1. Substance-Related and Addictive Disorders
Chapter 12
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2. Substance Use Disorders
Substance abuse
Substance dependence
Substance: A chemical that alters a person’s mood or behavior when it is smoked, injected, drunk, inhaled, or swallowed in pill form.
Substance abuse: Maladaptive pattern of substance use occurring within a 12-month period that leads to significant impairment or distress evidence by:
Failure to meet obligations
Repeated use of substances in physically hazardous situations
Legal problems
Interpersonal problems.
Substance dependence: Maladaptive pattern of use manifested by cognitive, behavioral, and physiological symptoms during a 12-month period and caused by continued use of substance.
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3. Substance Use Disorders
Withdrawal
Tolerance
Substance intoxication
Withdrawal: Physiological and psychological changes that occur when an individual stops taking a substance.
Tolerance: Extent to which the individual requires larger and larger amounts of a substance in order to achieve its desired effects, or the extent to which the individual feels less of its effects after using the same amount of the substance.
Substance intoxication: The temporary maladaptive experience of behavioral or psychological changes that are due to the accumulation of a substance in the body.
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4. 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:
impaired control,
social impairment,
risky use
pharmacological changes.
New diagnostic term has fewer negative connotations than the term “addiction”
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5. Disorders Associated with Specific Substances
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6. 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.
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7. FIGURE 12.2 - Effects of Drugs of Abuse on Dopamine Pathways
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8. FIGURE 12.3 Comorbidity of Substance Use and Psychological Disorders
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9. Alcohol Effects Alcohol is a depressant Immediate effects
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
In small amounts, alcohol has sedating effects leading users to feel relaxed.
In larger amounts, alcohol may lead drinkers to feel more outgoing, self-confident, and uninhibited.
As drinking continues, alcohol’s effects as a central nervous system depressant become more apparent, as sleepiness, uncoordination, dysphoria, and irritability set in.
Depressant: A psychoactive substance that causes the depression of central nervous system activity.
Excessive drinking affects vital functions and can be fatal.
Potentiation: Combination of the effects of two or more psychoactive substances such that the total effect is greater than the effect of either substance alone.
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10. 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
Wernicke’s disease: Form of aphasia in which the individual is able to produce language but has lost the ability to comprehend, so that these verbal productions have no meaning.
Korsakoff’s syndrome: Permanent form of dementia associated with long-term alcohol use in which the individual develops retrograde and anterograde amnesia, leading to an inability to remember recent events or learn new information.
Retrograde amnesia: Amnesia involving loss of memory for past events.
Anterograde amnesia: Amnesia involving the inability to remember new information.
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11. FIGURE 12.4 Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or Older, by Age: 2010
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12. Theories and Treatment of Alcohol Dependence
Biological
Genetic factors
Medications
Naltrexone
Disulfiram
Acamprosate
Biological
Twin, family, and adoption studies consistently point to the importance of genetic factors as contributors to alcohol-related disorder.
Genetics of alcohol-related disorders comes from studies examining associations with genes involved in alcohol metabolism and neural transmission.
Medications
Naltrexone - Blocks the effects of the body’s production of alcohol-induced opioids, through involving dopamine.
Disulfiram: Known popularly as Antabuse, a medication used in the treatment of alcoholism that inhibits aldehyde dehydrogenase (ALDH) and causes severe physical reactions when combined with alcohol.
Acamprosate - Reduces the risk of relapse by reducing the individual’s urge to drink and thereby reducing the drive to use alcohol as a way of reducing anxiety and other negative psychological states.
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13. 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
Dual-process theory: Proposes there are automatic processes that generate an impulse to drink alcohol and controlled, effortful processing that regulates these automatic impulses.
Alcohol myopia theory: Proposes that as individuals consume greater amounts of alcohol, they are more likely to make risky choices because the immediate temptation of the moment overcomes the long-term consequences of the behavior.
Relapse prevention: Based on the expectancy model, in which individuals are encouraged not to view lapses from abstinence as signs of certain failure.
The primary emphasis of CBI is on enhancing reinforcement and social support for abstinence.
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14. Theories and Treatment of Alcohol Dependence
Sociocultural
Family, community, & cultural stressors
Children of alcoholics at greater risk
Alcohol dependent individuals showed a variety of behaviors :
Early neural dysfunction.
Nervousness and fretfulness as infants.
Hyperactivity as children.
Poor physical coordination.
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15. Substances Other Than Alcohol
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16. Stimulants
This category of drugs includes substances that have an activating effect on the nervous system.
Amphetamine
Methamphetamine
Cocaine
Stimulants: Substances that have an activating effect on the nervous system.
Amphetamine: Affects the central nervous and the autonomic nervous systems.
Methamphetamine: Related to amphetamine but provokes more intense central nervous system effect.
Cocaine: Highly addictive central nervous system stimulant that an individual snorts, injects, or smokes.
Effects include feelings of euphoria, heightened mental alertness, reduced fatigue, and heightened energy.
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17. FIGURE 12.5 Long-term Effects of Methamphetamine on the Brain
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18. Figure 12.6 - Cocaine in the Brain
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19. Cannabis Marijuana Hashish
Marijuana: Psychoactive substance derived from the hemp plant whose primary active ingredient is delta-9-tetrahydrocannabinol (THC).
Hashish, containing a more potent form of THC, comes from the resins of the plant’s flowers.
Individuals use synthetic forms of THC for medicinal purposes:
Treating asthma and glaucoma and reducing nausea in cancer patients undergoing chemotherapy.
Heavy and continued use of marijuana:
Produce effects on bodily functioning.
Lead to higher risk of heart attack.
Lead to impaired respiratory functioning.
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20. Table 12.3 - Summary of Effects of Cannabis on Executive Functions
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21. 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.
Hallucinogens: Psychoactive substances that cause abnormal perceptual experiences in the form of illusions or hallucinations, usually visual in nature.
LSD (lysergic acid diethylamide): Users ingest in tablets, capsules, and liquid form.
Produces tolerance.
Peyote: Primary ingredient is mescaline.
Psilocybin: Found in certain mushrooms.
PCP (phencyclidine, a.k.a. “angel dust”): Originally developed as an intravenous anesthetic.
Symptoms that mimic schizophrenia, mood disturbance, memory loss, difficulties with speech and thinking, weight loss, and depression.
MDMA- known on the street as ecstasy, is a synthetic substance chemically similar to methamphetamine and mescaline. Users experience feelings of increased energy, euphoria, emotional warmth, distorted perceptions and sense of time, and unusual tactile experiences.
Users experience unpleasant psychological effects
Confusion, depression, sleep problems, cravings for the drug, and severe anxiety.
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22. Opioids An opioid is a substance that relieves pain.
Within opioid-related disorders are opioid use, intoxication, and withdrawal.
Hydrocodone
Oxycodone
Morphine
Codeine
Heroin
Opioids: Psychoactive substances that relieve pain.
Clinicians prescribe hydrocodone products for a variety of painful conditions, including dental and injury-related pain.
Physicians use morphine before and after surgical procedures to alleviate severe pain.
Clinicians prescribe codeine for mild pain.
Heroin: Form of opioid, synthesized from morphineis.
Serious health consequences of heroin use:
Fatal overdoses
Infectious diseases
Damage to the cardiovascular system, abscesses, and liver or kidney disease.
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23. Sedatives, Hypnotics, & Anxiolytics
Sedatives have calming effects on the central nervous system
Hypnotics induces sleep
Anxiolytics are anti-anxiety medications
Medications include:
Benzodiazepines
Barbiturates
Nonbenzodiazepine sleep medications such as:
Zolpidem (Ambien)
Eszopiclone (Lunesta)
Zalepon (Sonata)
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24. 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
Caffeine withdrawal symptoms:
Headache
Tiredness and fatigue
Sleepiness and drowsiness
Dysphoric mood
Difficulty concentrating
Depression
Irritability
Nausea
Vomiting
Muscle aches
Stiffness
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25. Tobacco Nicotine: Psychoactive substance found in cigarettes
Stimulates the release of adrenaline (norephinephrine)
Increases blood pressure, heart rate, and respiration
Withdrawal symptoms
Irritability, difficulties with concentration, and strong cravings for nicotine.
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26. Inhalants Volatile solvents Aerosols Gases Nitrites
Inhalants: Diverse group of substances that cause psychoactive effects by producing chemical vapors.
Inhalants have similar effects as alcohol.
Slurring of speech, loss of coordination, euphoria, dizziness, and, over time, loss of inhibition and control.
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27. 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)
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28. Theories and Treatment
To prevent heroin relapse
Methadone
Buprenorphine
Naltrexone
Methadone: Synthetic opioid that produces a safer and more controlled reaction than heroin and is used in treating heroin addiction.
Buprenorphine: Used in the treatment of heroin addiction.
Naltrexone: Used in the treatment of heroin addiction.
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29. Theories and Treatment
Psychological
Contingency management
Principles of treating substance dependence other than alcohol through CBT are similar to those involved in treating alcohol dependence.
Clinicians combine CBT with motivational therapies and behavioral interventions that focus on contingency management.
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30. Biopsychosocial Perspective
Useful for:
Understanding substance dependence
Approaches to treatment
Genetics
Action of substances on the central nervous system
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31. Non-Substance-Related Disorders
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32. 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.
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33. 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
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34. Biopsychosocial model
Pathways model is anApproach to gambling disorder that predicts that there are three main paths leading to three subtypes.
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35. TABLE 12.4 Common Cognitive Distortions in People with Gambling Disorder
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36. 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.
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