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1. Impulsive-com-
pulsive disorder
construct
2. Shifting from im-
pulsivity to com-
pulsivity.
3. Neurotransmit-
ter regulation of
mesolimbic
reward
4. Addiction •Addiction
•Behavior pattern characterized by continued use of a psychoactive substance
despite physical, psychologic, or social harm
•Boston Collaborative Drug Study
•12,000 hospitalized patients taking opioids
•4 patients became abusers
•Probable that behaviors reflect tendencies existing before patients entered hos-
pital, not due to opioids received in hospital
•2 theorized population groups
•Individuals prone to drug abuse - estimate 8% of population
•Individuals not prone to drug abuse - estimate 92% of the population
5. How Addicting
are Different Sub-
stances?
, NURS752:Impulsivity, Compulsivity, Addiction
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6. Stimulants
7. Cocaine •Extracted from leaves of coca plant
•CNS effect similar to that of amphetamines
•Two forms used by abusers:
•Cocaine
•"Crack"
•Can produce local anesthesia, vasoconstriction, and cardiac stimulation
8. Cocaine •Cocaine
•Cocaine hydrochloride
•White powder
•Diluted for sale
•Taken intranasally
•Cocaine base: Commonly called "crack"
•Heated for use
•Taken by IV injection
9. Cocaine Acute toxicity
Mild overdose: Agitation, dizziness, tremor, blurred vision
Severe overdose: Hyperpyrexia, convulsions, ventricular dysrhythmias, hemor-
rhagic stroke, angina pectoris, myocardial infarction
Treatment: Intravenous diazepam or lorazepam, nitroprusside, hypertonic sodium
bicarbonate, aspirin, external cooling
10. Cocaine •Chronic toxicity
•Intranasally: Atrophy of the nasal mucosa and loss of sense of smell
, NURS752:Impulsivity, Compulsivity, Addiction
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•Extreme cases: Necrosis and perforation of the nasal septum
•Injury to the lungs can occur from smoking cocaine base
•Use during pregnancy
11. Cocaine •Tolerance, dependency, and withdrawal
•Treatment of cocaine addiction
•Anticocaine vaccine - in development
•Removes cocaine before it reaches the brain
•Current research
•Naltrexone - stimulant addiction
•Buprenorphine - cocaine/opioid addiction
•Naltrexone/Buprenorphine - cocaine addiction not on opioids
•
12. Methampheta- •Amphetamines, Methylphenidate
mines •In abuse, usually taken orally, snorted, smoked, or IV
•The faster the drug's entry into the brain, the stronger are its reinforcing effects
•Also called "ice" or "crystal meth"
•Form of dextroamphetamine
•Smoked, snorted, or inserted into rectum
•Effects
•Arousal, euphoria, sense of increased physical strength and mental capacity
•Hallucinations, psychotic state, sympathomimetic actions
•
13. Methampheta- •Adverse cardiovascular effects
mines •Hypertension
•Angina pectoris
•Dysrhythmias
•Cerebral and systemic vasculitis and renal failure, stroke
•Vasoconstriction can be relieved with an alpha-adrenergic blocker (for example,
phentolamine)