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Substance Abuse
Mid term exam
169
Psychology
Graduate
05/31/2012

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Term
Toulene
Definition
major component in many paints, laquers, glues, inks, cleaning liquids, metal degreasing, enamels, and dry cleaning
Term
Trichloroethylene
Definition
industrial solvent
Term
What are the effects of inhaling butane, propane, or Freon?
Definition
abnormal heart rhythms and the possibility of sudden death
Term
Family Rules for addressing addiction?
Definition

serve to provide order, stability, consistency, and predictability. Restrict behavioral options.

  • Communication- to what extent, when, and how may family members communicate what they think and feel
  •  Who can speak to whom in what fashion and about what?
  • Conventionalism- is one allowed to be different?
  • Values and spirituality
  • MORE_____
Term
Wegcheider (1981)
Definition
  • The addict's drug use is the most imporant thing in the family's life.
  • The addict is not responsible for his or her behavior,and the drug isnot the cause of the family's problems.
  • Status quo must be maintained at all times.
Term
What are the common culprits in inhalant addiction?
Definition
Industrial substances such as toulene, trichloroethylene, gasoline, butane, propane, and Freon
Term
Framo (1981)
Definition
Do we seek mates based on nuclear family dysfunction? We may look for people with weaknesses that accomodate our weaknesses.
Term
What is the effect of inhaling solvents?
Definition
  • Similar to ETOH intoxication.
  • Higher doses lead to depression and perceptual distortions.
  • Death secondary to arrhythmia or anorexia
Term
What are nitrites and what effect do they have for inhalers?
Definition
  • Nitroglycerin-based
  • resultes in decreased BP, increased heart rate, sensations of warmth, euphoria, flushing, headache, enhanced orgasm 
Term
Bowlby Attachment Styles
Definition
  • secure attachment
  • insecure attachment
    • anxious/ambivalent
    • disorganized 
Term
What are the six different ways that drugs can work on on neurotransmitters?
Definition
1. Increasing the synthesis
2. Causing vesicles to leak
3. increasing release
4. decreasing reuptake
5. blocking the breakdown into inactive chemical
6. directly stimulating or blocking postsynaptic receptors
Term
What is AFFINITY?
Definition
The degree to which a drug perfers to bind to a particular receptor
Term
what is EFFICACY?
Definition
The tendency of a drug to activate the receptor
Term
How do Koob and LeMoal (2001) conceptualize addiction?
Definition
As a cycle of spiraling dysregulation of brain reward systems that progressively increases, resulting in the compulsive use and loss of control of drug taking.
Term
What drug has the largest medical and financial impact in the US?
Definition
Alcohol
Term
What is the most chemically addictive substance?
Definition
Nicotine
Term
What types of drugs have shown the most increase over the past 5-10 years?
Definition
prescription drugs
Term
What part of the brain is responsible for classical conditioning?
Definition
Amygdala
Term
What is the function of the nucleus accumbens?
Definition
Pleasure center
Term
What drug will cause the most significant neuro-trauma?
Definition
alcohol
Term
Name 6 stimulant drugs?
Definition
1. nicotine
2. alcohol*
3. cannibis*
4. cocaine
5. amphetamine
6. LSD/Ecstasy/MDMA
Term
Name 5 depressant drugs?
Definition
1. alcohol*
2. benzos
3. barbituates
4. cannibis*
5. opiates
Term
List the 3 GABA agonists.
Definition
alcohol
benzos
barbituates
Term
List 3 DA agonists.
Definition
alcohol
cocaine
amphetamine
Term
What are the receptor effects of cocaine>
Definition
DA, 5HT, and NE agonist-block reuptake
Term
Describe the gender bias of substance abuse.
Definition
SA is greater for makes but females experience greater physiological consequences in a shorter period of time.
Term
What is the projected cost of non-tobacco substance abuse yearly?
Definition
67 billion
Term
Nature or nurture?
Definition
Nature appears to have stronger effect, particularly in males.
Term
Heritability is highest for___
Definition
cocaine or heroin addiction
Term
From where does the nucleus accumbens receive direct input?
Definition
the ventraol tegmental area and the amygdala, hypothalamus, OFC, medial prefrontal cortex
Term
Where is the nucleus accumbens located?
Definition
Rostral to the preoptic area of the hypothalamus, near septum, between the ventral portions of the caudate nucleus.
Term
What does the nucleus accumbens do?
Definition
mediates between the limbic structures(emotional) and striatum (motor response)

motivation toward objects and activities, avoiding danger, and seeking reward

important for placing value on environmental cues
Term
Describe the Mesolimbic Dopaminergic Pathway (reward circuit)
Definition
Ventral tegmental area--nucleus accumbens, prefrontal cortex, dorsal striatum
Term
Decribe the Nigrostriatal Pathway
Definition
substancia nigra--basal ganglia
Term
What is low 5HT associated with?
Definition
depression and aggression
Term
what is high 5HT associated with?
Definition
psychotic symptoms and hallucinations
Term
Identify the levels of SA treatment
Definition
Level .5 IMPACT
Level I Substance abuse (outpatient)
Level II Intensive outpatient
Level III Residential
Level IV medical management (detox)
Term
Describe the DSM IV criteria for substance dependence
Definition
3 in year

1. tolerance
2. withdrawal
3. consuming more of for longer period of time than intended
4. persistant desire or unsuccessful efforts to cutback
5. increased time spent acquiring substance or recovering from effects
6. giving up social, occupational, or recreational activities
7. continued use despite related physical or psychological problems
Term
What are the specifiers for Substance dependence according to the DSM IV
Definition
with or without physiological dependence

Remission:
Early (> 1 month)
Sustained (> 1 year)
Full (no use)
Partial (continued use)

Environmental consideration
Term
Describe DSM IV criteria for substance abuse
Definition
1 in year

1. failing in obligations
2. recurrent use in unsage situations
3. recurrent related legal problems
4. continued use despite social or interpersonal problems

NOT DEPENDENCE
Term
What risk factors should be evaluated when considering substance abuse/dependence?
Definition
Family history
Gateway drugs
Age of onset
Blackouts
Antisocial behavior
Other Axis I or Axis II
Term
What contexual factors should be evaluated?
Definition
Purpose
Causality between use and problems
Lifestyle
Sabotaging original purpose?
Term
What are common comorbid conditions?
Definition
Mood disorders
Anxiety Disorders
Personality Disorders
ADHD
Pain disorders
Term
How much of the variance does genetics account for in alcohol dependence?
Definition
50%
Term
The disease model says alcohol dependence is ...
Definition
genetic
progressive
fatal
chronic
Term
Describe the Jellinick's phases of alcohol dependence
Definition
Prodromal-
Initial progression
Increased tolerance; first blackout
Increased sneaking, more blackouts, preoccupation, guilt, hurried ingestion

Crucial
-impaired control; alibis, attempts to decrease guilt, aggression, unsuccessful attempts to quit, change in pattern of use, chemical-centered behavior, isolation, self-pity, geographic escape, resentment, family breakdown, medical care, morning use

Chronic_
- physical, emotional, and spiritual bankruptcy
-prolonged binges and drug runs, protecting supply, lowering standards, decreased tolerance, withdrawal, compulsive use without euphoria, spiritual needs, rationalizationfails, admissiona and recovery
Term
What is the overall heribililty of alcohol dependence?
Definition
20-26%
30-36% in severe forms
Term
what % if variance does environment account for in quantity, frequency, and density of drinking?
Definition
60-64%
Term
What is the heritability of alcohol dependence among treatment seeking women?
Definition
40-50%
Term
What are potential markers of alcohol dependence?
Definition
aldehyde dehydrogenase (metabolizes alcohol in your system)

P3 event related potentials
Term
What are alcohol and alcohol related conditions and their prevalence rates?
Definition
Personality dx 15%
Anxiety dx 11%
Mood dx 9%
alcohol dependence 4%
drug dependence 1%
Term
what has the greatest lifetime comorbidity among cannabis-dependents?
Definition
alcohol dependence
Term
What doubles the odds of experiencing a co-existing mood disorder?
Definition
licit and illicit substance addiction together
Term
What % of adolescents with substance related disorder meet criteria for other disorders and what are the most common?
Definition
60%; Conduct, ODD, Depression
Term
What factors are included in the common factor model?
Definition
genetic vulnerability
antisocial PD
DA dysfunction (mesolimbic pathway)
poverty
Term
What factors are involved in the multiformity model of comorbidity?
Definition
heterogeneous, atypical forms of a disorder

degree of overlap among dxs (random) v more extreme forms of psych or SA disorder (extreme)
Term
what factors are included in the 3 Independent Disorders model of comorbidity?
Definition
comorbid condition is different than sole psychiatric or substance use DO
Term
What factors are involved in the Causation/Reciprocal causation model of comorbidity?
Definition
regardless of order of onset, do the separate DOs exacerbate one another?
Term
What are features of dual diagnosis?
Definition
antisocial features and supersensitivity to stress
Term
What has Clozapine been associated with?
Definition
reductions in alcohol abuse
Term
What are treatment considerations for dual diagnosis?
Definition
integrated v sequential tx
relationship v confrontation
harm reduction v abstinence
long-term, low intensity tx
Term
What are objectives of SAMSHA?
Definition
ID those with SA
ASSESS full spectrum of problems
PLAN appropriate interventions
INVOLVE family and significant others
EVALUATE effectiveness of interventions
Term
What are dimensions related to level of care?
Definition
Intoxication and withdrawal potential
Biomedical conditions and complications
emotional, behavioral, cognitive conditions and complications
Readiness for change
Relapse prevention
Recovery environment
Term
What contextual factors that SAMSHA evaluates?
Definition
expectations for use
internal triggers
external triggers
immediate reinforcers
positive aspects of use
negative aspects of use
Term
Describe the CAGE screening criteria.
Definition
need to Cut down?
felt Annoyed with criticism of your drinking?
felt Guilty about use?
need an Eye-opener dose in the AM?
Term
Describe the T-ACE screening criteria for pregnant women.
Definition
Tolerance?
Annoyed with criticism?
need to Cut down?
need an Eye opener?
Term
Describe TWEAK screener for women.
Definition
Tolerance?
friends Worried?
need an Eye opener dose in the AM?
Amnesia?
need to Kut down?
Term
What are 3 quantity frequency questions?
Definition
On average, how many DAYS/Wk do you drink alcohol?

How many drinks/day when you drink?

Max # drinks on any occassion in past month
Term
Rapid Alcohol problems screen
Definition
Do you sometimes take a drink in the morning when you first get up?
During the past year, has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?
During the past year, have you failed to do what was normally expected of you because of drinking?
During the past year, have you had a feeling of guilt or remorse after drinking?
During the past year, have you lost friends or girlfriends or boyfriends because of drinking?
Term
Common Alcohol screeners
Definition
MAST/BMAST- (Brief) Michigan Alcoholism Screening Test: 25 and 10-item versions
AUDIT- Alcohol Use Disorders Identification Test: 10-item screen. 3 on consumption; 7 on impact
DAST/ DAST 10- Drug Abuse Screening Test. 10 and 20 item versions
SASSI- Adolescent Substance Abuse Subtle Screening Inventory. Multiple versions
Term
Online screeners
Definition
DAST 10
NIDA Modified ASSIST: NIDA Modified Alcohol, Smoking and Substance Use Involvement Screening (Comprehensive)
CRAFFT Quiz: Designed for adolescents. 7- item SA screen.
Term
Most common hallucinogens?
Definition
LSD and mushrooms (psilocybin)
Term
Effects of hallucinagens?
Definition
Alter consciousness without excessive delirium, sedation, excitation, or cognitive impairment
Term
How are hallucinagens typically adminstered?
Definition
Orally (except DMT)
Term
Which processes are effected by hallucinagen intoxication?
Definition
Somatic
Perceptual
Psychic
Cognitive
Autonomic
Term
Health benefits of moderate ETOH use
Definition
stress reduction
protecive factor against coronary artery disease and cancer in men
lower risk of cardiovascular disease in women
Term
Women who drink an average of 3-9 drinks of ETOH weekly are at greater risk for ___? When does the risk reach 40%
Definition
breast cancer; 1-2 drinks daily
Term
Adolescents who abuse alcohol are more vulnerable to dysfunction in what areas of the brain when compared to adults?
Definition
Frontal lobe and hippicampus
Term
adolescents are more or less sensitive to the sedative effects of alcohol?
Definition
less
Term
individuals who begin drink at what point have higher risk?
Definition
in adolescence
Term
What are risk factors that are greater among women who abuse alcohol?
Definition
breast cancer, hypertension, liver and pancreatic damage, cognitive dysfunction
Term
What is the difference in BAC for women compared to men of similar weight and what are some reasons women obtain higher BAC?
Definition
25-30% higher BAC
different lipid distribution
less ADH than men, less metabolization
birth control pils slow down elimination of etoh
Term
What is the only form on alcohol that can be comsumed without being toxic?
Definition
ethanol
Term
What is the ethanol content of common drinks?
Definition
beer 3-7%
wine 8-14%
fortified wine 17-22%
liquor 40%+
Term
____ of etoh ingested is absorved through the stomach; ___ in the instestines.
Definition
20%; 80%
Term
what is the most powerful influence on absorption?
Definition
the presence of absence of food in the stomach
Term
As concentration of etoh _____, absorption ______ and BAC _______.
Definition
increases, increases, increases
Term
How does alcohol distributed thoughout the body impact absorption?
Definition
the more muscle and fat to absorb etoh, the slower the increase in BAC but the longer it remains in the tissues before elimination.

etoh passes freely from mother to fetus and fetus may achieve higher BAC
Term
etoh passes freely from mother to fetus and fetus may achieve higher or lower BAC?
Definition
higher
Term
How much of etoh is metabolized prior to excretion?
Definition
95%
Term
How much of etoh is eliminated unchanged through the lungs or urine?
Definition
5%
Term
Where is most alcohol metabolized?
Definition
the liver
Term
How is etoh metabolized?
Definition
alcohol dehydrogenase (ADH) breaks it down into acetaldehyde which is broken down into acetate which is excreted.
Term
What happens when acetaldehyde does not repidly metabolize?
Definition
It becomes toxic and causes acute nausea
Term
How does Antabuse work?
Definition
It cause acetaldehyde to accumulate with consumption of etoh causing nausea
Term
The rate of etoh metabolize is ______
Definition
constant over time
Term
1 oz whiskey is metabolized in _____
Definition
one hour
Term
BAC does not rise significantly unless more than _____ drink is consumed per _______
Definition
1; hour
Term
How does metabolism of etoh effect other drugs?
Definition
It increases enzymes to metabolize etoh which also metabolize other drugs making them less effective or more toxic
Term
cross-tolerance
Definition
metabolic tolerance to etoh causes tolerance to other drugs
Term
How is a person effected with a BAC of up to .10 (4oz/hr)?
Definition
positve subjective effects
may impact judgment, fine motor coordination, reaction time
Term
How is a person effected with a BAC between .10-.30 (48oz/hr)?
Definition
decreased motor coordination and reflexes
staggering
slurred speech
Term
How is a person effected with a BAC between .30-.40 (192oz/hr)?
Definition
impaired voluntary response stimulation
hyper or hypothermia
anesthesia
Term
How is a person effected with a BAC between .40-.60 (384oz/hr)?
Definition
impaired sensation, movement, and self-protective reflexes

comatose
Term
How is a person effected with a BAC above .60(1020 oz/hr)?
Definition
decreased breathing and cardiac function
death
Term
genetic risk for alcohol dependence is greater for men or women?
Definition
men
Term
males of __% risk of alcohol dependence in their lifetime v __% risk for women.
Definition
10%; 5%
Term
What is the difference between Type I and Type II alcoholism?
Definition
Type II is less common, occurs only in men, and is characterized by adolescent onset, aggression, legal problems, and use of other drugs
Term
Biphasic effect
Definition
impact of alcohol on brain wherewith only some cell groups are stimulated with low doses but the firing rate decreases with increased consumption.

It may also produce inhibitory neurons that provide a net effect of stimulation at lower doses.
Term
etoh _____ the ______ effect of GABA receptors and ________ the _______ effect of glutamate receptors.
Definition
increases, inhibitory
decreases, excitatory
Term
How does suppression of glutamate activity effect the brain?
Definition
It inhibits NMDA receptors which are important for forming new memories (blackouts)
Term
What % of college students endorse a history of blackouts?
Definition
40%
Term
What is one explanation for blackouts?
Definition
etoh suppresses glutamate activity inhibiting NMDA receptors which are important for forming new memories.
Term
Acute effects of alcohol use and their causes?
Definition
hangovers- etoh effect on blood vessels and fluid

GI upset- toxic by-products of etoh elimination and irritation to stomach

hippocampal neuronla loss among binging adolescent animals
Term
What are chronic alcohol effects?
Definition
dysfunctions of the brain,liver, and digestive system. Skin, peripheral neuropathy, endrocrine, and hypertension conditions, FAS
Term
What are some medical diagnostics to assess alcohol abuse?
Definition
Liver function tests
Mean corpuscular volume
blood pressure
physical exam (MSE, neuro, liver palpitation)
abdominal sonogram
Term
What are regions of the brain that are vulnerable to alcohol abuse?
Definition
frontal lobe- exectutive functioning
hippocampus- memory
cerebellum- wide based gait
mammillary bodies- beneath hypothalamus. lesions consistent with nutritional deficit and Korsakoff's syndrome
Term
What are some neuroimaging correlates with alcohol dependence?
Definition
increased ventricle size
white matter disease
atrophy in frontal, temporal, parietal lobes and cerebellum

**covaries with age
Term
How many drinks per day are associated with moderate deficits equivalent to alcohol dependent persons?
Definition
10 per day
Term
How long does it take cognitive deficits to resolve?
Definition
4-5 years
Term
Cognitive functioning is related more to ___ than ____ history of drinking.
Definition
recent; lifelong
Term
Adolescents are more affected by ____ drinking but older adults with long drinking history have more significant ____ and _____
Definition
binge; cognitive deficits and medical complications
Term
What % of long term alcohol abusing men report reduced libido?
Definition
40-90%
Term
What are sexual affects of long term alcohol abuse in men?
Definition
erectile dysfunction
decreased sperm count
decreased semen production
feminization in extreme cases
testicular atrophy
Term
Cannabis Sativa (Hemp)
Definition
used in making rope, cloth, paper
Term
Cannabis Indica
Definition
cultivated for psychoactive properties
Term
Where is highest THC content found in plant?
Definition
in the resinated flower tops or buds; not leaves
Term
How is the marijuana drug formed?
Definition
at maturation, cannabidiolic acid (CBDA) is converted to cannabidiol (CBD) then to THC and finally cannabinoid
Term
What determines potency of MJ?
Definition
the extent to which CBD is converted to THC. THe higher the rate of THC to CBD and CBN, the greater the pure drug effect
Term
What happens when MJ plant is harvested beyond peak THC ratio
Definition
it has a more sedating effect
Term
How has the potency of MJ changed over the last 40 years?
Definition
from 3.6% to 10%
Term
What is Low-grade content MJ?
Definition
1-3% THC. mixture of leaves and stems
Term
What is High grade content MJ?
Definition
female plans. fertilized plants typically have 7-8% THC. Unfertilized plants do not produce seeds and are the most potent (7-20% (hashish) )
Term
What drug has highest THC content?
Definition
Hash oil, up to 70% THC
Term
More THC is absorbed through ____ smoking than _____ smoking.
Definition
pipe; cigarette
Term
THC absorption is slower when THC products are ____
Definition
eaten
Term
THC is rapidly absorbed by blood in the ___
Definition
lungs
Term
_____ of THC is still present in the blood ___ hours after smoking
Definition
Half; 20
Term
___% of THC and its metabolites may remain in teh body a full ___ after smotking.
Definition
30%; week
Term
Where are cannabinoid receptors concentrated?
Definition
In the hippocampus and less so in the cerebellum and basal ganglia
Term
How does MJ effect memory?
Definition
It may suppress activity of hippocampal cells and hinder acquisition of new memories
Term
THC disrupts memory far more in adolescents or adults?
Definition
Adolescents
Term
What are subjective effects of THC intoxication?
Definition
relaxation
mood elevation
sedation
stimulation
silliness
sensory enhancement
contemplative silence
Term
What are cognitive effects of THC intoxication?
Definition
diminished memory while drug is still active
altered sense of time/altered attention
decreased problem solving/mental flexibilty in chronic users
paranoid ideation (contextual)

*long-term effects may be age dependent but more dependent on age of onset
Term
What are behavioral effects of THC intoxication?
Definition
hunger
decreased aggression
amotivation
impaired concentration and driving correction

*earlier use = higher risk for psyc sxs later
Term
What are some physiological effects of THC intoxication?
Definition
increased heart rate
decreased sperm count, erectile dysfunction, increased prolactin
irregular mensus
Term
What are some effects MJ use may have on other parts of the body?
Definition
may decrease immunological functioning
chronic bronchitis
lung cancer (esp with tobacco use)
Term
Why are MJ smokers at risk for developing lung cancer?
Definition
they inhale less smoke but higher levels of CO and tar
Term
What % of MJ users develop dependency?
Definition
9-10%
Term
What are acute presentations of inhalant abuse?
Definition
cardiac DO
hypoxia/anoxia
ataxia
encephalopathy
neuropathy
metabolic DO
degenerative DO
demyelinating DO
nutritional DO
Term
What are chronic problems related to inhalant abuse?
Definition
brain, liver, renal, and adrenal toxicity
neuropathies
cardiac problems
blood DO
muscle weakness
movement DO
embryonic DO
respiratory problems
Term
What are common high efficacy opiates?
Definition
Morphine
Dilaudid
Demerol
Fentanyl
Term
When are high efficacy opiates prescribed?
Definition
surgery of palliative care
Term
What are common medium efficacy opiates?
Definition
Vicodin
Oxycontin
Percocet
Darvocet
Term
What are common low efficacy opiates?
Definition
codeine
lomotil (diarrhea)
Term
Enkephalins
Definition
cite of neurotransmitter action for opiates. affect pain and breathing. CNS and GI tract
Term
Opiate receptors
Definition
Mu
Delta
Kappa (no euphoria)
Term
What are drug effects of ecstasy?
Definition
enhanced somatosensation, stimulation, interpersonal satisfaction, empathy and decreased aggression
Term
What are risks of ecstasy use?
Definition
risks are secondary to deydration and hyperthermia

cardic complications

seizures

5HT suppression

depression and memory dysfunction
Term
For what are amphetamines prescribed?
Definition
narcolepsy, ADHD, weight loss, performance enhancement, chronic fatigue, depression
Term
How do amphetamines work in the brain?
Definition
They stimulate release of NE, DA and 5HT
Term
WHere is cocaine metabolized?
Definition
liver
Term
What are some frequently prescribed hypnotics?
Definition
Ambien, Lunesta, Rozerem
Term
What % of US population abuse substances?
Definition
11%
Term
What % of ppl are effected bu SA in US?
Definition
45-68%
Term
What % children are exposed to etoh abuse or dependence?
Definition
25%
Term
How many 12yo+ dependent in US?
Definition
23 million
Term
Describe categories of family boundaries.
Definition
diffuse/enmeshed
clear
rigid
disengaged
Term
What are the 8 dynamics of addiction according to Platinga?
Definition
1. Repetitive habit forming behavior
2. negative effects
3. vow to stop
4. attempt to relieve distress with more addictive behavior
5. deterioration of relationships
6. obsession
7. compulsion
8. pulling others into web
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