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ABNORMAL PSYCHOLOGY,
SIXTEENTH EDITION
James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 11
Substance-Related
Disorders
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Introduction
Addictive behavior
• Behavior based on pathological
need for substance or activity
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Examples of abuse of substances
Nicotine
Alcohol
Barbiturates
Tranquilizers
Amphetamines
Heroin
Ecstasy
Marijuana
Substance abuse
generally involves
pathological use of
substance resulting in
Introduction
Potentially hazardous behavior
Continued use despite persistent
social, psychological, occupational, or
health problem
Physiological need for increasing
amounts of a substance
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Alcohol Abuse and
Dependence
Alcoholic
Alcoholism
• Person with
serious drinking
problem whose
drinking impairs
health, personal
relationships, and
occupational
functioning
• Dependence on
alcohol that
seriously
interferes with life
adjustment
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The Prevalence, Comorbidity,
and Demographics of Alcohol
Abuse and Dependence
Alcohol abuse cuts across all age, educational,
occupational, and socioeconomic boundaries
Lifetime prevalence for alcohol abuse in U.S. is
13.4%
More than 37% of alcohol abusers suffer from
at least one coexisting mental disorder
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The Clinical Picture of
Alcohol-Related Disorders
At higher levels, alcohol
depresses brain
functioning
At lower levels, alcohol
stimulates certain brain
cells and activates
brain’s “pleasure areas”
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The Clinical Picture of
Alcohol-Related Disorders
Late-stage
Middle stage
Early stage
Excessive
drinking
progression of
alcoholrelated
disorder
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The Clinical Picture of
Alcohol-Related Disorders
Malnutrition
Cirrhosis of
liver
Stomach
pains
Physical effects
of chronic
alcohol use
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The Clinical Picture of
Alcohol-Related Disorders
Depression
Impaired
reasoning
Oversensitivity
Chronic fatigue
Psychosocial
effects of
alcohol abuse
and
dependence
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Personality
deterioration
Biological Causal Factors in the Abuse of
and Dependence on Alcohol
esocorticolimbic dopamine pathway
• Center of psychoactive drug
activation in brain
Let’s take a closer look!
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Figure 11.1:
The Mesocorticolimbic Pathway
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Causal factors
Biological Causal Factors in the Abuse of
and Dependence on Alcohol
Genetics
Learning factors
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•Genetics probably play an important role in
developing sensitivity to the addictive
power of drugs like alcohol
•Learning factors appear to play an
important role in the development of
substance abuse
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Psychosocial Causal Factors in Alcohol
Abuse and Dependence
Take three minutes to see how many
characteristics of potential alcohol
abusers you can list.
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• Potential alcohol abusers tend to
– Have parents who are negative role models
– Be emotionally immature
– Expect a great deal of the world
– Require an inordinate amount of praise and
appreciation
– React to failure with marked feelings of hurt and
inferiority
– Have low frustration tolerance
– Feel inadequate and unsure of their abilities to fulfill
expected male or female roles
– Tend to be unable or unwilling to tolerate tension and
stress
– Expect that alcohol use will lower tension and anxiety
and increase sexual desire and pleasure in life
– Show greater drinking following sadness or hostility
with less intimate and supportive relationships
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Sociocultural Causal Factors
Religion
Causal
factors
Geographic
location
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•The incidence of alcoholism is minimal
among Muslims and Mormons, whose
religious views prohibit the use of alcohol
•The incidence of alcoholism is high among
Europeans (15% in France)
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Treatment of Alcohol-Related Disorders
Biological
approaches
• Medications to block
desire to drink:
antabuse, naltrexone
• Medications to lower
side effects of acute
withdrawal: valium
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Treatment of Alcohol-Related Disorders
Psychological
treatment
approaches
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• Group therapy
• Environmental
intervention
• Behavioral and
cognitivebehavioral
therapy
Treatment of Alcohol-Related Disorders
Other
approaches
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• Controlled
drinking rather
than
abstinence
• Alcoholics
Anonymous
Treatment of Alcohol-Related Disorders
Success rates of
alcoholism treatments
• “Project MATCH” success
rates
• Motivational enhancement
therapy success
• Relapse prevention
programs
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• Success of alcoholism treatments range from
low rates for hardcore substance abusers to
rates of 70-90% when modern treatment
procedures are used
• “Project MATCH” found equal success rates
among the following treatments:
• A 12-step program
• A CBT program
• Motivational enhancement therapy
• Relapse prevention programs attempt to
maintain abstinence once the behavioral
excesses have been checked
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Drug Abuse and Dependence
Psychoactive drugs most commonly
associated with abuse and
dependence
•
•
•
•
•
•
•
Narcotics
Sedatives
Stimulants
Anti-anxiety drugs
Pain medications
Hallucinogens
Caffeine and nicotine
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Opium and Its Derivatives (Narcotics)
Opium
Narcotics
Morphine
Heroin
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Opium and Its Derivatives (Narcotics)
Alleviation of physical
pain
Relaxation and
pleasant reverie
Immediate effects of
narcotics
Alleviation of anxiety
and tension
Euphoric spasm
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Opium and Its Derivatives (Narcotics)
Physiological
craving for the
drug
Long-term
effects
Withdrawal
symptoms
Gradual
deterioration
of well-being
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Opium and Its Derivatives (Narcotics)
Endorphins
Other
characteristics
Antisocial
personality
Narcotics
subculture
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•Some investigators have suspected that
endorphins play a causal role
•A high incidence of antisocial personality
has been found among heroin addicts
•In the U.S., addiction is associated with a
narcotics subculture
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Opium and Its Derivatives (Narcotics)
Treatment
Initially similar to that for
alcohol addiction
Methadone and
buprenorphine &
rehab program
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Cocaine and Amphetamines (Stimulants)
Cocaine and
amphetamines
Increase feelings
of alertness and
confidence
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Decrease
feelings of
fatigue
Cocaine and Amphetamines (Stimulants)
Long-term
amphetamine use
Psychologically
and physically
addictive
May result in
brain damage and
psychopathology
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Methamphetamine
Highly addictive
stimulant drug
Increases level of
dopamine in brain
Methamphetamine
Known by some as
“poor people’s cocaine”
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Methamphetamine
Substantial increased
use in last 10 years
Structural changes in
brain with prolonged
use
Rate, prolonged use,
and treatment
Treatment resistant to
treatment; relapse
common
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Barbiturates (Sedatives)
Barbiturates
Central nervous system
depressants that are similar to
depressant effects of alcohol
Once widely used to induce
sleep
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Barbiturates (Sedatives)
Barbiturate use
outcomes
Physiological and
psychological
dependence
Lethal overdoses
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Barbiturates (Sedatives)
Barbiturate users
and withdrawal
Dependence tends
to be middle-aged
people
Withdrawal is a key
treatment issue
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Hallucinogens:
LSD and Related Drugs
Hallucinogens
Diverse group of
drugs that cause
alteration in
perception, thought,
or mood
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Cause individual to
see or hear things in
different and unusual
ways
Hallucinogens:
LSD and Related Drugs
Hallucinogens
LSD
Ecstasy
Mescaline
Psilocybin
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Ecstasy
Ecstasy
Hallucinogen
and stimulant
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Chemically
similar to
methampheta
mine
Ecstasy
Ecstasy
results and
popularity
“Rush” and
well-being
AND serious
adverse
consequences
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Increasingly
popular
among young
adults
Marijuana
Classified as
mild
hallucinogen
Marijuana
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Marijuana
Effects
• Euphoria
• Increased
feelings of wellbeing
• Heightened
perceptual
acuity
• Relaxation
• Hallucination
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Marijuana
Treatment
Psychological
treatment
methods
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Stimulants: Caffeine and Nicotine
Problematic for many
reasons
•
•
•
•
•
•
Easy to abuse
Readily available
Addictive properties
Difficult to quit
Withdrawal symptoms
Health problems and side effects
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Pathological Gambling
Similar to chemical
addiction in several ways
• Personality factors
• Difficulties attributable to
compulsive gambling
• Treatment problems
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•Although pathological gambling does not
involve a chemically addictive substance, it
is similar in the following ways:
• The personality factors that tend to
characterize addictive gamblers
• The difficulties attributable to compulsive
gambling
• The treatment problems involved
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Unresolved Issues
Is the use of methadone
effective in the treatment of heroin, or does it
simply exchange one addiction for another?
What other approaches are being evaluated?
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