Substance Abuse Midterm

the nervous system

100 billion nerve cells and 100 trillion connections. Half the nervous system, and is further divided into the autonomic and somatic systems.

affects of alcohol men vs women

About 10%-20% of alcohol is metabolized by the stomach in men, who have more gastric metabolizing enzymes than women, so women generally have higher blood alcohol levels after ingesting the same amount of alcohol.

LSD

Acetylcholine, dopamine, serotonin

factors that affect the metabolism and the half-life of drugs

Age: the older you are the less enzymes you create (age 30), race asians break down alcohol more slowly than do whites, heredity, gender, health pertaining to the liver , emotional state, other drugs, exaggerated reaction such as an allergic reaction.

addiction associated genes

DRD2 A1 allele gene was found in more than 70% of alcoholics . This gene indicates a scarcity of dopamine receptors in the brain. A shortage of dopamine D2 receptors in the "go" switch of the brain's survival/reinforcement circuit causes a person to need more-intense sensory or emotional input to feel satisfaction. Therefore, a normal or excessive amount of D2 acts as a protective factor against alcoholism even if there is a family history of alcoholism.

dispositional tolerance

Decrease in drug effect over time resulting from increased disposition by excretion or metabolism. (alcohol stresses the liver and eventually creates a disease)

Heroin

Endorphin, enkephalin, dopamine

behavioral/environmental model

Environmental factors can change brain chemistry as drug use or hereditary. chronic stress can decrease brain levels of met-enkephalin (a neurotransmitter) in mice, making normal mice that avoid alcohol more susceptible to alcohol use. epigenetic gene expressions promote the position that all three models of addiction work together in result in an individuals unique vulnerability to addiction.

hijacking the survival/reinforcement and control circuits

For substance abusers who have altered brain chemistry, the "go" switch is more powerful than normal and the "Stop" switch become dysfunctional and does not shut off the craving, so the person continues to use because their is no instruction to stop. in chronic users, the"do it again" becomes impossible to ignore, and the "stop" switch is totally disabled. Drugs can imprint and reinforce the emotional memory of euphoria or pain relief more deeply than most natural survival memories. When drugs are used for intoxication or pleasure, the also affect physiological functions (heart rate, respiration).

Benzodiazepines

GABA, glycine

intramuscularly

IM or muscling into a muscle mass

intravenous injection

IV or slamming directly into the blood stream

creation of memories

We learn what makes us feel good or relieves our pain (physical and emotional). we are more likely to remember the pleasure rather than the discomfort of being sick.

positive and negative reinforcement

a desire for the positive effects of a psychoactive substance or a desire to avoid the negative effects or emotions of abstinence compels a user to continue.

Half-life

a drug's half-life is a measure of the time it takes for half the dose to be inactivated or eliminated by the body. from a clinical standpoint, it takes about one or two half-lives for a drug to become inactivated and about five half-lives to be completely eliminated from the body.

protracted withdrawal (environmental triggers and cues)

a flashback or recurrence of the addiction withdrawal symptoms that trigger a heavy craving for the drug after an addict has been detoxified. the cause of this reaction often happens when some sensory input (odor, sight, or noise) stimulates the memories of drug use or withdrawal, which in turn evokes a desire for the drug. this often causes recovering addicts to slip, or renew their drug use, ultimately leading to a relapse.

inverse tolerance "kindling"

a person becomes more sensitive to the effects of a drug as the brain chemistry and neuron pathways adapt to the drug's effects. For example, a marijuana or cocaine user may experience minimal effects from the drug for months and then suddenly get an intense reaction.

diathesis-stress theory of addiction

a predisposition (diathesis) to addiction is the result of genetic and environmental influences, which, when further stressed by the use of psychoactive drugs or the practice of certain compulsive behaviors, alters neurochemistry, brain function, and even new epigenetic gene expressions to the point that a return to normal behavior is extremely difficult.

cross-dependence

a tissue dependence on one drug creates dependence on other drugs. if one is dependent on heroin, they are also dependent on methadone, vicodin, and all other opioids.

academic model

addiction occurs when the body adapts to the toxic effects of drugs at the biochemical and cellular levels in the process called allostasis. four physiological changes characterize this process: tolerance, tissue dependence, withdrawal syndrome, psychological dependence.

the new brain

also called the neocortex. This processes information coming from the old brain, from different areas of the new brain, and from the senses via the peripheral nervous system. the new brain allows us to speak, reason, create, remember, make decisions, and then act. The old brain simply reacts. Cravings can override the new brain's rational arguments.

the old brain

also called the primal or primitive brain, consists of the brainstem, cerebellum, and mesocortex (midbrain), which contain the limbic system (the emotional center). Spinal cord is considered part of the old brain. the old brain responds to internal changes and memories as well as to sensory inputs from external influences from the environment. Craving to use a psychoactive drug almost always resides in the old brain due to the desire for pleasure, pain relief, and excitement. The old brain acts four times more rapidly than the new brain.

hedonic set point

an individual's preferred level of pharmacological effects from a drug.

Marijuana

anandamide, arachidonylglycerol (2AG), naladin ether, acetylcholine, dynorphin

cross-tolerance

as a person develops tolerance to one drug, he or she develops tolerance to other drugs as well. for example, a heroin addict is also tolerant to doses of morphine, Vicodin, oxycontin, and methadone, even if the addict has never taken them before.

reverse tolerance

as the drug destroys certain tissues and/or as the person grows older, the trend can be reversed and the user comes more sensitive and therefore less able to handle even moderate amounts. For example, in alcoholism, as the liver gets larger with scar tissue damage, it doesn't metabolize quickly as it did before, showing effects much quicker in smaller doses than before.

effects of heroin (depressant)

block the release of neurotransmitters from the vesicles. acts like a second messenger because it mimics enkephalins and slotting into opioid receptors, blocking the release of substance P, the pain transmitter

stress

can dramatically increase the ability of drugs to cross this barrier. psychoactive drug use often involves stressful or emotionally charged situations, which could speed absorption of the substance and perhaps exaggerate its effects.

epigenetic changes

changes in synapses and in parts of the brain and the body are due to alternative instructions given to the genes. the study of epigenetic also includes examining the way genes behave (gene expressions) when stressed by environmental events and substances.

habituation

characterized by a definite pattern of use. this is an early sign that one is losing control over use of the drug.

non-purposive withdrawal

characterized by objective physical signs that are direct result of developing tissue dependence and are directly observable once an addict ceases using a drug. these can include seizures, sweating, goose bumps, vomiting, diarrhea, and tremors.

autonomic system

controls involuntary internal functions such as circulation, respiration, digestion, glandular output, and genital reactions. consists of: sympathetic division, parasympathetic division, enteric division (coordinates reflexes).

synaptic plasticity

describes the ability of a synapse to change in strength and function when that pathway is overused or underused, often as a result of the intake of psychoactive drugs, the practice of compulsive behaviors or because of extreme stress. this helps the brain adapt to the toxicity of psychoactive substances and compulsive behaviors and can change the number of available transmitters, the number of receptors and receptor sites, and the way the dendrites react to the synaptic transmission. synaptic plasticity is responsible for many of the challenges that chronic abusers experience in recovery.

neurotransmitters

designed to bind with a compatible receptor site. each nerve cell produces and sends only one type of neurotransmitter, but a single nerve cell can have receptors for several different types of neurotransmitters, and it can have thousands of receptors.

theories of addiction: addictive disease model/medical model

disease of addiction is a chronic progressive, recurring, incurable, and potentially fatal condition that is generally a consequence of genetic irregularities in brain chemistry and anatomy that may be activated by the particular drugs that are abused. addiction is set into motion by experimentation with the agent/drug, by a susceptible host in an environment that is conductive to drug misuse

PCP

dopamine, acetylcholine, alpha-endopsychosin

cocaine and amphetamines

dopamine, epinephrine, norepinephrine, serotonin, acetylcholine

polydrug abuse

drug abuse and the practice of compulsive behaviors can sometimes be considered the symptoms of underlying problems rather than the cause. virtually every client who enters treatment has practiced poly drug abuse, using one or more of the following: replacement, multiple drug use, cycling, stacking, mixing, switching, morphing

drug distribution

drug is distributed by the bloodstream to the rest of the body.

side effects

drugs not only generate desired emotional and physical effects, they also trigger mild, moderate, dangerous, and sometimes fatal side effects. Drug use also causes negative social side effects, including legal, relationship financial and work difficulties.

agonist

drugs that bind to receptors ad mimic or facilitate the effects of neurotransmitters.

partial agonists

drugs that bind to receptors and partially mimic the effects of neurotransmitters.

inverse agonist

drugs that bind to receptors and stabilize the receptor in its inactive state by hyperpolarizing it so that it cannot react.

antagonist

drugs that bind to receptors but don't activate them and thereby block neurotransmitters

environment

environmental influences that determine the level at which a person uses drugs can be positive or negative include: sexual/physical/emotional abuse, stress, love, nutrition, living conditions, family relationships, nutritional balance, healthcare, neighborhood safety, school quality peer pressure, the internet, and television. these things can create new nerve cell connections, create memories, and alter a person's neurochemistry or neuroplasticity .

nicotine

epinephrine, endorphin, acetylcholine

cocaine to epinephrine and dopamine; ecstacy to serotonin (stimulants)

force the release of neurotransmitters by entering the presynaptic neurons, causing more to be released than occur naturally.

major neurotransmitters

four major groupings: 1. monoamines: norepinephrine, dopamine, histamine, serotonin; 2. amino acids: GABA, glycine, glutamic acid; 3. opioid peptides: endorphines, enkephalins, dynorphines, substance P; 4.miscellaneous: acetylcholine, anandamide, corticotrophins, nitric oxide, adenosine.

genetic addiction risk score (GARS)

genetic analysis by Dr. Kenneth Blum that identifies nine addiction-linked genes and their 18 alleles in a subjects saliva.

pharmacogenomics

genetic targeted treatment

down regulation

if the cell senses that there are too many neurotransmitters--which occurs during drug use--it retracts many of the receptor sites into the cell, causing a slowdown of the message transmission, causing the need to increase drug intake to make the few remaining receptor sites fire faster to make up for the fewer receptors available for activation

second messenger system

if the received neurotransmitters cause other biological and chemical changes that then afect the electrical transmission

up regulation

if there are too few neurotransmitters available to trigger the message, the receiving neuron will increase the number of receptor sites to provide the few remaining neurotransmitters with more receptors to activate.

acute tolerance

in these cases the brain and the body begin to adopt almost instantly to the toxic effects of the drug. For example, tolerance for tobacco begins in the first puff.

mucous membrane absorption

includes: snorting of drugs into the nose (insufflation) and absorbed by the capillaries enmeshed in the mucous membranes lining the nasal passages; under the tongue (sublingually) or between the gums and cheek (buccally). using this method, it takes three to five minutes for effects to begin.

excitatory neurotransmitters

increase cell fringes by opening the gate and allowing positive ions like sodium, potassium, or calcium into the neuron.

Routes of Administration

inhalation, injection, mucous membrane absorption, oral ingestion, and contact absorption

effects of stimulants

interfere with the reuptake and the storage of neurotransmitters, allowing them to seep out of vesicles and become degraded, thus causing a shortage of those particular neurotransmitters.

heredity

many genes affect addiction, more than 89 have been associated with drug abuse. if a person has just a few of the genes that promote addiction, he or she might have a low propensity to drug dependence; a few dozen may indicate a high propensity to addiction

abstinence

means a person does not use a psychoactive substance except by accident. for example, unintentionally drinking alcohol laced punch, taking prescribed medications that have a psychoactive effect, or being in an unventilated room with smokers. even if a person has very strong hereditary and environmental susceptibility to use drugs compulsively, he will never have a problem if he never begins to use.

implicit memory

memories storied at an unconscious level.

explicit memory

memories that are stored on a conscious level.

storage of memories

most memories last a lifetime because they are actually solid bits of protein imprinted on the brain as a microscopic memory bumps called dendritic spines. These bumps grow from the dendrites of nerve cells an are simulated by a sensory input. it takes 1,000 or more spines working together to form a single memory, and each memory has a number of connections to other memories. The memories are also linked together. Emotionally charged memories are more deeply imprinted that everyday memories because more dendritic spines are created from those events and they are much larger than those created from average sensory input. Addictive use of a drug along with the resultant withdrawal syndrome creates dozens of emotional memories.

psychoactive drugs

natural, semisynthetic and synthetic substances that directly affect the neurochemistry and the anatomy of the CNS, causing mental, emotional, and physical changes.

pharmacodynamic tolerance

nerve cells become less sensitive to the effects of the drug, or the body produces an antidote or antagonist to it. (the use of opioids causes the brain to generate fewer opioid receptor sites and down regulate, also forming a hormone antagonist of opioids in the intestines.

Alcohol

neurotransmitters directly affected: GABA (gamma aminobutyric acid), met-enkephalin, serotonin

active transport

occurs when a water soluble drug cross the blood-brain barrier by hitching a ride on protein molecules.

passive transport

occurs when lipid-soluble drugs pass from an area where there is a higher concentration of a drug to an area of lower concentration

somatic system

part of the peripheral nervous system that transmits sensory information about the environment and limb and muscle position through sensory neurons that reach the skin, muscles and joints.

social reinforcement

peer pressure, the desire or need for social inclusion, and other social factors encourage the continued use of an additive psychoactive substance.

effects of SSRI antidepressants

prevent neurotransmitters from being reabsorbed into the sending neuron, causing them to remain in the synapse to slot into receptors again, inducing more intense effect. essentially it leaves people feeling less "depressed"

blood-brain barrier

protects the CNS. the walls of the capillaries of this barrier consists of tightly sealed epithelial cells that allow only certain substances to penetrate. not fully functional until the age of one or two years. if a pregnant woman ingests toxins during pregnancy, her fetus is at high risk

drugs that can cross blood-brain barrier

psychoactive (stimulants, depressants, psychedelics, and inhalants).

Central Nervous System CNS

receives messages from the peripheral nervous system, analyzes them, and then sends responses via the peripheral nervous circuitry to the appropriate systems of the body; nervous, muscular, skeletal, circulatory, respiratory, digestive, lymphatic, urinary, endocrine, integumentary and reproductive. psychoactive drugs can alter information sent to the brain from the environment, they can disrupt messages sent back to the various parts of the body, and they can disrupt thinking.

inhibitory neurotransmitters

reduce cell fringes by allowing negative ions like chloride into the neuron, pushing positive ions out.

tissue dependence

results from the biological adaptation of the body due to prolonged use of a drug. the body compensates by resetting normal homeostatic levels and altering homeostatic mechanisms to withstand chemical stressors. this creates an allostatic state--an altered state of balance that maintains the stability of biological systems by the continued exposure to drugs. certain drugs change the body so much that tissues and organs become dependent on the drug simply to stay functional.

social/recreational use

seeking a known drug to experience a known effect, but no pattern has been established.

MDA, MDMA

serotonin, dopamine, epinephrine, nonrepinephrine

subcutaneously

skin popping under the skin

injection

substances such as methamphetamine, heroin, cocaine, and steroids can be injected directly into the body with a hypodermic syringe by any of three methods: intravenously, intramuscularly, subcutaneously.

drug automatism

substances such as sedatives and opiates can induce an aimless, unconscious, repetitive drug-taking behavior characterized by continually taking a substance without being fully aware of the action.

select tolerance

the body develops tolerance to mental and physical effects at different rates. tolerance to doses necessary to reach an emotional high from sedatives occurs more rapidly than the development of tolerance to their depressant effects. with continued use, the dose amount necessary to get high can come close to the lethal physical dose of the drug.

tolerance

the body treats all drugs as a poison, and works very hard to eliminate the chemical before it does too much damage. if use continues over a long period of time, the body is forced to change and adapt, developing tolerance to the continued input of a foreign substance. the net result is that larger and larger amounts must be taken to achieve the same effect.

withdrawal

the body's attempt to rebalance itself after cessation of prolonged use of a psychoactive drug or compulsive behavior. Many compulsive users are unwilling to go through withdrawal, which is one reason why they continue to use (negative reinforcement).

metabolism

the body's mechanism for processing, using, and inactivating a foreign substance that has entered the body. The liver is key to this process.

behavioral tolerance

the brain learns to compensate for the effects of a drug by using parts of the brain not affected.

levels of use

the categories used to judge a person's level of use: abstinence, experimentation, social/recreational use, habituation, abuse, addiction. With most psychoactive drugs, there is a point where it becomes harder and harder for the person to rationally choose the level of use at which to remain--the hedonic set point.

abuse

the definition of drug abuse is the continued use of a drug despite negative consequences.

bioavailability

the degree to which the active ingredients of a drug become available to the target tissues after administration.

oral ingestion

the drug passes through the esophagus and the stomach to the small intestine where it is absorbed into the capillaries enmeshed in the intestinal walls. Effects are delayed 20-30 minutes

the "go" and "stop" switch

the go switch tells us three things when activated" 1) what we are doing is necessary for survival, 2) remember what we did to survive, 3) do more of whatever you did continuously until you are satisfied;it is necessary for your survival. When the need is satisfied, the pain relieved, or the imbalance rectified, the "Stop" switch shuts down the "go" switch and the "do it again" message ceases. This is done through the release of glutamate from the prefrontal cortex reaches back to the VTA and signals the cells to stop releasing dopamine.

utilization of memories

the more an activity is repeated the more likely we are to repeat it when we run into a similar situation. There is no guarantee that the mind will make the best choice;often the choice is the one that feels more comfortable. is the most common, or is the easiest.

memory

the old brain and the new brain carry out their functions by creating, storing, and utilizing memories. storage, activation, and use of memories are at the heart of the obsession to use drugs, which is one-half of the addictive process. The other half of addiction is the "allergy" or extra sensitivity that vulnerable individuals have to a drug and the neurochemical/anatomical changes it induces in the brain, which trigger automatic reactions to the substance.

allostasis

the overall process of achieving and maintaining functionality by physiological and behavioral change through synaptic plasticity or brain cell adaptations that occur when the human body's homeostasis is disrupted, often by drugs and compulsive behaviors. (almost like building tolerance?)

excretion

the process of eliminating the foreign substance and its metabolites. The kidneys are the primary excretory organs.

first messenger system

the process whereby the neurotransmitter directly affects electrical transmission in the receiving neuron.

post-acute withdrawal symptoms PAWS

the recurrent persistence of subtle yet significant emotional and psychological problems that can last for three to six months or rarely even long into recover and can trigger relapse. symptoms include: unclear thinking and cognitive impairment, memory problems, emotional overreaction and mood swings, sleep disturbances, motor coordination and dizziness problems, difficulty managing stress.

euphoric recall

the remembrance of positive experiences with drugs or compulsive behaviors rather than the negative experience. when a craving is triggered in an addict by a positive event, it is activated by the memory of a desirable emotional experience. this memory is usually very intense, making the emotional memory powerful and influential. Cravings can also occur due to negative feelings that were relieved by using an abused drug. The brain tends to remember the positive memories more quickly and intensely than negative ones.

addiction

the step between abuse and addiction involves compulsion. Addiction is composed of the six C's, or cornerstones of addictive behavior: loss of control, compulsive drug use, cravings for drugs, continued use despite increasing catastrophic consequences associated with use.

memory, psychoactive drugs

the stronger the psychoactive drug, the more rapid the growth and proliferation of memory bumps, and therefore the more deeply imprinted the memory. The earlier in life a person begins using psychoactive drugs or practices addictive behaviors, the longer and stronger the memories remain in the brain and the more likely the brain is to use the information from those memories to deal with events later in life.

inhalation

the vaporized drug enters the lungs and is rapidly absorbed through capillaries lining the air sacs (alveoli) of the bronchi (air passages), then travels to the heart where it is pumped directly to the brain and other organs and tissues of the body. Acts the quickest, avoids the first-pass metabolism, results in more of the drug being available to affect brain cells.

effects of heart medications

they can inhibit enzyme that helps synthesize neurotransmitters to slow the nerve cell's production of neurotransmitters.

effects of methamphetamine

they can inhibit enzymes that metabolize neurotransmitters in the synaptic gap, thus increasing the number of active neurotransmitters.

contact absorption

transdermal absorption. drug saturated adhesive patches applied to the skin allow measured quantities of a drug to be passively absorbed for up to seven days.

prodrugs

transformed primarily by the livers enzymes into three or more metabolites that are themselves active and cause major effects in the brain and the body.

psychological dependence

users begin to rely on psychoactive drugs emotionally as well as physically. Drug use can alter one's state of consciousness, distort perceptions, and change emotions. these changes can reinforce continued use of the drug. Drugs also have the innate ability to guide and virtually hypnotize the user into continual use, called the positive reward-reinforcing action of the drug.

gene expressions or epigenetic factors

when epigenetic factors such as stress, toxins, drugs, or compulsive behaviors affect the version of a gene that was originally chosen to be copied, there is a chance that the alternative gene will be chosen and instead become the new recipe. the alternative gene might make someone much more susceptible to addiction. this explains why a small percentage of identical twins have different vulnerabilities to addiction and why early childhood trauma or a hectic environment can result in addiction in someone who originally had no genetic predisposition.

experimentation

when people become curious about the effects of the drug or are influenced by peers, friends, relatives, advertising, Tv or the internet, they experiment and take the drug if the situation presents itself.

purposive withdrawal

with purpose. a false portrayal of severe withdrawal symptoms by an addict to manipulate a physician or pharmacist into providing drugs to manage the symptoms. this withdrawal type can also occur from a psychic conversion reaction generated solely from the expectation of the withdrawal process. Psychic conversion is the physical manifestation of symptoms resulting from an emotional expectation of physical effects.