Psychotherapy: 123b - Substance Use Disorders

THC = partial agonist -> psychoactive effects

CBD = antagonist -> relaxation

• Cannabis use disorder

• Motor vehicle accidents

• Which peer group characteristics increase a person’s risk of substance use disorder?

  • Heavy drinking

  • Deviant behavior

  • Which of the 3 FDA approved medications for the treatment of alcohol use disorder has the least evidence for decreasing drinking?

    Disulfram

    (Naltrexone, acamprosate are the other 2 - good evidence supporting both, nal...

  What family factors can increase a person’s risk of substance use disorder?

  • Parental drinking

  • Permissiveness

  • What adverse events migth increase a person’s risk of substance use disorder?

    • Emotional neglect

    • Emotional abuse

    • What might make the use of synthetic cannabinoids more dangerous than marijuana?

      Synthetic cannabinoids are full agonists at the CB1 receptor

      • Risks
        

        <...

    A patient explains that they drink to relax, expecially when they are bored or frustrated with work or their relationship

    What is their motivation for drinking? (of the 4 motives)

    Coping

    This motivation carries the highest risk of alcohol use disorder

    What is the genetic contribution to substance use disorder?

    Genetics contribute 50% of the risk for alcohol use disorder

    • Low sensitivity to alcohol = higher risk of substance use disorder

    Which hormone is affected by most drugs of abuse?

    Dopamine

    • Increase dopamine release when using

    • What social/cultural factors can increase a person’s risk of a substance use disorder?

      • Norms/expectations of substance use

      • Role model use

    How likely are symptoms of depression to resolve with abstinence alone in a patient with alcohol use disorder, who is actively engaging in heavy episodic drinking?

    50%

    What medications can be used to treat alcohol dependence?

    • Naltrexone
      

      • Mu opioid receptors antagonist

      ...

    Which psychosocial treatments are most effective for substance use disorders?

    • Motivational interviewing

    • 12 step lans

    • In a person with alchohol use disorder and depression, how will abstinence from alcohol affect depression?

      Abstinence from alcohol is likely to improve depression

      50% of depression resovles in 1...

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    Psychotherapy: 123b - Substance Use Disorders

    Term	Definition
    According to the motivational model of use, what are the 4 types of motivations for alcohol use? Which carry the highest risk of alcohol dependence?	External source Social Positive valence: drinking is social and fun Conformity Negative valence: if I don’t drink, I won’t fit in Internal source - increased risk of alcohol use disorder Enhancement ​Positve valence: drinking is exciting (even if alone) Coping - highest risk of alcohol use disorder ​Negative valence: drink to not feel sad
    How do THC and CBD affect the CB1 receptor? What about synthetic cannabinoids?	THC = partial agonist -> psychoactive effects CBD = antagonist -> relaxation Synthetic = full agonist at CB1
    List 5 adverse effects of marijuana use that we have “high conficence” in	Cannabis use disorder Motor vehicle accidents Chronic bronchitis Diminished lifetime achievement Development of schizophrenia
    Which peer group characteristics increase a person’s risk of substance use disorder?	Heavy drinking Deviant behavior Decreased academic competence
    Which of the 3 FDA approved medications for the treatment of alcohol use disorder has the least evidence for decreasing drinking?	Disulfram (Naltrexone, acamprosate are the other 2 - good evidence supporting both, naltrexone is better toldrated but not good for anyone with liver failure or on opioids)
    What family factors can increase a person’s risk of substance use disorder?	Parental drinking Permissiveness Lower levels of bonding and support
    What adverse events migth increase a person’s risk of substance use disorder?	Emotional neglect Emotional abuse Sexual abuse
    What might make the use of synthetic cannabinoids more dangerous than marijuana?	Synthetic cannabinoids are full agonists at the CB1 receptor Risks Extreme anxiety Confusion Psychosis
    A patient explains that they drink to relax, expecially when they are bored or frustrated with work or their relationship What is their motivation for drinking? (of the 4 motives)	Coping This motivation carries the highest risk of alcohol use disorder
    What is the genetic contribution to substance use disorder?	Genetics contribute 50% of the risk for alcohol use disorder Low sensitivity to alcohol = higher risk of substance use disorder
    Which hormone is affected by most drugs of abuse?	Dopamine Increase dopamine release when using But downregulate dopamine D2 receptor long term Reverses if person stops using the drug, but the pathway is “already built”; relapse is easier than starting initially
    What social/cultural factors can increase a person’s risk of a substance use disorder?	Norms/expectations of substance use Role model use
    How likely are symptoms of depression to resolve with abstinence alone in a patient with alcohol use disorder, who is actively engaging in heavy episodic drinking?	50%
    What medications can be used to treat alcohol dependence?	Naltrexone Mu opioid receptors antagonist Well tolerated Do not use in people with liver disease Acamprosate Inhibits NMDA receptors -> decreased alcohol craving Need to dose 3x daily, harder to adhere to GI upset is a side effect Disulfram Irreversivly inhibits acetaldehyde dehydrogenase Least evidence to support use in treating alcohol dependence
    Which psychosocial treatments are most effective for substance use disorders?	Motivational interviewing 12 step lans CBT Contingency management Lose license if you fail a urine tox Keep job if you complete the 12 step program Couples and family therapy
    In a person with alchohol use disorder and depression, how will abstinence from alcohol affect depression?	Abstinence from alcohol is likely to improve depression 50% of depression resovles in 1 month with abstinence alone