1. Substance-Related and Impulse Control Disorders

2. Levels of Involvement – Substance Disorders Terminology
Prevalence: 8%
Specific drugs have specific effects, but terminology applies to all
Psychoactive substances: alter mood or behavior
Substance use: moderate ingestion of psychoactive substances, does not interfere with functioning

3. Levels of Involvement – Substance Disorders Terminology
Intoxication: physiological reactions resulting from ingestion of psychoactive substance
Impaired judgment
Changes in motor ability
Mood changes

4. Levels of Involvement – Substance Disorders Terminology
Substance abuse: pattern of substance use that leads to significant distress or impairment in roles, and in hazardous situations

5. Levels of Involvement – Substance Disorders Terminology
Substance dependence: characterized by need for increased amounts to achieve desired effect (tolerance)
Negative physical effects when withdrawn (withdrawal)
Unsuccessful attempts at control
Substantial effort expended to seek
Substantial effort to recover

6. Individual Substances
Depressants: sedation, relaxation. Include alcohol, sedative drugs
Stimulants: increase activity, alertness, mood. Amphetamines, cocaine, nicotine, caffeine
Opiods: reduce pain and increase euphoria. Heroin, opium, morphine
Hallucinogens: alter sensory perception. Marijuana, LSD

7. Psychiatric Definition – 3 of 9 required for addiction
TAKES more than intended
WANTS to cut back, but has failed
SPENDS lots of time trying to get or do
OFTEN intoxicated or in withdrawal
CURTAILS other activities
USES substance despite problems it causes
NEEDS more and more of substance to achieve effect
SUFFERS withdrawal
TAKES substance to avoid withdrawal

8. Relative Addictiveness Based on Expert Ratings

9. Alcohol Abuse 23% Americans binge drink (5+)
15 million Americans are alcohol dependent
Very culturally dependent
Peru: 25%
Shanghai: 0.45%
Dependency is chronic
Earlier age (11-14) = increased risk disorder

10. Amphetamine Use Disorders
Man-made
Weight loss, narcolepsy, ADHD
Behavioral symptoms
Changes in sociability, interpersonal sensitivity, anxiety, anger
Stereotypical behaviors
Impaired judgment
Quick tolerance

11. Opiod Use Disorders Natural, synthetic, endogenous to body
Euphoria, drowsiness, slowed breathing
Analgesics (e.g., morphine)
Very unpleasant withdrawal
6-12 hours
Yawning, nausea, vomiting, chills, muscle aches, diarrhea, insomnia (1-3 days)
Poor prognosis

12. Other Substances of Abuse
Inhalants
Most common poor adolescent males
Steroids
“Designer drugs”

13. Causes of Substance Abuse Disorders
Biological Factors
Genetic
Neurobiological
Psychological Factors
Reinforcement
Cognitive Factors
Social Factors
Culture
Integrative Model

14. Biological Influences - Genes
Drug abuse (particularly alcohol) have genetic influence
Easiest to study alcohol
Common genetics?
Use = environment, abuse = genetic?

15. Biological Influences - Neurobiology
Positive reinforcement of natural pleasure states neurologically
Dopaminergic system + opiods
How does negative reinforcement work?

16. Psychological Influences – Positive and Negative Reinforcement
Positive reinforcement can be physical
Also social
Negative reinforcement = relief (Such as anxiety, pain, etc.)
Used to “self medicate”

17. Cognitive Factors Expectancy effects
Predict future drinking use by teens
Drinking will improve social behavior, motor, and cognitive abilities
Expectancies might result from us
Cravings
Influenced by cognitions – availability, environment, moods

18. Social Factors Exposure to substances influences disorder development
Media exposure, peer exposure
Less monitoring by parents with disorder

19. Cultural Influences Cultural expectations for drug use
Economic influences

20. An Integrative Model Textbook p. 415
All influences work together to increase likelihood an individual will develop substance disorder
Also influences the maintenance of that disorder
Equifinality: a particular disorder can arise from multiple and different paths

21. Treatment of Substance-Related Disorders
Personal motivation is essential
Difficult and slow
Individualized
Treatments across type of drug very similar
Biological Treatments
Psychosocial Treatments

22. Biological Treatments – Agonist Substitution
Patient is provided with safe drug that has similar chemical makeup
E.g. methadone (opiod) for heroin
No high, but same analgesic and sedation
Results are mixed
Cross-tolerance
Abuse of other drugs
Lifelong dependency

23. Biological Treatments – Antagonist Treatment
Effects of drug are blocked, so no longer produce pleasant results
Naltrexone – produces immediate withdrawal symptoms from opiods
Might also help with alcoholism, with therapy

24. Biological Treatments – Aversive Treatment
Make ingesting psychoactive drug unpleasant
Associate drug use with side effects
Antabuse
Nausea, vomiting, elevated heart rate, respiration
Noncompliance is large problem

25. Psychological Treatments
Inpatient treatment
Alcoholics Anonymous (and variants)
Controlled Use
Component Treatment
Relapse Preventions

26. Inpatient Treatment Help addicts through initial withdrawal Expensive
May be no difference between inpatient and outpatient care
Environment is different

27. Alcoholics Anonymous Developed 1935
Alcoholism as a disease that requires lifelong management
High levels of social support
97,000 groups in 100 countries
3% of Americans report attending at least 1 meeting in their lifetime
Relies on prayer and belief in higher power
Research on AA is very difficult

28. Controlled Use Alternative to total abstinence
Some may become social users
Extremely controversial
both controlled use and abstinence is successful for only 20-30% of patients

29. Component Treatment Aversion therapy – use paired with punishment
Covert sensitization
Contingency management – rewards
Community reinforcement – address life
Close other participates
Identify antecedents and consequences
Assistance with social services
New recreational activities

30. Relapse Prevention Learned aspects of dependence
Relapse = failure of cognitive and behavioral coping skills
Target ambivalence
Positive aspects
Negative consequences
Identify high risk situations and plan

31. Impulse-Control Disorders
Intermittent Explosive Disorders
Kleptomania
Pyromania
Pathological Gambling
Trichotillomania
Problematic Internet Use

32. Intermittent Explosive Disorder
Aggressive impulses
Result in serious assault or destruction of property
Rarely diagnosed
Symptoms often accounted for by another disorder

33. Kleptomania Urges to steal things
Not needed for personal use or monetary value
Rare? (Difficult to study)
Urge brings sense of tension, which is relieved by stealing

34. Pyromania Urge to set fires
Pattern similar to kleptomania (tension & relief)
Less than 4% of arsonists
Very little research

35. Pathological Gambling
Increasing number of patients
3-5% of adult Americans
Increasing among adolescents
Similar criteria to substance abuse
Increasing amounts for “high”
Withdrawal
Interference with functioning

36. Pathological Gambling
fMRIs show decreased activation in regions of brain that regulate impulses, while gambling
Abnormalities in dopamine and serotonin
Gambler’s Anonymous
70-90% drop out
Need high motivation

37. Trichotillomania Urge to pull out one’s hair 1-5% of college students
Greater incidence in females
Antidepressants & Cognitive therapy seem to have effect
Research is very scarce

38. Internet Addiction Excessive Use Withdrawal Tolerance
Excessive gaming, sexual preoccupation, and/or /text use
Excessive Use
Loss of time, neglect of basic drives
Withdrawal
Anger, tension, depression when inaccessible
Tolerance
Better equipment, new software, longer times
Negative Repercussions
Lying, arguments, academic achievements, social isolation

39. Internet Addiction Difficult to research
In US, Internet and computers are accessed from home
86% estimated to have comorbidity
Shame, denial, motivation, lack of awareness
Estimated % prevalence in US