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Transcript
Substance Use Disorders Chapter 9 Just How Severe Is the Problem? 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 DSM-IV-TR Definition of Abuse A maladaptive pattern of substance use leading to clinically significant impairment or distress -Failure to fulfill role at work, school, or home -Use in situations in which it is hazardous (drinking and driving an automobile) -Substance-related legal problems -Continued use despite persistent or recurrent social or interpersonal problems caused by substance use DSM-IV-TR Definition of Dependence A maladaptive pattern of substance use leading to clinically significant impairment or distress, plus at least 3 of the following -Tolerance -Withdrawal -Using larger amounts of substance for longer -Persistent desire for the substance (unable to quit) -Spends significant time trying to obtain the drug -Effects on Axis IV & recreation -Continued use despite medical or psychological problems “Licit” Drugs (Legal Drugs)…Caffeine A CNS stimulant that boosts energy, mood, awareness, concentration, and wakefulness -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 Caffeine…functional impairment Consumption is socially accepted Health effects (cardiovascular disorders, reproductive problems, osteoporosis, cancer, and psychiatric disturbances) Acute caffeine intoxication Caffeine associated death Epidemiology of Caffeine Most widely used drug, universally accepted 80% of the world’s population consumes it daily 87% of the U.S. population -Sodas (2 to 5 mg to 60mg of caffeine per ounce, Coke vs. Mountain Dew) -Tea (5 mg per ounce) -Coffee (7 mg per ounce) -Lattes (over 20 mg per ounce) -Espresso (50 mg per ounce) -Energy drinks (10 mg to over 100 mg per ounce) “Licit” Drugs (Legal Drugs)…Nicotine A highly addictive component of tobacco that is considered to be both a stimulant and a sedative -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 It’s So Difficult to Stop…Nicotine and Functional Impairment Use leads to addiction Withdrawal symptoms and cravings Largest PREVENTABLE cause of death in the world Impact on health Complications related to pregnancy 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 “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 and Functional Impairment Withdrawal symptoms and cravings Delirium tremens (DTs) Alcohol cirrhosis Wernicke-Korsakoff syndrome Fetal alcohol syndrome (FAS) Epidemiology, Sex, Race, and Ethnicity of Alcohol Most common psychoactive substance More common among males (6.93%) versus females (2.55%) -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 “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 The Gateway Drug…Marijuana and Functional Impairment Persistent memory loss, impairment of attention, learning skills, and motor movement Addiction Physical health problems Medicinal purposes Withdrawal symptoms 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 Research Hot Topic: Medical Uses of Marijuana Prevalence of drug use “Illicit” Drugs…CNS Stimulants 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) Common effects -Euphoria -Increased energy -Mental alertness -Rapid speech Three preparations of amphetamine -Ways of administrations 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 -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 “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 Functional Impairment and Epidemiology of Cocaine Currently 2.6 million Americans age 12 and up users Highly addictive Used more by males (18.9%) -Impact on the neurotransmitter, Dopamine -Anesthetic and convulsant effects Prevalence rates -American Indians (2.0%) -African Americans (1.6%) -Whites (0.8%) -Hispanics, Native Hawaiian, or other Pacific Islanders (0.2%) -Asians (0.2%) “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 Functional Impairment and Epidemiology of Sedative Drugs Can result in over- sedation Problems in thinking and interacting with others Tolerance -High potential for overdose -Death -Withdrawal symptoms (similar to alcohol withdrawal symptoms) Most common users - 59% women -Anglo -Higher levels of education “Illicit” Drugs…Opioids Derived from opium poppy, such as heroin, morphine, and codeine Used to treat physical pain Synthetic (methadone) Routes of administration Effects of opioid use Impact on neurotransmitter (endorphins) 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 “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) Functional Impairment and Epidemiology of LSD and Natural Hallucinogens Psychological symptoms (emotional swings, panic, and paranoia) Hallucinogen persisting perception disorder More common among males Not considered addictive Do not produce withdrawal symptoms “Illicit” Drugs…Inhalants Inhalants (vapors from a variety of chemicals that yield an immediate effect of euphoria or sedation) Can cause permanent damage to all organ systems and the brain Include the following: -Cleaning fluid -Gasoline -Paint -Glue Immediate effects Functional Impairment and Epidemiology of Inhalants Chronic exposure can cause damage to all vital organs Nerve damage and neurological problems Muscle spasms and tremors Changes in brain structure by MRI 10.7% of youth from age 12 to 17 have used inhalants at least once Males more likely to use at 21.7% versus females at 5.8 to 13.5% Sex, Ethnicity, Education, and Illicit Drug Use 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%) 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) -Deficits in the brain reward pathway Impact of Drugs and Alcohol on the Brain 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 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 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 Ethics and Responsibility Although psychologists treat individuals with substance abuse and dependence, they too can suffer from these disorders If the psychologist is in denial, colleagues are ethically obligated to intervene State licensing board guidelines Doing harm by practicing psychology when competency is compromised Treatment of Substance-Abuse and Dependence: Biological Treatments Detoxification Nicotine replacement therapy Antagonist treatments Aversive treatments Vaccines Controlled Drinking?