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ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 11 Substance-Related Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Introduction Addictive behavior • Behavior based on pathological need for substance or activity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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” © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. The Clinical Picture of Alcohol-Related Disorders Late-stage Middle stage Early stage Excessive drinking progression of alcoholrelated disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. The Clinical Picture of Alcohol-Related Disorders Malnutrition Cirrhosis of liver Stomach pains Physical effects of chronic alcohol use © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. The Clinical Picture of Alcohol-Related Disorders Depression Impaired reasoning Oversensitivity Chronic fatigue Psychosocial effects of alcohol abuse and dependence © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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! © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Figure 11.1: The Mesocorticolimbic Pathway © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Causal factors Biological Causal Factors in the Abuse of and Dependence on Alcohol Genetics Learning factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. •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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Psychosocial Causal Factors in Alcohol Abuse and Dependence Take three minutes to see how many characteristics of potential alcohol abusers you can list. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Sociocultural Causal Factors Religion Causal factors Geographic location © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. •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) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Treatment of Alcohol-Related Disorders Biological approaches • Medications to block desire to drink: antabuse, naltrexone • Medications to lower side effects of acute withdrawal: valium © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Treatment of Alcohol-Related Disorders Psychological treatment approaches © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • Group therapy • Environmental intervention • Behavioral and cognitivebehavioral therapy Treatment of Alcohol-Related Disorders Other approaches © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. • 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Opium and Its Derivatives (Narcotics) Opium Narcotics Morphine Heroin © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Opium and Its Derivatives (Narcotics) Alleviation of physical pain Relaxation and pleasant reverie Immediate effects of narcotics Alleviation of anxiety and tension Euphoric spasm © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Opium and Its Derivatives (Narcotics) Physiological craving for the drug Long-term effects Withdrawal symptoms Gradual deterioration of well-being © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Opium and Its Derivatives (Narcotics) Endorphins Other characteristics Antisocial personality Narcotics subculture © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. •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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Opium and Its Derivatives (Narcotics) Treatment Initially similar to that for alcohol addiction Methadone and buprenorphine & rehab program © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Cocaine and Amphetamines (Stimulants) Cocaine and amphetamines Increase feelings of alertness and confidence © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Decrease feelings of fatigue Cocaine and Amphetamines (Stimulants) Long-term amphetamine use Psychologically and physically addictive May result in brain damage and psychopathology © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Methamphetamine Highly addictive stimulant drug Increases level of dopamine in brain Methamphetamine Known by some as “poor people’s cocaine” © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Barbiturates (Sedatives) Barbiturates Central nervous system depressants that are similar to depressant effects of alcohol Once widely used to induce sleep © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Barbiturates (Sedatives) Barbiturate use outcomes Physiological and psychological dependence Lethal overdoses © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Barbiturates (Sedatives) Barbiturate users and withdrawal Dependence tends to be middle-aged people Withdrawal is a key treatment issue © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Hallucinogens: LSD and Related Drugs Hallucinogens Diverse group of drugs that cause alteration in perception, thought, or mood © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Cause individual to see or hear things in different and unusual ways Hallucinogens: LSD and Related Drugs Hallucinogens LSD Ecstasy Mescaline Psilocybin © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Ecstasy Ecstasy Hallucinogen and stimulant © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Chemically similar to methampheta mine Ecstasy Ecstasy results and popularity “Rush” and well-being AND serious adverse consequences © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Increasingly popular among young adults Marijuana Classified as mild hallucinogen Marijuana © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Marijuana Effects • Euphoria • Increased feelings of wellbeing • Heightened perceptual acuity • Relaxation • Hallucination © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Marijuana Treatment Psychological treatment methods © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Pathological Gambling Similar to chemical addiction in several ways • Personality factors • Difficulties attributable to compulsive gambling • Treatment problems © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. •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 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. 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? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.