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• any rental, lease, or lending of the program. ISBN: 0-205-50294-6 Copyright © 2006 Allyn & BaconAllyn & Bacon copyright 2000 1
Substance-Related
Disorders
Chapter 13
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Drugs
• Drug: Chemical substance that alters biological
or cognitive processes
• Psychoactive Drugs
• Alter behavior, thought, or perception
• Therefore, can affect consciousness
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What is Substance Abuse?
When use leads to negative consequences
When drugs are overused and relied on to deal with
everyday life
A person is a substance abuser if:
• The person has used a substance for one month
• Use has caused legal, personal, social, or
vocational problems
• The person repeatedly uses the substance even
in situations when doing so is hazardous
2
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Alcohol Abuse and
Dependence
• Alcoholic: Person with a serious drinking
problem whose drinking impairs his or her
health, personal relationships, and
occupational functioning
• Alcoholism: Dependence on alcohol that
seriously interferes with life adjustment
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Properties of Drugs
Dependence: Occurs when the drug becomes part
of the body’s functioning
Withdrawal: Occurs when dependence has
developed and use of the drug is discontinued
Tolerance: Higher and higher doses of a drug are
needed to produce the same effect
Addiction: A combination of tolerance and
dependence
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Alcohol Abuse and
Dependence
• One in seven people meet the criteria for
alcohol abuse
• More than 37% of alcohol abusers suffer
from at least one coexisting mental disorder
• Alcohol abuse cuts across all age,
educational, occupational, and
socioeconomic boundaries
3
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With Dependence
Withdrawal symptoms will occur if use is decreased
or stopped
• Withdrawal symptoms are typically the opposite
of a drug’s effects
• Typically unpleasant
• Can be stopped by taking more drugs
• Doing so is often considered addiction
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True or False
Are the following statements about alcohol
true or false?
Everybody drinks
Damage to the liver always shows up long before brain damage
One can become an alcoholic just by drinking beer
Alcohol withdrawal is potentially more lethal than opiate withdrawal
People with “strong wills” need not be concerned about becoming alcoholics
False
False
True
True
False
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Alcohol & The Brain
• Alcohol has complex and often contradictory
effects on the brain
– At lower levels, alcohol stimulates certain brain
cells and activates the brain’s “pleasure areas”
– At higher levels, alcohol depresses brain
functioning
4
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Psychoactive Drugs
Must affect the nervous system
– Most do so by crossing the Blood–Brain
Barrier
– Mechanism that prevents some
molecules from entering the brain
Once in the brain, drugs alter neural activity
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The Clinical Picture of Alcohol
Abuse and Dependence
• Excessive drinking can be viewed as
progressing from early- to middle- to late-
stage alcohol abuse disorder
• For individuals who drink to excess, the
clinical picture is highly unfavorable and
may include
– Cirrhosis of the liver
– Malnutrition
– Stomach pains
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Psychosocial Effects
• Include:
– Chronic fatigue
– Oversensitivity
– Depression
– Impaired reasoning
– Personality deterioration
• Several acute psychotic reactions fit the diagnostic classification of substance-induced disorders
5
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Drug Abuse and Dependence
Psychoactive drugs most commonly
associated with abuse and dependence:
– Narcotics
– Sedatives
– Stimulants
– Anti-anxiety drugs
– Hallucinogens
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Biological Factors
• 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
• Potential alcohol abusers tend to
– 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
6
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Psychosocial Causal Factors
• Alcohol abusers also tend to be unable or
unwilling to tolerate tension and stress
• Many people expect that alcohol use will
lower tension and anxiety and increase
sexual desire and pleasure in life
• Adults with less intimate and supportive
relationships tend to show greater drinking
following sadness or hostility
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Sociocultural Factors
• 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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Alcohol
Produces tolerance and dependence
Crosses blood–brain barrier
Depresses brain activity
• Dampens arousal
• Decreases inhibitions
• Slows reaction time
7
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Treatment of Alcoholism
• Biological approaches include
– Medications to block the desire to drink:
• Antabuse
• Naltrexone
– Medications to lower the side effects of acute
withdrawal:
• Valium
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Treatment of Alcoholism
Group Therapy
• Alcoholics Anonymous has reportedly met with
considerable success
• Project MATCH found equal success rates among
the following treatments:
– A 12-step program
– A CBT program
– Motivational enhancement therapy
Environmental Intervention
Behavior Therapy
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Opiates
In the brain, opiates occupy Endorphin receptors
– Neurochemicals manufactured in the brain
– A natural mechanism of pain relief
• Opiates produce high tolerance and
dependence in those who use them for pleasure
• Few people given opiates for pain relief in
hospitals become addicted
8
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Opium and Its Derivatives
(Narcotics)
• Narcotics include
– Opium
– Morphine
– Heroin
• These drugs were originally praised for
their medical uses, but they are dangerously
addictive
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Opium and Its Derivatives
(Narcotics)
The immediate effects of narcotics include
– Alleviation of physical pain
– Relaxation and pleasant feelings
– Alleviation of anxiety and tension
Long-term effects include
– Physiological craving for the drug
– Withdrawal symptoms
– Gradual deterioration of well-being
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Treatments and Outcomes
• Methadone
• Buprenorphine
• Rehabilitation program
9
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Stimulants
Drugs that increase alertness, confidence, reduce
fatigue, and elevate mood states
Increase blood pressure, heart rate, metabolic rate,
and decrease appetite
Act on the peripheral and central nervous systems
All stimulants have tolerance and dependence
properties
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Stimulants
Caffeine
Nicotine
– Addictive drug in tobacco
– Does not have strong tolerance properties
– Does lead to strong dependence and
unpleasant withdrawal symptoms
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Amphetamines
Also produce strong dependence and tolerance
Produce arousal and alertness
Some people use amphetamines for their appetite-
suppressing effects
Continued use can cause altered thoughts
• Unfounded suspicion
• May result in brain damage &
psychopathology
• Symptoms similar to Schizophrenia
10
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Cocaine
Increases alertness
Rapidly creates positive feelings
These effects are short-lived, creating an urge to
use more
Strong potential for abuse
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Barbiturates (Sedatives)• Barbiturates were once widely used to
induce sleep
• They are dangerous drugs commonly associated with
– Physiological and psychological dependence
– Lethal overdoses
• Those who become dependent on barbiturates tend to be middle-aged people who rely on them as sleeping aids
• Withdrawal is a key issue in treatment
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Hallucinogens
Sometimes called Psychedelic drugs
Affect mood, thought, memory, judgment, and
perception
Alter perception and produce vivid imagery
Their impact varies widely depending on the user
and the particular drug
11
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LSD and Related Drugs
(Hallucinogens)
• Hallucinogens cause an individual to see or
hear things in different and unusual ways
• Includes:
– LSD
– Mescaline
– Psilocybin
– PCP
– Ecstasy
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LSD
Lysergic Acid Diethylamide
– Produces altered visual and auditory
perception
– Sometimes causes changes in time and
distance perception
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Mescaline
• 3,4,5-trimethoxyphenethylamine: is a
hallucinogenic alkaloid
• Naturally in the peyote cactus
12
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Psilocybin
• Also known as psilocybine: Is a
psychedelic alkaloid
• It is a fungi
• Psilocybin-containing mushrooms are
commonly called magic mushrooms or
more simply "shrooms"
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PCP
• Phencyclidine: is a dissociative drug
formerly used as an anesthetic agent,
exhibiting hallucinogenic and neurotoxic
effects. It is commonly known as Angel
Dust .
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Ecstasy
Methylenedioxymethamphetamine (MDMA)
– Causes massive release of serotonin in the
brain
• Produces feelings of well-being and
kinship
• This action may be dangerous
– May lead to prolonged problems regulating
serotonin levels
– May contribute to depression and memory
problems
13
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Marijuana
• Elation and well-being
• Sleepiness
• Paranoia and nausea
• Marijuana affects
judgment and
coordination
• Euphoria
• Hilarity
• Hyper-talkativeness
• Anxiety
• Depression
• Hallucination
The dried leaves and flowering tops of the cannabis
sativa plant
Most widely used illicit drug
Reactions vary widely but may include:
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Marijuana
• Marijuana may be classified as a mild hallucinogen
• Marijuana is not strongly physiologically addictive, but it may be psychologically addictive for some people
• Psychological treatment methods have been shown to be effective in reducing use in dependent adults
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Marijuana
Produces neither tolerance nor dependence
– But, some people use marijuana to the point
that it interferes with their lives
– Seems to create a “psychological”
dependence in some
14
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Sedatives/Hypnotics
A class of drugs that relax and calm a user
Can induce sleep at higher doses
Depress neural activity
• Sometimes called Depressants
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Sedative–Hypnotics
Tranquilizers
Barbiturates
Opiates
– Derived from the opium poppy
– Opium, morphine, and heroin
– Synthetic opiates
• Oxycodone (Oxycontin) and Hydrocodone
(Vicodin)
• Chemically similar and have similar effects
– Medical uses include pain relief
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Drug Use and Abuse
Legal or over-the-counter medications are often
not thought of as drugs
– Leads to underestimating hazards of
drugs such as alcohol and tobacco
– Alcohol and tobacco present the biggest
drug problem in the United States
• 51% of adolescents are current
drinkers and 27% are current smokers
15
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Pathological Gambling
• 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