Addiction I & II Flashcards

1
Q

Definition of substance use disorders

A
  • 11 criteria including e.g.:
    • substance taken in large amounts/long period
    • unable to cut down/control substance use
    • ==> social/interpersonal problems
    • tolerance or withdrawal
  • mild: 2-3 sx
  • moderate: 4-5 sx
  • severe: 6+ sx
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2
Q

Neurobiology of substance abuse

A
  • multiple brain regions involved
  • motivational systems/reward:
    • ventral tegmental area ==>
    • nucleus accumbens
  • frontal regions/prefrontal cortex
    • learning, cognitive control, inhibition
  • mood and stress reactivity
  • all substances of abuse ==> dopamine release @ nucleus accumbens
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3
Q

Medications available to treat alcohol abuse

A
  • disulfiram (Antabuse)
    • inhibits acetaldehyde dehydrogenase
    • ==> antabuse rxn
  • Naltrexone
    • opiod antagonist
    • (possibly) blocks euphoria from alcohol
  • Acamprosate
    • enhances GABA transmission
    • interferes w/glutamate transmission
    • possible restoration of GABA/glutamate balance
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4
Q

Medications available to treat opioid abuse

A
  • methadone
    • long-acting opioid agonist
    • doesn’t always lead to complete abstinence, but reduces harm and increases positive outcomes
  • buprenorphine
    • partial opioid agonist/naloxone
    • can precipitate w/drawal
  • naltrexone
    • blocks effects of heroin
    • can precipitate withdrawal
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5
Q

Medications available to treat tobacco abuse

A
  • NRT
    • can lead to rash, tachycardia
  • Buproprion
    • nicotinic receptor antagonist
    • dopamine reuptake inhibitor
    • doubles quit rates
  • Varenicline
    • partial alpha4beta2 agonist
    • some reports of depression/suicidal ideation
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6
Q

Psychosocial tx of substance abuse

A
  1. Contingency management
  2. Motivational interviewing
  3. Cognitive behavioral therapy
  4. Twelve step facilitation
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7
Q

Contraindications of Disulfram (Antabuse use)

A
  • Risk for MI
  • Risk for CVA
  • Cognitive dysfunction (can’t remember what will happen if drinks)
  • Pregnancy
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8
Q

“free-will” vs. biological disease in substance abuse disorders

A
  • All drugs of abuse share the final common pathway of increasing dopamine release in the nucleus accumbens; associated with the “high” (reward reinforcement)
  • Over time, dopamine circuitry compensates so that individuals now have to use drugs to create physiological normal levels of dopamine
  • Orbitofrontal cortex
    • SUD patients have decreased response-reversal learning, mediated by the OFC; i.e. they do not learn to alter their behavior when behavior that was previously rewarded/reinforced is now punished
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9
Q

Age impact on development of SUD

A
  • brain circuits involved:
    • dopamine-reward sytem ==> reinforcement of SUD
    • prefrontal cortex ==> resists development of SUD
  • circuits ==> susceptability of teenage development of SUD b/c reward system is fully developed while prefrontal cortex is not
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10
Q

Factors that impact SUD

A
  • Substance availability
  • Pharmacological reinforcement (e.g. withdrawal ==> reinforced substance use)
  • History of prior substance abuse
  • Genes
  • Gender (M>F by time young adulthood is reached)
  • Age (Teenagers = susceptible)
  • Risk-taking disposition
  • Stress
  • social punishment/reinforcement
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11
Q

Genetic impact on SUDs

A
  • ~ 50% heritability (based on twin and adoption studies)
  • First degree relatives w/SUD ==> higher rates of SUD
  • Rats can be bred to create lines that are highly susceptible to drug addiction
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12
Q

Important screening tools for SUDs

A
  • AUDIT (Alcohol Use Disorder Identification Test)
    • “At Risk Drinking”
    • Men: > 5 standard drinks in a day, or >14 per week
    • Women: > 4 in a day or >7 per week
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