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78 Cards in this Set
- Front
- Back
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Substance related d/o are a cluster of d/o in which |
Cognitive
behavioral and physical sx occur indicating that an individual is experiencing the effects of a drug of abuse |
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Psychiatric sx clusters in substance related d/o may be related to
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substance use
discontinuation of substance use or withdrawal from habitual substance use |
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The word substance can describe
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a drug of abuse
a medication or a toxin that produces psychoactivation and alters cognitive, behavioral and affective perceptions |
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Psychodynamic theory of etiology of substance related d/o main points
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Behaviors of abuse are seated in oral stage fixation
an individual seeks gratification through oral behaviors maladaptive regressive behaviors can become overlearned, fixed and reinforced through dysfunctional family patterns sociocultural factors attempt to explain population based differences in substance abuse rates *gender differences *ethnic differences |
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According to what theory of etiology of substance related d/o
Behaviors of abuse are seated in oral stage fixation |
Psychodynamic theory of etiology of substance related d/o
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According to what theory of etiology of substance related d/o
an individual seeks gratification through oral behaviors |
Psychodynamic theory of etiology of substance related d/o
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According to what theory of etiology of substance related d/o
maladaptive regressive behaviors can become overlearned, fixed and reinforced through dysfunctional family patterns |
Psychodynamic theory of etiology of substance related d/o
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According to what theory of etiology of substance related d/o
sociocultural factors attempt to explain population based differences in substance abuse rates *gender differences *ethnic differences |
Psychodynamic theory of etiology of substance related d/o
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In the psychodynamic theory of etiology of sub. related d/o
sociocultural factors attempt to explain population based differences in substance abuse rates what 2 differences? |
*gender differences
*ethnic differences |
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maladaptive regressive behaviors can become overlearned, fixed and reinforced through ____________
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dysfunctional family patterns
Main point of Psychodynamic theory of etiology of substance related d/o |
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an individual seeks gratification through oral behaviors leads to
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Substance related d/o according to the psychodynamic theory
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Behaviors of abuse are seated in ____________
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Oral-stage fixation
according to the etiology of Substance related d/o according to the psychodynamic theory |
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Biological theory of etiology of Substance related d/o
main points |
GENETIC LOADING
Involves 2 neurobiological processes: 1) reinforcement **the process of + & - rewards is physiologically linked to memory fxn 2) neuroadaption **drug specific alterations in the normal level & fxn of NTs occur as the body adapts to the chronic presence of the substance abuse and can lead to tolerance and withdrawal |
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Genetic loading in substance d/o main points
Biological theory of etiology of Substance related d/o |
Individuals w. a strong genetic vulnerability to addiction are thought to have defects in the working of the reward center of the brain which predisposed them to stronger-than-normal positive rewards that draw them to substance use
this also predisposes them to stronger-than-normal negative rewards making it more difficult to stop abuse once it has begun |
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According to the Biological theory of etiology of Substance related d/o what predisposes them to stronger-than-normal negative rewards making it more difficult to stop abuse once it has begun
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Genetic loading
thought to have defects in the working of the reward center of the brain |
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Individuals w. a strong _________ to addiction are thought to have defects in the working of the _______ of the brain which predisposed them to stronger-than-normal positive rewards that draw them to substance use
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Individuals w. a strong
*** genetic vulnerability**** to addiction are thought to have defects in the working of the ****reward center***** of the brain which predisposed them to stronger-than-normal positive rewards that draw them to substance use Biological theory of etiology of Substance related d/o |
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Genetic loading and substance abuse
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genetic vulnerability to addicition d/t problems with the reward center (nucleus accumbens) makes them have very strong + and - rewards
so stronger high when on substance stronger low when try to quit substance Involves 2 neurobio processes 1) reinforcement 2) neuroadaption |
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Reinforcement + & - main points
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brain based changes in structure and fxn can lead to addictive behavior. Changes appear to occur w. any drug of abuse
the process of + & - rewards is physiologically linked to memory fxn reinforcement results in "feel good" sensations when a drug of abuse is used and in "feel bad" sensations when the drug exits the body Positive rewards of reinforcement result in the social rewards commonly associated w/ drug use such as disinhibition, euphoric mood and anxiety reduction (mediated by DA pathways) negative rewards are aversive such as increased anxiety and dysphoria (mediated bye the GABA pathways) |
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Negative rewards are aversive such as
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increased anxiety and dysphoria (mediated bye the GABA pathways)
Reinforcement one of the 2 neurobio processes responsible for sub d/o |
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Positive rewards of reinforcement result in the social rewards commonly associated w/ drug use such as
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disinhibition, euphoric mood and anxiety reduction (mediated by DA pathways)
Reinforcement one of the 2 neurobio processes responsible for sub d/o |
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________ results in "feel good" sensations when a drug of abuse is used and in "feel bad" sensations when the drug exits the body
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Reinforcement
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Feel good sensations mediated by
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DA pathways
Reinforcement results in "feel good" sensations when a drug of abuse is used and in "feel bad" sensations when the drug exits the body. |
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Feel bad sensations mediated by
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Gamma-amin-butyric acid (GABA) pathways
Reinforcement results in "feel good" sensations when a drug of abuse is used and in "feel bad" sensations when the drug exits the body. Biological theory of etiology of sub d/o |
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Reinforcement occurs in what areas of the brain
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Ventral tegmental area
& nucleus accumbens Collectively call the reward center |
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Collectively call the reward center
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Ventral tegmental area
& nucleus accumbens Reinforcement occurs in this area of the brain |
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During reinforcement
DA release w/in the reward center (nucleus accumbens & ventral tegmental area) is further enhanced by |
the release of natural morphine like NTs called neuropeptides (enkephalins, beta-endorphins
neuropeptides further enhance the reinforcing pleasure experienced by the individual |
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________ further enhance the reinforcing pleasure experienced by the individual
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neuropeptides
natural morphine like NTs called neuropeptides (enkephalins, beta-endorphins) |
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Neuropeptides define
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natural morphine like NTs called neuropeptides (enkephalins, beta-endorphins)
DA release w/in the reward center (nucleus accumbens & ventral tegmental area) is further enhanced by neuropeptides Therefore neuropeptides further enhance the reinforcing pleasure experienced by the individual |
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enkephalins & beta-endorphins are examples of
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Neuropeptides
natural morphine like NTs called neuropeptides DA release w/in the reward center (nucleus accumbens & ventral tegmental area) is further enhanced by neuropeptides Therefore neuropeptides further enhance the reinforcing pleasure experienced by the individual |
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What happens to the DA system with repeated drug use?
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With repeated drug use, the DA system becomes increasingly sensitized
Eventually associated drug use stimuli (e.g. pictures of drug paraphernalia) can cause DA release, leading to reinforcement of use and often to increased drug use. |
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With repeated drug use, the DA system becomes increasingly sensitized
Eventually associated drug use stimuli (e.g. pictures of drug paraphernalia) can cause DA release, leading to reinforcement of use and often to increased drug use. |
DA release, leading to reinforcement of use and often to increased drug use.
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With repeated drug use, the DA system becomes
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increasingly sensitized
Eventually associated drug use stimuli (e.g. pictures of drug paraphernalia) can cause DA release, leading to reinforcement of use and often to increased drug use. |
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Why does associated drug use stimuli (e.g. pictures of drug paraphernalia) cause cravings?
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With repeated drug use, the DA system becomes increasingly sensitized
Eventually associated drug use stimuli (e.g. pictures of drug paraphernalia) can cause DA release, leading to reinforcement of use and often to increased drug use. |
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Neuroadaption
Main points |
Brain based changes in structure and fxn can lead to tolerance & withdrawal
drug specific alterations in the normal level & fxn of NTs occur as the body adapts to the chronic presence of the substance of abuse Neuroadaptive processes become very significant when the individual stops substance use these processes become the basis for withdrawal sx as adaptive responses are unopposed when the substance is no longer present Neuroadaptive changes may be more permanent in some individuals possibly lasting for yrs thus increasing their potential fro relapse |
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How long to do neuroadaptive changes last?
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Neuroadaptive changes may be more permanent in some individuals possibly lasting for yrs thus increasing their potential fro relapse
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Why after a long period of sobriety do individuals who return to sub abuse often pick up at the same level of tolerance & physical impact as experienced before sobriety
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Neuroadaptive changes (Brain based changes in structure and fxn can lead to tolerance & withdrawal) may be more permanent in some individuals possibly lasting for yrs thus increasing their potential fro relapse
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Brain based changes in structure and fxn can lead to tolerance & withdrawal
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Neuroadaption
drug specific alterations in the normal level & fxn of NTs occur as the body adapts to the chronic presence of the substance of abuse |
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Neuroadaptive processes become very significant when the individual ___________
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stops substance use
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drug specific alterations in the normal level & fxn of ______ occur as the body adapts to the chronic presence of the substance of abuse
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Neurotransmitters
Card describes neuroadaption |
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Possibility of relapse is increased by
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Neuroadaptive changes (Brain based changes in structure and fxn can lead to tolerance & withdrawal) may be more permanent in some individuals possibly lasting for yrs thus increasing their potential fro relapse
this concept helps to explain why after a long period of sobriety do individuals who return to sub abuse often pick up at the same level of tolerance & physical impact as experienced before sobriety |
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Developed country with higest rates of substance abuse
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USA
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More than 50% of us clients w a _______ also are experiencing substance abuse or dependence
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psych d/o
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Individuals with schizophrenia are _____x more likely to have a substance dependence comorbidity than the general population
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Schizophrenics are 4x more likely to have substance dependence comorbidity than the gen. pop.
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Individuals with bipolar affective d/o are _____x more likely to have a substance dependence comorbidity than the general population
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Bipolar are 5x more likely to have substance dependence comorbidity than the gen. pop.
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most commonly abused illegal drug
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Marijuana
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most commonly abused drug
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EtOH
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Rates are ____ in men than women
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Higher
90% of men have used EtOH 70% of women have used EtOH |
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Rates of sub d/o highest in what ethnicity
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African Americans
Hispanics Native Americans |
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Rates of sub d/o lowest in what ethnicity
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Asian americans
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Lifetime risk for EtOH dependence in the general US population
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15%
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Risk factors of substance d/o
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Genetic loading
**fam hx sub abuse or MDD Association w/ peer structure w/ heavy sub use or abuse co-occuring psych d/o age & gender existance of chronic pain untx chronic pathological- level anxiety |
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Genetic loading
**fam hx sub abuse or MDD |
Risk factors of substance d/o
Genetic loading **fam hx sub abuse or MDD Association w/ peer structure w/ heavy sub use or abuse co-occuring psych d/o age & gender existance of chronic pain untx chronic pathological- level anxiety |
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existence of chronic pain
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Risk factors of substance d/o
Genetic loading **fam hx sub abuse or MDD Association w/ peer structure w/ heavy sub use or abuse co-occuring psych d/o age & gender existence of chronic pain untx chronic pathological- level anxiety |
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untx chronic pathological- level anxiety
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Risk factors of substance d/o
Genetic loading **fam hx sub abuse or MDD Association w/ peer structure w/ heavy sub use or abuse co-occuring psych d/o age & gender existence of chronic pain untx chronic pathological- level anxiety |
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age & gender
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Risk factors of substance d/o
Genetic loading **fam hx sub abuse or MDD Association w/ peer structure w/ heavy sub use or abuse co-occuring psych d/o age & gender existance of chronic pain untx chronic pathological- level anxiety |
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co-occuring psych d/o
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Risk factors of substance d/o
Genetic loading **fam hx sub abuse or MDD Association w/ peer structure w/ heavy sub use or abuse co-occuring psych d/o age & gender existence of chronic pain untx chronic pathological- level anxiety |
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Association w/ peer structure w/ heavy sub use or abuse
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Risk factors of substance d/o
Genetic loading **fam hx sub abuse or MDD Association w/ peer structure w/ heavy sub use or abuse co-occuring psych d/o age & gender existence of chronic pain untx chronic pathological- level anxiety |
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professional nursing standards on sub d/o
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Practice guideline for the advanced practice nurse: EtOH withdrawal in the acute care setting
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Implications of EtOH and other drugs of abuse during preggo
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Birth defects
FAS: fetal alcohol syndrome |
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Acute EtOH intoxication in non-tolerant individuals such as teens
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Coma
respiratory depression death |
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Cage screening test
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Most commonly used screening tool for EtOH abuse
C Have u ever felt u ought to CUT DOWN on your drinking? A Have people ANNOYED u about ur drinking? G Have you ever felt bad or GUILTY about your drinking? E Have you ever has a drink 1st think in the morning to steady your nerves or get rid of a hangover EYE-OPENER? |
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C in CAGE screening test
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Cut down
Have u ever felt u ought to CUT DOWN on your drinking? |
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A in CAGE screening test
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Annoyed
Have people ANNOYED u about ur drinking? |
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G in CAGE screening test
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Guilty
Have you ever felt bad or GUILTY about your drinking? |
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E in CAGE screening test
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Have you ever felt bad or GUILTY about your drinking?
Eye-opener Have you ever has a drink 1st think in the morning to steady your nerves or get rid of a hangover EYE-OPENER? |
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Cage screening test scoring
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administered by asking the pt 4 questions
each positive answer scored as 1 point; negative answers receive no score The more positive answers the greater the probability of an EtOH abuse d/o Pt scoring 0-2 are at mild to moderate risk for alcohol dependency Pt scoring 3-4 are considered to be at high risk for EtOH dependency |
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Cage screening test scoring
Pt scoring _____ are considered to be at high risk for EtOH dependency |
3-4
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Cage screening test scoring
Pt scoring ____ are at mild to moderate risk for alcohol dependency |
0-2
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who is it important to identify the category of drug abused by the pt
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knowing category allows for anticipation of physical impact of drug and prediction of potential sx of withdrawal
pt often abuse drugs from categories with similar pharm properties |
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Categories of abused agents
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* EtOH
* Amphetamines or similar sympathomimetics *caffeine *cannabis *cocaine *hallucinogens *inhallants *nicotine *opioids *phencylidine (PCP) or similar arylcycloheylamines *sedatives *hypnotics *anxiolytics |
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Substance abuse def
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maladaptive pattern of sub use manifested by recurrent and significant adverse consequences r/t repeated us of a substance
Is not synonymous with use, misuse, or hazardous use |
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maladaptive pattern of sub use manifested by recurrent and significant adverse consequences r/t repeated us of a substance
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Substance abuse
Is not synonymous with use, misuse, or hazardous use |
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specific criteria needed to identify sub use as abuse
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*maladaptive pattern of use occurring for at least a 12 mo period of sustained abuse
*Must be accompanied by repeated FAILURE TO FULFILL MAJOR ROLE obligation Must be accompanied by use in situation that presents as physically hazardous sucs as drinking and driving Abuse continues despite multiple problems r/t substance use patterns such as legal interpersonal or social |
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____ & ______ use patterns not considered when determining presence of substance abuse
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Caffeine and nicotine
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Abuse continues despite multiple problems r/t substance use patterns such as legal interpersonal or social
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one of the specific criteria needed to identify sub use as abuse
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Must be accompanied by use in situation that presents as physically hazardous sucs as drinking and driving
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one of the specific criteria needed to identify sub use as abuse
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Must be accompanied by repeated FAILURE TO FULFILL MAJOR ROLE obligation
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one of the specific criteria needed to identify sub use as abuse
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maladaptive pattern of use occurring for at least a 12 mo period of sustained abuse
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one of the specific criteria needed to identify sub use as abuse
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