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SUBSTANCE-RELATED
AND
ADDICTIVE DISORDERS
CHAPTER 12
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written consent of McGraw-Hill Education
SUBSTANCE USE DISORDERS
• Substance
• Substance abuse
• Substance dependence
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written consent of McGraw-Hill Education
SUBSTANCE USE DISORDERS
• Withdrawal
• Tolerance
• Substance intoxication
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SUBSTANCE USE DISORDER
• A cluster of cognitive, behavioral, and physiological symptoms
indicating that the individual continues using a substance even
though it causes significant problems in his or her life.
• Clinicians diagnose substance use disorders by assessing the
individual in four categories of symptoms:
1.
2.
3.
4.
impaired control,
social impairment,
risky use
pharmacological changes.
• New diagnostic term has fewer negative connotations than the
term “addiction”
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DISORDERS ASSOCIATED WITH
SPECIFIC SUBSTANCES
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written consent of McGraw-Hill Education
SUBSTANCE ABUSE
• 8.9 percent of the population are current users of illicit
drugs.
• Marijuana is the most commonly used illicit drug
• Most drugs of abuse directly or indirectly target the reward
center of the brain by flooding its circuits with dopamine.
• Overstimulation of the reward system produces the
euphoric effects that abusers seek and leads them to
repeat the behavior in order to repeat the experience.
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FIGURE 12.2 - EFFECTS OF DRUGS OF
ABUSE ON DOPAMINE PATHWAYS
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written consent of McGraw-Hill Education
FIGURE 12.3 COMORBIDITY
OF SUBSTANCE USE AND
PSYCHOLOGICAL DISORDERS
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ALCOHOL EFFECTS
• Alcohol is a depressant
• A psychoactive substance that causes the depression of
central nervous system activity.
• Immediate effects
• Sedating
• Central nervous system depressant
• Potentially fatal in excess
• Potentiation compounds these effects
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ALCOHOL EFFECTS
• Long-term effects
• Permanent brain damage
• Dementia
• Wernicke’s disease
• Korsakoff’s synodrome
• Harmful changes in the liver, gastrointestinal system, bone
density, muscles, and immune system
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FIGURE 12.4 CURRENT, BINGE, AND HEAVY
ALCOHOL USE AMONG PERSONS AGED 12 OR
OLDER, BY AGE: 2010
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THEORIES AND TREATMENT OF
ALCOHOL DEPENDENCE
• Biological
• Genetic factors
• Medications
• Naltrexone
• Disulfiram
• Acamprosate
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THEORIES AND TREATMENT OF
ALCOHOL DEPENDENCE
• Psychological
• Dual-process theory
• Alcohol myopia theory
• Treatment
•
•
•
•
•
Cognitive-behavioral interventions
Motivational approaches
Expectancy manipulation
Relapse prevention
Combined behavioral intervention
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THEORIES AND TREATMENT OF
ALCOHOL DEPENDENCE
• Sociocultural
• Family, community, & cultural stressors
• Children of alcoholics at greater risk
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written consent of McGraw-Hill Education
SUBSTANCES OTHER THAN ALCOHOL
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written consent of McGraw-Hill Education
STIMULANTS
• This category of drugs includes substances that
have an activating effect on the nervous system.
• Amphetamine
• Methamphetamine
• Cocaine
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FIGURE 12.5 LONG-TERM EFFECTS OF
METHAMPHETAMINE
ON THE BRAIN
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written consent of McGraw-Hill Education
FIGURE 12.6 - COCAINE IN THE BRAIN
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CANNABIS
• Marijuana
• Hashish
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TABLE 12.3 - SUMMARY OF EFFECTS OF
CANNABIS ON EXECUTIVE FUNCTIONS
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HALLUCINOGENS
• Hallucinogens are drugs that cause people to
experience profound distortions in their perception of
reality.
•
•
•
•
•
LSD
Peyote
Psilocybin
PCP
MDMA
• Included in hallucinogen-related disorders are use and
intoxication, but not withdrawal.
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OPIOIDS
• An opioid is a substance that relieves pain.
• Within opioid-related disorders are opioid use,
intoxication, and withdrawal.
•
•
•
•
•
Hydrocodone
Oxycodone
Morphine
Codeine
Heroin
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SEDATIVES, HYPNOTICS, &
ANXIOLYTICS
• Sedatives have calming effects on the central
nervous system
• Hypnotics induces sleep
• Anxiolytics are anti-anxiety medications
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CAFFEINE
• Found in coffee, tea, chocolate, energy drinks, diet
pills, and headache remedies.
• Increases:
• An individual’s perceived level of energy alertness
• Blood pressure and may lead to increases in the body’s
production of cortisol
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TOBACCO
• Nicotine: Psychoactive substance found in
cigarettes
• Stimulates the release of adrenaline (norephinephrine)
• Increases blood pressure, heart rate, and respiration
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INHALANTS
•
•
•
•
Volatile solvents
Aerosols
Gases
Nitrites
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THEORIES AND TREATMENT
• Biological
• Genetic abnormalities
• Opioid receptor on chromosome 1 (OPRM1)
• Chromosome 15 in a cluster of nicotinic receptor subunits
(CHRNA-3, -5, and -4)
• Catechol-o-methyltransferase (COMT)
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THEORIES AND TREATMENT
• To prevent heroin relapse
• Methadone
• Buprenorphine
• Naltrexone
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THEORIES AND TREATMENT
• Psychological
• Contingency management
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BIOPSYCHOSOCIAL PERSPECTIVE
• Useful for:
• Understanding substance dependence
• Approaches to treatment
• Genetics
• Action of substances on the central nervous system
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written consent of McGraw-Hill Education
NON-SUBSTANCE-RELATED
DISORDERS
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without the prior written consent of McGraw-Hill Education
GAMBLING DISORDER
• A non-substance-related disorder involving the
persistent urge to gamble.
• This disorder is included with substance use disorders
as it is now conceptualized as showing many of the
same behaviors, such as:
• Cravings
• Increasing needs to engage in the behavior
• Negative social consequences.
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GAMBLING DISORDER
• People with gambling disorder also have high rates
comorbidity:
•
•
•
•
Nicotine dependence (60 percent)
Dependence on other substances (58 percent)
Mood disorder (38 percent)
Anxiety disorder (37 percent)
• Mood and anxiety disorders are more likely to
precede, rather than follow, the onset of gambling
disorder
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BIOPSYCHOSOCIAL MODEL
• Pathways model is anApproach to gambling
disorder that predicts that there are three main
paths leading to three subtypes.
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TABLE 12.4 COMMON COGNITIVE
DISTORTIONS IN PEOPLE WITH GAMBLING
DISORDER
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SUBSTANCE DISORDERS:
THE BIO-PSYCHOSOCIAL PERSPECTIVE
• Various treatment programs for people with
substance-related have emerged.
• Biological treatment may involve the prescription of
substances that block or reduce cravings.
• Behavioral treatment involves techniques such as
contingency management, cognitive behavioral therapy,
and relapse prevention.
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