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Chapter 10Substance-Related Disorders
Perspectives on Substance-RelatedDisorders: An Overview
The Nature of Substance-Related Disorders Problems related to the use and abuse of psychoactive
substances Produce wide-ranging physiological, psychological, and
behavioral effects Some Important Terms and Distinctions
Substance use vs. substance intoxication Substance abuse vs. substance dependence Tolerance vs. withdrawal
Perspectives on Substance-RelatedDisorders: An Overview (cont.)
Five Main Categories of Substances Depressants – Result in behavioral sedation (e.g.,
alcohol, sedative, anxiolytic drugs) Stimulants – Increase alertness and elevate mood (e.g.,
cocaine, nicotine, caffeine) Opiates – Primarily produce analgesia and euphoria (e.g.,
heroin, morphine, codeine) Hallucinogens – Alter sensory perception (e.g.,
marijuana, LSD) Other drugs of abuse – Include inhalants, anabolic
steroids, medications
Perspectives on Substance-RelatedDisorders: An Overview (cont.)
Figure 11.1
Ice, LSD, chocolate, TV: Is everything addictive?
Perspectives on Substance-RelatedDisorders: An Overview (cont.)
Figure 11.1 (cont.)
Ice, LSD, chocolate, TV: Is everything addictive?
Perspectives on Substance-RelatedDisorders: An Overview (cont.)
Figure 11.2
Easy to get hooked on, hard to get off
Perspectives on Substance-RelatedDisorders: An Overview (cont.)
Figure 11.2 (cont.)
Easy to get hooked on, hard to get off
The Depressants: Alcohol Use Disorders
Psychological and Physiological Effects of Alcohol Central Nervous system depressant Influences several neurotransmitter systems, but mainly
GABA Effects of Chronic Alcohol Use
Alcohol intoxication Alcohol withdrawal Associated brain conditions – Dementia and Wernicke’s
disease Fetal alcohol syndrome
DSM-IV Criteria for Disordered Alcohol Use
The Depressants: Alcohol Use Disorders (cont.)
Figure 11.3
The path traveled by alcohol throughout the body
In the United States Most adults consider themselves light drinkers or
abstainers Most alcohol is consumed by 11% of the U.S. population Alcohol use is highest among Caucasian Americans Males use and abuse alcohol more so than females Violence is associated with alcohol, but alcohol alone
does not cause aggression
Alcohol: Some Facts and Statistics
Facts and Statistics on Problem Drinking 10% of Americans experience problems with alcohol Most persons with alcoholism can moderate or cease
drinking on occassion 20% of those with alcohol problems experience
spontaneous recovery Anhedonia – Lack of pleasure, or indifference to
pleasurable activities Affective flattening – Show little expressed emotion, but
may still feel emotion
Alcohol: Some Facts and Statistics (cont.)
Sedative, Hypnotic, or AnxiolyticSubstance use Disorders: An Overview
The Nature of Drugs in This Class Sedatives – Calming Hypnotic – Sleep inducing (e.g., barbiturates) Anxiolytic – Anxiety reducing (e.g., benzodiazepines)
Effects of Such Drugs Are Similar to Large Doses of Alcohol Combining such drugs with alcohol is synergistic
All Exert Their Influence Via the GABA Neurotransmitter System
DSM-IV Criteria for Sedative, Hypnotic, or Anxiolytic Substance Use Disorders
Stimulants: An Overview
Nature of Stimulants Most widely consumed drug in the United States Such drugs increase alertness and increase energy Examples include amphetamines, cocaine, nicotine, and
caffeine
Stimulants: Amphetamine Use Disorders
Effects of Amphetamines Produce elation, vigor, reduce fatigue Enhance the release of dopamine and norepinephrine,
while blocking reuptake Such effects are followed by a “crash” (e.g., feeling
depressed and tired) DSM-IV Criteria for Amphetamine Intoxication
Psychological symptoms Physiological symptoms
Ecstasy and Ice Produces effects similar to speed, but without the crash 2% of college students report using Ecstasy Both drugs can result in dependence
Stimulants: Cocaine Use Disorders
Effects of Cocaine Produce short lived sensations of elation, vigor, reduce
fatigue Effects result from blocking the reuptake of dopamine Cocaine is highly addictive, but addiction develops slowly Cocaine use in the United States has declined over the
last decade DSM-IV Criteria for Cocaine Intoxication and Withdrawal
Psychological symptoms Physiological symptoms Most cocaine users cycle through patterns of tolerance
and withdrawal
Stimulants: Nicotine Use Disorders
Effects of Nicotine Stimulates the central nervous system, specifically
nicotinic acetylcholine receptors Results in sensations of relaxation, wellness, pleasure Nicotine is highly addictive
DSM-IV Criteria for Nicotine Withdrawal Only Psychological symptoms Physiological symptoms Nicotine users dose themselves to maintain a steady
state of nicotine
Stimulants: Nicotine Use Disorders (cont.)
Figure 11.8
Relapse rates for nicotine compared to alcohol and heroin
Stimulants: Caffeine Use Disorders
Effects of Caffeine – The “Gentle” Stimulant Found in tea, coffee, cola drinks, and cocoa products Caffeine blocks the reuptake of the neurotransmitter
adenosine Small doses elevate mood and reduce fatigue Used by over 90% of Americans Regular use can result in tolerance and dependence
DSM-IV Criteria for Caffeine Intoxication Psychological symptoms Physiological symptoms
Opiods: An Overview
The Nature of Opiates and Opiods Opiate – Natural chemical in the opium poppy with
narcotic effects (i.e., pain relief) Opiods – Refers to a class of nature and synthetic
substances with narcotic effects Such drugs are often referred to as analgesics Examples include heroin, opium, codeine, and morphine
Effects of Opiods Activate body’s enkephalins and endorphins Low doses induce euphoria, drowsiness, and slowed
breathing High doses can result in death Withdrawal symptoms can be lasting and severe
DSM-IV Criteria for Opiod Intoxication and Withdrawal Psychological symptoms Physiological symptoms Mortality rates are high for opiod addicts
Opiods: An Overview (cont.)
Hallucinogens: An Overview
Nature of Hallucinogens Substances that change the way the user perceives the
world May produce delusions, paranoia, hallucinations, and altered
sensory perception Examples include marijuana, LSD
Marijuana Active chemical is tetrahydrocannabinol (THC) May produce several symptoms (e.g., mood swings,
paranoia, hallucinations) Impairment in motivation is not uncommon (i.e.,
amotivational syndrome) Major signs of withdrawal and dependence do not typically
occur
Hallucinogens: An Overview (cont.)
LSD and Other Hallucinogens LSD is most common form of hallucinogenic drug Tolerance tends to be rapid, and withdrawal symptoms
are uncommon Psychotic delusional and hallucinatory symptoms can be
problematic DSM-IV Criteria for Marijuana and Hallucinogen Intoxication
Psychological and physiological symptoms are similar
Other Drugs of Abuse: Inhalants
Nature of Inhalants Substances found in volatile solvents that are breathed
into the lungs directly Examples include spray paint, hair spray, paint thinner,
gasoline, nitrous oxide Such drugs are rapidly absorbed with effects similar to
alcohol intoxication Tolerance and prolonged symptoms of withdrawal are
common DSM-IV criteria for inhalant intoxication
Other Drugs of Abuse: Anabolic Steroids
Nature of Anabolic-Androgenic Steroids Steroids are derived or synthesized from testosterone Used medicinally or to increase body mass Users may engage in cycling or stacking Steroids do not produce a high Steroids can result in long-term mood disturbances and
physical problems
Other Drugs of Abuse: Designer Drugs
Designer Drugs Drugs produced by pharmaceutical companies for
diseases Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine
(“special K”) are examples Such drugs heighten auditory and visual perception,
sense of taste/touch Becoming popular in nightclubs, raves, or large social
gatherings All designer drugs can produce tolerance and
dependence
Causes of Substance-Related Disorders: Family and Genetic Influences
Results of Family, Twin, and Adoption Studies Substance abuse has a genetic component Much of the focus has been on alcoholism Genetic differences in alcohol metabolism Multiple genes are involved in substance abuse
Causes of Substance-Related Disorders:Neurobiological Influences
Results of Neurobiological Research Drugs affect the pleasure or reward centers in the brain The pleasure center – Dopamine, midbrain, frontal cortex GABA turns off reward-pleasure system Neurotransmitters responsible for anxiety/negative affect
may be inhibited
Causes of Substance-Related Disorders:Psychological Dimensions
Role of Positive and Negative Reinforcement The self-medication and the tension reduction hypotheses Most see substance abuse as a means to cope with
negative affect Opponent-Process Theory
Explains why the crash after drug use fails to keep people from using
Role of Expectancy Effects Expectancies influence drug use and relapse
Causes of Substance-Related Disorders:Social and Cultural Dimensions
Exposure to Drugs is a Prerequisite for Use of Drugs Media, family, peers Parents and the family appear critical
Societal Views About Drug Abuse Sign of moral weakness – Drug abuse is a failure of self-
control Sign of a disease – Drug abuse is caused by some
underlying process The Role of Cultural Factors
Influence the manifestation of substance abuse
Exposure or Access to a Drug Is Necessary, but not Sufficient
Drug Use Depends on Social and Cultural Expectations Drugs Are Used Because of Their Pleasurable Effects Drugs Are Abused for Reasons That Are More Complex
The premise of equifinality Stress may interact with psychological, genetic, social,
and learning factors
An Integrative Model of Substance-Related Disorders
An Integrative Model ofSubstance-Related Disorders (cont.)
Figure 11.11
An integrative model of substance related disorders
Biological Treatment of Substance-Related Disorders
Agonist Substitution Safe drug with a similar chemical composition as the
abused drug Examples include methadone for heroin addiction, and
nicotine gum or patch Antagonistic Treatment
Drugs that block or counteract the positive effects of substances
Examples include naltrexone for opiate and alcohol problems
Biological Treatment ofSubstance-Related Disorders (cont.)
Aversive Treatment Drugs that make the injection of abused substances
extremely unpleasant Examples include antabuse for alcoholism and silver
nitrate for nicotine addiction Efficacy of Biological Treatment
Such treatments are generally not effective when used alone
Psychosocial Treatment of Substance-Related Disorders
Debate Over Controlled Use vs. Complete Abstinence as Treatment Goals
Inpatient vs. Outpatient Care Data suggest little difference in terms of overall
effectiveness Community Support Programs
Alcoholics Anonymous and related groups Seem helpful and are strongly encouraged
Psychosocial Treatment ofSubstance-Related Disorders (cont.)
Components of Comprehensive Treatment and Prevention Programs Individual and group therapy Aversion therapy and convert sensitization Contingency management Community reinforcement Relapse prevention Preventative efforts via education
Summary of Substance-Related Disorders
DSM-IV and DSM-IV TR Substance Related Disorders Cover Four Classes Depressants, stimulants, opiates, and hallucinogens Specific diagnoses include dependence, abuse,
intoxication, or withdrawal Most Psychotropic Drugs Activate the Dopaminergic Pleasure
Pathway in the Brain Psychosocial Factors Interact with Biological Influences to
Produce Substance Disorders Treatment of Substance Dependence Is Largely Unsuccessful
Highly motivated persons do best when part of combined treatment programs
Substance-Related Disorders Are 100% Preventable
Summary of Substance-Related Disorders (cont.)
Figure 11.x1
Exploring substance-related disorders
Summary of Substance-Related Disorders (cont.)
Figure 11.x1 (cont.)
Exploring substance-related disorders
Summary of Substance-Related Disorders (cont.)
Figure 11.x2
Exploring substance-related disorders, treatment
Summary of Substance-Related Disorders (cont.)
Figure 11.x2 (cont.)
Exploring substance-related disorders, treatment
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