Substance Abuse

  • Created by: Gemma
  • Created on: 02-06-17 08:30

DSM-V substance-related disorders

  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogen
  • Inhalant
  • Opioids
  • Sedative, Hypnotic or Anxiolytic
  • Stimulants
  • Tobacco

X related disorders

  • X use disorder
  • X intoxication
  • X withdrawal
  • Other X-induced disorders
  • Unspecified X-related disorder
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Substance Use Disorder

Problematic pattern of substance use leading to a clinicaly significant impairment or distress, as manifested by at least 2 of the following, occuring within a 12 month period:

  • substance taken in large amounts or over a longer period than intended
  • Persistant desire to cut down or control substance use
  • Time spent obtaining, using or recovering the substance
  • Craving or strong desire to use substance
  • Recurrent use results in failure to fulfil major role obligations
  • Continued use despite persistant or recurrent social or interpersonal problems caused or eacerabeted by the effects of the substance
  • Important social, occupational, recreational activities given up or reduced because of substance use
  • Recurrent use in situations where it is physically hazardous
  • Substance use continued despite knowledge of physical or psychological problems caused by the substance
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Tolerance and withdrawal

Tolerance and withdrawal symptoms are not counted towards the diagnosis when the patient is involved in an appropriate medical treatment program for a problem such as pain, depression or anxiety.

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Biopsychosocial model

Complex interactive contributions of biological, psychological and socio-cultural factors

Identifying a person's motivation to change their substance use behaviour is helpful in understading both initiation and cessation of alcohol and other drug use.

Substance use patterns vary across the lifespan, with adolescence and early adulthood being life stages of particular risk for harmful use.

It is essential to understand the social and cultural context of substance use. This is critical for all people, but is particularly salient for youth, Aboriginal and Torres Strait Islander people.

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Aetiology (causes)- Genetics

Some people are predisposed to developing addictive behaviours

Neuropsychiatric conditions are ultimately expressed in the brain

Chronic drug use involves changes in gene expression (epigenetics)

Genes may affect:

  • Risk taking behaviour
  • Impulsivity
  • Novelty seeking
  • Drug metabolism, absorption, excretion, sensitivity
  • Liklihood of dependence

Susceptibility genes maybe?

Prenatal exposure

Social factors

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Aetiology- Neurobiology

Mollecular and cellular mechanisms can lead to changes in structures and function of important neural circuits which can impact on cognition and behaviour characteristics of addiction

Addictive drugs act on the brains 'reward pathway' which motivates people to continue to use drugs despite harmful effects

Midbrain, forebrain, ventral tegmental area, nucleus accumbens, prefrontal cortex

Amygdala and hippocampus= conditioning= dopamine

Addictive drugs produce long lasting changes

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Aetiology- Psychopathology

Dual diagnosis- its hard to tell which one came first- psychopathy or drug use?

  • 75% of people with substance use problems have a mental illness
  • 64% of psychiatric inpatients may have a current or past drug use problem
  • 90% of males with schizophrenia hav substance use problems
  • High levels of anxiety and novelty seeking in kindergarten predicted later drinknig, drug use and smoking
  • In women, borderline personality disorder is linked to alcohol use
  • Aggression and rebelliousness is related to substance abuse
  • Attention deficit/hyperactivity disorder is linked to tobacco, drug and alcohol abuse.
  • Early exposure to trauma
  • Lack of attachment
  • Impulsive/rebellious behaviour
  • Poor self-control
  • Anxiety
  • Depression
  • Pain
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Aetioloy- Environmental, social and cultural facto

  • Env stressors
  • Academic failure
  • Drug abusing peers/ family members
  • Domestic violence
  • Loos of purpose/hope
  • Family functioning
  • Ineffective parenting
  • Negative communication patterns
  • Psychiatric, marital, or legal problems in family
  • Peer influences
  • Culture
  • Location
  • Advertising and Media 
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Risk factors for problematic drug use

  • Age of first use
  • Low socioeconomic status/unemployment
  • Familial history
  • Genetic susceptibility
  • Support systems
  • Peers
  • Psychological health
  • History of abuse/trauma
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Comorbidity

Chicken or the egg?- What comes first...

Medical

Obstetric

Mental health- Suicide is strongly related to dual diagnosis

Social

  • Domestic violence
  • Homelessness
  • Unemployment
  • Trauma
  • Forensic
  • Low SES
  • Child protection 
  • Relationship
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Process of developing substance use disorder

1) Positive attitude

2) Experimentation

3) Regular use

4) Heavy use

5) Dependence or abuse

Poly-substance use- the use of 3 or more groups of addictive substances of a period of 12 months. It occurs when an individuals abuses several substances over a short period of time, often in an attempt to enhance the effect of a signel drug to create a more intense high.

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Addiction

Pharamaceutical drugs can be used no medically and are commonly associated with addiction.

  • Opioids (pain- morphine, codeine, pethididne, oxycodone, fentanyl)
  • Benzodiazipines (anxiety- diazepam [Valium])
  • Dexamphetamine (ADHD)
  • Phentermine (appetite suppressant)
  • Ephedrine (asthman, weight loss)

Licit substances

  • Tobacco
  • Alcohol

Illicit substances

  • Heroin
  • Cocaine
  • Meth
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Categories of substances

Depressants- slow down messages between brain and body (CNS)

  • Alcohol
  • Benzos
  • Opiates

Stimulants- Speed up CNS to increase activity in the brain

  • Ecstacy
  • Cocaine
  • Nicotine
  • Steroids
  • Amphetamines

Hallucinogens- Produce a change in perception

  • LSD
  • Magic mushrooms
  • Ketamine

Steroids + perfomance enhancing drugs- generally are hormones

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Alcohol

Short term

Interacts with sevelal neural systems:

  • Stimulates GABA receptors
  • Increases dopamine and seratonin
  • Inhibits glutamate receptors

Long term

  • Can cause permanent damage to liver, heart and brain
  • Increased risk of cancers
  • Capillary hemorrhages
  • infections
  • reduced fertility
  • Sexual impotence
  • Cirrhosis of the liver
  • Damage to endocrine glands and pancreas
  • Hypertension
  • Stroke
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Tobacco

Major risk for coronary heart disease, stroke, peripheral vascular disease, cancer and more.

Long term effects:

  • Stomach ulcers
  • Wrinkles
  • Irregualr periods
  • Difficulty having children
  • Cancer
  • Stroke + brain damaeg
  • Heart attack + disease
  • Dependence
  • Eye disease + hearing loss
  • Mood swings

Benefits of quitting= risks of cancers etc reduced

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Cannabis

  • Depressant
  • Cannabis Sativa
  • THC= mind altering ingredient- mood, thoughts, perception, motor skills
  • Generlly- Early person starts- more heavily they use- more likely they will continue
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Amphetamine-type substances

  • Stimulant (and hallucinogen) 
  • Made in labs by mixing different chemicalss
  • MDMA= Methylenedioxymethamphetamine
  • Powder (speed), Paste (base), Crystalline (ice)

Stimulates the CNS to produce effects

Tolerance can develop after only 6 days use

Less is known about long-term effects of MDMA

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Heroin

  • Depressant

Opioids- similar to opiates but synthetically derived, used for pain

  • Oxycodone
  • Codeine
  • Morphine

Sedation, respiratory depression, constipation, euphoria

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Cocaine

Stimulant

Reduces pain, produces euphoria, heightens sexual desire, increases self-confidence and indefatigability

Blocks reuptake of domanine in mesolimbic areas of brain

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Drugs in pregnancy/lactating

Fetal Alcohol Spectrum Disorder

Neonatal Abstinence Syndrome

Other risks:

  • Low birth rate
  • Respitatory
  • Development concerns
  • genetics
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Stages of change

Cycle

  • 1) Precontemplation (the happy user)
  • 2) Contemplation (fence sitter)
  • 3) Preparation (decisin/prep)
  • 4) Action (the doer)
  • 5) Maintenance (waling the tightrope)
  • 6) Relapse vs lapse (slip/bust)
  • 1) Precontemlation...

Treatment options

  • Counselling
  • Withdrawal
  • Residentail rehabilitation, day care
  • Diversion,
  • NSPs- prevent HCV, HBV, HIV
  • Self help (AA, NA)
  • Family support
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