CHAPTER 12 SUBSTANCE-RELATED AND ADDICTIVE DISORDERS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SUBSTANCE USE DISORDERS Substance Substance abuse Substance dependence Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SUBSTANCE USE DISORDERS Withdrawal Tolerance Substance intoxication Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SUBSTANCE USE DISORDER A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using a substance even though it causes significant problems in his or her life. Clinicians diagnose substance use disorders by assessing the individual in four categories of symptoms: 1.impaired control, 2.social impairment, 3.risky use 4.pharmacological changes. New diagnostic term has fewer negative connotations than the term “addiction” Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

DISORDERS ASSOCIATED WITH SPECIFIC SUBSTANCES Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SUBSTANCE ABUSE 8.9 percent of the population are current users of illicit drugs. Marijuana is the most commonly used illicit drug Most drugs of abuse directly or indirectly target the reward center of the brain by flooding its circuits with dopamine. Overstimulation of the reward system produces the euphoric effects that abusers seek and leads them to repeat the behavior in order to repeat the experience. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

FIGURE EFFECTS OF DRUGS OF ABUSE ON DOPAMINE PATHWAYS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

FIGURE 12.3 COMORBIDITY OF SUBSTANCE USE AND PSYCHOLOGICAL DISORDERS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

ALCOHOL EFFECTS Alcohol is a depressant A psychoactive substance that causes the depression of central nervous system activity. Immediate effects Sedating Central nervous system depressant Potentially fatal in excess Potentiation compounds these effects Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

ALCOHOL EFFECTS Long-term effects Permanent brain damage Dementia Wernicke’s disease Korsakoff’s synodrome Harmful changes in the liver, gastrointestinal system, bone density, muscles, and immune system Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

FIGURE 12.4 CURRENT, BINGE, AND HEAVY ALCOHOL USE AMONG PERSONS AGED 12 OR OLDER, BY AGE: 2010 Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

THEORIES AND TREATMENT OF ALCOHOL DEPENDENCE Biological Genetic factors Medications Naltrexone Disulfiram Acamprosate Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

THEORIES AND TREATMENT OF ALCOHOL DEPENDENCE Psychological Dual-process theory Alcohol myopia theory Treatment Cognitive-behavioral interventions Motivational approaches Expectancy manipulation Relapse prevention Combined behavioral intervention Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

THEORIES AND TREATMENT OF ALCOHOL DEPENDENCE Sociocultural Family, community, & cultural stressors Children of alcoholics at greater risk Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SUBSTANCES OTHER THAN ALCOHOL Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

STIMULANTS This category of drugs includes substances that have an activating effect on the nervous system. Amphetamine Methamphetamine Cocaine Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

FIGURE 12.5 LONG-TERM EFFECTS OF METHAMPHETAMINE ON THE BRAIN Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

FIGURE COCAINE IN THE BRAIN Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

CANNABIS Marijuana Hashish Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

TABLE SUMMARY OF EFFECTS OF CANNABIS ON EXECUTIVE FUNCTIONS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

HALLUCINOGENS Hallucinogens are drugs that cause people to experience profound distortions in their perception of reality. LSD Peyote Psilocybin PCP MDMA Included in hallucinogen-related disorders are use and intoxication, but not withdrawal. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

OPIOIDS An opioid is a substance that relieves pain. Within opioid-related disorders are opioid use, intoxication, and withdrawal. Hydrocodone Oxycodone Morphine Codeine Heroin Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SEDATIVES, HYPNOTICS, & ANXIOLYTICS Sedatives have calming effects on the central nervous system Hypnotics induces sleep Anxiolytics are anti-anxiety medications Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

CAFFEINE Found in coffee, tea, chocolate, energy drinks, diet pills, and headache remedies. Increases: An individual’s perceived level of energy alertness Blood pressure and may lead to increases in the body’s production of cortisol Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

TOBACCO Nicotine: Psychoactive substance found in cigarettes Stimulates the release of adrenaline (norephinephrine) Increases blood pressure, heart rate, and respiration Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

INHALANTS Volatile solvents Aerosols Gases Nitrites Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

THEORIES AND TREATMENT Biological Genetic abnormalities Opioid receptor on chromosome 1 (OPRM1) Chromosome 15 in a cluster of nicotinic receptor subunits (CHRNA-3, -5, and -4) Catechol-o-methyltransferase (COMT) Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

THEORIES AND TREATMENT To prevent heroin relapse Methadone Buprenorphine Naltrexone Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

THEORIES AND TREATMENT Psychological Contingency management Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

BIOPSYCHOSOCIAL PERSPECTIVE Useful for: Understanding substance dependence Approaches to treatment Genetics Action of substances on the central nervous system Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

NON-SUBSTANCE-RELATED DISORDERS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

GAMBLING DISORDER A non-substance-related disorder involving the persistent urge to gamble. This disorder is included with substance use disorders as it is now conceptualized as showing many of the same behaviors, such as: Cravings Increasing needs to engage in the behavior Negative social consequences. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

GAMBLING DISORDER People with gambling disorder also have high rates comorbidity: Nicotine dependence (60 percent) Dependence on other substances (58 percent) Mood disorder (38 percent) Anxiety disorder (37 percent) Mood and anxiety disorders are more likely to precede, rather than follow, the onset of gambling disorder Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

BIOPSYCHOSOCIAL MODEL Pathways model is an Approach to gambling disorder that predicts that there are three main paths leading to three subtypes. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

TABLE 12.4 COMMON COGNITIVE DISTORTIONS IN PEOPLE WITH GAMBLING DISORDER Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SUBSTANCE DISORDERS: THE BIO-PSYCHOSOCIAL PERSPECTIVE Various treatment programs for people with substance-related have emerged. Biological treatment may involve the prescription of substances that block or reduce cravings. Behavioral treatment involves techniques such as contingency management, cognitive behavioral therapy, and relapse prevention. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

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