Download Psyc 303_2012_L Notes_Substance Use Disorders

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?