Treating Addiction, Second Edition: Addiction Exam 2 Notecards (#1) Flashcards


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1

Summary

- a gathering together of what has been said

2

Reflection

shorter than a summary and done in the here and now

3

Micro factors

things that I do, that are a part of me, that contribute to my addiction

4

Levels of influences

  • Micro= me, idiosyncratic
  • Intermediate= family, neighborhood, school, friends
  • Macro= general; broader environment
  • At each level there are risk factors and protective factors
  • Environment plays a really important role in how the genetic predispositions present (aka whether if they do or don’t)
  • You are born with risk factors and protective factors
5

Examples of Micro factors

  1. psychological factors
  2. personality traits
  3. subjective reactions
  4. genetics
6

Genes

basic structural units of heredity

7

Genotype

  • accounts for 40-60% of vulnerability to addiction. BUT you can still have the “perfect” genotype to become addicted and still NOT get addicted.
  • Includes genes, initial level of dopamine receptors, chromosomes, etc
8

Phenotype

  • how you express your genes; manifestations of the genotype.
  • Includes skin color, height, etc. This is an interaction between your genotype and your environment (you might be tall via your genes but being malnourished will not make you tall)
  • 1500 genes linked to addiction
  • Identical twins with the exact same genotype will have different phenotypes
9

potentiation

  • learning; development of new pathways
  • kindling is another word for this
  • addiction is an outcome of learning; addiction is actually a form of learning
10

Lobes of the brain

  1. parietal (top/ back of brain)
  2. temporal (side of brain)
  3. frontal (front of brain)
  4. occipital (lower/ back of brain)
11

Frontal lobe

  • Front
  • Reasoning
  • Motor skills
  • High level cognition
  • Expressive language (taking language, putting it together in a meaningful way, then present it)
  • Modern brain or mature brain; last part of brain to develop
12

Temporal lobe

  • Sides
  • Primary auditory cortex
  • Includes the hippocampus for memories
13

Occipital lobe

  • Back
  • Visual stimuli
14

Parietal lobe

  • Top of brain
  • Processes tactile sensory info (like pressure, pain, and touch)
15

Neuroplasticity

  • Ability of the brain to learn and create new pathways
  • The brain is the most plastic in youth/ adolescence
  • The brain is less plastic when you’re older; harder to create new pathways or alter existing pathways (why addiction is so hard to beat when you're older)
16

Myelination

  • Fatty substance that encases an axon. Allows for quicker electrical impulses (action potentials; neuron firing)
  • Kids have less myelination. The frontal lobe myelinates last. It takes a long time for the brain to have these quick and efficient neuronal systems
  • Kids are really great at sensation- processing and less efficient in decision making, etc
17

Childress’ Stop-Go method

  • GO- function in anterior, ancient area of the brain
    • Reward system. Where dopamine is released
  • STOP- function in newer, more recently developed frontal area of the brain
  • Childress studies the time it takes for the go signal to fire and the stop signal to fore
    • .3 milliseconds
  • “before I know it I’m using”
18

Half second delay

  • “free won’t” (healthy decision making) lags behind the impetus (desire, urge, decision) to use by half a second
    • Takes time to crank up consciousness
    • Longer, exaggerated log time in persons with addictions because fo the well worn pattern of learned compulsive behavior
19

Drugs effects on frontal lobe

  1. Depressed neural processing and distort functions specifically in frontal regions, similar to patients with lesions or injuries (not drug induced) in same area
  2. Reduced blood flow and glucose metabolism
  3. Contribute to suboptimal choices and decisions made concerning drug use
  4. Increase wanting (not necessarily liking drugs, i.e. for pleasure) and sensitization (increase in drug effects, opposite of tolerance)
20
card image

What does this show?

Mesolimbic pathway

21

Mesolimbic pathway

  • Two parts of the pathway
  • Dopamine originals in ventral tegmental area (VTA) (in the brainstem)
  • When dopamine is released, it always travels to the nucleus accumbens
    • Central area of the brain; around the amygdala (fear, pain area)
    • All about expectation, finding pleasure, pursuing reward
    • The ID lolz
22

Dopamine associated with...

  • associated with relieving pain
    • Can also be associated with pleasure seeking and assigning pleasure to certain situations, etc
23

Dopamine and our body's response to drug use

  • We seek reward/ pleasure
  • Drugs increase dopamine in the synapse
  • We experience or expect pleasure
  • When we take drugs:
    • The brain tries to restore balance (bc there’s too much dopamine in synaptic cleft)- the brain learns to NOT release dopamine
    • We experience less pleasure- because the brain has learned to NOT release dopamine… The more you use/ supplement your dopamine, the more the brain tries to adjust and balance.
    • We seek more pleasure- so we seek out drugs bc the brain is not producing dopamine on its own
    • Brain structures are changed, downregulating dopamine…making it harder to experience or expect pleasure
24

Dopamine is active or effective when its...

.....in the synaptice cleft. Substances can work by blocking reuptake of dopamine or by releasing more dopamine

25

Types of medically-assisted programs

  • Replacement therapy- giving someone an opiate to create the dopamine level (but not spikes of getting high; helps the brain re-regulate and learn). Then titrate to lower. Some people cannot titrate to 0 (Simboxone)
  • Antagonist treatment- block receptors. Used with people who haven’t been using for a while. Used in prison populations usually. Antagonist blocks the receptors so when they do use, they wont feel the effect of the drug
26

Pharmacology

  • Study of the interaction between chemical agents (drug) and living organisms
  • Action of drug on/in body—body’s response to presence (And absence) of drug
  • When you take a drug, its having an effect on all systems of the body
27

Pharmacokinetics

  • process by which the substance moves through the body (how does it get in, get used, and get out). ADME
    • absorption
    • distribution
    • metabolism/biotranformation
    • excretion
28

Absorption

  • cite of entry. How substance enters body.
  • Cite of action (usually the brain). Movement of drug from entry, into bloodstream, and to the place of action. Injection, orally.
  • Things like rate of bloodflow or if you’ve eaten will affect this
29

Distribution

  • how does it get around the body.
  • Water soluble (mixes freely w blood and moves quickly) or lipid soluble (bind to fat molecules and get into the body tissue faster).
  • Where does it go and how well it gets there. Things like age, muscle/ fat content, etc
30

Metabolism/ biotransformation

  • breaking down the substance. Chemical is broken down in preparation of excretion.
  • Detoxification.
  • Typically happens in liver (makes it water soluble so it can be excreted via urine.
  • Things that are water soluble are excreted more quickly than things that are lipid soluble)
31

Excretion

  • -elimination. Kidney takes it out. Can breathe it out, sweat it out, pee it out, poo it out, etc.
32

half life

  • Based on one dose of the substance
  • Amount of time necessary for the body to remove 50% of a substance
  • 5 half-lives to be essentially eliminated
  • complicated when multiple substances are used simultaneously
  • a drug like marijuana with a really long half life is still affecting you a week later (you don’t feel it but it is still affecting you)
  • cocaine and alcohol have short half lives- 1 hour per dose, usually
  • oxycodone- 2-4 hours
  • methadone- 50-60 hours
  • drugs that are lipid soluble have longer half lives- they stay in your system longer bc they’re in your fat
33

Pharmacodynamics

biological processes that happen because of the drug

34

Routes of administration (absorption)

  1. ingestion
  2. inhalation
  3. intranasal
  4. injection
35

ingestion

  • “safest”
  • Usually has to go through your stomach and into the rest of the GI tract before it starts to do something
  • The amount of food in your stomach will also affect this
36

Inhalation

  • breathing in thru lungs
  • Can be dangerous
  • Goes right into the lungs and right into the blood
  • Happens REALLY fast
37

Intranasal

  • snort into nose.
  • Not trying to get into your nose or lungs but into the mucous membrane of the nose
38

Injection

  • use of syringe to shoot substance into vein (intravenous- directly into blood and into distribution) or muscle (intramuscular- like steroids) or beneath the skin (subcutaneous- slower release)
39

The faster the drug gets to the brain....

the more addictive it is

- so inhalation and intravenous is the most dangerous ways of absorbing a drug

40

As addiction progresses...

users seek out more intense and immediate highs

41

The way you deliver the drug affects the brain

  • Rapid delivery has strongest effect on the reward system = probably have the really negative affects of the drug use and addiction
  • Slow delivery has weaker, longer lasting effect- less withdrawal, less tolerance, less negative effect
42

A-Dehydrogenase

  • Women do not produce as much A-Dehydrogenase as men *** this helps break down alcohol down into acetaldehyde (What can be metabolizes and excreted)
    • Harder for women to break down alcohol
    • Men have more of this dehydrogenase in stomach lining than do women
43

Drug testing

  • Really goes back to elimination
  • Urine- least expensive so most often use. Longer range of tests than saliva
  • Saliva
  • Hair
  • Blood
  • Sweat
  • Nail
44

Drug classifications

  • CNS depressants
    • Alcohol
    • Sedative- hypnotics
    • benzos
  • CNS stimulants
    • Cocaine
      • Powdered
      • Crack
    • Amphetamines
      • Methamphetamine
    • Nicotine
  • Opioids
    • Heroine
    • Fentanyl
    • Prescription opioids
  • Hallucinogens
    • Ecstasy
    • LSD
  • Marijuana/ cannabis
  • Inhalants
  • Steroids
45

CNS depressants

  • Alcohol
  • Sedative- hypnotics
  • benzos
46

CNS stimulants

  • Cocaine
    • Powdered
    • Crack
  • Amphetamines
    • Methamphetamine
  • Nicotine
47

Opioids

  • Heroine
  • Fentanyl
  • Prescription opioids
48

Hallucinogens

  • Ecstasy
  • LSD
49

Rebound effects

  • What goes up… must come down
  • If you feel good using a substance, you will feel bad after
  • You don’t just go back to baseline… you are worse than your baseline
50
  • Alcohol administration
  • Most common
  • depressant CSN
  • Binge dirnking- dirnking to or beyond the ..08 BAC level
  • About 90% of all drinking by those under 21 is binge drinking
  • BAC- percentage of purse alcohol dissolved in your blood
  • Anything over .10 is pretty drunk
  • Biotransform single serving- 60-90 minutes
  • Alcohol doesn’t come in a pure form- its mixed into other things and in different ways
51

“at risk” drinking defined as:

  • Men: more than 4/day or 14/week
  • Women: more than 3/day or 7/week
52

Effect of alcohol

  • Increased urination
  • Reduced oxidation of body fat
  • Peripheral dilation
  • Increased gastric secretions
  • Release of corticosteroids
  • Disrupted sleep patterns: suppressed
  • Impaired memory: blackouts and grayouts
  • Hangover: minor withdrawal
  • Reduced pain sensitivity: especially .08 andup
  • Slowed reaction time
  • Increased body sway
  • Lowered inhibitions