Substance Use Disorders Overview
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Substance Use Disorders Overview

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Questions and Answers

What term has replaced 'substance abuse' in current diagnostic classification?

  • Substance dependence
  • Addiction
  • Substance use (correct)
  • Substance-induced disorder

    • Which of the following categories is NOT included as a symptom of Substance Use Disorder?

  • Social impairment
  • Impaired control
  • Pharmacological criteria
  • Happiness when using (correct)

    • What is the required number of symptoms for a diagnosis of moderate Substance Use Disorder?

  • 6 or more
  • 4-5 (correct)
  • 1
  • 2-3

    • Among the listed age groups, which has the highest rates of substance use?

    <p>18-24 years</p> Signup and view all the answers

    Which characteristic is a key factor for diagnosing Alcohol Use Disorder?

    <p>Experiencing significant distress</p> Signup and view all the answers

    What is a notable limitation of Alcoholics Anonymous (AA) as a treatment method?

    <p>Experimental studies have not proven its effectiveness in reducing alcohol dependence.</p> Signup and view all the answers

    Which component is NOT emphasized in the holistic treatment approach of Therapeutic Communities?

    <p>Intensive one-on-one therapy sessions</p> Signup and view all the answers

    What percentage of clients in AOD services are reported to have cognitive impairment?

    <p>30-80%</p> Signup and view all the answers

    Cognitive Impairment in treatment for substance use disorders commonly leads to which of the following outcomes?

    <p>Decreased treatment retention and outcomes</p> Signup and view all the answers

    What is a characteristic of Cognitive Bias Modification (CBM) in addressing substance use?

    <p>It involves moving desired substances away during practice.</p> Signup and view all the answers

    The effects of Working Memory training, such as programs like Lumosity, are generally regarded as:

    <p>Not significant enough to have an everyday impact</p> Signup and view all the answers

    Goal-Directed Training provides clients with what type of strategies?

    <p>Step-by-step lists to manage cravings and enhance executive functioning</p> Signup and view all the answers

    Dropout rates during Cognitive Bias Modification trials indicate:

    <p>High dropout rates despite observed positive effects</p> Signup and view all the answers

    What is the primary focus of Koob's Allostasis theory in relation to substance use?

    <p>The brain's set point can change to a pathologically detrimental level.</p> Signup and view all the answers

    What is a significant neuropsychological effect associated with long-term methamphetamine use?

    <p>Global deficits across various neuropsychological processes.</p> Signup and view all the answers

    Which cognitive function is most associated with deficits due to alcohol-related impairments?

    <p>Impulse control</p> Signup and view all the answers

    What is a characteristic of Cognitive Behavioral Therapy (CBT) for substance use disorder?

    <p>It involves structured sessions focusing on relapse prevention strategies.</p> Signup and view all the answers

    What condition is characterized by confusion, abnormal eye movements, and gait ataxia related to alcohol use?

    <p>Wernicke-Korsakoff syndrome</p> Signup and view all the answers

    Which aspect of rehabilitation aims to encourage positive behaviors through reinforcement?

    <p>Contingency Management</p> Signup and view all the answers

    How does the Opponent Process Theory explain withdrawal symptoms in substance use?

    <p>Changes in neural activity decrease receptor site function post withdrawal.</p> Signup and view all the answers

    What is a primary factor that explains the variance in risk for substance use disorders?

    <p>Cultural attitudes towards substance use.</p> Signup and view all the answers

    In which demographic is the prevalence of substance use disorder typically higher?

    <p>Adult men compared to adult women</p> Signup and view all the answers

    What type of substances tend to slow down the central nervous system (CNS)?

    <p>Depressants</p> Signup and view all the answers

    Which therapy promotes internal motivation for change, contrasting with externally driven methods?

    <p>Motivational Interviewing</p> Signup and view all the answers

    What cognitive function tends to remain relatively intact despite alcohol-related cognitive impairments?

    <p>Verbal skills</p> Signup and view all the answers

    Which of the following statements about neurochemical transmission and substance use is correct?

    <p>Substances can alter brain function specifically through the inhibition of neurotransmitter pathways.</p> Signup and view all the answers

    Which of the following best describes the primary characteristic of Alcohol Use Disorder?

    <p>Compulsive engagement in drinking despite negative consequences</p> Signup and view all the answers

    What neurochemical change is commonly associated with addiction disorders?

    <p>Decreased dopamine receptor density</p> Signup and view all the answers

    Which demographic typically shows higher prevalence rates of substance use disorders?

    <p>College-aged students</p> Signup and view all the answers

    Which treatment strategy primarily focuses on building internal motivation for change?

    <p>Motivational Interviewing</p> Signup and view all the answers

    What factor is often cited as a risk factor for developing substance use disorders?

    <p>History of mental illness</p> Signup and view all the answers

    Which of the following best describes a characteristic of substance-induced neurocognitive disorders?

    <p>Long-term cognitive deficits beyond the period of substance use</p> Signup and view all the answers

    Which of the following is NOT a recognized component of Cognitive Behavioral Therapy for substance use disorders?

    <p>Increasing physical fitness</p> Signup and view all the answers

    What is often a significant consequence of cognitive impairment in individuals with substance use disorders?

    <p>Diminished ability to engage in treatment</p> Signup and view all the answers

    What is the minimum number of criteria that must be met for diagnosing a severe substance use disorder?

    <p>Six or more</p> Signup and view all the answers

    Which of the following is NOT a category of symptoms used to assess substance use disorder severity?

    <p>Social environment dysfunction</p> Signup and view all the answers

    What characterizes the neurochemical changes associated with alcohol use disorder?

    <p>Reduced serotonin levels in the central nervous system</p> Signup and view all the answers

    Among the following, which factor is known to increase the risk of developing substance use disorders?

    <p>Genetic predisposition</p> Signup and view all the answers

    What is the primary withdrawal symptom associated with the cessation of alcohol use?

    <p>Tremors and seizures</p> Signup and view all the answers

    Which criteria reflect social impairment in the diagnosis of alcohol use disorder?

    <p>Continued use despite relationship problems caused by alcohol</p> Signup and view all the answers

    Which statement correctly defines a key characteristic of alcohol use disorder related to risk factors?

    <p>Stress levels and coping strategies can significantly influence addiction risk.</p> Signup and view all the answers

    Which pharmacological criterion indicates a reliance on alcohol through withdrawal symptoms?

    <p>Taking alcohol or similar substances to evade withdrawal symptoms.</p> Signup and view all the answers

    What is the significance of the prevalence rates of alcohol use disorder among different demographics?

    <p>The rates are significantly elevated among adult men compared to adult women.</p> Signup and view all the answers

    Which neurochemical mechanism plays a crucial role in the addiction process?

    <p>Reuptake processes are key in regulating neurotransmitter activity.</p> Signup and view all the answers

    In what way can late onset of alcohol use disorder influence treatment strategies?

    <p>Treatment approaches may need to adapt to different psychological profiles in late-onset individuals.</p> Signup and view all the answers

    How does the Opponent-Process Theory relate to withdrawal symptoms in substance use?

    <p>Increased activity leads to down-regulation of receptor sites to maintain balance.</p> Signup and view all the answers

    Which of the following statements best reflects the relationship between neurochemical changes and addiction?

    <p>Neurochemical changes can alter receptor interactions during addiction development.</p> Signup and view all the answers

    Which is a potential consequence of continued alcohol use despite psychological issues?

    <p>It could exacerbate existing mental health issues.</p> Signup and view all the answers

    What does Addictions Neuroclinical Assessment (Kwako) aim to address?

    <p>Incentive Salience, Executive Function, and Negative Emotionality</p> Signup and view all the answers

    What is the main difference between a mild and a major substance/medication induced neurocognitive disorder?

    <p>Mild has a change in cognition but does not impact everyday functioning</p> Signup and view all the answers

    Which of the following does alcohol impact?

    <p>GABA</p> Signup and view all the answers

    How common is severe cognitive impairment in those with alcohol dependence?

    <p>10%</p> Signup and view all the answers

    Which is not a risk factor for severe cognitive impairment for those with alcohol use disorder?

    <p>Engagement in regular exercise</p> Signup and view all the answers

    What is the prevalence of mild to moderate cognitive impairment amongst those with alcohol use disorder?

    <p>45%</p> Signup and view all the answers

    What are the neuropsychological effects of alcohol use disorder? (Select all that apply)

    <p>Cortical atrophy- reduced brain white and white matter, causing enlarged ventricles</p> Signup and view all the answers

    What neuropsychological skills aren't typically impacted by alcohol use disorder?

    <p>Intellect, verbal skills and surface level presentation</p> Signup and view all the answers

    Upon abstinence from alcohol, how do people with mild to moderate brain impairments recover?

    <p>Recovery occurs over 6-12 weeks and may continue for a year</p> Signup and view all the answers

    What are the neuropsychological effects of methamphetamine on the brain? (Select all that apply)

    <p>Neurotoxicity via oxidative stress</p> Signup and view all the answers

    What are the long-term effects of methamphetamine usage? (Select all that apply)

    <p>Global deficits across neuropsychological processes</p> Signup and view all the answers

    What substance-use rehabilitation strategy relies on the principles of operant conditioning?

    <p>Contingency Management</p> Signup and view all the answers

    How do Motivational Interviewing and CBT compare for rehabilitation of those with SUD?

    <p>Motivational interviewing is associated with greater long term change</p> Signup and view all the answers

    Which is not a risk for dropping out of rehabilitation treatment

    <p>Older Age</p> Signup and view all the answers

    What does Cognitive Bias Modification involve?

    <p>Practicing moving the desired substance away</p> Signup and view all the answers

    What is the purpose of Goal-Directed Training?

    <p>To give practical strategies to help avoid having the substance</p> Signup and view all the answers

    Study Notes

    Substance Use Disorder

    • Substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms related to the continued use of a substance despite negative consequences.
    • DSM-5 classifies substance use disorders into 4 categories: impaired control, social impairment, risky use, and Pharmacological criteria refer to the specific physiological adaptations that occur with prolonged substance use, which can lead to the development of tolerance and withdrawal symptoms. Tolerance means that over time, an individual may require larger amounts of the substance to achieve the desired effect, while withdrawal encompasses the range of symptoms experienced when the substance is reduced or discontinued. Understanding these criteria is crucial for diagnosing and treating substance use disorders, as they highlight the biological aspects of addiction that contribute to the complexity of recovery.
    • Severity is measured as mild (2-3 symptoms), moderate (4-5 symptoms), and severe (6 or more symptoms).
    • Prevalence in Australia: 5% of the population in a 12-month period, with males being twice as likely to have a substance use disorder, and higher rates for individuals aged 18-24 years old.

    Alcohol Use Disorder

    • Defined as a problematic pattern of alcohol use leading to significant impairment or distress, characterized by at least 2 symptoms within a 12-month period, including:
      • Consuming more alcohol than intended
      • Unsuccessful attempts to cut down or control alcohol use
      • Spending excessive time on alcohol-related activities
      • Craving alcohol
      • Failing to fulfill major work or school obligations due to alcohol
      • Continued alcohol use despite its negative impact on life
      • Giving up or reducing important activities due to alcohol
      • Recurrent use of alcohol in hazardous situations
      • Continued alcohol use despite awareness of physical or psychological problems caused by alcohol
      • Tolerance (needing more alcohol for the same effect)
      • Withdrawal symptoms (experiencing withdrawal syndrome, using alcohol to alleviate or avoid withdrawal symptoms)
    • Prevalence in the US: 4.6% among teenagers and 8.5% among adults, with higher rates among men (12%) compared to women (5%).
    • Risk factors include cultural attitudes towards alcohol, availability of alcohol, personal experiences with alcohol, stress levels, and lack of coping strategies.
    • Genetic influences account for 40-60% of the variance in alcohol use disorder risk.

    Comorbidity

    • High comorbidity exists between substance use disorders and anxiety or mood disorders, making treatment complex due to the need for different services for each condition.
    • This comorbidity highlights the potential for a shared biological vulnerability between these disorders.

    Neurochemical Transmission

    • Substance use impacts the brain through brain cells called neurons, influencing neurochemical transmission.
    • Different substances affect different neurotransmitters and brain regions, leading to variable effects on cognition and behavior.

    Opponent Process Theory

    • Solomon's opponent process theory proposes that the brain seeks homeostasis.
    • When neural activity is abruptly changed by substance use, the brain regulates receptor sites by down or up-regulating them, leading to reduced drug effects and increased withdrawal symptoms over time.

    Koob's Allostasis

    • Similar to homeostasis but emphasizes that the brain's set point can shift to a potentially pathological level due to substance dependance.
    • This shift can lead to an increase in anxiety during withdrawal, as the brain attempts to regain its new set point.

    Neuropsychological Effects of Alcohol

    • Alcohol acts on GABA, serotonin, and dopamine systems, leading to cognitive impairments.
    • Two distinct groups:
      • Individuals with severe cognitive impairment (10% of those with dependence)
        • Associated with Wernicke-Korsakoff syndrome (WKS)
        • Risk increases with age and nutritional deficiencies
        • Poor reversibility
      • Individuals with mild to moderate cognitive impairments (45% of those with dependence)
        • Greater chance of reversibility
        • Less severe memory problems
    • Alcohol use can lead to cortical atrophy, resulting in reduced brain weight and white matter, and enlarged ventricles.
    • Reduced blood flow in frontal and parietal lobes is observed.
    • Wernicke-Korsakoff syndrome: characterized by confusion or delirium, abnormal eye movements, gait ataxia, and is caused by thiamine deficiency. Associated with permanent and severe memory impairment.
    • Deficits in:
      • Executive function, particularly impulse control, reasoning, cognitive flexibility, and problem-solving.
      • Learning and memory, including encoding, storage, intrusion errors, visual memory, and confabulation (in WKS).
      • Visuo-spatial skills, including constructional and motor skills.
    • Preserved cognitive functions:
      • Intellect
      • Verbal skills
      • Individuals may appear superficially normal.

    Cognitive Recovery Following Abstinance from Alcohol

    • Recovery is generally good for mild impairments, not in cases of WKS.
    • Younger brains recover more quickly.
    • Recovery occurs over 6-12 weeks following abstinence.
    • Brain morphology changes:
      • Reduced CSF spaces
      • Increased white matter
      • Observable from 4 weeks onwards
      • May continue for a year
      • Possibly attributed to dendritic regrowth.

    Neuropsychological Effects of Methamphetamine

    • Causes neurotoxicity through oxidative stress, damaging neural pathways.
    • Impacts dopaminergic pathways.
    • Reduced cerebral blood flow and metabolism in frontal and striatal regions.
    • Acute effects:
      • Enhanced attention
      • Faster information processing speed
    • Long-term effects:
      • 40% experience global deficits across neuropsychological processes
      • Persist after months of abstinence, with some potential for minor recovery

    Poly Substance Use Disorder

    • More common than single substance use.
    • Has more severe and widespread effects on cognition.
    • Even after several weeks of abstinence, half of individuals still show impaired cognition and motor functioning.
    • Cognitive impairments are worse in older individuals, those with poverty, and those with comorbid developmental issues.

    Rehabilitation for Substance Use Disorder

    • Cognitive Behavioral Therapy (CBT)- Relapse Prevention:
      • Focuses on identifying and changing problematic thoughts and behaviors.
      • Widely used and favored.
    • Contingency Management (CM):
      • Utilizes operant conditioning principles.
      • Encourages positive behaviors and at times, punishment.
      • Four principles:
        • Regular substance use monitoring
        • Clinician provides reinforcers for abstinence
        • Withholding reinforcers if substance use is detected
        • Encouraging engagement in healthy, non-substance related behaviors.
      • Primarily used in hospitals and rehab settings.
      • Supported by animal models.
      • Relapse rates similar to those who haven't received CM.
    • Transtheoretical Model of Change (Miller):
      • More humanistic approach.
      • Explores values and goals, contemplation and decision to change, and maintenance of change.
      • Motivational Interviewing (MI):
        • Collaborative, person-centered approach to elicit and strengthen motivation for change.
        • Four principles:
          • Empathetic understanding
          • Identifying discrepancies between behavior and goals/values
          • Accepting resistance rather than imposing change strategies
          • Supporting self-efficacy.
    • MI vs CBT:
      • MI promotes intrinsic motivation for change.
      • CBT might be more effective in controlled environments like rehab.
      • MI demonstrates greater long-term change.
    • 12-Step Programs:
      • Self-help groups, e.g., Alcoholics Anonymous (AA).
      • No experimental studies have proven their effectiveness in reducing alcohol dependence or problems.
      • A critique: religious focus of the 12 steps.
      • AA Agnostica exists for those who prefer a non-religious approach.
    • Therapeutic Communities:
      • Holistic treatment addressing psychosocial issues surrounding substance use.
      • The community serves as both the context and method of treatment.
      • Recovery requires:
        • Renewal of personal values
        • Reestablishment of behavioral skills for community living
        • Personal development and lifestyle changes consistent with community values.

    Cognitive Impairment in AOD Services

    • 30-80% of AOD clients experience cognitive impairment.
    • Studies using the Montreal Cognitive Assessment (MoCA):
      • AOD treatment clients: 44% impairment.
      • Head injury and loss of consciousness following head injury are common in this population.
      • Executive functioning is the domain that best distinguishes individuals with head injury (hospitalized, non-hospitalized, and no head injury).
      • Comorbidity between AOD and head injury is prevalent.
    • Risk factors for treatment dropout:
      • Cognitive impairment
      • Younger age
      • Personality disorder.
    • Impact of cognitive impairment on AOD treatment:
      • Decreased treatment retention and outcomes.
      • Reduced likelihood of change.
      • Effective SUD treatment requires behaviors that individuals with cognitive impairment may struggle with.

    Cognitive Interventions

    • Cognitive Bias Modification:
      • Aims to change automatic thoughts and behaviors related to substance use.
      • "Bottom-up processing"
      • Action tendency bias: Greater approach towards substances.
      • CBM: Participants practice moving the substance away from them.
      • RCTs showed higher abstinence rates in CBM groups one month later.
    • Working Memory Training:
      • Enhances working memory capacity through repetitive mental tasks.
      • Example: Lumosity.
      • Small effect sizes, not enough to have a significant impact on everyday functioning.
    • Goal-Directed Training:
      • Provides strategies for everyday executive functioning.
      • Examples: Creating lists of steps to manage cravings.
      • High dropout rates but some positive cognitive remediation effects observed.

    Terminology

    • Substance abuse is characterized by chronic and excessive reliance on a drug, becoming central to a person’s life.
    • Addiction is a brain disorder, the hallmark of which is compulsive engagement with a rewarding stimulus despite adverse consequences.
    • An individual with addiction exhibits psychological or physical dependence (or both) on alcohol or drugs.
    • Addiction is a state characterized by compulsive engagement in behaviors such as drug taking, gambling, drinking or gaming.

    Substance Use Disorder (DSM-5)

    • A substance use disorder is a cluster of cognitive, behavioral and physiological symptoms that indicate the individual continues to use the substance despite significant substance-related problems.
    • The diagnostic criteria for a substance use disorder is categorized into four groups:
      • impaired control
      • social impairment
      • risky use
      • pharmacological
    • The severity of the substance use disorder is determined by the number of symptoms present:
      • mild (2-3 symptoms)
      • moderate (4-5 symptoms)
      • severe (6+ symptoms)

    Alcohol Use Disorder

    • Alcohol Use Disorder is characterized by a problematic pattern of alcohol use leading to clinically significant impairment or distress.
    • To be diagnosed, individuals must meet at least two criteria in a 12 month period, which are organized into four categories:
      • impaired control
      • social impairment
      • risky use
      • pharmacological

    Prevalence

    • In the United States, the 12-month prevalence of alcohol use disorder is estimated to be 4.6% among 12- to 17-year-olds and 8.5% among adults aged 18 years and older.
    • Alcohol use disorder is more prevalent among adult men (12.4%) than among women (4.9%).

    Onset

    • Alcohol use disorder often emerges in the late teens to early 20s.

    Risk Factors

    • Cultural attitudes towards drinking and intoxication
    • The availability of alcohol (including price)
    • Acquired personal experiences with alcohol
    • Stress levels (or poor coping strategies)
    • Genetic influences are responsible for 40% - 60% of the variance in risk.

    Comorbidity

    • There is a high prevalence of comorbidity - the presence of two or more disorders - between substance use disorders and mental health conditions.

    Neurochemical Transmission Mechanisms

    • Neurotransmitters are chemical messengers that transmit signals between neurons. The process of neurotransmission is commonly broken down into seven steps:
      • synthesis
      • storage
      • release
      • receptor interaction
      • deactivation
      • re-uptake
      • degradation

    Opponent-Process Theory

    • The brain seeks homeostasis, or a steady state.
    • With sudden changes in neural activity, (e.g., increased or decreased), there is down-or up-regulation of receptor sites.

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    Addiction and its Rehabilitation - Lecture Notes PDF

    Description

    Explore the complexities of substance use disorders and alcohol use disorder, as defined by DSM-5. This quiz covers the classifications, severity measurements, and prevalence in Australia, focusing on the impact and statistics of these disorders. Test your knowledge on recognizing symptoms and understanding their implications.

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