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The Spectrum of Use and the Historical Context Lecture 2 Chapter 1 & 2 Drugs Are Old Drugs have been around since the dawn of time… Probably Coming on the Scene • • • • • • • • • Alcohol as early as 6400 years BC (Middle East) Cannabis 3000 years BC (Middle East) Opium 5000 BC (China) Tobacco 100 BC (Mexico) Coca 3000 BC Cocaine Extracted 1855 Heroin 1874 MDMA (XTC) 1912 LSD 1938 Despite the Laws People Still Use Does Use Mean Abuse? The Spectrum of Use • • • • Use – Periodic non-problematic use Misuse – Periodic Use Abuse – A pattern of misuse Dependence – Compulsive problematic use often with physiological dependence Use • Many drugs can be used relatively safely • Most people who use drugs do not develop problems, however this depends on the drug • Drugs are used for many reasons – – – – Social Religious Coping Experimentation Misuse • Periodic circumscribed negative consequences – College students and alcohol – “It only happened once.” – Sometimes the consequences are catastrophic DSM-IV Abuse 1. Failure to fulfill major role obligations 2. Use in hazardous situations 3. Legal Problems 4. Use despite problems 17 DSM-IV Dependence 1. Tolerance 2. Withdrawal 3. Larger amounts/longer period than intended 4. Inability to, or persistent desire to, cut down or control 5. A great deal of time spent obtaining, using, or recovering 6. Important activities given up or reduced 7. Use despite problems caused or exacerbated by use 18 How Does One Move Through the Spectrum? Public Health Model • Agent Factors – Properties of the drug or substance • Host Factors – Characteristics of the person • Environment Factors – Context/Situation Perspectives on SubstanceRelated Disorders: An Overview (cont.) • Five Main Categories of Substances – Depressants – Result in behavioral sedation – Stimulants – Increase alertness and elevate mood – Opiates – Primarily produce analgesia and euphoria – Hallucinogens – Alter sensory perception – Other drugs of abuse – Include inhalants, anabolic steroids, medications The Depressants: Alcohol Use Disorders • Psychological and Physiological Effects of Alcohol – Central Nervous system depressant – Affects several neurotransmitter systems – Specific target is GABA • Effects of Chronic Alcohol Use – Alcohol intoxication & withdrawal – Associated conditions – Dementia & Wernicke’s disease – Fetal alcohol syndrome Alcohol: Some Facts and Statistics • In the United States – Most adults view themselves light drinkers or abstainers – Over 50% of the U.S. (> 12 years age) report current use – 15 million Americans are alcohol dependent – Rates are highest among Caucasian & Native Americans – Males use and abuse alcohol more than females – Violence is associated with alcohol – Alcohol alone does not cause aggression Stimulants: An Overview • Nature of Stimulants – Most widely consumed drug in the United States – Such drugs increase alertness and increase energy – Examples include amphetamines, cocaine, nicotine, and caffeine • Stimulants: Amphetamine Use Disorders Effects of Amphetamines – Produce elation, vigor, reduce fatigue – Effects are followed by extreme fatigue and depression • DSM-IV-TR Criteria for Amphetamine Intoxication • Ecstasy and Ice – Produces effects similar to speed, but no “comedown” – 2% of college students report using Ecstasy – Both drugs can result in dependence • Amphetamines stimulate CNS by – Enhancing release of norepinephrine and dopamine – Reuptake is subsequently blocked Stimulants: Cocaine Use Disorders • Effects of Cocaine – Short lived sensations of elation, vigor, reduce fatigue – Blocks reuptake of dopamine – Highly addictive, but addiction develops slowly • DSM-IV-TR Criteria for Cocaine Intoxication and Withdrawal – Psychological symptoms – Physiological symptoms • Most Cycle Through Patterns of Tolerance and Withdrawal Opioids: An Overview • The Nature of Opiates and Opioids – – – – Opiate – Narcotic like chemical in the opium poppy Opioids – Substances that produce narcotic effects Often referred to as analgesics (i.e., help relieve pain) Examples include heroin, opium, codeine, and morphine • Effects of Opioids – – – – Activate body’s enkephalins and endorphins Low doses – Euphoria, drowsiness, and slow breathing High doses can be fatal Withdrawal symptoms can be lasting and severe Other Drugs of Abuse: Designer • Designer Drugs Drugs – Drugs produced by pharmaceutical companies for diseases – Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine (“special K”) are examples – All heighten auditory and visual perception (taste and touch) – Popular in nightclubs, raves, or large social gatherings – All designer drugs can produce tolerance and dependence Causes of Substance-Related Disorders: Family and Genetic Influences • Results of Family, Twin, and Adoption Studies – – – – Substance abuse has a genetic component Much of the focus has been on alcoholism Genetic differences in alcohol metabolism Multiple genes are involved in substance abuse Causes of Substance-Related Disorders: Neurobiological Influences • Results of Neurobiological Research – Drugs affect the pleasure or reward centers in the brain – The pleasure center – Dopamine, midbrain, frontal cortex – GABA turns off reward-pleasure system – Inhibition of neurotransmitters for anxiety / negative affect Causes of Substance-Related Disorders: Psychological Dimensions • Role of Positive and Negative Reinforcement – The self-medication and the tension reduction hypotheses – Substance abuse as a means to cope with negative affect • Opponent-Process Theory – Why the crash after drug use fails to stop drug use • Role of Expectancy Effects – Expectancies influence drug use and relapse Causes of Substance-Related Disorders: Social and Cultural Dimensions • Exposure to Drugs is a Prerequisite for Use of Drugs – Media, family, peers – Parents and the family appear critical • Societal Views About Drug Abuse – Sign of moral weakness – Failure of self-control – Sign of a disease – Caused by underlying processes • The Role of Cultural Factors – Influence the manifestation of substance abuse An Integrative Model of SubstanceRelated Disorders • Exposure or Access to a Drug – Is necessary, but not sufficient for abuse and addiction • Drug Use Depends on Social and Cultural Expectations • Drugs Are Used Because of their Pleasurable Effects • Drugs Are Abused for Reasons that are More Complex – The premise of equifinality – Stress may interact with psychological, genetic, social, and learning factors From A Psychological Standpoint • Drug abuse and dependence are disorders of behavior • Not only do each have health implications, abuse and dependence have extreme psychosocial implications • People make changes in their alcohol/drug abuse behavior in the same way they make changes in all other behaviors • Much alcohol and drug abuse/dependence is related to psychopathology • Most people stop on their own Substance Abuse Treatment • “Self-Help” (AA NA CA Rational Recovery) • Psychosocial Interventions • Medications Self-Help 12 Step Fellowships • Alcoholics Anonymous Narcotics Anonymous – View of Problem: Spiritual disease – Tools: 12 steps to recovery – Mechanism: Powerful social support – Issues: Effective for those who stick. Can be difficult to stick Psychosocial Interventions • Behavioral and Cognitive Behavioral – View of Problem: Behavioral disorder. – Tools: Functional analysis, contingency management and cognitive interventions as well as relapse prevention – Mechanisms: Skills improvement, attitude change, coping w/psychopathology – Issues: Highly researched treatments. Very effective. Not sure how they work actually. Psychosocial Interventions • Motivational Interviewing – Alternative to confrontational approach – Designed to move individual through stages of change – Brief (1-4 sessions) – Effective as stand-alone and a booster to treatment Pharmacotherapy • Alcohol Dependence – Antabuse – Naltrexone • Drug Dependence – Methadone & Naltrexone (Heroin) – Antidepressants (Cocaine) – Cocaine vaccine????? • • • • • • • • Outcome Abstinence vs. Harm Reduction AA/NA, CBT, MI are all effective Meds can be as well Stage-matched interventions The longer people stick the better they do Most often takes multiple treatments Social support after treatment is critical Treatment works better than jail in the short and long run