Substance-Related Disorders Chapter 10

Perspectives on Substance-Related Disorders The Nature of Substance-Related Disorders Kills 500 000 Americans annually Problems related to the use and abuse of psychoactive substances Produce wide-ranging physiological, psychological, and behavioral effects related to use and abuse of drugs Some Important Terms and Distinctions Substance – alter mood and behavior Substance use (moderate amount that does not interfere with functioning) vs. substance intoxication (physiological reactions to ingestion to psychoactive substances) Substance abuse (leads to significant distress or impairment in functioning) vs. substance dependence (need for increasing amounts to achieve the desired effects) Tolerance (diminished effect with continuous use) vs. withdrawal (negative physiological reaction to removal of a psychoactive substance)

Perspectives on Substance-Related Disorders (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

**Ice, LSD, chocolate, TV: Is everything addictive? Figure 10.1

Easy to get hooked on, hard to get off Figure 10.2

The Depressants: Alcohol Use Disorders Psychological and Physiological Effects of Alcohol Central Nervous system depressant Influences several neurotransmitter systems, mainly GABA (inhibition of behavior) but also glutamate system and serotonin system Effects of Chronic Alcohol Use Alcohol intoxication Alcohol withdrawal (withdrawal delirium – delirium tremens) Associated brain conditions – Dementia and Wernicke’s disease Fetal alcohol syndrome

The path traveled by alcohol throughout the body Figure 10.3

Alcohol: Some Facts and Statistics 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 Statistics on Abuse and Dependence 10% of Americans experience problems with alcohol Most persons with alcoholism can moderate or cease drinking 20% of those with alcohol problems experience spontaneous recovery

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 Such effects are followed by a “crash” (e.g., feeling depressed and tired) Enhance the release of dopamine and norepinephrine, while blocking reuptake 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 DSM-IV Criteria for Cocaine Intoxication and Withdrawal Psychological symptoms Physiological symptoms Most cocaine users cycle through patterns of tolerance and withdrawal Effects of Cocaine Produce short lived sensations of elation, vigor, reduce fatigue Cocaine use in the United States has declined over the last decade Effects result from blocking the reuptake of dopamine Cocaine is highly addictive, but addiction develops slowly

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: Caffeine Use Disorders Effects of Caffeine – The “Gentle” Stimulant Used by over 90% of Americans Found in tea, coffee, cola drinks, and cocoa products Small doses elevate mood and reduce fatigue Regular use can result in tolerance and dependence Caffeine blocks the reuptake of the neurotransmitter adenosine 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 natural and synthetic substances with narcotic effects Such drugs are often referred to as analgesics Examples include heroin, opium, codeine, and morphine Effects of Opiods Low doses induce euphoria, drowsiness, and slowed breathing High doses can result in death Withdrawal symptoms can be lasting and severe Activate body’s enkephalins and endorphins DSM-IV Criteria for Opiod Intoxication and Withdrawal Psychological symptoms Physiological symptoms Mortality rates are high for opiod addicts

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 systems (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 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: 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 Most see substance abuse as a means to cope with negative affect The self-medication and the tension reduction hypotheses 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 in 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

An integrative model of substance related disorders Figure 10.7

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 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 not generally very effective when used alone

Psychosocial Treatment of Substance-Related Disorders 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 Debate Over Controlled Use vs. Complete Abstinence as Treatment Goals

Psychosocial Treatment of Substance-Related Disorders 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