SUBSTANCE ABUSE MIDTERM

Know the difference between abuse and dependence

(cannot have abuse and dependence together)
Substance abuse: a maladaptive pattern of substance use leading to
clinically significant impairment or distress
Characterized by:
Recurrent substance use resulting in a failure to fulfill major
obligations at work, school or home
Recurrent use in situation in which it is physically hazardous
Recurrent substance-related legal problems
Continued use despite having persistent or recurrent social or
interpersonal problems caused or exacerbated by the effects of
the substance

Know about tolerance, withdrawal and dependence

Substance dependence: a maladaptive pattern of substance use
leading to clinically significant impairment or distress.
Substance is taken in larger amount or over a longer period than
intended
Persistent desire or unsuccessful efforts to cut down or control
substance use
A great deal of time is spent in activities necessary to obtain,
use, or recover from the substance
Substance use is continued despite knowledge of a persistent
physical or psychological problem that is likely to have been
caused or exacerbated by the substance
Physiological Dependence Characterized by:
Tolerance: a need for markedly increased amounts of the
substance to achieve intoxication or the desired effect or
markedly diminished effect with continued use of the same
amount of the substance.
o due to homeostasis and the bodys attempt to metabolize
toxins, a user has to take larger mounts of substances in
order to achieve same effect
Withdrawal: the characteristic withdrawal syndrome for the
substance or the same substance or a closely related substance
is taken to relieve or avoid withdrawal symptoms.
DO NOT MEMORIZE HISTORY

List out a couple themes in history and be able to back up the themes
Psychoactive drug: any substance that alters the normal functioning of the central
nervous system
Historical Uses:
A basic need of human beings to cope with their external or internal environment

o Alcohol was used as pain management; opium was used for pain
management.
A susceptible brain chemistry that can be affected by psychoactive drugs
Business and government involvement in growing, manufacturing, distributing,
taxing, and prohibiting drugs
o Wine was condemned in the Middle Ages in Islam but opium, coffee,
tobacco, hashish and khat were acceptable.
o Alcohol is limited in the Renaissance and the Age of Discovery because it
was the number one substance associated with violence
o Gin is prohibited in Tipling Act of 1751; rum and whiskey are highly
taxed in new colonies to get out of federal debt.
o 1851 Prohibition Laws
Technological advances in refining and synthesizing drugs
o There was development of alcohol distillation in the Middle Ages so
potency rose from 14-40%
Development of more efficient and faster methods of putting drugs in the body
o In the 80s, methamphetamines are changed to a powerful, smokeable form
known as ice
Often used for religious purposes but as time passed they would realize the bad of
the drug.
o In the stone age, Shamans used natural induced remedies, these medicine
men would use substances to subdue illnesses and deal with fears
o In ancient civilizations such as Mesopotamia, alcohol was seen as a gift
from the gods. Tobacco was used for religious purposes as was peyote and
mescaline.
o In the middle ages, the cocoa leaf was a symbol of the divine. Psychedelic
fungi and plants were of religious significance in the Americas.
Many drugs initially had medicinal purposes
o Alcohol was used as a disinfectant and for pain
o Opium was used for pain relief and for diarrhea and used to sedate those
with neuroticism
o Cannibas was used for constipation, dysentery, and as an analgesic
o Tobacco was used by Europeans for fertility, animal bites and toothaches
o During the Early Industrial Revolution, cocaine was used as a topical
anesthesia for eye surgery
o Heroin was original developed by Beyer to help pain, asthma, coughs and
tuberculosis.
o Cocaine was used for hay fever and allergies, used to make you alert and
used to help women in menstrual distress
o Amphetamines are used to fight fatigue and suppress appetites
Methadone: opioid management or pain management
Know the various theories, be aware, and know a couple fairly well
Allostasis Theory:

The process of achieving stability through change, homeostasis (the bodies

attempt to retain function within a normal range) does not fully explain the physiological
changes associated with stress and anxiety. This theory posists that chronic substance use
move from an impulsive behavior to a compulsive behavior as drug taking goes from
positive reinforcement (substance is taken to achieve pleasure) to negative reinforcement
(substance is taken to remove distress). This theory suggests that the set point of
normalcy moves from drug free condition to a position experienced only under the
influence of psychoactive substances that relieves what is now an unpleasant sensation of
a drug free condition. During withdrawal, Allostasis changed and in order to get back to
homeostasis, neurotransmitters change.
Impulsive acts Pleasure, relief, gratification Regret, guilt Tension and arousal
Repetitive behavior Relief of anxiety Obsessions Anxiety
Incentive Sensitization Theory
Learning and Memory Mechanisms Theory
Pathology of Motivation and Choice Theory
Suggests that chronic drug use usurps the reward circuitry associated with
survival needs. Theory traces the dependent persons path from initial use and its effects
through transition to addiction and ultimately to end stage addiction or dependency.
While dopamine plays a primary role in the initial stage in the process, changes in
glutamate pathway between the prefrontal cortex and the nucleus accumbens are the
primary drivers of dependency. The desire for the reward response to drug cues
overshadows the rational reasons not to use that originate in the prefrontal cortex. The
conscious decision to continue using in the beginning but towards the end it is no longer a
decision.
Diathesis Stress Model
People are predisposed to be addicted by it depends on the environment to
determine whether or not it is switched on.

Know all various ways drugs are administered

Substances are carried to the brain by the circulatory system, the quicker it enters the
system the shorter the route to the brain, the speed of onset of a substance coupled with
speed it wears off is an indicator to addiction potential.
Inhaling
o Substance is vaporized and absorbed through lungs into blood stream,
carried from lungs to heart and pumped to brain
o Quickest method of delivery, 7-10 seconds, easy to control intake
Injecting into bloodstream or muscle
o Quick and potent, intense rush when directly injected.
o Three methods:
Intravenous (IV, slamming) direct delivery into vein 15-30
seconds.
Intramuscularly (IM) delivery into muscle mass 3-5 minutes.
Subcutaneously (skin popping) under the skin 3-5 minutes
o Marks on arms, hands, legs and toes
Snorting and Mucosal Exposure

o Absorbed through mucous membrane into the bloodstream and pumped

through heart to brain
o Inhaled through nose, under tongue or cheek (3-5min), suppository (1015)
Orally, Ingesting
o Substance passes through esophagus and stomach to small intestines then
absorbed into bloodstream, goes through liver then metabolized before
going to heart and brain
o Diluted by mouth, stomach enzymes and liver
o 20-30minutes, may take up to 24 hours
Contact or Transdermal (patch)
o Substance administered through a patch, slow and long term delivery, 17days

Know hereditary

If one biological parent is alcoholic, his or her male child is 34%

more likely to be an alcoholic
If both biological parents are alcoholic, the child is 400% more
likely
If both biological parents and a grandfather were, the child was
900% more likely
Those with the addiction gene are more likely to be addicted to
substance or anything
Genetic factors: those predisposed to develop alcohol
dependence need more alcohol to feel intoxicated
Genetics can affect tolerance
Predisposition to alcohol dependence positively correlates to
hyperactivity and impulsivity
ADH and MAO enzyme levels appear to be related to
predisposition
Specific gene associated with alcoholism
The same allele is associated with all addictions
Gene is associated with a shortage of dopamine receptors in
brain

Know neurotransmitters associated with which drugs

Opioidsendorphins
Cocainedopamine
Prozac (SSRI)Serotonin
NicotineAcetylcholine
CannabisEndocannabinoids

Know the levels of abuse

Abstinence
Experimentation
Social/Recreational Use

Habituation
Abuse
Addiction

Drugs, Their category, Their effects, Their withdrawal effects

Opioids: (sedatives/downers)
Morphine, codeine, opium, methadone, heroin, hydrocodone, subutex, oxycodone
Ingested, smoked, IV use, insufflation
Endorphins, dynorpgins, enkephalins
Causes constipation
Pain relief, diminishes dysphoria, no longer stressed, care free
Pleasure: Stimulate reward pathway, inhibits GABA, increase glutamate receptors
on dopamine
Satiation
Side effects:
o Insensitivity of warning pain signals
o Lowered blood pressure
o Lowered pulse and respiration
o Pinpoint pupils that dont react to light
o Drooped eyelids
o Slowed walking and coordination
o Triggering of nausea center
o Suppression of cough center
o Constipation
o Paradoxical effect
o Tolerance
o Tissue dependence
Withdrawal:
o Rarely life threatening
o Flu like symptoms
o Bone, joint, muscular pain
o Anxiety
o Runny nose
o Rapid pulse
o Coughing
o Muscle cramps, hyper reflexes
o Anorexia
o Teary eyes
o Fever
o Insomnia
o Sweating
o Diarrhea
o High blood pressure
o Dilated pupils

o Yawning
o Chills and goose bumps
o Vomiting
o Stomach cramps
Benzodiazepines:
Used for anxiety and sleep
Xanax, Klonopin, Librium, Valium, Ativan
Used for panic attacks
Sedative
Control skeletal muscles
Control acute alcohol withdrawal symptoms
Chaser for cocaine and other stimulants
100% addicts report dependence on another substance, secondary substance
Inhibit GABA
Increases serotonin and dopamine
Age dependent tolerance, younger can tolerate more
Tissue dependence
Withdrawal
o Recurrence of symptoms that were being treated with benzos
o Rebound or magnification of these treatments
o Tremors
o Twitches
o Hypertension
o Dizziness
o Anxiety
o Restlessness
o Tachycardia
o Seizures
o Temporary loss of some senses
o Hallucinations
o Depersonalization
o Derealization
o FATAL!!!!
o Can last several months, cycles separated by 2-10 days
Barbiturates are detox for these
GHB: date rape
Ambien: trance like state
Alcohol:
Women have a higher BAC than men do from same amount
o Women have lower percentage of body water so there is less to dilute
alcohol, hormones during menstruation affect metabolism, less enzyme to
break down alcohol
No specific receptor, releases GABA and produces Glutamate

Sense of euphoria
Impaired muscle control
Slow reaction time
Decreases inhibitions
Depressant
More likely to take chances
React to mood swings
Poor judgement
Increased appetite
Decrease falling asleep time
Increase self confidence
Withdrawal:
o Rapid pulse or sweating
o Insomnia
o Nausea/vomiting
o Visual, tactile, and auditory hallucinations
o Psychomotor agitation
o Anxiety
o Seizures
o Toxic
o Lowers seizure threshold and heart rate
o FATAL
o Delirium tremens
Trembling, grand mal seizures, severe hallucinations,
disorientation, insomnia, delirium
Stimulants:
Increase activity in CNS
Raise heart rate and blood pressure
Reduce appetite and thirst
More alert, active and confident
Heart arrhythmias, stroke, malnutrition, agitated, paranoid, violent
Effects dopamine and norepinephrine and epinephrine, force release
Ingested, smoked, injected or snorted
Extra energy
Teeth grinding, shaking hands
Dehydration, weight loss
Tolerance takes form of depression, lack of motivation of anhedonia (lack of
focus and concentration)
Cocaine
o Acetylcholine: increases reflexes, alertness, memory, learning, muscle
tremors, memory lapses, confusion, hallucination
o Serotonin: elation, confidence, sexual activity, leads to insomnia, agitation

and depression
o Dopamine: increase fight or flight, paranois
o E, NE, DA: rush of pleasure, causes exhaustion, lethargy and anhedonia
(inability to feel pleasure)
o Cardiovascular effects
o Neonatal effects
o PSYCHOSIS: excess dopamine activity leads to paranoid psychosis
o Withdrawal:
Anhedonia, anergia, loss of motivation and initiative, depression,
intense cravings
Sleep crash
Amphetamines
o E, NE, DA, block metabolism in addition to increasing neurotransmitters
and blocking reuptake
o Increased heart rate, raised body temperature, rapid respiration, higher
blood pressure, dilation of bronchial vessels, suppressed appetite
o Sleep deprivation, malnutrition, blood vessel toxicity, aneurisms, cerebral
hemorrhages, arrhythmias
o Bluish tinge, look anorexic
o Produces sense of euphoria, well-being and confidence
o Irritability, anxiety, paranoia, mental confusion, poor judgement
o Decreased sex drive
o Aggression and violence
o Hallucination, pressured speech, loss of connection with reality
Bath Salts
o Increase dopamine, serotonin, norepinephrine
o Hallucinations, paranoia, panic attacks, heart palpitations, headache, heart
attack, kidney failure, liver failure, violent behavior, suicide
Smokeable Cocaine
o Rub eyes raw and not feel it, callouses on hands, burns
Others: Ritalin, Adderall, diet pills, caffeine, ephedrineagitation and withdrawal
Psychedelics:
Cannibols (marijuana, hasish)
Indole psychedelics (LSD, psilocybin)
Phenylalklamine (mescaline, peyote, ecstasy)
Anticholinergics (belladonna)
PCP, Ketamine
Cause illusions (object there and see as something else) , delusions (unrealistic
beliefs), hallucinations (not there)
More act of serotonin rather than dopamine, target more than the reward pathway
Less likely to lead to dependence, not fast acting so addiction takes time
Marijuana
o THC

o Cannabinoid receptor causing euphoria, no lethal dose

o Relaxation, sedation, bloodshot eyes, coughing, increase in appetite
o Increased heart rate, decrease blood pressure, decreased pressure behind
eyes, increased blood flow through the mucous membranes of eye,
decreased nausea
o Impairs visual perception, obscuring depth perception and hand-eye
coordination, disrupts tracking ability
o Temporary decrease in testosterone, low sperm count
o Slight confusion, isolation from environment, difficulty concentratin, dj
vu
o Giddiness, icreases awareness, major distortions of sound, time, color,
illusions and hallucinations
o STM no LTM
o Disrupts sense of time
o Withdrawal:
Anger, irritability, agresstion
Aches, pains, chills
Depression
Sleep disturbances
Decreased appetite
Sweating
Slight tremors
More agitation
Indole psychedilics
o Mental and emotional withdrawal
o Rise in heart rate, blood pressure, higher body temperature, dizziness,
dilated pupils, sweating, visual distortion, light trails, optical illusions
o Overloads brain stem causing sensory distortions, synesthesia, dreaminess,
depersonalization, altered mood, impaired concentration, loss of judgment
and impaired reasoning, subject to extremes of euphoria and panic
o Visceral sensations, changes in sight, taste, hearing, touch, altered states of
consciousness
o Shoots up serotonin
MDMA
o Tightness of muscles, muscle spasms, clenching of teeth, high body
temperature and blood pressure, seizures, rapid tolerance
o Feelings of happiness, clarity, peace, pleasure, altered perceptions without
depersonalization, nonsexual empathy for others
Anticholinergic Psychedelics:
o Block acetylcholine in CNS and PNS
o Speeds heart rate, intense thirst, raised body temperature
o Hallucination, separation from reality, deep extended sleep
o Treat side effects of antipsychotic medications
Others

o PCP causes out of body near death experience with depersonalization,

hallucinations. Delirium, bizarre or mystical experience
o Ketamine is a dissociative general anesthetics, short acting, respiratory
depression, increaser heart rate and blood pressure, belligerent behavior,
convulsions and come
Principles of Stage-wise Treatment
Precontemplation Engagement
o Person has no intention in foreseeable future and may not be aware of
problem
o Outreach, practical help, crisis intervention, develop alliance, assessment
Contemplation & Preparation Persuasion
o Person is aware of problem and is thinking about overcoming it but has
made no commitment to take action, person weighs pros and cons of
problem and its solution
o Education, set goals, build awareness, family and peer support
Action Active Treatment
o Intention and behavior are combined, plan to take action within the next
month
o Substance abuse counseling, medication treatments, skills training, family
support, self help groups
Maintenance Relapse prevention
o The individual is actively working to prevent relapse and consolidate gains
achieved during the action stage, the person is remaining free from
addictive behavior and is consistently engaging in a new incompatible
behavior for more than six months
o Relapse prevention place, continue skills building in active treatment,
expands recovery to other areas of life

be able to define them and give an example

know stages of change, pre contemplation.action.maintenance
know about alcohol and what alters the effects for men and women, metabolized
differently, eating vs not eating, using drugs and effects based on gender and what else
may change them
be able to provide explanation for why people overdose
identify why people go into psychosis from drugs
what drugs are more common for psychosis
methadone
withdrawal effects, some of which are lethal, risks of withdrawal