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Substance Abuse.docx

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 12 – Substance-Related Disorders:  2 categories: substance abuse and substance dependence Substance dependence:  At least 3 of the following: o Person develops tolerance: a) larger doses for desired effect b) effects less if usual amount taken  DSM 5: distinction b/w substance abuse and dependence dropped and replaced with Addiction and Related Disorders o Withdrawal symptoms o Uses it for longer than needed o Unable to stop using o Much of person’s time spend obtaining drug o Continues to use despite health signs o Gives up/cuts back participating in activities  DSM 5: pathological gambling be included, inclusion of behavioural addictions  Substance abuse diagnosed as accompanied by physiological dependence Substance abuse (less serious):  One of the following: o Failure to fulfil major obligations o Exposure to physical damages o Legal problems o Persistent social or interpersonal problems  Substance intoxication – ingestion of substance affects the CNS  DTs/delirium tremens – substance withdrawal from alcohol  DSM-5: quantitative severity distinction rather than qualitative b/w substance abuse and dependence; so include both disorders together o Substance use disorder symptoms less useful for severe/mild pathology Alcohol Abuse and Dependence:  Alcohol dependence – tolerance or withdrawal, those who drink early have issues in 30-40’s o Increased tolerance following heavy drinking o Body adapts to drug and can process more effectively o Tolerance results from changes in number/sensitivity of GABA or glutamate receptors o When drinking stops, receptors overactive  Often part of polydrug (polysubstance) abuse – using or abusing more than one drug at a time o 80-85% alcoholics are smokers o Nicotine and alcohol are cross tolerant o Alcohol + barbiturates lethal Prevalence of Alcohol Abuse and Comorbidity with other Disorders:  Alcohol misuse 3 in 10  Prevalence higher in men, younger, whites – often chronic (4 years)  Comorbid with mood and anxiety disorders  25% suicides Course of the Disorder:  Alcoholics Anonymous: 4 stages: social drinking  person only lives to drink  No single pattern of alcohol abuse  Difficulties with alcohol at a later age in women, tend to be steady drinkers, drink alone, more likely to binge Binge Drinking in Schools:  1 in 4 students were binge drinkers (US)  Half million US students hurt in drinking accidents  1 in 6 Canadian students binge drink  Students drink before 16 more likely to binge drink later Costs of Alcohol Abuse and Dependence: th  4 leading cause of worldwide disability  Problem drinkers use mental health places 4 times more  Suicide rate much higher  Drunk drivers kill 3-4 people each day, injure 187 per day  Prototypical drinking driver: male b/w ages 25-34  No blood alcohol in 21/under  Half of all murders committed Short-Term Effects of Alcohol:  Alcohol metabolized by enzymes after swallowed and reaching stomach  Most of it goes to small intestines where it is absorbed by blood, then broken down in liver  Absorption rapid, removal always slow  Initial effect of alcohol is stimulating, but after it peaks it is depressive  Stimulates GABA receptors which may be responsible for reducing tension  Increases levels of serotonin and dopamine = pleasurable effects  Inhibits glutamate receptors Long-Term Effects of Prolonged Alcohol Abuse:  Severe biological damage + physiological decline  Almost every tissue and organ in body affected  Malnutrition  Deficiency in B complex = memory loss, amnestic symptoms, memory gaps  Cirrhosis in liver – liver cells engorged with fat and protein  Destroys brain cells – loss of grey matter in temporal lobes  Reduces effectiveness of immune system increases susceptibility for cancer/infection  Fetal alcohol syndrome – mental retardation in infants o 1 in 100 pregnancies  Light drinking (wine) decreases coronary heart disease and stroke Inhalant Use Disorders:  Peak age for inhalant use 14-15 years, initial onset at 6  Inexpensive and readily available  Gasoline sniffing – problem in Aboriginals  Most inhalants = depressants  Feelings of euphoria, psychic numbing  Damage to CNS, nausea, headaches Nicotine and Cigarette Smoking:  Nicotine – addicting agent of tobacco, stimulates nicotinic (Acetylcholine) receptors in brain  Causes neurotransmitter release (ie. Dopamine) = pleasure  Just one puff can be enough to start addiction  Females had more brain activity in cortical and subcortical prefrontal systems (linked with attention and memory)  Females have greater changes in cognition than males Prevalence of Health Consequences of Smoking:  Smoking causes 47 000 deaths each year in Canada  Risks of smoking less for cigar/pipe smokers, but mouth cancer increased  Lung cancer, emphysema, cancer of larynx and esophagus and cardiovascular diseases  Harmful components: nicotine, tar, carbon monoxide  Health risk decline 5-10 years after quitting  Daily smokers smoke 14.9 cigarettes a day, males smoke 3 more cigarettes than females  Erectile problems in men Consequences of Second Hand Smoke:  Aka environmental tobacco smoke (ETS) – contains high conc of ammonia, carbon monoxide, nicotine and tar than does smoke inhaled by smoker  2/3 smoke of cigarette not inhaled by smoker but in air around smoker  Second hand smoke has at least 2x nicotine and tar  Regular exposure increase lung disease by 25% and heart disease by 10%  No smoking in cars when passenger is under 16 Marijuana:  Dried and crushed leaves and flowering tops of hemp plant (cannabis sativa)  Most often smoked, can be chewed, tea, baked goods  Hashish – much stronger than marijuana, produced by removing/drying resin of the tops of high-quality cannabis plants  Illegal in most countries  Canada – 15g allowed campaign (NOT ANYMORE) Psychological Effects of Marijuana:  Depend on potency and size of dose  Find it makes them feel relaxed and sociable  High doses produces hallucinations  Difficult to regulate dose because effects seen after 30 min  Delta-9-tetrahydrocannabinol (THC) – major active ingredient  Cannabis receptors in brain  Chronis use = mild impairments (not severe)  4/5 seeking treatment were male The Stepping Stone Theory:  Alcohol was gateway for cannabis  amphetamine  cocaine  Marijuana associated with heavy drinking and cocaine use  Cannabis high in males, peaked at age 18-19  Network theory more appropriate than stepping-stone Somatic Effects:  CB (cannabis) receptors in various regions, believed that receptors in hippocampus account for short-term memory loss that sometimes follows smoking marijuana o Short-term side effects: itchy eyes, bloodshot eyes, dry throat, increase appetite, reduced pressure within eye, raised BP o No evidence it has effects on a normal heart  Marijuana + tobacco = increased risk for respiratory disorders  One marijuana joint = 4 cigarettes  May be addictive  Those who started before 14 more likely to be addicts, than those started after 17 Therapeutic Effects:  Can reduce nausea and loss of appetite that accompany chemotherapy for cancer patients  Also a treatment for discomfort of AIDS, glaucoma, epilepsy, MS  2% Canadians use it for medical purposes Sedative and Stimulants:  2 categories: sedative and stimulants Sedatives:  Aka downers – slow activities of the body and reduce its responsiveness Opiates:  Relieve pain and induce sleep when taken in moderate doses  Morphine – separated from raw opium, bitter-tasting powder = powerful sedative and pain reliever  Morphine converted to heroin – initially used to cure morphine addiction, however it is more addictive and harmful than morphine, acts quicker with more intensity Psychological and Physical Effects:  Produce euphoria, drowsiness, reverie and lack of coordination  Heroin has additional effect: rush, a feeling of warm, ecstasy right after injection, user forgets worries (4-6hrs) then is letdown  Produce effects by stimulating neural receptors in body’s opioid system  Heroin  morphine  opioid receptors  Body produces opioids = endorphins and enkephalins  Addictive  Withdrawal within 8 hours for heroin, symptoms resemble influenza (more severe in 36 hours)  More than a million heroin addicts in US  Dependence high in physicians and nurses, than any other educated background  5% street youth use heroin every day  Today heroin 25-50% pure  $200/day for opiates Synthetic Sedatives:  Barbiturates – major sedative, aids for sleeping and relaxation  Addictive  Benzodiazepine (Valium) – more commonly used and abused  Methaqualone – street drug  Sedatives relax the muscles, reduce anxiety and in small doses produce a euphoric state  Stimulate GABA system like alcohol  Large doses fatal, frequently chosen as means of suicide Stimulants:  Aka uppers – act on brain and sympathetic NS to increase alertness and motor activity  Cocaine = natural stimulant, amphetamines = synthetic stimulants Amphetamines:  Isolated alkaloid from Ephedra  ephedrine  treat asthma  Amphetamines – synthetic o First amphetamine = Benzedrine – inhalant for stuffy nose o Control mild depression/appetite o Treat hyperactive children o Benzedrine, Dexedrine, Methedrine – causing release of norepinephrine, dopamine and blocking reuptake of these o Taken orally or injected and can be addictive o Wakefulness increased, appetite decreased (Weight loss) o Boundless energy/confidence o Large dose = schizophrenia  Tolerance develops rapidly  Methedrine = strongest of all (esp when injected)  Increased use in workplace to stay awake Cocaine:  Extracted from the leaves of coca plant  Has been used as a local anesthetic  Acts rapidly on brain blocking reuptake of dopamine in mesolimbic area  Increases sexual desire, feeling of self-confidence, well-being  Chronic use leads to personality changes  Severe withdrawal symptoms  Causes blood vessels to narrow  Crack – another form, cheap, appealing to younger generation  0.3% for people ages 18-34  Most dangerous illicit drug in society Caffeine:  Two cups of coffee with 150-300mg of caffeine affect people within 30 min LSD and Other Hallucinogens:  Hofmann created D-lysergic acid diethylamide  Thought to be psychotomimetic because it showed sim symptoms to psychosis  LSD = hallucinogen  Mescaline, psilocybin and synthetic compounds MDA and MDMA  Mescaline – alkaloid, active ingredient peyote cactus  Psilocybin – crystalline powder, isolated from mushroom  All stimulate serotonin receptors  Tolerance develops rapidly, no withdrawal symptoms known, cheap  Psilocybin (ingredient in magic mushrooms) given to OCD patients – substantial decreases in OCD  Also decreases in depressions  Ecstasy – 2 closely similar synthetic compounds, MDA and MDMA o Produced via chemical synthesis o Drug enhances intimacy, improves relationships, elevates mood and promotes aesthetic awareness Effects of Hallucinogens:  Setting in which drug experienced important  Bad trip – flow blown panic attack from taking LSD (more likely to occur in anxious person)  Flashbacks – reoccurrence of effects after drug has worn off Etiology of Substance Abuse and Dependence:  Generally a developmental process  Baker: 2 elements a) intense negative effect from withdrawal b) urges to take drug  Process of becoming a substance abuser:  positive attitude  experimentation  regular use  heavy use  physical dependence/abuse Social Variables:  highest al
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