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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Chapter 11
Substance-Related and Impulse-Control Disorders
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Perspectives on Substance-Related
Disorders: An Overview
 The Nature of Substance-Related Disorders
 Use and abuse of psychoactive substances
 Wide-ranging psychophysiological and behavioral
effects
 Associated with significant impairment and costs
 Some Important Terms and Distinctions
 Substance use vs. substance intoxication
 Substance abuse vs. substance dependence
 Tolerance vs. withdrawal
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Perspectives on Substance-Related
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
 DSM-IV-TR Criteria for Disordered Alcohol Use
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Sedative, Hypnotic, or Anxiolytic
Substance use Disorders: An Overview
 The Nature of Drugs in This Class
 Sedatives – Calming (e.g., barbiturates)
 Hypnotic – Sleep inducing
 Anxiolytic – Anxiety reducing (e.g.,
benzodiazepines)
 Effects Are Similar to Large Doses of Alcohol
 Combining such drugs with alcohol is synergistic
 All Influence the GABA Neurotransmitter System
 DSM-IV-TR Criteria for this Class of Disorders
 Main criteria and distinguishing features
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control 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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Stimulants: Nicotine Use Disorders
 Effects of Nicotine
 Stimulates nicotinic acetylcholine receptors
 Results in sensations of relaxation, wellness, pleasure
 Nicotine is highly addictive
 Relapse rates equal those for alcohol and heroin users
 DSM-IV-TR Criteria for Nicotine Withdrawal Only
 Psychological symptoms
 Physiological symptoms
 Nicotine Users Dose Themselves
 Maintain a steady level of nicotine in the Bloodstream
 Examples include smoking before sleep or after waking
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Stimulants: Caffeine Use Disorders
 Effects of Caffeine – The “Gentle” Stimulant
 Found in tea, coffee, cola drinks, and cocoa
products
 Blocks the reuptake of the neurotransmitter
adenosine
 Small doses elevate mood and reduce fatigue
 Used by over 90% of Americans
 Regular use can result in tolerance and
dependence
 DSM-IV-TR Criteria for Caffeine Intoxication
 Psychological symptoms
 Physiological symptoms
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Opioids: Diagnostic Criteria and Associated Features
 DSM-IV-TR Criteria for Opioid Intoxication and
Withdrawal
 Psychological symptoms
 Physiological symptoms
 Mortality rates are high for opioid addicts
 Users at increased risk for HIV infection
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Hallucinogens: An Overview
 Nature of Hallucinogens
 Substances that alter perceptions of the world
 Produce delusions, paranoia, hallucinations,
and/or altered sensory perception
 Examples include marijuana, LSD
 Marijuana
 Active chemical is tetrahydrocannabinol (THC)
 Symptoms – Mood swings, paranoia,
hallucinations
 Impairment in motivation is not uncommon
 Withdrawal and dependence are uncommon
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Hallucinogens: An Overview (cont.)
 LSD and Other Hallucinogens
 LSD is most common form of hallucinogenic drug
 Tolerance tends to be rapid
 Withdrawal symptoms are uncommon
 Can produce psychotic delusions & hallucinations
 DSM-IV-TR Criteria
 Marijuana and Hallucinogen Intoxication
 Psychological and physiological symptoms are
similar
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Other Drugs of Abuse: Inhalants
 Nature of Inhalants
 Found in volatile solvents
 Breathed into the lungs directly
 Examples include spray paint, hair spray, paint
thinner, gasoline, nitrous oxide
 Such drugs are rapidly absorbed
 Effects similar to alcohol intoxication
 Produce tolerance and prolonged withdrawal
symptoms
 DSM-IV-TR Criteria for Inhalant Intoxication
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
 Long-term mood disturbances and physical
problems
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
 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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
An Integrative Model of Substance-Related 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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Figure 11.11 An integrative model of substance-related disorders.
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Biological Treatment of Substance-Related
Disorders
 Agonist Substitution
 Substitute safer drug with a similar chemical
composition
 Examples include methadone and nicotine gum or
patch
 Antagonistic Treatment
 Drugs that block or counteract pleasurable drug
effects
 Examples include naltrexone for opiate and
alcohol problems
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Biological Treatment of
Substance-Related Disorders (cont.)
 Aversive Treatment
 Drugs that make use of drugs extremely
unpleasant
 Examples include Antabuse for alcoholism and
silver nitrate for nicotine addiction
 Efficacy of Biological Treatment
 Generally ineffective when used alone
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Psychosocial Treatment of Substance-Related
Disorders
 Inpatient vs. Outpatient Care
 Overall efficacy is comparable
 Controlled Use vs. Complete Abstinence as
Treatment Goals
 Community Support Programs
 Alcoholics Anonymous and related groups
 Seem helpful and are strongly encouraged
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Psychosocial Treatment of
Substance-Related Disorders (cont.)
 Comprehensive Treatment and Prevention Programs
 Individual and group therapy
 Aversion therapy and convert sensitization
 Contingency management
 Community reinforcement
 Relapse prevention
 Preventative efforts via education
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Summary of Substance-Related Disorders
 DSM-IV and DSM-IV-TR Substance Related Disorders
 Cover four classes
 Depressants, stimulants, opiates, and hallucinogens
 Diagnoses include dependence, abuse, intoxication, or
withdrawal
 Most Activate the Dopaminergic Pleasure Pathway
 Psychosocial factors interact with biological influences to
produce substance disorders
 Treatment of Substance Dependence
 Largely unsuccessful – Highly motivated persons do well
 Important to use a comprehensive treatment approach
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Impulse-Control Disorders
 DSM-IV-TR
 Intermittent explosive disorder
 Kleptomania
 Pyromania
 Pathological gambling
 Trichotillomania
 Each is Characterized by the Following
 Increased tension/anxiety prior to the act
 A sense of relief following the act
 Impairment of social and occupational functioning
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Impulse-control Disorders (cont’d.)
 Intermittent Explosive Disorder
 Rare condition
 Characterized by frequent aggressive outbursts
 Leads to injury and/or destruction of property
 Few controlled treatment studies exist
 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
Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow, V. Mark Durand
Chapter 11: Substance-Related and Impulse-Control Disorders
Impulse-control Disorders (cont’d.)
 Pyromania
 Involves having an irresistible urge to set fires
 Diagnosed in less than 4% of arsonists
 Little etiological and treatment research
 Pathological Gambling
 Estimated to affect 3-5% adult Americans
 Treatment is similar to that for substance dependence
 Treatment studies are currently underway
 Trichotillomania
 Inability to resist the urge to pull hair
 Observed in 1-5% of college students, mostly female
 Clomipramine and CBT have been shown to be helpful