Alcohol and Other Drugs Definition How Do Drugs Work?

Drug Intake Pathways Injection Inhalation Intranasal Ingestion Intravenous Inunction (subcutaneous) Inhalation Intranasal Ingestion Others, not used for drugs of abuse Intramuscular, Transdermal, Implantation Pathway determines onset and duration

Continuum of Use Abstinence Use Addiction (“addict”)? Alcoholism (“alcoholic”)?

DSM Categorization Substance Intoxication Substance Abuse Affects Functioning Substance Dependence Tolerance Withdrawal Substance Seeking Behavior or Thoughts Psychological Dependence

Classes of Drugs Depressants Stimulants Opioids Hallucinogens Cannabinoids Inhalants

Alcohol Most adults in the U.S. consider themselves light drinkers or abstainers Over 50% of the U.S. (> 12 years age) report current use Alcohol use is highest among Caucasian Americans Men use and abuse alcohol more than women Violence is associated with alcohol Alcohol alone does not cause aggression 15 million Americans are alcohol dependent 20% with alcohol problems experience spontaneous recovery

Stimulants Effects Substances Euphoria (Intense Rush) Increased Activity Level/Decreased Fatigue Subsequent crash Decreased Appetite Cause Release and Block Reuptake of Dopamine and/or Norepinephrine Substances Amphetamines/Methamphetamines Cocaine/Crack Nicotine Caffeine

Opioids Effects Substances Euphoria Analgesic Drowsiness Activate body’s enkephalins and endorphins (“natural opiates”) Substances Opium Heroine Morphine Pain Killers (Darvon, Percocet, etc.) Codeine

Hallucinogens Effects Substances Sensory and Perceptual Alterations, Including Hallucinations Synesthesia Substances LSD PCP Psyllocybin (Mushrooms) Peyote (Cactus) “Designer” Drugs Others

Cannabinoids Effects Substances Mild Euphoria and “Mellowing” Increased Appetite Hallucinogenic in very high doses Substances Marijuana Hashish THC

Inhalants Effects Substances “Head Rush” (Dizziness) Perceptual Distortions Substances Aerosols Solvents Nitrous Oxide

Causal Factors Biological Psychological Pleasure Centers in the Brain Dopamine GABA suppression Inhibition of Negative Affect/Anxiety Psychological Positive Reinforcement Negative Reinforcement Self-medication Hypothesis Expectancy Effects

Causal Factors Familial Social and Cultural Genetics Psychosocial Positive and Negative Influence

Additional Concepts Denial Addictive Thinking Value of Group Therapy

FIGURE 10.6  An integrative model of substance-related disorders. 15

Treatment Controlled Use vs. Abstinence Biological Agonist Substitution e.g., Methadone Antagonist e.g., Naloxone Aversive Treatment Antabuse Ineffective Alone

Treatment Psychosocial Prevention Individual and Group Hospitalization vs. Outpatient Treatment 12-step Programs (e.g., AA) Relapse Prevention Abstinence Violation Effect Prevention Primary, Secondary, Tertiary

Impulse-Control Disorders Intermittent Explosive Disorder Kleptomania Pyromania Pathological Gambling Trichotillomania