Substance Use Disorders PDF

Substance Use Disorders Dr. Cabrera Salaiza  Learning Objectives Session goals: Analyze the current accepted theory of addiction. Relate the neurobiological, psychosocial and epigenetic factors underlying addiction. Contrast and critique c...

Substance Use Disorders Dr. Cabrera Salaiza  Learning Objectives Session goals: Analyze the current accepted theory of addiction. Relate the neurobiological, psychosocial and epigenetic factors underlying addiction. Contrast and critique current epidemiology USA/MEXICO – a bicultural emphasis. Revise and value the physician’s role – the clinical assessment of substance use disorders. Devise future directions. Adapted from http://www.ucdenver.edu/academics/colleges/medicalschool/education/degree_programs/MDProgram/administration/curriculumoffice/Documents/CUSOM_Learning-Objectives-Guidelines.pdf  Disclaimer. Sensitive matters requiere sympathy from you. Opinions and views are free, please make your own. Scientific information will always be cited APA and available for you to further discuss. We learn by aiding each other.  Lesson Contents & Index I. Terminology – naming issues. II. The Big Bang Theory of Addiction III.Neurobiology, psychosociology and epigenetics, a mix. IV. USA/MEXICO, an illicit substance affair. V. The multidisciplinary team: physician, psychiatrist, CBT psychoterapist, counselor. VI. Future Directions, where do we go from here?  Words Matter Problems need to be named, not misnamed. (Appendix 1) For much of history, substance use has been viewed as a moral failing for which individuals themselves are to blame, particularly individuals of color. Stigmatizing language reflecting this implicit bias and moralistic view. Many of these pejorative terms have racist connotations, and derogatory terms like “crack babies” carry with them decades of legislation targeting communities of color with a carceral response to substance use, such as the War on Drugs. In the face of the increasing prevalence of the use of opioids, marijuana, and novel psychoactive substances, the medical community has recognized a great scientific evidence supporting that addiction is a chronic illness that has the potential for recurrence similar to other medical conditions and is not a moral failing. Alinsky RH, Hadland SE, Quigley J, Patrick SW; COMMITTEE ON SUBSTANCE USE AND PREVENTION. Recommended Terminology for Substance Use Disorders in the Care of Children, Adolescents, Young Adults, and Families. Pediatrics. 2022 Jun 1;149(6):e2022057529. doi: 10.1542/peds.2022-057529. PMID: 35977095; PMCID: PMC9386168. https://nida.nih.gov/sites/default/files/nidamed_words_matter_terms.pdf  Historical Data While the fact that the DSM identifies SUDs as primary mental health disorders may be taken for granted today, it is noteworthy that SUDs were, prior to the third publication of the DSM (1980), largely conceptualized as manifestations of underlying primary psychopathology. American Medical Association (AMA) classified alcoholism as a disease in 1956 and included addiction as a disease in 1987. In 2011 the American Society of Addiction Medicine (ASAM) joined the AMA, defining addiction as a chronic brain disorder, not a behavior problem. Robinson SM, Adinoff B. The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations. Behav Sci (Basel). 2016 Aug 18;6(3):18. doi: 10.3390/bs6030018. PMID: 27548233; PMCID: PMC5039518. Robinson SM, Adinoff B. The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations. Behav Sci (Basel). 2016 Aug 18;6(3):18. doi: 10.3390/bs6030018. PMID: 27548233; PMCID: PMC5039518. The Humanities Colaboration Archive https://humanitiescollaborative.ut ep.edu/project-blog/history- humanities-and-addiction-crises- the-us-opioid-epidemic https://www.researchgate.net/publication/316748579_Leaning_on_syrup_The_misuse_of_opioid_cough_syrup_in_Houston  Theories of Addiction Greener MR and Storr SJ (2023) Conflicting theories on addiction aetiology and the strengths and limitations of substance use disorder disease modelling. Front. Mol. Neurosci. 16:1166852. doi: 10.3389/fnmol.2023.1166852 Representation of the Reward System: https://www.researchgate.net/figure/Schematic-diagram-of-the-main-brain-sites-of-the-reward-system-and-their-dopaminergic-and_fig1_340186310 Neurobiology of Addiction Stage 1: Binge/Intoxication Subjective perception of rewarding benefits, such as anxiety relief, and a sense of happiness. Basal ganglia, containing caudate nucleus, putamen, and globus pallidus. Dopamine pathway in the basal ganglia is activated, causing a strong rush of pleasure. Stage 2: Withdrawal/Negative Affect Phase Involves the amygdala, stimuli discontinues = withdrawal symptoms. Physical and emotional symptoms. Decreased activation in the reward systems of the basal ganglia, obstructs the person’s ability to experience pleasure, followed by an increased activation of the brain’s stress systems, which includes stress neurotransmitters such as NE CRF in the extended amygdala. Stage 3: Preoccupation / Anticipation Patient experiences cravings after a period of abstinence. Craving occurs at PFC, thought organisation, planning, and decision making. This causes a disruption to dopamine and glutamate regulation and impairs the person’s emotional control and decision making, causing cravings, potentially leading to risky behaviour to pursue more of the addictive behaviour. Uhl GR, Koob GF, Cable J. The neurobiology of addiction. Ann N Y Acad Sci. 2019 Sep;1451(1):5-28. doi: 10.1111/nyas.13989. Epub 2019 Jan 15. PMID: 30644552; PMCID: PMC6767400. Koob GF, Volkow ND. Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry. 2016 Aug;3(8):760-773. doi: 10.1016/S2215- 0366(16)00104-8. PMID: 27475769; PMCID: PMC6135092.  WANTING & LIKING An stimulus that activates the mesolimbic pathway and the D reward system. The intensified “wanting” is not matched by an intensification of “liking”. Dissociation occurs because, even for the same reward, brain “liking” and “wanting” systems can function somewhat independently of one another. The role of dopamine seems to be restricted to “wanting” as dopamine stimulations, by contrast, always fail to enhance “liking” (K.C Berridge & Kringelbach, 2015; K.S. Smith et al., 2011). The “wanting” might increase independently of whether a drug is still “liked” after several uses because only “wanting” systems become sensitised (Poland & Graham, 2011). In contrast to the “wanting” system, the smaller functional system called “liking” produces intense levels of pleasure but they correlate with the PFC. (Berridge & Kringelbach, 2015). Uhl GR, Koob GF, Cable J. The neurobiology of addiction. Ann N Y Acad Sci. 2019 Sep;1451(1):5-28. doi: 10.1111/nyas.13989. Epub 2019 Jan 15. PMID: 30644552; PMCID: PMC6767400. Volkow N. Addiction: Beyond dopamine reward circuitry. https://doi.org/10.1073/pnas.1010654108 Volkow N. Addiction: Beyond dopamine reward circuitry. https://doi.org/10.1073/pnas.1010654108 Volkow N. Addiction: Beyond dopamine reward circuitry. https://doi.org/10.1073/pnas.1010654108  Psychosocial Factors Relevant to Adolescent Psychosocial factors underlying addiction. Substance Use Based on Bronfenbrenner’s Bioecological Model. Italicized contexts represent those reflected in the current review. Trucco EM. A review of psychosocial factors linked to adolescent substance use. Pharmacol Biochem Behav. 2020 Sep;196:172969. doi: 10.1016/j.pbb.2020.172969. Epub 2020 Jun 18. PMID: 32565241; PMCID: PMC7415605.  The hypothetical role of DNA epigenetics in addiction susceptibility. (Top) Factors related to addiction susceptibility that Epigenetics also have a DNA epigenetic basis. & Addiction (Center) A schematic of DNA epigenetic dynamics. (Bottom) Addiction susceptibility is associated with DNA modification Kaplan Graham , Xu Haiyang , Abreu Kristen , Feng Jian, changes. DNA Epigenetics in Addiction Susceptibility. Frontiers in Genetics. Vol 13 2022. methyltransferase; Abbreviations: DNMT, DNA TET, ten-eleven https://www.frontiersin.org/journals/genetics/articles/10.3 translocation methylcytosine 389/fgene.2022.806685 dioxygenase; BER, base excision repair. Eman Abdelraheem, Benjamin Thair, Romina Fernández Varela, Emely Jockmann, Désirée Popadić, Helen C. Hailes, John M. Ward, Adolfo M. Iribarren, Elizabeth S. Lewkowicz, Jennifer N. Andexer, Peter-Leon Hagedoorn, Ulf Hanefeld https://doi.org/10.1002/cbic.202200212 https://www.frontiersin.org/journals/genetics/articles/10.3389/fg ene.2022.806685 DOI=10.3389/fgene.2022.806685  USA / Mexico Statistics https://cecaj.jalisco.gob.mx/sites/cecaj.jalisco.gob.mx/files/sisvea_2022.pdf  USA / Mexico Statistics https://drugabusestatistics.org/ How close are we? https://padlet.com/csmocte/substance-use-padlet-5iyudf0qljoex053 The Clinical Approach  DSM-IV and DSM-5 Criteria for Substance Use Disordersa One or more abuse criteria within a 12-month period and no dependence diagnosis; applicable to all substances except nicotine, for which DSM-IV abuse criteria were not given. b Three or more dependence criteria within a 12-month period. c Two or more substance use disorder criteria within a 12-month period. d Withdrawal not included for cannabis, inhalant, and hallucinogen disorders in DSM-IV. Cannabis withdrawal added in DSM-5. Clinical Assessment Future Directions Greener MR and Storr SJ (2023) Conflicting theories on addiction aetiology and the strengths and limitations of substance use disorder disease modelling. Front. Mol. Neurosci. 16:1166852. doi: 10.3389/fnmol.2023.1166852 APPENDIX 1 Recommended Terminology Regarding Substance Use Full chart: https://nida.nih.gov/sites/default/files/nidamed_ words_matter_terms.pdf