Substance Related Disorders

Substance Use Disorders  Problems associated with  using and abusing drugs or substances which alter the way people think, feel, and behave.  Substance dependence  Maladaptive pattern of substance use that leads to clinically significant impairment or distress  Substance abuse  Recurrent and significant adverse consequences related to substance use Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Substance Dependence  Tolerance  Withdrawal  Ingestion of more than intended  Persistent desire or unsuccessful effort to use less  Spending a lot of time on obtaining, using, or recovering from the substance  Reduced social, occupational, or recreational activities due to use of substance  Continued use despite knowledge of the psychological and/or physical problems caused  Presence of 3 or more of the above in a 12-month period Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Substance Abuse  Recurrent substance use leading to failure to fulfill work, school, home obligations  Recurrent substance use in hazardous situations, like driving  Recurrent substance-related legal problems, like arrests  Continued substance use despite persistent social or interpersonal problems caused by using the substance, such as getting in fights  The presence of three or more of the above within a 12-month period Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Substance Intoxication  Disturbances of  perception  wakefulness  attention  thinking  judgment  motor behavior  interpersonal behavior Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Substance Intoxication  Level of intoxication depends on  the substance  the dose  history of use  person’s tolerance (related to body size, gender, history of use)  person’s expectation of use  environment or setting in which substance is ingested Abnormal Psychology, 11/e by Sarason & Sarason © 2005

The effects of alcohol  Ethyl alcohol (a CNS depressant), or ethanol, is the alcohol in beer, wine, hard liquor  Alcohol blocks messages between nerve cells  First affects frontal lobes where reasoning, memory, judgment, and inhibitions take place  Next affects cerebellum, seat of motor and muscle control, balance, five senses  Finally affects the spinal cord and medulla, which governs breathing, heart rate, and body temperature  Blood alcohol content of 0.5% or more can lead to death Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Alcohol use and risks  70% of Americans drink occasionally  21- to 34-year olds drink the most  Half of all alcohol is consumed in binge sprees (5 or more drinks at a time)  Alcohol use in US implicated in  40% of traffic fatalities  50% of deaths from falls  52% of fire-related deaths  38% of drowning deaths  20% of health-related expenditures Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Models of Alcohol Disorders  Biological  Metabolic, genetic, and neural processes  Psychodynamic  Effort to change negative emotional states  Behavioral  Learned from modeling and social reinforcement  Cognitive  Expectations about effects of alcohol  Interactional  Stress precipitates use in people with predisposition to use Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Treatment of Alcohol Disorders  Biological  Drug  Management of withdrawal symptoms  Psychodynamic  Psychotherapy provides little benefit unless family contexts of drinking explored  Cognitive-behavioral  Aversive conditioning  Covert sensitization  Controlled drinking  Relapse prevention  Community-based treatment  Alcoholics Anonymous most widely used Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Relapse in Drug Treatment Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Relapse in Drug Treatment Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Alcohol-related Disorders: Risk Factors  Poverty  Neighborhood disorganization  Childhood behavior problems  Poor family management practices  Family conflict  Lack of family cohesion  Academic failure  Social pressure to use  Alienation and rebelliousness  Rejection by peers Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Barbiturates and Tranquilizers  Depressing effect on central nervous system  Dangerous in combination with alcohol  Barbiturates often prescribed to relieve anxiety and prevent convulsions  Tranquilizers can lead to tolerance and thus overuse Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Opioids  Drugs from the opium class; with morphine-like effect that bind to brain’s opioid receptors  Sometimes called narcotics  Heroin and morphine most commonly used  Endorphins, enkephalins, and polymorphins are body’s endogenous opioids  Cause change in mood, sleepiness, mental clouding, constipation, slow respiratory system  Withdrawal can be severe  Methadone maintenance is most widely used treatment Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Cocaine  Produced from leaves of coca plant  Stimulates CNS and decreases appetite  Can produce mania, paranoia, and impaired judgment  Crack is more potent distilled form and is highly addictive  Treatment focuses on self-help and social support (AA-type programs) Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Amphetamines  Psychomotor stimulants  Affect central nervous system and cardiovascular system  Moderate use  Wakefulness, alertness, elevated mood  High dosage  Nervousness, dizziness, confusion, elevated blood pressure  Tolerance develops rapidly  Methamphetamines  Chemically similar but has greater CNS impact Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Hallucinogens  Also known as psychedelics  CNS action produces alterations in consciousness  Natural hallucinogens (e.g., Mescaline, Psilocybin)  Synthetic hallucinogens (e.g., STP, LSD)  Abuse leads to respiratory or cardiovascular collapse and psychotic behavior  Treatment consists of support groups of enhancing social skills Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Phencyclidine (PCP)  Synthetic chemical  Causes disorientation and hallucination  User may feel dissociated  Users may develop severe depression or psychosis  Effects may be irreversible Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Inhalents  Volatile substances or organic solvents (gasoline, spray paint)  Produce changes in perception  Use may lead to withdrawal from social, occupational, or recreational activities  More commonly used by young people  Use can lead to dependence with tolerance and withdrawal symptoms Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Cannabis Sativa (Marijuana/ Hashish)  Most often used in marijuana form  Hashish is the solidified resin of the cannabis plant  Major active ingredient in cannabis is THC  Marijuana use  Impairs motor coordination and perception  Affects short-term memory and learning  Treatment  Relapse prevention  Social support groups  Legalized in some countries (e.g Holland) Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Nicotine  CNS stimulant found in tobacco  Stimulates acetylcholine receptors  Increases heart rate and blood pressure  Can be highly addictive  Cessation requires  commitment to change  implementation of change  relapse prevention  Nicotine gum and patch may be helpful if used with counseling.  Note that the negative effects are not limited to nicotine addiction, but other effects of smoking Abnormal Psychology, 11/e by Sarason & Sarason © 2005