1. Substance-Related Disorders
Chapter 10

2. Perspectives on Substance-Related Disorders
The Nature of Substance-Related Disorders
Kills Americans annually
Problems related to the use and abuse of psychoactive substances
Produce wide-ranging physiological, psychological, and behavioral effects related to use and abuse of drugs
Some Important Terms and Distinctions
Substance – alter mood and behavior
Substance use (moderate amount that does not interfere with functioning) vs. substance intoxication (physiological reactions to ingestion to psychoactive substances)
Substance abuse (leads to significant distress or impairment in functioning) vs. substance dependence (need for increasing amounts to achieve the desired effects)
Tolerance (diminished effect with continuous use) vs. withdrawal (negative physiological reaction to removal of a psychoactive substance)

3. Perspectives on Substance-Related Disorders (cont.)
Five Main Categories of Substances
Depressants – Result in behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs)
Stimulants – Increase alertness and elevate mood (e.g., cocaine, nicotine, caffeine)
Opiates – Primarily produce analgesia and euphoria (e.g., heroin, morphine, codeine)
Hallucinogens – Alter sensory perception (e.g., marijuana, LSD)
Other drugs of abuse – Include inhalants, anabolic steroids, medications

4. **Ice, LSD, chocolate, TV: Is everything addictive?
Figure 10.1

5. Easy to get hooked on, hard to get off
Figure 10.2

6. The Depressants: Alcohol Use Disorders
Psychological and Physiological Effects of Alcohol
Central Nervous system depressant
Influences several neurotransmitter systems, mainly GABA (inhibition of behavior) but also glutamate system and serotonin system
Effects of Chronic Alcohol Use
Alcohol intoxication
Alcohol withdrawal (withdrawal delirium – delirium tremens)
Associated brain conditions – Dementia and Wernicke’s disease
Fetal alcohol syndrome

7. The path traveled by alcohol throughout the body
Figure 10.3

8. Alcohol: Some Facts and Statistics
In the United States
Most adults consider themselves light drinkers or abstainers
Most alcohol is consumed by 11% of the U.S. population
Alcohol use is highest among Caucasian Americans
Males use and abuse alcohol more so than females
Violence is associated with alcohol, but alcohol alone does not cause aggression
Statistics on Abuse and Dependence
10% of Americans experience problems with alcohol
Most persons with alcoholism can moderate or cease drinking
20% of those with alcohol problems experience spontaneous recovery

9. Sedative, Hypnotic, or Anxiolytic Substance use Disorders: An Overview
The Nature of Drugs in This Class
Sedatives – Calming
Hypnotic – Sleep inducing (e.g., barbiturates)
Anxiolytic – Anxiety reducing (e.g., benzodiazepines)
Effects of Such Drugs Are Similar to Large Doses of Alcohol
Combining such drugs with alcohol is synergistic
All Exert Their Influence Via the GABA Neurotransmitter System
DSM-IV Criteria for Sedative, Hypnotic, or Anxiolytic Substance Use Disorders

10. Stimulants: An Overview
Nature of Stimulants
Most widely consumed drug in the United States
Such drugs increase alertness and increase energy
Examples include amphetamines, cocaine, nicotine, and caffeine

11. Stimulants: Amphetamine Use Disorders
Effects of Amphetamines
Produce elation, vigor, reduce fatigue
Such effects are followed by a “crash” (e.g., feeling depressed and tired)
Enhance the release of dopamine and norepinephrine, while blocking reuptake
DSM-IV Criteria for Amphetamine Intoxication
Psychological symptoms
Physiological symptoms
Ecstasy and Ice
Produces effects similar to speed, but without the crash
2% of college students report using Ecstasy
Both drugs can result in dependence

12. Stimulants: Cocaine Use Disorders
DSM-IV Criteria for Cocaine Intoxication and Withdrawal
Psychological symptoms
Physiological symptoms
Most cocaine users cycle through patterns of tolerance and withdrawal
Effects of Cocaine
Produce short lived sensations of elation, vigor, reduce fatigue
Cocaine use in the United States has declined over the last decade
Effects result from blocking the reuptake of dopamine
Cocaine is highly addictive, but addiction develops slowly

13. Stimulants: Nicotine Use Disorders
Effects of Nicotine
Stimulates the central nervous system, specifically nicotinic acetylcholine receptors
Results in sensations of relaxation, wellness, pleasure
Nicotine is highly addictive
DSM-IV Criteria for Nicotine Withdrawal Only
Psychological symptoms
Physiological symptoms
Nicotine users dose themselves to maintain a steady state of nicotine

14. Stimulants: Caffeine Use Disorders
Effects of Caffeine – The “Gentle” Stimulant
Used by over 90% of Americans
Found in tea, coffee, cola drinks, and cocoa products
Small doses elevate mood and reduce fatigue
Regular use can result in tolerance and dependence
Caffeine blocks the reuptake of the neurotransmitter adenosine
DSM-IV Criteria for Caffeine Intoxication
Psychological symptoms
Physiological symptoms

15. Opiods: An Overview
The Nature of Opiates and Opiods
Opiate – Natural chemical in the opium poppy with narcotic effects (i.e., pain relief)
Opiods – Refers to a class of natural and synthetic substances with narcotic effects
Such drugs are often referred to as analgesics
Examples include heroin, opium, codeine, and morphine
Effects of Opiods
Low doses induce euphoria, drowsiness, and slowed breathing
High doses can result in death
Withdrawal symptoms can be lasting and severe
Activate body’s enkephalins and endorphins
DSM-IV Criteria for Opiod Intoxication and Withdrawal
Psychological symptoms
Physiological symptoms
Mortality rates are high for opiod addicts

16. Hallucinogens: An Overview
Nature of Hallucinogens
Substances that change the way the user perceives the world
May produce delusions, paranoia, hallucinations, and altered sensory perception
Examples include marijuana, LSD
Marijuana
Active chemical is tetrahydrocannabinol (THC)
May produce several systems (e.g., mood swings, paranoia, hallucinations)
Impairment in motivation is not uncommon (i.e., amotivational syndrome)
Major signs of withdrawal and dependence do not typically occur

17. Hallucinogens: An Overview (cont.)
LSD and Other Hallucinogens
LSD is most common form of hallucinogenic drug
Tolerance tends to be rapid, and withdrawal symptoms are uncommon
Psychotic delusional and hallucinatory symptoms can be problematic
DSM-IV Criteria for Marijuana and Hallucinogen Intoxication
Psychological and physiological symptoms are similar

18. Other Drugs of Abuse: Inhalants
Nature of Inhalants
Substances found in volatile solvents that are breathed into the lungs directly
Examples include spray paint, hair spray, paint thinner, gasoline, nitrous oxide
Such drugs are rapidly absorbed with effects similar to alcohol intoxication
Tolerance and prolonged symptoms of withdrawal are common
DSM-IV criteria for inhalant intoxication

19. Other Drugs of Abuse: Anabolic Steroids
Nature of Anabolic-Androgenic Steroids
Steroids are derived or synthesized from testosterone
Used medicinally or to increase body mass
Users may engage in cycling or stacking
Steroids do not produce a high
Steroids can result in long-term mood disturbances and physical problems

20. Other Drugs of Abuse: Designer Drugs
Drugs produced by pharmaceutical companies for diseases
Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine (“special K”) are examples
Such drugs heighten auditory and visual perception, sense of taste/touch
Becoming popular in nightclubs, raves, or large social gatherings
All designer drugs can produce tolerance and dependence

21. Causes of Substance-Related Disorders: Neurobiological Influences
Results of Neurobiological Research
Drugs affect the pleasure or reward centers in the brain
The pleasure center – Dopamine, midbrain, frontal cortex
GABA turns off reward-pleasure system
Neurotransmitters responsible for anxiety/negative affect may be inhibited

22. Causes of Substance-Related Disorders: Psychological Dimensions
Role of Positive and Negative Reinforcement
Most see substance abuse as a means to cope with negative affect
The self-medication and the tension reduction hypotheses
Opponent-Process Theory
Explains why the crash after drug use fails to keep people from using
Role of Expectancy Effects
Expectancies influence drug use and relapse

23. Causes of Substance-Related Disorders: Social and Cultural Dimensions
Exposure to Drugs in a Prerequisite for Use of Drugs
Media, family, peers
Parents and the family appear critical
Societal Views About Drug Abuse
Sign of moral weakness – Drug abuse is a failure of self-control
Sign of a disease – Drug abuse is caused by some underlying process
The Role of Cultural Factors
Influence the manifestation of substance abuse

24. An integrative model of substance related disorders
Figure 10.7

25. Biological Treatment of Substance-Related Disorders
Agonist Substitution
Safe drug with a similar chemical composition as the abused drug
Examples include methadone for heroin addiction, and nicotine gum or patch
Antagonistic Treatment
Drugs that block or counteract the positive effects of substances
Examples include naltrexone for opiate and alcohol problems
Aversive Treatment
Drugs that make the injection of abused substances extremely unpleasant
Examples include antabuse for alcoholism and silver nitrate for nicotine addiction
Efficacy of Biological Treatment
Such treatments are not generally very effective when used alone

26. Psychosocial Treatment of Substance-Related Disorders
Inpatient vs. Outpatient Care
Data suggest little difference in terms of overall effectiveness
Community Support Programs
Alcoholics Anonymous and related groups
Seem helpful and are strongly encouraged
Debate Over Controlled Use vs. Complete Abstinence as Treatment Goals

27. Psychosocial Treatment of Substance-Related Disorders
Components of Comprehensive Treatment and Prevention Programs
Individual and group therapy
Aversion therapy and convert sensitization
Contingency management
Community reinforcement
Relapse prevention
Preventative efforts via education