Main Post with Responses:
Regis College
Addiction is a worldwide issue that affects a large percentage of Americans. Examining the
statistics behind substance use in American, the America Addictions Centers, in 2017, states
that 19.7 million American adults battled a substance use disorder. A large percentage, 74% of
the 19.7 million American adults, struggled with alcohol use (Thomas, 2020). Almost half of the
population battling substance use, 8.5 million American adults, also suffers from a mental health
disorder (Thomas, 2020). Examining gender, men are more susceptible to develop a substance
use disorder by almost double when compared to women (Thomas, 2020). Comparing ethnicity,
American Indians and Alaska Natives have the highest incident of substance abuse at an
astonishing 12.8% of the population (Thomas, 2020). Caucasians are 3rdat a rate of 7.7%
followed by African Americans, Hispanics, Pacific Islanders and Asian Americans having the
lowest rate (Thomas, 2020). Assessing the costs, substance abuse ad addiction cost America
more than $740 billion annually in healthcare expenses and crim-related costs (Thomas, 2020).
The definition of addiction by Saddock, Saddock, and Ruiz (2015) states that, “addiction is
the repeated and increased use of a substance, the deprivation of which gives rise to symptoms
of distress and an irresistible urge to use the agent again which leads to physical and mental
deterioration. Although initial drug use may be voluntary or linked to trait impulsivity, drug
abusers gradually lose control which leads to compulsive behaviors such as drug seeking
(Stahl, 2013). The definitions states this as repeated drug use gives rise to symptoms of
distress and irresistible urge to use again. Neuroanatomically can explain a major reason
behind this impulsivity and compulsivity. The Thalamus to the ventromedial prefrontal cortex,
and to the ventral striatum is considered the top-down response for the circuitry of impulsivity
and reward (Stahl, 2013). When this top-down response is inadequate or is overcome by activity
from the bottom-up ventral striatum, impulsive behaviors result (Stahl, 2013). The initial
impulses to do drugs or perform certain behaviors give a “high” response that creates
satisfaction (Stahl, 2013). Another major pathway involved with addiction is the mesolimbic
dopamine circuit as use of the substance acts as a reward or increases dopamine in the ventral
striatum (Sthal, 2013). This repeated use progresses to compulsive use driven by reward and
desire to reduce distressing symptoms often is the process of addiction.
The objective physical and mental findings when examining a client with substance abuse
disorder can highly depend on the substance used. For example, objective findings for an
individual who uses stimulants such as amphetamine includes dilated pupils, restlessness,
hyperactivity, weight loss, and sweating (Volkow, Koob, & McLellan, 2016). Whereas an
individual who abuses alcohol may present with inappropriate behavior, impaired judgement,
slurred speech, impaired coordination, nausea and vomiting, or fatal seizures (Stahl, 2013).
First-line pharmacotherapy and psychotherapy interventions for opioid-use disorder
includes maintenance therapy with agonists or partial agonists such as methadone or
buprenorphine (Volkow, Koob, & McLellan, 2016). These agents are often used to help control
symptoms of withdrawal, cravings, targeting patients with mild to moderate physical
dependence (Stahl & In Grady, 2017). Two main pharmacological agents used to treat alcohol
use disorder is naltrexone and acamprosate (Stahl & In Grady, 2017). If alcohol use disorder is
severe, benzodiazepines are a first-line treatment to reduce the risk of alcohol withdrawal
(Volkow, Koob, & McLellan, 2016). Therapy for alcohol use disorder is often a combination of
cognitive behavioral therapy and the use of support groups such as alcoholics anonymous
(Volkow, Koob, & McLellan, 2016). Therapy for opioid use disorder is too a combination of
cognitive behavioral therapy and the use of support groups such as narcotics anonymous
(Volkow, Koob, & McLellan, 2016).
References
Thomas, S. (2020). America Addictions Centers: Alcohol and Drug Abuse Statistics. Retrieved
fromhttps://americanaddictioncenters.org/rehab-guide/addiction-statistics
Sadock, B. J., Sadock, V. A. & Ruiz, P. (2015). Kaplan and Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer
Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical
applications. Cambridge: Cambridge University Press.
Stahl, S. M., & In Grady, M. M. (2017). Stahl's essential psychopharmacology: Prescriber's
guide. Cambridge: Cambridge University Press.
Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain
disease model of addiction.New England Journal of Medicine,374(4), 363-371.
Reply 1
Of course, it is true that addiction is an alarming and worldwide issue affecting a huge
number of Americans. Research shows that close to 19.7 million American adults battle a
substance use disorder. That is, 74% of the 19.7 million American adults are alcohol addicts. But
wait, the increased and repeated use of the drugs by individuals give an irresistible urge to use
the substance again. According to Shaddock and Ruiz, the constant abuse of drugs results into
negative behaviors. Drug abusers often lose control leading to compulsive behaviors. And yes,
one of the major pathways involved with addiction is the Thalamus.
I acknowledge that objectives findings for an individual with substance disorder mainly
depends on substance used. Individuals who abuse alcohol may show inappropriate behavior,
slurred speech, impaired judgment, fatal seizures, and impaired coordination. Apparently,
alcohol use disorder is treatable and the two main pharmacological agents used for treatment is
acamprosate and naltrexone. And, Benzodiazepines are often used to reduce the risk of alcohol
withdrawal.
The healthcare sector in America spends over 740billion annually in matters of substance
abuse and addiction. Statistics behind substance use shows that the absolute therapy for alcohol
use disorder is an inclusion of cognitive behavioral therapy and the use of support groups such as
alcoholic anonymous.
References
Bryden, M. P., Munhall, K., & Allard, F. (1983). Attentional biases and the right-ear effect in
dichotic listening. Brain and language, 18(2), 236-248.
Bonanno, G. A., Davis, P. J., Singer, J. L., & Shwartz, G. E. (1991). The repressor personality
and avoidant information processing: A dichotic listening study. Journal of Research in
Personality, 25(4), 386-401.
Hugdahl, K. (1995). Dichotic Listening: Probing temporal lobe functional integrity: Brain
asymmetry, 1, 123-156.
Post 2:
Eric-Paul Olsson
Substance use disorder (SUD) is a crisis in the United States, affecting
approximately 19.3 million people (18 years and older). Among those individuals, it
is estimated in 2018 that about 3 in 8 individuals (7.4 million) struggled with illicit
drugs, 3 in 4 (14.4 million) struggled with alcohol use, and 1 in 8 (2.5 million)
individuals struggled with both illicit drugs and alcohol (McCance-Katz, 2019).
Individuals use substances for a myriad of reasons, some initially may use a
substance from peer pressure, some from curiosity, some from boredom and some
from trying to relieve themselves of an issue (i.e. stress, anxiety, pain). The process
of using a substance is to achieve a purpose, whether it to be to achieve the
approval of others, Use of substances can provide different sensations for
individuals, for some substances, the feeling can be described as a euphoric feeling,
a sense of calm or a burst of intense stimulus (Bechara et al., 2019) (Sadock,
Sadock, & Ruiz, 2015).
Substances used and abused are generally agents that provide a pleasant or
desirable effect to an individual. The desirable effect of the drug or even recognition
from peers creates a positive-reinforcement scenario; in the event of opiates, one
may take this agent to gain relief from pain or to achieve a euphoric feeling, in both
cases the user is experiencing a benefit from using the agent (Bechara et al., 2019).
This positive reinforcement becomes a negative reinforcement scenario as an
individual begins to adapt to having the agent and unpleasant withdrawal
experiences occur. Individuals will start to take these agents to not necessarily
achieve previous desired effect but to feel “normalized.”
In the case of heroin or opiates, the mechanism of action is the drug binding to
different types of opioid receptors (μ opioid, δ opioid, or κ opioid receptors)
throughout the brain, which are usually targets of endorphins, dynorphins, and
enkephalins (endogenous opioids). Endorphins are known to be the endogenous
opioid that is released during exercise, excitement, orgasm and pain, giving a sense
of being high. Opioid drugs such a fentanyl or heroin or other opiates bind to opioid
receptors and produce intense feelings of euphoria, often more than the naturally
occurring effect. This occurs because of an inhibition of γ-aminobutyric acid (GABA)-
producing neurons that normally suppress dopaminergic cell firing. The inhibition of
GABA neurons leads to an increase in the firing rate of the dopaminergic cells and
directly increases dopamine release (Bechara et al., 2019).
Addiction and substance use do not just come with unpleasant side effects of
withdrawal. Often methods used to intake addictive substances cannot only cause
direct harm to the body but are themselves harmful to the body. Utilizing the
example of heroin and opiates, these substances can cause respiratory depression
to a level of death, making the substance itself dangerous to the body. Methods
used to abuse heroin can be via intravenous injection, this method can lead to
issues of cellulitis, phlebitis, endocarditis, HIV, and Hep C. Treatments for these
issues can become quite costly, especially for the treatment of Hep C and
maintenance treatment of HIV. The average lifetime cost to treat HIV for one
individual is $379,668 and ranging from $83,319 to $95,000 to treat Hep C (CDC,
2019) (Henry, 2018). In identifying an individual who may be under the influence of
opiates, individuals may be seen with needle marks on arms and legs from
intravenous use, constricted or “pinpoint” pupils, “nodding off” or individuals falling
asleep at inappropriate times due to a euphoric state, and flushed, itchy skin which
is a reaction some receive to a sensitivity from opiates (NIDA, 2020).
Treatment options for those suffering from substance abuse are mainly consistent
of pharmacologic and psychotherapeutic interventions. It is approximated that 50%
of individuals with substance issues also have a diagnosable mental illness (Sadock,
Sadock, & Ruiz, 2015). Use of psychotherapy for talk therapy, CBT, motivational
interviewing and use of support groups are exceptionally helpful for those with SUD.
Groups can be uniquely helpful for individuals as they are present with individuals
that have been in similar situations and can utilize peer viewpoints to help in their
path toward sobriety, groups also can provide a new sense of community to help
empower an individual to change their current patterns and behaviors (Sadock,
Sadock, & Ruiz, 2015). In addressing the mental health aspect of SUD, psychiatric
providers can address these issues with psychopharmacologic medications
dependent on the issue at hand.
For specific pharmacologic treatment options for SUD, in particular opiate use,
treatment options consist of methadone, suboxone, or naloxone. All of these agents
work to occupy opiate receptors or diminish one’s ability to feel a “high.”
Methadone is an opiate agonist utilized as a substitute therapy for other opiates.
This agent is tapered to a level that an individual feels normalized on. Methadone
can cause many of the side effects opiates do (as it is a synthetic opiate) and is
typically prescribed on a daily dosing schedule. Methadone can be associated with
QTc prolongation typically for doses that are greater than 100 mg/day. Suboxone is
consistent of buprenorphine (opiate agonist) and naloxone (opiate antagonist) and
is formulated into sublingual tablet or film. This agent is typically prescribed on a
weekly basis up to a monthly basis and allows for more control on the individual’s
end. Naloxone is an opiate antagonist that completely blocks the effect of an
individual becoming high from an opiate. This is an agent that is used emergently
for opiate overdose and for those interested in taking oral tablets for treatment,
individuals must be free from opiate use from 7 to 10 days in order to not
immediately experience withdrawal with its use (Puzantian & Carlat, 2020).
References
Bechara, A., Berridge, K. C., Bickel, W. K., Morón, J. A., Williams, S. B., & Stein, J. S.
(2019). A neurobehavioral approach to addiction: Implications for the opioid
epidemic and the psychology of addiction. Psychological Science in the Public
Interest, 20(2), 96–127.Thttps://doi.org/10.1177/1529100619860513
Centers for Disease Control and Prevention (CDC). (2019). HIV Cost-effectiveness.
Retrieved fromThttps://www.cdc.gov/hiv/programresources/guidance/costeffectiveness/index.html
Henry B. (2018). Drug pricing & challenges to hepatitis c treatment access. Journal
of Health & Biomedical Law, 14, 265–283. Retrieved
fromThttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6152913/
McCance-Katz, E. (2019). The national survey on drug use and health: 2018.
Substance Abuse and Mental Health Services Administration. Retrieved
fromThttps://www.samhsa.gov/data/sites/default/files/cbhsq-reports/Assistant-Secretary-
nsduh2018_presentation.pdf
National Institute for Drug Abuse on Teens (NIDA). (2020). Mind matters: The body's
response to opioids. Retrieved fromThttps://teens.drugabuse.gov/teachers/mind-matters/opioids
Sadock, B. J., Sadock, V. A. & Ruiz, P. (2015). Kaplan and Sadock’s synopsis of
psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA:
Wolters Kluwer.
Puzantian, T. & Carlat, D. (2020). Medication Fact Book for Psychiatric Practice (5th
edition). Newburyport, MA: Carlat Publishing, LLC.
Response:
Reply 2 Eric-Paul Olsson
I acknowledge that substance use disorder is a crisis in the United States. Over the past, the
topic has received increasing attention in the United States. Statistics show that close to 19.3
million people in America are affected with substance use disorder. A breakdown of this is that
14.4 million are struggling with alcohol use, 7.4 million Americans are struggling with illicit
drugs, and 2.5 million individuals are struggling with both illicit drugs and alcohol. However, the
often use of drugs can deliver diverse sensations for individuals.
It is true that substances that are used or abused are generally agents that provide desirable
and pleasant effect to individuals. Sure, the positive reinforcement at times becomes a negative
reinforcement scenario. Research shows that, approximately 50% of individuals with substance
issues have diagnosable mental illness. Nevertheless, addiction and substance abuse come with
unpleasant side effects. Individuals begin to have unpleasant withdrawal experience and adapt
having the agent. Utilizing the examples of heroin and opiates, it is evident that the substance is
quiet dangerous and can cause direct harm to the body.
Treatment for this issue can be costly, the best treatment option for an individual suffering
with substance abuse are mainly consistent of psychotherapeutic and pharmacologic
intervention. Most importantly, the use of support groups, psychotherapy for talks, and
motivational interviewing is fundamental for those with substance used disorder.
References
Kimura, D. (1967). Functional asymmetry of the brain in dichotic listening. Cortex, 3(2), 163-
178.
Hugdahl, Kenneth. “12 Dichotic Listening in the Study of Auditory Laterality. The asymmetrical
brain.
Bryden, M. P., Munhall, K., & Allard, F. (1983). Attentional biases and the right-ear effect in
dichotic listening. Brain and language, 18(2), 236-248.
Bonanno, G. A., Davis, P. J., Singer, J. L., & Shwartz, G. E. (1991). The repressor personality
and avoidant information processing: A dichotic listening study. Journal of Research in
Personality, 25(4), 386-401.
