addiction
- compulsive drug seeking and drug taking despite sever harms
- inability to control the strong urges to consume the drug, even when there is a strong desire to quit
why people do drugs:
- source of pleasure - only small amounts of addicts are addicted due to the pleasure - dopamine (DA) lies at the centre of drug reward - every drug increases DA indirectly or directly
- coping mechanism - involved in the maintenance of addiction - changes happen in your brain due to addiction - difficult childhoods - makes you less resistant to stress
Substance use disorder
addiction
Polysubstance Abuse Disorder:
The simultaneous misuse or dependence upon two or more substances
* Synergistic → dangerous
diagnostic indicators
Impairment of control - taking more than intended - cannot stop
* Social impairment - eg. don’t show up to work due to hangover
* Risky use - using a lot
* Pharmacological dependence - need more of the drug to achieve the same effect
* Tolerance: need increased amounts to achieve the same effect
* Withdrawal: symptoms when the substance is removed from the body
DSM-5 Diagnostic Criteria for Alcohol Use Disorder
mild: 2-3 symptoms
moderate: 4-5 symptoms
sever: 6 or more symptoms
A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
- Craving, or a strong desire or urge to use alcohol.
- Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or
exacerbated by the effects of alcohol. - Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
- Recurrent alcohol use in situations in which it is physically hazardous.
- Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
- Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol. - Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol
(refer to Criteria A and B of the criteria set for alcohol
withdrawal, pp. 499–500).
b. Alcohol (or a closely related substance, such as a
benzodiazepine) is taken to relieve or avoid with- drawal symptoms.
Alcohol Withdrawal symptoms
- anxiety
- insomnia
- fever
- restlessness
- nausea
- tremors
- delirium tremens
- agitation
- autonomic instability
- gross tremor
- confusion
- disorientation
- paranoia
- hallucinations
effects of ethyl alcohol
- alcohol is a depressant
- Reduce anxiety, produces euphoria, sense of well-being, reduce inhibition - enhances social perception
- Passes directly into the bloostream (BAL)
- Breathalyzers
- Broken down in the stomach by the enzyme alcohol
dehydrogenase - Less available in women (+ higher body fat) = higher BAL
- (this is the true nature of alcohol) Depressant: deficits in eye-hand coordination, drowsiness,
decreased sensitivity to taste, smell, and pain, slow reaction
time, etc. - Hangover symptoms
Memory blackouts - interferes with the ability to keep new information for brief amounts of time
Long terms effects of alcohol
- Damage to many organs
- Risk for certain types of cancer
- Wernicke-Korsakoff syndrome
- Thiamine deficiency
- Treatment for thiamine deficiency is injections in the first stage
- Chronic impairment of memory
and loss of contact with reality
Wernicke-Korsakoff Syndrome
‘Wet Brain’
- commonly experience confusion and disorientation and eye movement and movement abnormalities
- extensive memory deficits - inability to form new memories
- deficiency in vitamin thiamine - deficiency in thiamine can disrupt process of utilisation of carbohydrates for energy - and disrupt brain activity
common areas effected: hypothalamus, thamalum, cerebellum, cortex and brain stem
patients are treated with thiamine supplementation
however, generally considered irreversible
etiology - biological factors
- genes effect the vulnerabilities in the reward system of the brain and ability to metabolise alcohol
neurobiological influences
- EEG higher rates of the fast beta wave, less change (smaller P300 amplitudes)
- Low level of serotonin
- Men with relatives with alcohol-dependent relatives: larger increases in hear rate
- Measure of sensitivity to the stimulating properties of alcohol
etiology - psychological factors
Personality
* Behavioural disinhibition, negative emotionality (depression and anxiety) - neuroticism
- impulsivity - easier to have binge episodes - unable to stop yourself - ADHD, CD - impulsivity - comorbid with substance use
Tension-reduction hypothesis
* Reinforcement - reduction in unpleasant emotions - alcohol use becomes reinforced
* Missing element: Role of expectations
Alcohol expectancy theory
* Effects largely determined on your expectations - convince yourself that the only thing that will help you relax is the alcohol - self-fulfilling prophecy
* The pharmacological effects can have the opposite effect of expectation
(depressant)
Etiology - socio-cultural factors
- family values
- attitudes
- expectations
- environment
medications are sometimes used in treatment of alcohol use disorders, mainly to…
reduce the pleasurable feelings that result from drinking
Pharmacotherapy
- benzodiazepines - reduces anxiety due to withdrawal symptoms - can develop an addiction to benzodiazepines
- naltrexone - antagonist drug - reduce gratification
- reduce the sensation of craving
- acamprosate - agonist drug - facilitates the inhibitory action of GABA
- reduce the sensation of craving
- Antabuse
- making drinking aversive (eg. make someone throw up)
treatment - residential treatment and mutual support groups
Residential treatment
* Alcohol use disorder as a disease
* Minnesota Model – Hazelton treatment program
* Education
* Group and individual therapy
Alcoholics Anonymous (AA)
* AA works with more alcoholics worldwide than any
other treatment organization.
* Self-help group
* Based on the disease model
* Limited research and effectiveness data
psychological treatment
Behavioural approach:
- contingency management
- community reinforcement approach
- condition by pairing with aversive effect
Relapse prevention treatment:
- What should be identified? High-risk situations
- Why does it happen? Failure of coping strategies & self-defeating thoughts
Marital and family therapy
- with someone who is not addicted
Brief interventions and motivational interviewing
- black and white thinking - I had one drink, I might as well have many
Depressants
- barbiturates
- benzodiazepines
CNS depression
tense to calm:
- tranquillisers
- anti-anxiety meds
- anxiolytics
calm to drowsy:
- sedatives
- reduce the desire for physical activity
drowsy to sleep:
- hypnotics
- CNS depressants and Meds used for sleep
- barbiturates
- benzodiazepines
Barbiturates and Benzodiazepines
- There are a number of drugs considered to be depressants because they inhibit neurotransmitter activity in the CNS.
- Barbituric acid, produced in 1903, was one of the first drugs
developed to treat anxiety, tension, and sleep issues. - Addictive
- Benzodiazepines (‘anti-anxiety’ meds) can take many forms:
- Tranquilizers, sedatives, hypnotics, muscle relaxants, anticonvulsants
- safer alternative to barbituric, still do have addictive potential
- inhibits reticular activating system
- Combination of depressants is dangerous
- inhibition of limbic system
- reduces anxiety
Facts about Barbiturates &
Benzodiazepines
Prevalence of usage
* 10% of the general population (more women)
* High-school students: 1.3% males, 3% females
Effects
* (-) Mild euphoria
* (+) Slurred speech, poor motor coordination, impaired
judgment + concentration
* Long-term: depression, chronic fatigue, mood swings, paranoia
Treatment for a dependency
* Progressively smaller doses of the addictive drug to minimize
withdrawal symptoms
* Abstinence syndrome: insomnia, headaches, and body ache
* Psychological and educational programs (Narcotics
Anonymous)
Hallucinogens
- Drugs that change a person’s mental state by inducing perceptual
and sensory distortions or hallucinations. - Excitatory effects on the CNS
- Mimic the effects of serotonin
- LSD affects the sympathetic nervous system
- Flashbacks
- Psychedelics – “soul” and “to make manifest”
- Albert Hoffman – 1938
- LSD
- Mushrooms
- Psilocybe mexicana
common side effects of LSD
- dramatic changes in sensations and feelings
- altered sense of self
- swing rapidly from one emotion to another
- feeling several different emotions at once
- altered sense of time
- crossover senses - synesthesia
hallucinogens - dependancy
- psychological
- hallucinogens are believed to have little addictive potential
- few programs have been developed for treatment
hallucinogens as antidepressants?
- Serotoninergic hallucinogens are agonists at frontal and limbic 5-HT2A
receptors. - Ex. lysergic acid diethylamide (LSD), dimethyltryptamine (DMT) and psilocybin
- Controlled trials with these drugs report anxiolytic and antidepressive
effects + antiaddictive effects - Biological mechanisms include neuroplasticity and fronto-limbic activation.
- Psychological mechanisms include enhanced social cognition and
openness to experience.
