Substance-Related and Addictive Disorders Chapter 12 Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Substance Use Disorders Substance abuse Substance dependence Substance: A chemical that alters a person’s mood or behavior when it is smoked, injected, drunk, inhaled, or swallowed in pill form. Substance abuse: Maladaptive pattern of substance use occurring within a 12-month period that leads to significant impairment or distress evidence by: Failure to meet obligations Repeated use of substances in physically hazardous situations Legal problems Interpersonal problems. Substance dependence: Maladaptive pattern of use manifested by cognitive, behavioral, and physiological symptoms during a 12-month period and caused by continued use of substance. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Substance Use Disorders Withdrawal Tolerance Substance intoxication Withdrawal: Physiological and psychological changes that occur when an individual stops taking a substance. Tolerance: Extent to which the individual requires larger and larger amounts of a substance in order to achieve its desired effects, or the extent to which the individual feels less of its effects after using the same amount of the substance. Substance intoxication: The temporary maladaptive experience of behavioral or psychological changes that are due to the accumulation of a substance in the body. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

substance use disorder A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using a substance even though it causes significant problems in his or her life. Clinicians diagnose substance use disorders by assessing the individual in four categories of symptoms: impaired control, social impairment, risky use pharmacological changes. New diagnostic term has fewer negative connotations than the term “addiction” Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Disorders Associated with Specific Substances Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Substance abuse 8.9 percent of the population are current users of illicit drugs. Marijuana is the most commonly used illicit drug Most drugs of abuse directly or indirectly target the reward center of the brain by flooding its circuits with dopamine. Overstimulation of the reward system produces the euphoric effects that abusers seek and leads them to repeat the behavior in order to repeat the experience. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

FIGURE 12.2 - Effects of Drugs of Abuse on Dopamine Pathways Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

FIGURE 12.3 Comorbidity of Substance Use and Psychological Disorders Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Alcohol Effects Alcohol is a depressant Immediate effects A psychoactive substance that causes the depression of central nervous system activity. Immediate effects Sedating Central nervous system depressant Potentially fatal in excess Potentiation compounds these effects In small amounts, alcohol has sedating effects leading users to feel relaxed. In larger amounts, alcohol may lead drinkers to feel more outgoing, self-confident, and uninhibited. As drinking continues, alcohol’s effects as a central nervous system depressant become more apparent, as sleepiness, uncoordination, dysphoria, and irritability set in. Depressant: A psychoactive substance that causes the depression of central nervous system activity. Excessive drinking affects vital functions and can be fatal. Potentiation: Combination of the effects of two or more psychoactive substances such that the total effect is greater than the effect of either substance alone. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Alcohol Effects Long-term effects Permanent brain damage Dementia Wernicke’s disease Korsakoff’s synodrome Harmful changes in the liver, gastrointestinal system, bone density, muscles, and immune system Wernicke’s disease: Form of aphasia in which the individual is able to produce language but has lost the ability to comprehend, so that these verbal productions have no meaning. Korsakoff’s syndrome: Permanent form of dementia associated with long-term alcohol use in which the individual develops retrograde and anterograde amnesia, leading to an inability to remember recent events or learn new information. Retrograde amnesia: Amnesia involving loss of memory for past events. Anterograde amnesia: Amnesia involving the inability to remember new information. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

FIGURE 12.4 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2010 Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Theories and Treatment of Alcohol Dependence Biological Genetic factors Medications Naltrexone Disulfiram Acamprosate Biological Twin, family, and adoption studies consistently point to the importance of genetic factors as contributors to alcohol-related disorder. Genetics of alcohol-related disorders comes from studies examining associations with genes involved in alcohol metabolism and neural transmission. Medications Naltrexone - Blocks the effects of the body’s production of alcohol-induced opioids, through involving dopamine. Disulfiram: Known popularly as Antabuse, a medication used in the treatment of alcoholism that inhibits aldehyde dehydrogenase (ALDH) and causes severe physical reactions when combined with alcohol. Acamprosate - Reduces the risk of relapse by reducing the individual’s urge to drink and thereby reducing the drive to use alcohol as a way of reducing anxiety and other negative psychological states. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Theories and Treatment of Alcohol Dependence Psychological Dual-process theory Alcohol myopia theory Treatment Cognitive-behavioral interventions Motivational approaches Expectancy manipulation Relapse prevention Combined behavioral intervention Dual-process theory: Proposes there are automatic processes that generate an impulse to drink alcohol and controlled, effortful processing that regulates these automatic impulses. Alcohol myopia theory: Proposes that as individuals consume greater amounts of alcohol, they are more likely to make risky choices because the immediate temptation of the moment overcomes the long-term consequences of the behavior. Relapse prevention: Based on the expectancy model, in which individuals are encouraged not to view lapses from abstinence as signs of certain failure. The primary emphasis of CBI is on enhancing reinforcement and social support for abstinence. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Theories and Treatment of Alcohol Dependence Sociocultural Family, community, & cultural stressors Children of alcoholics at greater risk Alcohol dependent individuals showed a variety of behaviors : Early neural dysfunction. Nervousness and fretfulness as infants. Hyperactivity as children. Poor physical coordination. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Substances Other Than Alcohol Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Stimulants This category of drugs includes substances that have an activating effect on the nervous system. Amphetamine Methamphetamine Cocaine Stimulants: Substances that have an activating effect on the nervous system. Amphetamine: Affects the central nervous and the autonomic nervous systems. Methamphetamine: Related to amphetamine but provokes more intense central nervous system effect. Cocaine: Highly addictive central nervous system stimulant that an individual snorts, injects, or smokes. Effects include feelings of euphoria, heightened mental alertness, reduced fatigue, and heightened energy. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

FIGURE 12.5 Long-term Effects of Methamphetamine on the Brain Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Figure 12.6 - Cocaine in the Brain Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Cannabis Marijuana Hashish Marijuana: Psychoactive substance derived from the hemp plant whose primary active ingredient is delta-9-tetrahydrocannabinol (THC). Hashish, containing a more potent form of THC, comes from the resins of the plant’s flowers. Individuals use synthetic forms of THC for medicinal purposes: Treating asthma and glaucoma and reducing nausea in cancer patients undergoing chemotherapy. Heavy and continued use of marijuana: Produce effects on bodily functioning. Lead to higher risk of heart attack. Lead to impaired respiratory functioning. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Table 12.3 - Summary of Effects of Cannabis on Executive Functions Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Hallucinogens Hallucinogens are drugs that cause people to experience profound distortions in their perception of reality. LSD Peyote Psilocybin PCP MDMA Included in hallucinogen-related disorders are use and intoxication, but not withdrawal. Hallucinogens: Psychoactive substances that cause abnormal perceptual experiences in the form of illusions or hallucinations, usually visual in nature. LSD (lysergic acid diethylamide): Users ingest in tablets, capsules, and liquid form. Produces tolerance. Peyote: Primary ingredient is mescaline. Psilocybin: Found in certain mushrooms. PCP (phencyclidine, a.k.a. “angel dust”): Originally developed as an intravenous anesthetic. Symptoms that mimic schizophrenia, mood disturbance, memory loss, difficulties with speech and thinking, weight loss, and depression. MDMA- known on the street as ecstasy, is a synthetic substance chemically similar to methamphetamine and mescaline. Users experience feelings of increased energy, euphoria, emotional warmth, distorted perceptions and sense of time, and unusual tactile experiences. Users experience unpleasant psychological effects Confusion, depression, sleep problems, cravings for the drug, and severe anxiety. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Opioids An opioid is a substance that relieves pain. Within opioid-related disorders are opioid use, intoxication, and withdrawal. Hydrocodone Oxycodone Morphine Codeine Heroin Opioids: Psychoactive substances that relieve pain. Clinicians prescribe hydrocodone products for a variety of painful conditions, including dental and injury-related pain. Physicians use morphine before and after surgical procedures to alleviate severe pain. Clinicians prescribe codeine for mild pain. Heroin: Form of opioid, synthesized from morphineis. Serious health consequences of heroin use: Fatal overdoses Infectious diseases Damage to the cardiovascular system, abscesses, and liver or kidney disease. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Sedatives, Hypnotics, & Anxiolytics Sedatives have calming effects on the central nervous system Hypnotics induces sleep Anxiolytics are anti-anxiety medications Medications include: Benzodiazepines Barbiturates Nonbenzodiazepine sleep medications such as: Zolpidem (Ambien) Eszopiclone (Lunesta) Zalepon (Sonata) Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Caffeine Found in coffee, tea, chocolate, energy drinks, diet pills, and headache remedies. Increases: An individual’s perceived level of energy alertness Blood pressure and may lead to increases in the body’s production of cortisol Caffeine withdrawal symptoms: Headache Tiredness and fatigue Sleepiness and drowsiness Dysphoric mood Difficulty concentrating Depression Irritability Nausea Vomiting Muscle aches Stiffness Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Tobacco Nicotine: Psychoactive substance found in cigarettes Stimulates the release of adrenaline (norephinephrine) Increases blood pressure, heart rate, and respiration Withdrawal symptoms Irritability, difficulties with concentration, and strong cravings for nicotine. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Inhalants Volatile solvents Aerosols Gases Nitrites Inhalants: Diverse group of substances that cause psychoactive effects by producing chemical vapors. Inhalants have similar effects as alcohol. Slurring of speech, loss of coordination, euphoria, dizziness, and, over time, loss of inhibition and control. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Theories and Treatment Biological Genetic abnormalities Opioid receptor on chromosome 1 (OPRM1) Chromosome 15 in a cluster of nicotinic receptor subunits (CHRNA-3, -5, and -4) Catechol-o-methyltransferase (COMT) Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Theories and Treatment To prevent heroin relapse Methadone Buprenorphine Naltrexone Methadone: Synthetic opioid that produces a safer and more controlled reaction than heroin and is used in treating heroin addiction. Buprenorphine: Used in the treatment of heroin addiction. Naltrexone: Used in the treatment of heroin addiction. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Theories and Treatment Psychological Contingency management Principles of treating substance dependence other than alcohol through CBT are similar to those involved in treating alcohol dependence. Clinicians combine CBT with motivational therapies and behavioral interventions that focus on contingency management. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Biopsychosocial Perspective Useful for: Understanding substance dependence Approaches to treatment Genetics Action of substances on the central nervous system Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Non-Substance-Related Disorders Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Gambling Disorder A non-substance-related disorder involving the persistent urge to gamble. This disorder is included with substance use disorders as it is now conceptualized as showing many of the same behaviors, such as: Cravings Increasing needs to engage in the behavior Negative social consequences. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

gambling disorder People with gambling disorder also have high rates comorbidity: Nicotine dependence (60 percent) Dependence on other substances (58 percent) Mood disorder (38 percent) Anxiety disorder (37 percent) Mood and anxiety disorders are more likely to precede, rather than follow, the onset of gambling disorder Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Biopsychosocial model Pathways model is anApproach to gambling disorder that predicts that there are three main paths leading to three subtypes. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

TABLE 12.4 Common Cognitive Distortions in People with Gambling Disorder Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

Substance Disorders: The Bio-psychosocial Perspective Various treatment programs for people with substance-related have emerged. Biological treatment may involve the prescription of substances that block or reduce cravings. Behavioral treatment involves techniques such as contingency management, cognitive behavioral therapy, and relapse prevention. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

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