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Substance Abuse
Terms

Substance dependence- (Addiction older term
replaced by substance dependence) more severe,
refers to a pattern of repeated self-administration that
often results intolerance.
– Tolerance- (short def.) the need for increased amounts of
the drug to achieve intoxication; withdrawal, unpleasant
physical and psychological effects that the person
experiences when they try to stop taking the drug.

Substance abuse- less severe pattern of drug use that
is defined in terms of interference with the person’s
ability to fulfill major role obligations at work or at
home, the recurrent use of a drug in dangerous
situations. and repeated legal difficulties associated
with the drug use.
Terms (cont.)

Drug of Abuse-sometimes called psychoactive
substances, are chemical substances that alter a
person’s mood, level of perception or brain
functioning.
– CNS Depressants-depressants of the CNS that include
alcohol, hypnotics, and anxiolytics.
– CNS Stimulants-include illegal drugs such as
amphetamine and cocaine as well as nicotine and
caffeine.
– Opiates-clinically used to decrease pain, can cause
euphoria
– Cannabinoids-marijuana produce euphoria and an
altered sense of time.
Terms (cont)
– Hallucinogens-euphoria and hallucinations from mild
to very severe r.
Polysubstance Abuse- the observation that
people with a substance abuse disorder
frequently abuse several types of drugs.
 Commonalities- Forms of abuse share many
common elements. All forms of abuse represent
an inherent conflict between immediate pleasure
and longer term harmful consequences.

Typical Symptoms and Associated
Features `

Number of problems encountered as a
consequence of the disorder. Loosely
divided into two general areas:
– Patterns of Consumption-to include
psychological and physiological dependence.
– Consequences following a prolonged pattern
of abuse including social and occupational
impairment, legal and financial difficulties and
deteriorating medical conditions.
Symptoms & Associated Features
Dependence –people who state they are dependent on a drug often say they take
the drug to control how they are feeling. (psychological)
 Tolerance and Withdrawal– Tolerance-process through which the nervous system becomes less sensitive to
the effects of alcohol or any other drug of abuse. Three separate mechanisms
for developing tolerance: Two are pharmacological and the third is behavioral
 Metabolic Tolerance-develops when the liver produces more enzymes to
break down the drug, therefore the drug is metabolized more quickly and
larger doses are required to maintain the same level of the drug in the body.
 Pharmacodynamic tolerance- receptors in the brain adapt to the continued
presence of the drug and thereby down regulate (decrease)the number of
receptors to that drug, reducing sensitivity to the drug.
 Behavioral Conditioning Mechanisms- cues regularly associated with the
administration or consumption of the drug begin to function as CS and elicit
a CR that is in the opposite direction of the natural effect of the drug
Compensatory response.
Withdrawal- symptoms experienced when a person stops using a drug and are
considerably different depending on the substances. Unpleasant reactions
are most evident during withdrawal from alcohol, opioids and the general
class of sedatives, hypnotics, and anxiolytics. Symptoms can include hand
tremors, sweating, nausea, anxiety and insomnia, with more serious
symptoms including convulsions, hallucinations and delirium.

. Common Drugs of Abuse

Alcohol- affects virtually every organ in the body.
– Absorption- through membranes in the stomach, small intestine, and colon.
Influenced by alcohol content( higher content faster absorption), volume and
rate of consumption as well as presences of food in digestive system.
– Metabolism-in the liver, rates of metabolism vary, but is somewhere around 1 0z
of liquor or 12 ozs of beer per hour.
– Short Term Effects—slowed reaction times and interference with driving times,
slowed cognitive processes and slurred speech. Neurological and respiratory
problems can occur a high blood alcohol levels of 400 mg per 100 ml. of blood
– Consequences of Prolonged Use
 Disruption of relationships with family and friends to include marital
conflicts.
 Interference with Job performance
 Legal problems-DWI, as well as spousal or child abuse
 Health related problems including deterioration of the liver, pancreas,
gastrointestinal system, cardiovascular system, and endocrine system
 Dementia-Korsakoff’s syndrome
 Leads to enormous number of severe injuries, and premature deaths in
every region of the world.
Nicotine

active ingredient in tobacco, almost never taken in pure form as it can be toxic. Can be
inhaled or chewed, inhalation is the fasted route of administration as it results in highest
concentration of nicotine carried directly from the lungs to the heart and then to the brain.
– Short Term Effects Peripheral Nervous System-increased heart rate and blood pressure
 CNS-affects several NT systems including, DA, NE and which causes both arousal and
stimulation of pleasure via the mesolimbic pathway (reward pathway). Also effects
serotonin, therefore having some anti-depressant effects.
 Complex influence on subjective mood states as smokers report it helps them relax
when in fact it is an arousing drug, however they could be relieving unpleasant
withdrawal symptoms such as anxiety and mild tremors, drowsiness,
lightheadedness, headache, and nausea.

– Consequences of Prolonged abuse-One of the most harmful and deadly addicting drugs
 Psychologically addictive-thought to be as difficult to quit smoking as it is to stop
using heroin.
 People who are attempting to quit experience very unpleasant symptoms such as
insomnia, weigh gain, concentration difficulties, and erratic mood.
 Increases risk of developing heart and lung disease and various types of cancer,
especially lung. Women who smoke also have increased problems with fertility and
give birth to low birth weight babies, as well as increased vulnerability to birth
defects.
Amphetamine and Cocaine
–
–
–
–
Amphetamine-produced synthetically
Cocaine-naturally occurring stimulant drug that is extracted from the leaf of the coca plant
Short term effects –stimulants in general activate the sympathetic nervous system, thus increasing heart
rate an dilating blood vessels . They also suppress appetite and prevent sleep
 Induce positive mood states.
 Low doses of amphetamine make people feel more confident, friendly and energetic higher
doses cause euphoria.
 Snorting or injecting cocaine extreme euphoria
 Tolerance to Euphoric effects develops quickly and is followed several hours later by the onset of
lethargy, and a mildly depressed, or irritable mood.
Consequences of Long Term Effects- High dose of both can lead to the onset of psychosis. The
psychotic episode or syndrome, may appear in people with no prior history of mental disorder and
usually disappears a few days after the drug has cleared the person’s system. Stimulants can also
increase the severity of symptoms among people who had already developed some type of psychotic
condition and can include both visual and auditory hallucinations as well as delusions of grandeur or
persecution.
 Disruption of occupational and social roles.
 Compulsion to continue using cocaine can lead to physical exhaustion and financial ruin.
 Cocaine dependent users must spend enormous amounts of money to support their habit which
may result in loss of all assets or criminal activity.
 Prolonged amphetamine use has been linked to violent behavior.
 Withdrawal from stimulants is not severe, most common reaction is depression , and long term use
can lead to profound depression or suicide on discontinuation.
Opiates

Drugs that have properties similar to opium, the natural source is
the poppy flower and the main active ingredients are morphine and
codeine. Opiates can be ingested orally, injected or inhaled.
– Short-term effects-induce a state of dream-like euphoria which
can be accompanied by an increased sensitivity in hearing and
vision. However, the positive emotional effects do not last and
are soon replaced by negative changes in mood and emotion.
The opiates can also induce nausea, and vomiting as well as
constricting of the pupils.
– Consequences of Long Term Effects- Addiction at high doses
causes chronic lethargy and loss of motivation to be productive.
However people who have a low dose addiction can remain
relatively healthy and function at work in spite of the addition.
People who are addicted to opiates at any level become
preoccupied with finding and using the drug in order to
experience the rush and to avoid withdrawal symptoms.
Barbiturates and Benzodiazepenes
– Tranquilizers-used to decrease anxiety or agitation.
– Sedatives- more general term used for drugs that calm people
and reduce excitement, ( other than the relief from anxiety)
– Hypnotics-Help people to sleep
– Short Term Effects- Sedatives and Hypnotics can lead to a state
of intoxication that is identical to that associated with alcohol
and is characterized by impaired judgment, slowness of speech,
lack of coordination, a narrowed range of attention, and
disinhibition of sexual and aggressive impulses. The
benzodiazepines can sometimes lead to an increase in hostile
and aggressive behavior referred to aggressive dyscontol.
– Cosequences of Long Term Use and Abuse-discontinuance
syndrome-symptoms experienced by people who abruptly stop
taking high doses of benzo’s which can include a seizure and in
some cases worsening of the original anxiety symptoms or
development of new symptoms that are directly associated with
drug withdrawal such as irritability, paranoia, sleep disturbance,
agitation, muscle tension, restlessness, and perceptual
disturbances.
Cannabis

Marijuana and hashish are derived from the hemp plant
and the most common active ingredient is THC.
– Short Term Effects-subjective effects almost always pleasant and
refers to pervasive sense of well being. Laboratory research
indicated that some people become anxious or paranoid.
Temporal disintegration often accompanies cannabis intoxication
which caused people to have trouble retaining and organizing
information, even over relatively short periods of times.
– Consequences of Prolonged Use and Abuse-Issues of addictive
properties remain controversial. Tolerance effects in humans
remain ambiguous with most evidence suggesting that people
do not develop tolerance to THC unless exposed to high doses
over an extended period of time. Withdrawal is also unlikely
unless people have been exposed to continuous high doses of
THC. These symptoms may include irritability, restlessness, and
insomnia.
Hallucinogens and Related Drugs

cause people to experience hallucinations at relatively low doses. The
molecular structure of many hallucinogens is similar to the molecular
structure of various neurotransmitters such as serotonin and NE.
– Short Term Effects- difficult to study as the effects are based primarily
on subjective experience. Most hallucinogens are not particularly toxic
as people do not die from taking an overdose of LSD, psilocybin or
mescaline. However, high doses can lead to coma, convulsions,
respiratory arrest and brain hemorrhage. Ecstasy can damage serotonin
neurons on a permanent basis and has been associated with some
deaths.
– Consequences of Prolonged Use-Pattern of use is different than other
drugs as they are most often used sporadically and on special
occasions, with the exception of PCP. Tolerance develops quickly and if
used daily their effect disappears after 2-3 days. Most people do not
increase their usage of hallucinogens over time, and there seem to be
no withdrawal symptoms associated with the hallucinogens. There have
been cases where the use of the drugs has brought on persistent
psychotic behavior, but it is thought the drug was a trigger for an
already pre-existent condition. Flashbacks are also known to occur long
after a person has used the drug at unpredictable intervals long after
the drug has cleared the bodies system. There is currently no
explanation for this phenomenon.
History of Legal and Illegal Substances
– Drinking patterns vary widely from country to country
and public attitudes have changed dramatically during
the course of U.S. history.
– In Colonial times, heavy drinking was an integral part of
life, average amount of alcohol consumed per person in
the 18th century was 4 gallons per year, compared to
2.5 gallons today.
– Drunkenness was not considered to be either socially
deviant or symptomatic of medical illness.
– Temperance movement-early 19th century-based on
moral and religious reasons and not medicine or
science.
DSM IV-TR-Classification
– Substance Dependence ( more severe) A maladaptive pattern of substance
use leading to clinically significant impairment or distress, as manifested by three
or more of the following occurring at any time in the same 12 month period.
1. Tolerance as defined by either of the following:
– A need for markedly increased amounts of the substance to achieve
intoxication or desired effect.
– Markedly diminished effect with continued use of the same amount of
the substance.
2. Withdrawal as manifested by either of the following:
– Characteristic withdrawal syndrome for the substance (criteria listed
separately for specific substance)
– Same substance is taken to relieve or avoid withdrawal symptoms.
3. The substance is often taken in larger amounts or over a longer period than
it was intended.
4. There is a persistent desire or unsuccessful efforts to cut down or control
substance use.
5. A great deal of time is spend acquiring the substance or recovering from its
effects.
6. Important social, occupational or recreational activities are given up or
reduced because of substance use.
7. The substance use is continued despite knowledge or having a persistent or
recurrent physical or psychological problem that is likely caused or
DSM IV-TR-Classification

– Substance Abuse- A maladaptive patter of substance use leading
to clinically significant impairment or distress, as manifested by
one or more of the following occurring with a 12 month period.
1. Recurrent substance use resulting in a failure to fulfill major
role obligations at work, school, or home.
2. Recurrent substance use in situations in which it is physically
hazardous.
3. Recurrent substance related legal problems.
4. Continued substance use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of the substance.
Course and Outcome-Impossible to specify a typical course for
substance dependence, especially alcoholism. Age of onset varies
widely, ranging from childhood and early adolescence throughout
the lifespan.
Epidemiology
Pattern of Abuse is regional-due to availability
 Culture shapes people choice
 Prevalence of Alcohol Use and Dependence

– second most common type of mental disorder in
the United States, second only to phobias.
– most common forms of mental disorder among men
with men outnumbering women at a ratio of 5 to 1.
Prevalence of Drug and Nicotine Dependence
The percentage of lifetime prevalence for
nicotine dependence in the United States is
24% as compared to heroin-23%, cocaine-17%
and alcohol-15%.
 Declined since 1964 when the Surgeon
General’s report found a definite link between
smoking and cancer.
 Among people age 18-25 smoking rates have
increased in the past 8 years.

Etiology
Three Basic Stages

Initiation and Continuation
 Escalation and Transition to Abuse
 Development of Tolerance and Withdrawal
Initiation and Continuation
Social Factors-cultures that actively
prohibit or disapprove of drinking can
decrease rates of substance abuse.
 Biological-Initial response

– negative physiological reactions
– Positive reaction

Psychological- stress reduction and
expectancy patterns
Escalation and Transition to Abuse
Social Factors- Development of drug
dependence requires continued use and it is
influenced by the person’s initial reaction to the
drug.
 Biological- Lifetime prevalence of alcoholism is
three to five times higher among the parents,
siblings, and children of people with alcoholism
than the rate in the general population. Two
main biological hypotheses. (DA & Serotonin)
 Psychological-Interaction between environment
and biological eventsTension Reduction
hypothesis

Escalation and Transition to Abuse

Psychological- Progression of substance
dependence involves the interaction between
environmental and biological events as seen
in the Tension Reduction hypothesis.
– Expectations about Drug Effects
– Expectancies from alcohol consumption
Hypothesis of Biological Factors

Dopamine Reward Pathway
– Medial Forebrain Bundle
– Mesolimbic DA pathway
– Amphetamine and Cocaine-block the re-uptake of DA
which accumulates in the synapse where it can
further stimulate DA receptors.
– Alcohol, opioids and nicotine ( indirect)-decreases the
activity of the GABA neurons which normally inhibit
DA neurons
– Endorphins ( endogenenous opioidsnaturally
synthesized in the brain, and closely related to
morphine.

Serotonin Hypothesis
Serotonin Hypothesis
Alcohol does not bind to any specific receptor sites in
the brain, however, it does alter the permeability of
neuronal membranes.
 The net result is a depression of the Central Nervous
system. Initially, concentrations of NT such as DA and
serotonin are increased.
 If the person continues to drink over an extended
period of time, the alcohol produces opposite effects
of short term intoxication such as CNS excitation and
the reversal of the ion channels.
 Assumes that alcohol dependence is caused by a
genetically determined deficiency.

3. Development of Tolerance and Withdrawal
 Social Factors
 Psychological
 Biological
Factors
Factors
Treatment
Goals of Treatment
 Detoxification
 Medication during Remission
 Self-Help Groups
 Cognitive Behavioral Therapy
 Outcome Results and General Conclusions
