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Substance-Related Disorders Perspectives on Substance-Related Disorders • The Nature of Substance-Related Disorders – Problems related to the use and abuse of psychoactive substances – Produce wide-ranging physiological, psychological, and behavioral effects • Some Important Terms and Distinctions – Substance use vs. substance intoxication – Substance abuse vs. substance dependence – Tolerance vs. withdrawal Perspectives on Substance-Related Disorders (cont.) • Five Main Categories of Substances – Depressants – Result in behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs) – Stimulants – Increase alertness and elevate mood (e.g., cocaine, nicotine, caffeine) – Opiates – Primarily produce analgesia and euphoria (e.g., heroin, morphine, codeine) – Hallucinogens – Alter sensory perception (e.g., marijuana, LSD) – Other drugs of abuse – Include inhalants, anabolic steroids, medications • **Ice, LSD, chocolate, TV: Is everything addictive? Figure 10.1 Easy to get hooked on, hard to get off Figure 10.2 The Depressants: Alcohol Use Disorders • Psychological and Physiological Effects of Alcohol – Central Nervous system depressant – Influences several neurotransmitter systems, but mainly GABA • Effects of Chronic Alcohol Use – Alcohol intoxication – Alcohol withdrawal – Associated brain conditions – Demenita and Wernicke’s disease – Fetal alcohol syndrome • DSM-IV Criteria for Disordered Alcohol Use The path traveled by alcohol throughout the body Figure 10.3 Alcohol: Some Facts and Statistics • In the United States – Most adults consider themselves light drinkers or abstainers – Most alcohol is consumed by 11% of the U.S. population – Alcohol use is highest among Caucasian Americans – Males use and abuse alcohol more so than females – Violence is associated with alcohol, but alcohol alone does not cause aggression • Statistics on Abuse and Dependence – 10% of Americans experience problems with alcohol – Most persons with alcoholism can moderate or cease drinking – 20% of those with alcohol problems experience spontaneous recovery Sedative, Hypnotic, or Anxiolytic Substance use Disorders: An Overview • The Nature of Drugs in This Class – Sedatives – Calming – Hypnotic – Sleep inducing (e.g., barbiturates) – Anxiolytic – Anxiety reducing (e.g., benzodiazepines) • Effects of Such Drugs Are Similar to Large Doses of Alcohol – Combining such drugs with alcohol is synergistic • All Exert Their Influence Via the GABA Neurotransmitter System • DSM-IV Criteria for Sedative, Hypnotic, or Anxiolytic Substance Use Disorders 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 – Such effects are followed by a “crash” (e.g., feeling depressed and tired) – Enhance the release of dopamine and norepinephrine, while blocking reuptake • DSM-IV Criteria for Amphetamine Intoxication – Psychological symptoms – Physiological symptoms • Ecstasy and Ice – Produces effects similar to speed, but without the crash – 2% of college students report using Ecstasy – Both drugs can result in dependence Stimulants: Cocaine Use Disorders • DSM-IV Criteria for Cocaine Intoxication and Withdrawal – Psychological symptoms – Physiological symptoms – Most cocaine users cycle through patterns of tolerance and withdrawal • Effects of Cocaine – Produce short lived sensations of elation, vigor, reduce fatigue – Cocaine use in the United States has declined over the last decade – Effects result from blocking the reuptake of dopamine – Cocaine is highly addictive, but addiction develops slowly Stimulants: Nicotine Use Disorders • Effects of Nicotine – Stimulates the central nervous system, specifically nicotinic acetylcholine receptors – Results in sensations of relaxation, wellness, pleasure – Nicotine is highly addictive • DSM-IV Criteria for Nicotine Withdrawal Only – Psychological symptoms – Physiological symptoms – Nicotine users dose themselves to maintain a steady state of nicotine Relapse rates for nicotine compared to alcohol and heroin Figure 10.6 Stimulants: Caffeine Use Disorders • Effects of Caffeine – The “Gentle” Stimulant – Used by over 90% of Americans – Found in tea, coffee, cola drinks, and cocoa products – Small doses elevate mood and reduce fatigue – Regular use can result in tolerance and dependence – Caffeine blocks the reuptake of the neurotransmitter adenosine • DSM-IV Criteria for Caffeine Intoxication – Psychological symptoms – Physiological symptoms Opiods: An Overview • The Nature of Opiates and Opiods – Opiate – Natural chemical in the opium poppy with narcotic effects (i.e., pain relief) – Opiods – Refers to a class of natural and synthetic substances with narcotic effects – Such drugs are often referred to as analgesics – Examples include heroin, opium, codeine, and morphine • Effects of Opiods – Low doses induce euphoria, drowsiness, and slowed breathing – High doses can result in death – Withdrawal symptoms can be lasting and severe – Activate body’s enkephalins and endorphins • DSM-IV Criteria for Opiod Intoxication and Withdrawal – Psychological symptoms – Physiological symptoms – Mortality rates are high for opiod addicts Hallucinogens: An Overview • Nature of Hallucinogens – Substances that change the way the user perceives the world – May produce delusions, paranoia, hallucinations, and altered sensory perception – Examples include marijuana, LSD • Marijuana – Active chemical is tetrahydrocannabinol (THC) – May produce several systems (e.g., mood swings, paranoia, hallucinations) – Impairment in motivation is not uncommon (i.e., amotivational syndrome) – Major signs of withdrawal and dependence do not typically occur Hallucinogens: An Overview (cont.) • LSD and Other Hallucinogens – LSD is most common form of hallucinogenic drug – Tolerance tends to be rapid, and withdrawal symptoms are uncommon – Psychotic delusional and hallucinatory symptoms can be problematic • DSM-IV Criteria for Marijuana and Hallucinogen Intoxication – Psychological and physiological symptoms are similar Other Drugs of Abuse: Inhalants • Nature of Inhalants – Substances found in volatile solvents that are breathed into the lungs directly – Examples include spray paint, hair spray, paint thinner, gasoline, nitrous oxide – Such drugs are rapidly absorbed with effects similar to alcohol intoxication – Tolerance and prolonged symptoms of withdrawal are common – DSM-IV criteria for inhalant intoxication Other Drugs of Abuse: Anabolic Steroids • Nature of Anabolic-Androgenic Steroids – Steroids are derived or synthesized from testosterone – Used medicinally or to increase body mass – Users may engage in cycling or stacking – Steroids do not produce a high – Steroids can result in long-term mood disturbances and physical problems Other Drugs of Abuse: Designer Drugs • Designer Drugs – Drugs produced by pharmaceutical companies for diseases – Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine (“special K”) are examples – Such drugs heighten auditory and visual perception, sense of taste/touch – Becoming 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 – Neurotransmitters responsible for anxiety/negative affect may be inhibited Causes of Substance-Related Disorders: Psychological Dimensions • Role of Positive and Negative Reinforcement – Most see substance abuse as a means to cope with negative affect – The self-medication and the tension reduction hypotheses • Opponent-Process Theory – Explains why the crash after drug use fails to keep people from using • Role of Expectancy Effects – Expectancies influence drug use and relapse Causes of Substance-Related Disorders: Social and Cultural Dimensions • Exposure to Drugs in a Prerequisite for Use of Drugs – Media, family, peers – Parents and the family appear critical • Societal Views About Drug Abuse – Sign of moral weakness – Drug abuse is a failure of self-control – Sign of a disease – Drug abuse is caused by some underlying process • The Role of Cultural Factors – Influence the manifestation of substance abuse An Integrative Model of Substance-Related Disorders • Exposure or Access to a Drug Is a Necessary, but not Sufficient • 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 An integrative model of substance related disorders Figure 10.7 Biological Treatment of Substance-Related Disorders • Agonist Substitution – Safe drug with a similar chemical composition as the abused drug – Examples include methadone for heroin addiction, and nicotine gum or patch • Antagonistic Treatment – Drugs that block or counteract the positive effects of substances – Examples include naltrexone for opiate and alcohol problems • Aversive Treatment – Drugs that make the injection of abused substances extremely unpleasant – Examples include antabuse for alcoholism and silver nitrate for nicotine addiction • Efficacy of Biological Treatment – Such treatments are not generally not effective when used alone Psychosocial Treatment of Substance-Related Disorders • Inpatient vs. Outpatient Care – Data suggest little difference in terms of overall effectiveness • Community Support Programs – Alcoholics Anonymous and related groups – Seem helpful and are strongly encouraged • Debate Over Controlled Use vs. Complete Abstinence as Treatment Goals Psychosocial Treatment of Substance-Related Disorders • Components of Comprehensive Treatment and Prevention Programs – Individual and group therapy – Aversion therapy and convert sensitization – Contingency management – Community reinforcement – Relapse prevention – Preventative efforts via education Summary of Substance-Related Disorders • DSM-IV and DSM-IV TR Substance Related Disorders Cover Four Classes – Depressants, stimulants, opiates, and hallucinogens – Specific diagnoses include dependence, abuse, intoxication, or withdrawal • Most Psychotropic Drugs Activate the Dopaminergic Pleasure Pathway in the Brain • Psychosocial Factors Interact with Biological Influences to Produce Substance Disorders • Treatment of Substance Dependence Is Largely Unsuccessful – Highly motivated persons do best when part of combined treatment programs • Substance-Related Disorders Are 100% Preventable Summary of Substance-Related Disorders (cont.) Figure 11.x1 (cont.) Exploring substance-related disorders Summary of Substance-Related Disorders (cont.) Figure 11.x2 Exploring substance-related disorders, treatment Summary of Substance-Related Disorders (cont.) Figure 11.x2 (cont.) Exploring substance-related disorders, treatment Web sites • • • • National Clearinghouse for Alcohol and Drug Information – www.health.org National Institute on Drug Abuse – www.nida.nih.gov Inhalants – www.inhalants.org Substance Abuse and Mental Health Services Administration – www.samhsa.gov Impulse-Control Disorders • DSM-IV-TR – Intermittent explosive disorder – Kleptomania – Pyromania – Pathological gambling – Trichotillomania Impulse-Control Disorders (continued) • Each is Characterized by – Increased tension/anxiety prior to the act – A sense of relief following the act – Impairment of social and occupational functioning Impulse-control Disorders: Intermittent Explosive Disorder • Intermittent Explosive Disorder – Rare condition – Characterized by frequent aggressive outbursts – Leads to injury and/or destruction of property – Few controlled treatment studies Impulse-control Disorders: Kleptomania • Kleptomania – Failure to resist urge to steal unnecessary items – Seems rare, but it is not well studied – Highly comorbid with mood disorders – Also co-occurs with substance-related problems Impulse-control Disorders: Pyromania, Pathological Gambling • Pyromania – Involves having an irresistible urge to set fires – Diagnosed in less than 4% of arsonists – Little etiological and treatment research • Pathological Gambling – Affect 3-5% adult Americans – Treatment is similar to that for substance dependence Trichotillomania (continued) • Trichotillomania – Inability to resist the urge to pull hair – Observed in 1-5% of college students, mostly female – Clomipramine (Anafranil) and CBT have been shown to be helpful