Chapter 10 Substance-Related Disorders

Perspectives on Substance-Related Disorders: 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-Related Disorders: 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-Related Disorders: An Overview (cont.) Figure 11.1 Ice, LSD, chocolate, TV: Is everything addictive?

Perspectives on Substance-Related Disorders: An Overview (cont.) Figure 11.1 (cont.) Ice, LSD, chocolate, TV: Is everything addictive?

Perspectives on Substance-Related Disorders: An Overview (cont.) Figure 11.2 Easy to get hooked on, hard to get off

Perspectives on Substance-Related Disorders: 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 Anxiolytic Substance 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 of Substance-Related Disorders (cont.) Figure 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 of Substance-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 of Substance-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