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Chapter 11

Chapter 11 - Substance Abuse.pdf

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David Moscovitch

Substance-Related Disorders -abuse of drugs (ex. Alcohol, cocaine, heroin) taken to alter feelings, thinking etc. -polysubstance use: multiple drugs Perspectives on Substance-Related Disorders -substance: chemical compounds ingested to alter mood/behavior; diff. levels of use Levels of involvement -use: moderate ingestion: don’t significantly interfere with social, educational, occupational functioning -intoxication: physiological reaction, impaired judgment, mood changes, lowered motor ability -abuse: depends on how significantly it interferes with user’s life -substance dependence: physiologically dependent on drug; tolerance: ^ use required to produce same effect -withdrawal: physically negative response if substance is no longer ingested; -symptoms: delirium (hallucinations), tremors, chills, fever, nausea, aches and pains -criteria for dependence: drug seeking behaviours: ex. Stealing money, standing in the cold to smoke etc. -gambling: similar: show tolerance and withdrawal symptoms as well; same treatments for drug abuse may work -can be dependent w/o abuse; ex. Cancer patients w/ morphine; some drugs easier to be addicted to -ex. Nicotine, crack, meth most addictive; weed, MDMA, shrooms, LSD least addictive Diagnostic Issues -orig. substance use = symptom of other problems; now: subtypes of diagnoses for each substance -unsure over directionality of substance use and other disorders (ex. Depression); maybe just due to prevalence -ex. Alcohol -> ^ risk taking-> gambling; PTSD -> self-medication -> substance use -rule: if symptoms of schizophrenia/anxiety appear during substance use/ w/n 6 weeks, must be due to drug -5 groups of drugs: depressants, stimulants, opiates, hallucinogens, and other (ex. Airplane glue, steroids, NO) Depressants -decrease CNS activity; help to relax; ex. Alcohol, insomnia sedatives; most likely -> dependence, tolerance, etc. Alcohol Use Disorders -description: initial stimulant effect; due to decreased inhibition; then motor coordination, reaction time, etc. -effects: circulatory system distributes alcohol throughout body; affects number of diff. neuroreceptor systems -ex. GABA system: inhibitory NT, alcohol use -> difficult for neurons to communicate, -> anti-anxiety -memory loss, blackouts due to effect on glutamate system; mood, sleep, eating due to serotonin system effect -pain numbing: due to effect on endogenous opioids release (body’s natural analgesic) -withdrawal delirium: aka. Delirium Tremens (DT) hallucination/tremors; reduced w/ medical treatment -briain damage: from alcohol dependence; may -> wernicke’s(unintelligible speech) or dementia (brain poison) -fetal alcohol syndrome: from mothers drinking while pregnant: -> retardation, cognitive deficits, difficulties etc. -statistics: 23% of CDNs exceed low-risk; 17 %=high risk; usu. more in men; 4x as much; varies across settings -9% of all drinkers experience alcohol problems; 3% CDNs become alcohol dependent-> financial problems etc. -progression: fluctuation b/w heavy, social, and abstinence; 20% of dependents have spontaneous remission -dependence is progressive but abuse is not; in terms of violence; alcohol -> less fear of punishment Sedative, hypnotic, or anxiolytic substance use disorders -sedative: calming; hypnotic: sleep; anxiolytic: less anxiety; barbiturates: meant to replace alcohol, help sleep -benzodiazepines: anti-anxiety; safer than barbiturates; less risk of abuse/dependence -anxiolytics: potential for dependence; may also be used for other things; ex. Rohypnol (date-rape) -description: barbiturates: low dose-> muscle relaxed, feeling well; high: slur, problem walking/concentration -similar to alcohol: include maladaptive behavioural change; combining w/ other drugs -> synergy effect -statistics: declining use of barbiturates, ^ benzodiazepines; ^ use of slowly eliminated benzo’s (higher risk) Stimulants -ex. Coffee, nicotine; make you more alert and energetic; ex Ma Huang: serious health problems (^ BP) Amphetamine Use Disorders -upper, followed by crash: orig. prescribed for asthma, narcolepsy; abused by pilots, uni students, truck drivers -intoxication -> euphoria, sociability changes, anxiety, tension, anger, appetite loss; tolerance builds quickly -stimulate norepinephrine/dopamine; ^ release and block reuptake; may -> hallucinations, delusions Cocaine Use Disorders -use varies according to fashion, moods, and sanctions; major stimulant choice in 1970s -description: ^ alertness, euphoria, loss of appetite; side effects: paranoia, irregular heartbeat, sleep, -cocaine significantly damages fetus development, deficits esp. in auditory info, language -stats: 1% of adults, 6% of students; high (60-70) % of needle injection is cocaine -affects dopamine reuptake, dependence is different; -> ^ inability to resist taking more -withdrawal symptoms=apathy, boredom, feel like only cocaine can bring you back Nicotine Use Disorders -no intoxication pattern, just withdrawal symptoms: depressed mood, insomnia, irritability, anxiety -stimulates CNS: relieves stress, ^ mood; side effects: ^ BP, heart disease, cancer -affects nicotinic acetylcholine receptors in midbrain reticular formation and limbic system (pleasure area) -nicotine needed at steady level (usu. 10-50 ng/mm); synergistic effect w/ alcohol on dopamine release Caffeine Use Disorders -gentle stimulant: presumed less harmful; in low dose-> ^mood, decrease fatigue -high dose: jittery, insomnia; takes 6 hours to pass through blood; moderate use (1 cup) doesn’t harm -affects adenosine and serotonin NTs, withdrawal symptoms: headache, irritability in morning Opioids -narcotic: relieve pain and induce sleep; ex. Natural opioids, synthetics (methadone) and comparable substances - analgesic: relieves pain, ex. Morphine. But high dose -> death if respiration is completely depressed; -oxycodone (oxycontin); popular street drug, high prevalence in nova scotia -awful withdrawal; experience withdrawal symptoms w/n 6-12 hours; ex. Nausea, vomiting, chills, <3 days -risk of HIV due to intravenous use, ½ deaths from homicide, suicide, accident; 1/3 overdose -rush comes from activation of opioid system (aka endorphins/enkephalins); -> narcotic effect(pain relief, sleep) Hallucinogens -hallucinogenic use disorder: change perception of world (ex. Via marijuana, LSD) Marijuana -CDN males: highest prevalence across countries of frequent cannabis use -> altered perception, mood swing, things are funny, heightened sensory experiences, vivid colours -possible to ‘turn off’ the high if motivated, possible paranoia, hallucinations in large doses -long term use -> impaired memory, concentration, motivation, self-esteem, impaired motivation -less major signs of withdrawal but there are effects of tolerance and reverse tolerance(better w/ repeated use) LSD and Other Hallucinogens -most common hallucinogenic; synthetic, naturally occurring in ergot; may treat for alcoholism with single dose -other hallucinogens: psilocybin(mushrooms), ly
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