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Transcript
Substance Disorders Psychoactive = alters behavior/mood • Use = ingesting psychoactive substances in moderate amounts - no life impairment - not a disorder • Intoxication = physiological reaction to ingesting excess substance • Abuse = recurrent & maladaptive pattern of use (life impairment/distress) • Dependence/addiction a) Physical - tolerance = increasingly greater amounts of drug needed for same desired effect - withdrawal = severe negative physiological reaction to removal of substance, alleviated by the substance b) Psychological addiction - drug-seeking behaviors Types of Psychoactive Substances • Depressants = decrease CNS activity - often physical dependence - death by decreased vital organ functioning & by withdrawal • Opioids = narcotics (reduce pain & induce sleep) - death by decreased respiration - very unpleasant withdrawal but not life-threatening • Stimulants = increase CNS activity - most common • Hallucinogenics/Psychodelics = change perception - no evidence of withdrawal - psychological dependence - quick tolerance to most - reverse tolerance to marijuana Alcoholism • • • • 10-14% U.S. adults (dependence or abuse) 1983 cost of alcoholism = $117 billion 1/3 medical problems/inpatient care 50-80% traffic injuries & deaths History • 17th c. US - heavy drinking commonplace • 18th & 19th c. - Change in view of alcohol “Demon Rum” Levine’s socioeconomic theory • Colonials thought behavior shaped by church (external locus of control) • Less blame for person • Industrialism => rise of individual (internal locus of control) • Alcoholism = loss of self-control Gusfield • Colonial Am. = rich elite & poor masses • Industrialization = middle class & “empowering of mass” • Temperance movement = keep elite in control • Alcohol is evil • Today: more moderate • Alcohol seen as direct cause of deviant behavior Models of Alcoholism I. Alcoholism as a Disease A. Rush, M.D. – 18th c. alcoholism as disease & moral problem • Alcohol causes drunkenness (external LOC) • Alcoholism is a disease • Result = lose control of behavior - not from person’s immorality - from alcohol’s addictive nature • Abstinence is only cure -> prohibition B. 1960 - Jellinek Most prevalent type includes physical tolerance & dependence/withdrawal - the individual (internal LOC) - alcoholics are different - loss of control as key C. Alexander (1988) Genetic Env. Stress Predisposition Susceptibility Addiction Upbringing (Env. Predisp) Exposure to Drugs & Access Life Problems • AA: Life problems -> bottoming out Either die or recover • The current, dominant model • Disease model allows for tx, reduces stigma (& responsibility) II. Cognitive Model of Alcoholism - Loss of control due to expectancies - AA/mainstream model leads to failure “One drink, one drunk” 3.Behavioral Models of Alcoholism a. Positive Reinforcement - drugs make us feel good - Addiction = recurrent use to recapture the feeling BUT - not all evidence supports b. Negative Reinforcement - drugs to escape unpleasant experiences => tension reduction/self-med Once physically dependent, withdrawal -> increased use But evidence does not support c. Associative learning (cues) - to maintain problem 4.Neural Sensitization - Current theory - Brain cells become sensitized to drug from repeated exposure - Mesolimbic system is involved in motivation - So increased motivation for drug - Systems cause wanting, not liking Initial use -> liking -> wanting (incentive value) Treatment of Alcoholism 1.Biological Treatment a. Agonist substitution - use other, similar drug - can develop tolerance - can become addicted b. Antagonist drugs - block or counteract drug - can reduce craving BUT - must be motivated - can cause withdrawal c. Aversive Treatment - Drugs that cause unpleasantness take the addictive drug - Again, must be motivated - Can include behavioral methods d. Classical/associative conditioning - change cues for drinking if 2.Alcoholics Anonymous - popular - Self-help group of lay people who provide support - Alcoholism = loss of control from allergy Solution: total abstinence Results from AA • Positive response • Negative response Fosters dependency & reduces responsibility • Research: little & difficult to conduct more positive outcome however, 75% drop out by 1 year 3.Cognitive/Behavioral Treatment A. Controlled Drinking - Teach some alcoholics to drink in a limited, social way - Expectancies lead to outcomes - Research = better than abstinence B. Relapse Prevention – Current - failure of coping skills - tx = change beliefs & focus on negative consequences - identify high-risk situations & develop strategies • Overall picture for treatment: 70-80% not helped long-term by any approach