super K  Mechanism: complex sensory effects; different receptors & action Short term effects: Distorted perception of reality and time Several emotions at once Synesthesia Loss of perception of self/environment boundaries Dilated pupils, increased body temp, HR, BP, sweating, loss of appetite, sleeplessness, dry mouth, tremors,  labile mood, anxiety Ecstasy What is it? MDMA Mechanism: Presynaptic cell releases serotonin Ecstasy mimics serotonin in reuptake More serotonin is made Postsynaptic cell over­stimulated Short term effects: Euphoria, energy, emotional warmth, empathy Chills, muscle cramps, clenched teeth  Reduced cognitive capacity Anxiety, agitation, panic, loos of consciousness, seizure, dehydration, hypothermia, organ failure, blurred  vision, hypertension  Other Drug Abuse Polysubstance abuse Some combinations of drugs produce strong reaction Not one drug is favored E.g. alcohol r
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