Substance-Related Disorders and Addictive Disorders Levels of involvement –Substance use –Substance intoxication –Substance abuse –Substance dependence Psychoactive substances alter mood, behavior, or both

Main Categories of Substances –Depressants –Stimulants –Opiates –Hallucinogens –Marijuana –Other drugs of abuse Inhalants Anabolic steroids Medications

SPECIFIC DRUGS AND RELATED TOPICS LEGAL DRUGS: alcohol(FAS, DUI, violence…) tobacco / nicotine (health care debate) caffeine(addictive? Long-term effects?) depressants (benzos - Rohypnol; barbiturates)

>SUBSTANCE USE DISORDERS SPECIFIC DRUGS AND RELATED TOPICS ILLEGAL DRUGS: cocaine (“crack babies”) amphetamines (Ritalin and ADHD) hallucinogens(LSD, Ecstasy…) marijuana (medical uses; legalization?) CAN OTHER BEHAVIORS BE ADDICTIVE?

Diagnostic Issues The DSM-5 term substance-related disorders include 11 symptoms that range from relatively mild (e.g., substance use results in occasional failure to fulfill major role obligations) to more severe (e.g., occupational or recreational activities are given up or reduced because of substance use) Substance-related disorders and anxiety and mood disorders are highly prevalent

Alcohol Use Disorder

Statistics on Use and Abuse –Most adults: light drinkers or abstainers –Current use = ~50% –Binge drinking = 22.6% –Dependence = 3 million –Males > Females

Statistics on Alcohol Use and Abuse

Cannabis-Related Disorders Marijuana –Most frequently used drug; medical uses –Tetrahydrocannabinol (THC) –Variable, individual reactions Euphoria Mood swings Paranoia Hallucinations

Cannabis-Related Disorders

Causes of Substance-Related Disorders Once thought to be moral weakness or willful misconduct Combination of factors –Biological –Psychological –Social –Cultural

Biological Dimensions Familial and genetic influences –Twin, family, and adoption studies –Use = environmental influences –Abuse and dependence = polygenetic vulnerability

Neurobiological Influences Pleasure or reward centers –Dopaminergic system Midbrain - ventral tegmental area Frontal cortex – nucleus accumbens –Endorphins/enkephalins –Rewards system Serotonin and norepinephrine

Psychological/Behavioral Dimensions Positive reinforcement –Repeated pairings with rewards Negative reinforcement –Escape from unpleasantness –Self-medication –Tension reduction –Coping mechanism for negative affect –Avoid withdrawal

Cognitive Factors Expectancy effects –Beliefs about drugs and drug effects Cravings –Cues –Environmental triggers

Social Dimensions Exposure to drugs –Prerequisite for use –Media –Peers –Family Monitoring Peer groups Models of Addiction –Moral weakness - Behavioral/Psychological –Disease model

>SUBSTANCE USE DISORDERS Assumptions of Disease Model addiction seen as a “primary” disease process alcoholics qualitatively different from non alcoholics: can’t drink in moderation central symptom of addiction is loss of control (e.g., one drink, one drunk) addiction is chronic and progressive; no cure, can only be arrested with total abstinence (e.g. progression models)

>SUBSTANCE USE DISORDERS CRITIQUE OF DISEASE MODEL Strengths -perception shift: from sin to TX -eases guilt, self-blame -disease is a good metaphor that fits the experience - 12-step support and framework works for many (prevalence of meetings; 24-hour support…) -Other strengths? _______________________

>SUBSTANCE USE DISORDERS Limitations -not all data-based -dichotomous thinking dangerous; no middle ground (you’re an alcoholic or not) - loss of control and responsibility paradox

>SUBSTANCE USE DISORDERS METHODS OF TREATMENT Inpatient Detoxification and Rehabilitation Outpatient Individual, Couple, or Family Counseling Self-help Groups (Alcoholics Anonymous; NA, CA, OA, GA, Al-Anon etc.) Residential Facilities & Therapeutic Communities Medications

Treatment of Substance Use Disorders - Medications

Treatment of Substance-Related Disorders Relapse prevention –Learned aspects of abuse primary target after detox –Address distorted cognitions –Identify negative consequences –Identify high risk situations –Reframe relapse failure of coping skills, not person as learning opportunity –Increase motivation to change

>SUBSTANCE USE DISORDERS MOTIVATION AND STAGES OF CHANGE Pre-Contemplation(Denial?) Contemplation(Ambivalence) Preparation (Commitment & Goal-setting) Action (explicit change activities) Maintenance(Relapse) **