1. Substance Use Disoders

2. Health Effects of Drinking 75,000 deaths excessive consumption of alchohol 2.3 million years of life lost STDs, unintended pregnancy, acute myocardial infarction, motor vehicle crashes (14 600 deaths from a mvc in 2003; alcohol is associated with half of automobile-related deaths and major injuries) 4% of global burden of disease (only slightly less than that of tobacco and high blood pressure)

3. Disorder with an Defined Etiology Etiological Agent Clear Impulsive and Compulsive Aspects Health Effects of Substance Abuse/Dependence — Public health and Mental Health Issue History of Political/Moral Perspectives

4. Overview While genetic diatheses exist, a substantial proportion of those who are dependent have no family history Social and Cultural Factors play a large role Natural hx of the disorder is not progressive Conditioned cues and positive consequences of drinking play an important role in the development of the disorder

5. Drinking and Violence Homicide (28 – 86%) Assault (24 – 37%) Robbery (7-72%) Sexual offenses (13-60%) Drug/alcohol use by partners is assoc with 10-15 fold increase in physical violence against partners Within ED, patients with blood alcohol of.08 g/dL were more than 3.2 time more likely to experience a violent injury than patients with an unintentional injury Slight dose response relationship between amount of alcohol consumed and risk of violent injury

6. Health Effects and Smoking The Leading Cause of Preventable Death Dying from lung cancer is more than 22 times higher among men who smoke cigarettes, and about 12 times higher among women who smoke cigarettes compared with never smokers; There are significantly greater respiratory effects and cardiovascular effects; Risk for stroke is doubled and individuals are 10 times more likely to develop peripheral vascular disease; Exposure to environmental tobacco smoke continues to be a problem particularly for vulnerable populations (I.e., children and lower socioeconomic groups)

7. Comorbidity of SUDs 41-65.5% of individuals with a LT addictive disorder also have a lifetime hx of at least one other mental disorder Major depressive disorder Bipolar Disorder Antisocial Personality Disorder Of those with a LT mental disorder 50.9% also have a LT history of at least one addictive disorder Comorbidity affects course, treatment, and prognosis Recommend that individuals be alcohol free for several weeks before differential can be made Comprehensive assessment of substance use is critical

8. Epidemiology Next to caffeine, alcohol is the second most common psychoactive substance; Problem Drinkers (w/o dependence): 15%-35% Severely Dependent Drinkers: 5-7% Alcohol Abuse 2x prevalence of Alcohol Dependence

9. Sociodemographic Patterns Males outnumber females though the gap is narrowing Females develop alcohol problems later in life Overall, highest problem rates are in the 18-29 years of age Single > problems than married

10. Alcohol Abuse vs Dependence Alcohol Dependence is much more severe and less common

11. Diathesis/Personality/Stress: Alcohol Diathesis Genes 40-65% variance in ETOH abuse/dependence esp. male Male In younger groups, white>black, reversed trend in older groups >Native American >Type 2 <beta endorphin; < serotonin > Tolerance in COAs Personality Type 1: anxiety, > dependence; drinks to reduce anxiety Type 2: >sensation, fearless, autonomous; drinks to reduce inhibition Males display traits early, prealcoholic Females display anxiety and belligerence >antisocial > Sensation seeking Stressor Type 1 more likely to have a stress precipitant >stressors may be assoc w/relapse >parental antagonism Fa alcoholic

12. Diathesis/Personality/Stress: Smoking Diathesis Age < 25 for Daily Smoking Black Smokers < White Personality  Risk taking >impulsivity < education <employment <self-esteem Neuroticism Stressor < problemsolving >stress via withdrawal >history of childhood trauma experiences >depression >anxiety dx