1. PSYC 2621 Substance Abuse and Dependence Psychoactive Substance Use Disorder –Alcoholism Symptoms –Maladaptive pattern of pathological use leading to clinically significant impairment or distress. –Failure to fulfill role obligations at work, home, or school –Using drug in hazardous situations –Recurrent arrests for drug use –Persistent conflict about use of drug

2. Cont. Alcoholism –Other examples: intoxication throughout the day inability to cut down or stop repeated efforts to control continued use in spite of physiological problem need for daily use to function episodes of blackouts impairment in social/occupational functioning, ie., failure to meet obligations display erratic/impulsive behaviorlegal problems inappropriate expression of aggression

3. Substance Dependence The development of physiological signs of dependence. –Lack of control over drug use –May experience tolerance or withdrawal

4. Drugs associated with dependence/abuse: Alcohol Opiods Stimulants (amphetamines and cocaine) Sedatives and barbiturates Prescription tranqulizers Some hallucinogens

5. Facts about Addiction More men are durg and alcohol dependent than women but the gender gap is lessening at least among non-Blacks.

6. Risk Factors Low SES Low education unemployed living alone No religious preferences

7. Stages of Addiction Experimentation Continued use of drug due to intoxicating effects Denial Loss of control

8. Depressants Alcohol –Leading drug of abuse –Risk factors gender - men age anti-social PD Family history Low SES, Low education, living alone

9. Cont. Depressants: alcohol –Physiological effects of Alcohol heighten sensitivity of GABA, an inhibitory neurotransmitter, depressing the nervous system Chronic use is associated with some forms of cancer, coronary heart disease, ulcers hypertension, gout, pancreatitis, liver diseases such as hepatitis and cirrhosis, malnutrition, Korsakoff’s Syndrome (amnesia d/o), Fetal Alcohol Syndrome (found in women who drink as little as 2 oz/day during the first trimester)

10. Cont. Depressants: alcohol Some evidence of benefits of light to moderate consumption reduces risks of heart attack.

11. Cont. Depressants Sedatives, hypnotics, and anti-anxiety drugs –Barbiturates (phenobarbital - epilepsy) are used to treat anxiety, high blood pressure. –Addicting

12. Cont. Depressants Opiods –Natural opiods: morphine, heroin, codeine derived from juice of poppy plant –Synthetic opiods: Demerol, Percodan, Darvon –pain relievers –Produce pleasurable effects because they stimulate brain centers that regulate sensations of pleasure and pain. –Endorphins: endogenous morphine –Morphine –Heroine: God’s own medicine. Withdrawal begins 4 -6 hours after last dose with flu-like symptoms; rarely die.

13. Stimulants Amphetamines –Speed –Uppers –bennies –Meth Cocaine –Used in Coca-Cola

14. Cont. Stimulants Nicotine –400,000 died from smoking related causes –Withdrawal: decrease energy, nervousness lightheadedness headaches insomnia tremors

15. Hallucinogens LSD PCP: angel-dust Marijuana

16. Theoretical Perspectives Some adolescents use because of peer pressure or rebelling. Biological –Normal endorphins but with opiods no endorphins so depend on drug for feeling of comfort, pleasure.

17. Cont. Theoretical Perspectives Cont. Biological –Genetic Factors evidence to support: adoption, cross-species, but twins yield mixed results. Identify the gene linked to dopamine receptors in brain but unknown how it contributes to alcoholism. Research with GABA levels in sons of alcoholics showed that the sons had lower GABA (associated with anxiety/tension) than sons of nonalcoholics. When they drank, their GABA level rose to normal.

18. Cont. Theoretical Perspectives Cont. Biological –Genetic research Sons of alcoholics tend to produce fewer alpha waves. For most people, when drink, alpha waves increase. 1/3 alcoholics show no family history. Other factors –instability in early home life –father had a low status job –availability of alcoholpeer pressure –permissiveness attitude about drunkenness

19. Cont. Theoretical Learning –Drug use is a positive reinforcement reduces tension self-medication for depression/anxiety With dependence comes negative reinforcement –drink to relieve the shakes, tachycardia, sweating Classical Conditioning –the cues associated with drug use can elicit conditioned responses in the form of cravings

20. Cont. Theoretical Perspectives Cognitive –Expectancies People choose to use or not based on expected positive or negative consequences. –According to Hull’s self-awareness model, depressants can create psychological shield to protect users from negative social feedback.

21. Cont. Theoretical Sociocultural –Culture and religion influence attitudes Psychodynamic –Oral fixation –Dependent personality –Research is mixed

22. Treatment Biological –Detox –Disulfiram (Antabuse) –Antidepressants: stem cravings for cocaine –Nicotine replacement (long-term ineffective unless behavior modification to change habits) –Methadone (to treat withdrawal from Heroin, taken indefinitely) –Naloxone (prevents users from getting high)

23. Cont. Treatment Nonprofessional support group –Alcoholics Anonymous (AA) 90% drop out after a few meetings. Limited controlled studies Residential approaches –Hospitalization when need to control/provide a drug free environment, safe withdrawal, protection from suicide/homicide –Communal opportunity: Daytop/Phoenix House

24. Cont. Treatment Psychodynamic –Resolve underlying conflicts –to focus on abuse is superficial Behavioral –change behavior when faced with temptation –Self-control strategies: ABC A = antecedents that trigger abuse B= behaviors C=consequences (either reinforcing or punishing

25. Cont. Treatment Aversive conditioning –Rapid smoking –Covert sensitization (imaginal) –Social skills training

26. Cont. Treatment –Relapse Prevention 50-90% will relapse develop skills to cope with temptations/high risk situations –negative moods –interpersonal conflicts –social situations –Abstinence Violation Effect (AVE »Overreact to a lapse which leads to self-perceived weakness, shame, guilt

27. Cont. Treatment Disease model –Interpretation of lapse determines relapse –Social support is the key to relapse prevention.