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Substance Use Disorders
Chapter 9
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Just How Severe Is the Problem?
Key words to consider: frequency, duration, and
severity of behavior association with use.
Substance use – low to moderate use of a
substance that does not impair Axis IV functioning
Substance intoxication – acute effects of
substance use
Substance abuse – ingestion of substances
leading to disruption in Axis IV functioning
Substance dependence – tolerance and
withdrawal
Tolerance is the diminished
response to a drug after
repeated exposure to it.
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Withdrawal
is symptoms
associated
with physical
dependence
on a drug that
occur when
the drug is no
longer taken.
What Does the DSM-IV-TR Say about
Abuse?
-Failure to fulfill role at work,
A maladaptive
pattern of substance school, or home
-Use in situations in which it is
use leading to
hazardous (drinking and driving
clinically
an automobile)
significant
-Substance-related legal problems
impairment or
-Continued use despite persistent
or recurrent social or
distress
One enjoys the mood-changing
experiences of the substance use
and planned use.
interpersonal problems caused by
substance use
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What Does the DSM-IV-TR Say about
needs the drug to function
Dependence? One
and feel “normal.” A physical
 A maladaptive
-Tolerance
and psychological dependence
pattern of substance
on the substance. The
-Withdrawal
“addiction” stage.
use leading to
-Using larger amounts of substance for
clinically
longer
significant
-Persistent desire for the substance
impairment or
(unable to quit)
distress, plus at
-Spends significant time trying to obtain
least 3 of the
the drug
following
-Effects on Axis IV
-Continued use despite medical or
psychological problems
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“Licit” Drugs (Legal Drugs)…Caffeine
A CNS stimulant
that boosts energy,
mood, awareness,
concentration, and
wakefulness
How is coffee used in
relation to our social and
personal lives?
-Can be consumed safely in
moderation
-Coffee aspect of social life
-Side effects of use
-Most frequently used drug
-Impact on neurotransmitters
-Long half life
Most widely used drug
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“Licit” Drugs (Legal Drugs)…Nicotine
A highly addictive
component of
tobacco that is
considered to be
both a stimulant
and a sedative
How do you feel about the smoking
laws banning smoking in public
places?
-Methods of delivery (cigars,
pipes, and smokeless tobacco,
cigarettes)
-Ways of entering the body
-Rapid effects
-Relief from tension
-Social implications
-Physical effects
-Impact on neurotransmitters
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Epidemiology of Nicotine
Trends in declines
in the number of
people who smoke
Currently 44.5
million adults and
3 million teens
smoke
-23.4% of smokers are men
-18.5% of smokers are women
-Impacts all ethnic and racial
groups
-Also impacts all SES levels
What factors influence
a higher rate of
smoking for men
versus women?
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“Licit” Drugs (Legal Drugs)…Alcohol
Also termed ethyl
alcohol
Depressant
Absorbed by the
stomach and
intestines into the
bloodstream
-Impact on the neurotransmitter
Gamma Aminobutyric Acid
(GABA)
-Physiological and psychological
impact of alcohol
-Impairment ranges from feeling
“tipsy” to extreme levels of
intoxication “being drunk”
Alcohol inhibits other brain activity which is
why it is called a downer or “depressant.”
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Just One More Drink…Alcohol and
Functional Impairment
Withdrawal symptoms and cravings
Delirium tremens (DTs)
Alcohol cirrhosis
Wernicke-Korsakoff syndrome
Fetal alcohol syndrome (FAS)
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Epidemiology, Sex, Race, and
Ethnicity of Alcohol
Most common
psychoactive
substance
More common
among males
(6.93%) versus
females (2.55%)
Do you think a lack of
coping skills or societal
factors contribute to men
having higher rates of
substance abuse disorders?
-Heavy drinking defined as more
than five drinks a day
-Men greater risk
-Women are more susceptible to
the negative health risks from
drinking
-Alcohol abuse is higher among
whites
-Alcohol dependence is higher in
whites, Native Americans, and
Hispanics than Asians
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“Illicit” Drugs…LSD and Natural
Hallucinogens
Hallucinogens
(drugs that produce
altered states of bodily
perception and
sensations, intense
emotions, detachment
from self and
environment, and for
some users, feeling of
insight with mystical or
religious significance.
D-lysergic acid
diethylamide (LSD; a
synthetic hallucinogen, first
synthesized in 1938)
Psilocybin (magic
mushrooms)
Mescaline (a product of the
peyote cactus)
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Functional Impairment and Epidemiology
of LSD and Natural Hallucinogens
Psychological
More common among
symptoms (emotional males
swings, panic, and
Not
considered
paranoia)
addictive
Hallucinogen
Do not produce
persisting
withdrawal
symptoms
perception
disorder
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“Illicit” Drugs…Marijuana
Derived from
Cannabis sativa
Tetrahydrocannibal
(THC active ingredient
in marijuana)
Leaves can be used
in food, drink, or
smoked
-When smoked, enters the brain
and lasts for 1 to 3 hours
-Effects of marijuana use
-Impact on cannabinoid
receptors
-Activation of the brain’s
reward system
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The Gateway Drug…Marijuana and
Functional Impairment
Persistent memory loss, impairment of
attention, learning skills, and motor
Do you feel that you can really become
movement
“addicted,” physically dependent to
marijuana? Why or why not?
Addiction
Physical health problems
Medicinal purposes
Withdrawal symptoms
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Epidemiology of Marijuana
Most frequently
used (14.8 million
users)
More common
among males
(8.3%) versus
females (4.3%)
-Average age of first use 18
-Men greater risk
-74% of people who use illicit
drugs use marijuana
-Prevalence of use stable from
1991 to 2002
-Abuse and dependence has
increased
Why do you believe males
are more likely to use
marijuana than females?
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Research Hot Topic: Medical Uses of
In 1970, marijuana became
Marijuana
officially illegal.
 States with exempt laws for  How do we draw the line
patients:
between which medical
-Alaska, Arizona, California, conditions are acceptable
or not for medical
Colorado, Maine, Montana,
marijuana use?
Nevada, Oregon, Michigan,
and Washington
 What are the negative
implications?
-Hawaii bill vs. Vermont bill
 Need for controlled clinical  How can we regulate
this?
trials
marijuana can provide relief from chronic
 Therapeutic applications Medical
pain and symptoms associated with AIDS, cancer,
glaucoma, epilepsy, and multiple sclerosis.
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Prevalence of drug use
What makes
marijuana the most
frequently used
illicit drug among
people aged 12 and
older?
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Figure 9.2 Use of Illicit Drugs
Amphetamines
(stimulant drugs that
prolong wakefulness and
suppress appetite)
Ecstasy (the pill form of
MDMA a common “club”
drug)
Crystal
methamphetamine
(form of meth that
produces longer
physiological reactions)
“Illicit” Drugs…CNS
Stimulants
Common effects
-Euphoria
-Increased energy
-Mental alertness
-Rapid speech
Three preparations of
amphetamine
-Ways of administrations
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Functional Impairment and
Epidemiology of CNS stimulants
Currently 1.2
million Americans
age 12 and up are
users
Prevalence equal
among both males
and females
Also users of CNS stimulants
can appear emaciated due to
the appetite suppression.
-Causes increased heart rate and
blood pressure
-Damage blood vessels in brain
causing stroke
-Development of psychotic
symptoms
-Tolerance develops rapidly
-Greater use among whites
-Over time users become violent
and aggressive
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“Illicit” Drugs…Cocaine
Derived from
leaves of coca
plant
1800s, a legal
additive to cigars,
cigarettes, and
Coca Cola
Used as a
painkiller
Powder form vs. rock
form
Ways of administration
Effects of cocaine use
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Functional Impairment and Epidemiology
of Cocaine
-Impact on the neurotransmitter,
Currently 2.6
Dopamine
million Americans -Anesthetic and convulsant effects
age 12 and up
Prevalence rates
users
-American Indians (2.0%)
-African Americans (1.6%)
Highly addictive
-Whites (0.8%)
Used more by
-Hispanics, Native Hawaiian, or
males (18.9%)
other Pacific Islanders (0.2%)
Remember how marijuana is
considered the “gateway” drug?
Ninety percent of cocaine users
reported marijuana use before
they used cocaine.
-Asians (0.2%)
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“Illicit” Drugs…Sedative Drugs
Two classes
-Barbiturates (sedatives
that act on the GABA
system in a manner
similar to alcohol)
-Benzodiazepines
(sedatives that can be
responsibly and
effectively used for the
short-term but still have
addictive properties)
Routes of administration
Effects of sedative drug
use
Common barbiturates
-Amobarbital, Pentobarbital,
and Secobarbital
Common benzodiazepines
-Valium, Xanax, and Halcion
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Functional Impairment and Epidemiology
of Sedative Drugs
Can result in over- -High potential for overdose
-Death
sedation
-Withdrawal symptoms (similar
Problems in
to alcohol withdrawal
thinking and
symptoms)
interacting with
Most common users
others
- 59% women
-Anglo
Tolerance
What do you believe drives Anglo
women from upper socioeconomic
status to frequently use sedatives?
-Higher levels of education
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“Illicit” Drugs…Opioids
Derived from
Routes of
opium poppy, such
administration
as heroin,
Effects
of
opioid
use
morphine, and
Impact on
codeine
neurotransmitter
Used to treat
(endorphins)
Drugs within the opioid
physical pain
group range from legal
medically prescribed
Synthetic
drugs (codeine) to
highly illicit drugs
(heroin).
(methadone)
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Functional Impairment and
Epidemiology of Opioids
Tolerance
develops very
rapidly (2 to 3 days)
Ways of
administration
Withdrawal
symptoms
18% of substance abuse
treatment account for
opioid use
84.3% involved heroin
use
Dangers associated with
opioid use
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“Illicit” Drugs…Inhalants
Inhalants (vapors
from a variety of
chemicals that yield an
immediate effect of
euphoria or sedation)
Include the following:
-Cleaning fluid
-Gasoline
-Paint
-Glue
Can cause
Immediate effects
permanent damage
Why are inhalants so appealing to
to all organ
teenagers?
systems and the
brain
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Functional Impairment and Epidemiology
of Inhalants
Chronic exposure Changes in brain
can cause damage
structure by MRI
to all vital organs 10.7% of youth from
Nerve damage and age 12 to 17 have used
neurological
inhalants at least once
problems
Males more likely to use
Muscle spasms
at 21.7% versus females
and tremors
at 5.8 to 13.5%
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Sex, Ethnicity, Education, and Illicit
Why do you think education level
Drug Use can act as a protective factor to
substance abuse disorders?
Women (use associated with relationship issues and
comorbidity with mental illness)
Men (more likely to be diagnosed with substance abuse
disorders)
Influence of ethnicity and socioeconomic
status
Education level (lowest among college graduates,
5.9%)
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Etiology of Substance-Related
Disorders: Biological factors
Family and genetic studies (environmental
factors predict use, and genetic factors influence
dependence)
Neurobiology (alcohol and drugs activate the brain’s
reward system)
-Impact on neurotransmitters (dopamine, opioid,
serotonergic, and GABA systems)
Why do some individuals
-Deficits in the brain reward pathway
have difficulty accepting
biological reasons for
substance-abuse disorders?
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Impact of Drugs and
Alcohol on the Brain
Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 9.3 The Brain’s Reward
System
Etiology of Substance-Related
Disorders: Psychological factors
Behavioral factors
-Operant conditioning (drug-induced euphoria produces
positive physical feelings)
-Reinforcement (positive versus negative)
-Drug-compensatory conditioned responses (bodily
changes in presence of conditioned stimuli)
Cognitive factors
-Social learning theory
-Cognitions
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Can you come up with some
examples of behavioral and
cognitive influences of drug
use?
Not just biology and psychology
factors related to substance abuse…
Sociocultural,
family, and
environment
-Family, peers, and
socioeconomic status
-Social and
environmental variables
-Protective factors
Developmental
-Experimentation during
adolescence
-Drug involvement is
progressive (use of licit
drugs before using illicit
drugs)
-Precipitating factors
-Social consequences of use
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Treatment of Substance-Abuse and
Dependence: Therapy
CBT
-Avoidance of the stimulus (fellow drug users, drug
paraphernalia)
-Relapse prevention (RP identify antecedents and
consequences of drug use, and develop ways to reduce
the risk of future use)
Motivation enhancement therapy
Behavioral therapies
Twelve-step approaches
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Treatment of Substance-Abuse and
Dependence: Biological Treatments
Detoxification
Nicotine replacement therapy
Antagonist treatments
Aversive treatments
Vaccines
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The Facts about Sex and Racial/Ethnic
Differences in Treatment…
Women (face barriers to treatment and are more likely
to drop out)
Ethnic/racial minorities (less likely to seek,
receive, and complete treatment)
Additional research is needed
Latino and African American drug users (less
likely to enter residential treatment unlike white
counterparts)
Impact of inferior treatment
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