Psych 183: Substance-Related Disorders

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Questions and Answers

Which demographic is most affected by opiate abuse and dependence?

White, middle-class young adults ages 18-25 (correct)

Hispanic teens under 18

African American adults over 30

Elderly individuals in rural areas

What is considered one of the most effective treatments for reducing mortality associated with Opioid Use Disorders?

Inpatient rehabilitation without medication

Long-term opioid prescriptions without monitoring

Traditional heroin maintenance therapy

Prescribed daily use of low-potency opioids (Methadone) (correct)

What is a significant risk associated with the black-market use of Fentanyl?

It is frequently found in relatively low doses

It is less potent than traditional opioids

It is often mixed with safer pharmaceuticals

It can be 100 times more potent than heroin (correct)

What is the main purpose of Abuse-deterrent formulations (ADF's) in treating opioid overdoses?

To act as a narcotic antagonist reversing opioid effects Signup and view all the answers

What treatment strategy involves the prescribed daily use of low-potency opioids?

Substitution treatment Signup and view all the answers

Which of the following is NOT a common withdrawal symptom in substance use disorders?

Euphoria Signup and view all the answers

What recent development has been approved by the FDA for treating opioid overdoses?

Over-the-counter availability of Narcan nasal spray Signup and view all the answers

What are the primary focuses of rehabilitation strategies for substance use disorders?

Coping strategies, cue avoidance, and relapse prevention Signup and view all the answers

What is the primary focus of the Medical (Disease) View in understanding addiction?

Addictive substances hijack brain functions, requiring treatment to restore normalcy. Signup and view all the answers

Which of the following describes substance abuse based on sociocultural norms?

Substance abuse occurs when drug use leads to personal and social problems outside of accepted norms. Signup and view all the answers

What is indicated by the term 'withdrawal' in the context of Substance Use Disorders?

Signs and symptoms that arise opposite to those experienced during substance ingestion. Signup and view all the answers

Which criterion is NOT included in the DSM-5-TR for Substance Use Disorders?

Socially acceptable use of substances during festivals. Signup and view all the answers

Which of the following accurately describes dependence on substances?

Habitual abuse of substances leading to significant cravings and tolerance development. Signup and view all the answers

What is one of the major social costs associated with alcohol use disorder?

Higher rates of absenteeism at work Signup and view all the answers

Which serious health risk is NOT associated with chronic heavy alcohol use?

Increased fertility Signup and view all the answers

What is a common effect of Fetal Alcohol Spectrum Disorders on children?

Craniofacial deformities Signup and view all the answers

What is a key question in the CAGE Questionnaire for screening alcohol use problems?

Do you feel guilty about your drinking? Signup and view all the answers

What substance is primarily responsible for over 90 daily overdose deaths in the U.S.?

Opioids Signup and view all the answers

Which of the following is NOT a medical use for opiates?

Weight loss Signup and view all the answers

Which of the following conditions is a serious risk associated with fetal alcohol exposure during pregnancy?

Learning disabilities Signup and view all the answers

What common misconception about vaping nicotine is mentioned?

Statistics on its use are unreliable Signup and view all the answers

What is one of the risks of using opiates improperly?

Opioid overdose Signup and view all the answers

What is one of the core principles emphasized in Alcoholics Anonymous (AA) as part of its recovery process?

Acknowledgment of a higher power for support Signup and view all the answers

Which of the following is NOT a 12-Step program based on Alcoholics Anonymous?

Heroin Anonymous Signup and view all the answers

Which statement is true regarding the effectiveness of Alcoholics Anonymous compared to other treatments for ETOH dependency?

Studies suggest AA participation results in higher abstinence rates. Signup and view all the answers

What aspect of the 'Big Book' of AA stresses a significant part of the recovery process?

Making personal amends for past actions Signup and view all the answers

What approach does the 12-Step Program primarily take regarding the nature of addiction?

Medical model combined with a moral view Signup and view all the answers

What is a common characteristic of 12-Step programs that distinguishes them from other types of treatment?

Emphasis on group support and shared experiences. Signup and view all the answers

Which of the following principles is a fundamental component of the 12-Step recovery approach?

Helping others achieve sobriety through sponsoring Signup and view all the answers

Which of the following statements best reflects the significance of family involvement in recovery from substance use disorders?

Family members should be educated through support groups. Signup and view all the answers

How is Abstinence viewed within the 12-Step Program structure?

As a daily commitment made one day at a time. Signup and view all the answers

What is the primary focus of the 12-Step group's approach to recovery?

Fostering community and accountability. Signup and view all the answers

Which of the following substances is classified under the category of other hallucinogens?

LSD Signup and view all the answers

What is a common medical use for opioids?

Pain relief Signup and view all the answers

Which statement about substances classified as stimulants is accurate?

They enhance mood and motivation by working on neurotransmitter systems. Signup and view all the answers

Which substance is associated with an increase in dopamine levels?

Stimulants Signup and view all the answers

What is the most significant reason for classifying phencyclidine (PCP) separately from other hallucinogens?

Its extreme cardiovascular and neurological toxicity. Signup and view all the answers

Which of the following substances has been noted for its potential benefits in treating schizophrenia?

Nicotine Signup and view all the answers

In what context is moderate consumption of red wine potentially cardio-protective?

Under a physician’s guidance. Signup and view all the answers

Cannabis has emerged for use in treating which of the following disorders?

Seizure disorders Signup and view all the answers

Which of these substances is NOT noted for its medical applications?

Heroin Signup and view all the answers

What type of substance are barbiturates classified as?

Sedatives, Hypnotics, and Anxiolytics Signup and view all the answers

Study Notes

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Addiction is characterized by uncontrolled, compulsive substance use despite ongoing negative consequences to health, mental state, or social life
Moral view: Addicts are morally weak, self-destructive, uncaring of their actions, and need to improve behavior
Medical (Disease) view: Addiction may be rooted in genetic predisposition and/or social learning. Addicts' brains experience a biological "hijacking" by addictive substances.

Substance Use Norms

Every culture has norms surrounding substance use that dictate what substances are used, when, how, by whom, and in what amounts
"Use" describes ingestion within sociocultural guidelines
Examples include using peyote in Native American rituals, ceremonial wine or beer consumption in particular traditions
"Abuse" describes using substances outside of these norms, and typically results in personal and social problems

Substance Use Disorders: Spectrum of Severity

Intoxication: The ingestion of a substance leading to impairment, typically temporary and reversible. With the withdrawal, it shows opposing symptoms relative to initial intoxication.
Abuse: A pattern of harmful use, characterized by regular periods of intoxication, and occasionally withdrawal
Dependence: Habitual abuse and significant cravings and tolerance (requiring increasingly larger amounts to obtain desired effects)
The DSM-5-TR classifies substance use disorders into graduated severity levels, and for each of the ten types

Ten Classes of Substance Use Disorders

Alcohol (ETOH)
Caffeine
Cannabis
Phencyclidine-related hallucinogens (PCP, ketamine)
Other hallucinogens (LSD, psilocybin, salvia, ayahuasca, DMT, dextromethorphan)
Opioids (morphine, heroin, codeine, hydrocodone, oxycodone, fentanyl)
Sedatives, hypnotics, anxiolytics (barbiturates, benzodiazepines)
Stimulants (amphetamine, Ritalin, cocaine, MDMA)
Tobacco
Inhalants (nitrous oxide, glue, solvents, aerosols, cleaning fluids)

What Substances Are Likely to Be Abused?

Many abused substances have beneficial uses in medicine, for example heroin, opioids used for pain relief, and antidiarrheal agents, cocaine as a local anesthetic, or alcohol as a relaxant or anxiety reducer among others.
These substances affect the neurotransmitter systems in the brain, impacting mood and motivation.

Non-Substance "Behavioral Addictions"

Historically, addiction was associated solely with substances
More recently, some argue for including behaviors like sex, exercise, eating, gambling, shopping, pornography, and the internet among the categories of addictions
Gambling Disorder is classified as a Non-Substance-Related Disorder in DSM-5-TR due to the addictive pattern in this behavior.
Other behavioral addictions are excluded because of a lack of data

DSM-5-TR Substance Use Disorder Criteria

Maladaptive pattern of substance use, leading to significant impairment and distress
Presence of 2 or more symptoms within a 12-month period
Taking more and/or longer than intended
Desire to cut down or cease use but unable to succeed
Excessive time spent acquiring, using, or recovering from substance use
Inability to meet responsibilities at work, home, or school due to substance use
Persistence in use despite ongoing interpersonal issues
Abandoning significant social or recreational activities due to substance use
Repeated use despite arising danger
Continuing use despite physical illnesses or exacerbated psychological issues
Tolerance buildup (increased amounts required to feel the effect)
Emergence of withdrawal symptoms

Cannabis Use Disorder

Withdrawal symptoms include fatigue, yawning, problems concentrating, appetite loss, insomnia
Cannabis use disorder involves separate diagnostics for intoxication, withdrawal, abuse, and dependence.
It's connected with other substance use disorders and is associated, in adolescents, with anxiety disorders, Major Depression, PTSD, Conduct Disorder, and ADHD.
It's also associated with chronic respiratory disorders (e.g., asthma, COPD, pneumonia), and a three-fold increase in psychosis.

Not Your Parents' Marijuana

The potency (THC content) of seized marijuana has significantly increased since the 1990s.

Cannabidiol - The Good

CBD cuts seizure severity and frequency
CBD is used as a medical cannabis for severe epilepsy
CBD has potential for treating pain and reducing opioid use
Studies show CBD benefits for cancer care, AIDS care, and type 2 diabetes

Alcohol (ETOH) Use Disorder

Diagnoses of alcohol intoxication, withdrawal, abuse, and dependence

What is Alcohol?

Ethanol is a volatile, clear, flammable liquid created via sugar fermentation.
It's a temporary central nervous system depressant, affecting GABA (inhibitory neurotransmitter) and glutamate (excitatory neurotransmitter) receptors in the brain.
ETOH is a potential neurotoxin that can cause gray matter loss, affecting memory and coordination, and mostly reversible with moderate use.

Alcohol Use in the U.S.

ETOH is consumed by 80% of the population, primarily through beer, wine, and spirits

Alcohol Effects - Dependent on BAC%

.03-.06: Sense of well-being, reduced anxiety, social lubrication
.06-.10: Incoordination, irritability, impaired reaction time
.11-.20: Slurred speech, ataxia, impaired judgment
.21-.29: Blackouts, amnesia, unsteady gait, nausea
.30: Coma, respiratory/cardiac depression, possible death

Alcohol Withdrawal Syndrome from Severe Dependence

"Shakes" (within 12-18 hours after drinking)
Nausea and vomiting
Alcoholic seizures ("rum fits")
Alcoholic hallucinosis (vivid auditory hallucinations)
Delirium tremens ("the DT's") (confusion, disorientation, agitation, frightening visual hallucinations)

Who Develops Alcohol Use Disorder (I, II, and III)

Age: Younger drinking onset; higher risk for dependency
Sex: Males at higher risk for developing ETOH disorders but females have potentially negative health consequences sooner
Level of response to alcohol (LR): People who require higher alcohol intake for effects tend to be more prone to ETOH Use Disorders.
Family History: Children of ETOH-dependent individuals are at heightened risk; this holds true even if raised by non-dependent adoptive parents
Ethnicity: Ethnic groups exhibit varying susceptibility; Asians show lower rates due to genetic factors.
Personality
Social
Education - College students drink more, with Greek Letter Organizations being more prone to drinking-related issues
Personality: Impulsiveness; sensation-seeking traits; Unstable personality disorders

Consequences of Alcohol Use Disorder

Driving fatalities
Injuries
Social problems: Criminal behaviors, domestic violence, family strife
Impairments in work and school function
Increased risks of diseases: gastric irritation, bleeding, cancer (breast, oral, intestinal tract, liver, testicular, pancreatic), peripheral neuropathy, and dementia.

Fetal Alcohol Spectrum Disorders

Associated with heavy prenatal drinking
Affects children: Craniofacial deformities, physical/mental retardation, learning disabilities, behavioral problems (ADHD), Skeletal anomalies (hand and finger malformations)

Screening for Alcohol Use Disorder

Single-question screening, CAGE Questionnaire

The Opioid Crisis

Extensive drug use of Opioids, especially fentanyl, causing many deaths; highly potent and causes rapid overdose
Increased mortality rates, and high costs for society
Treatment is limited
FDA approved Over the Counter Narcan nasal spray

National Drug-Involved Overdose Deaths

Different substances, and various groups experiencing increasing deaths

The U.S.'s Opioid (Narcotic) Crisis

Opiates (derivatives of morphine from Opium Poppy) are used to create controlled substances, with wide ranging misuse
Prescription and illicit opiates are high, and contribute to overdose deaths.
Primarily affects middle-class, young adults

America's Opioid Crisis: Fentanyl

Black-market fentanyl is much more potent than heroin.
New fentanyl and nitrazone synthetics are vastly more potent, and extremely prevalent in current drug trade

Current Strategies in Treatment of Opioid Use Disorders

Better physician training on opioid use
Prescription of low-potency opioids, e.g. Methadon, or other abuse deterrent formulations like Suboxone
Training and resources for rapid response teams to treat overdoses
Promoting availability of Narcan over-the-counter
Research on psychedelic treatment and new non-addictive analgesics

General Treatment of Substance Use Disorders

Various treatments and strategies for different substance use disorders

Stages of Substance Use Disorder Treatment

Acute management (inpatient detox): Treatment of acute withdrawal symptoms
Rehabilitation (outpatient): Group and family therapy, and addressing co-morbid conditions. Addressing denial by the patient
Referring to additional therapies and support groups

Treatments for Common Substance-Use Disorders Show Low Rates of Abstention

High relapse rates are displayed for all substances in the graphic.

AA and 12-Step Groups

Based on a medical model (disease model), and moral view
12-step programs emphasize a frank admission of the problem, powerlessness, and seeking a higher power, vows of abstinence, making amends, and helping others.
Studies show potential improvements in sustained abstinence rates in individuals participating in AA.

Trends in Substance Use Disorder Treatment

Mainstay of treatments include 12-step programs
Willingness to treat co-morbid mental disorders
Increase of emphasis on early detection, education, and community prevention programs
Increased use of pharmaceutical treatments, including antagonists, substitutes, and abuse-deterrent formulations

Addiction and Crime

A cycle shows links between addiction and criminal behavior.

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Description

Explore key concepts in substance-related and addictive disorders with this quiz from UCSB Psych 183. Test your understanding of addiction characteristics, legal limitations on course materials, and ethical considerations in academic settings. Ideal for students wishing to reinforce their knowledge in psychology.