1. Substance-Related Disorders

2. Substance-Related Disorders
Substance dependence
Substance abuse
Substance intoxication
Substance withdrawal
alcohol
amphetamines
caffeine
cannabis
cocaine
hallucinogens
inhalants
nicotine
opioids
phencyclidine
sedative/hypnotic/anxiolytic

3. Criteria for Substance Dependence
A maladaptive pattern of substance abuse, leading to impairment or
distress as manifested by 3 or more symptoms within a 12-mo. period
tolerance
a need for markedly increased amount of substance
markedly diminished effect with same amount of substance
withdrawal
characteristic withdrawal syndrome for substance
taking same substance to relieve withdrawal symptoms
larger amounts over longer period than intended
persistent desire or unsuccessful efforts to cut down
time spent in acquiring, using, & recovering
important activities given up/reduced
continued use despite persistent physical or psychological
problem caused by substance

4. Substance Dependence Specifyers: with physiological dependence
(evidence of tolerance or withdrawal)
without physiological dependence
(no evidence of tolerance or withdrawal)

5. Cocaine and Physiological Brain Changes
use dopamine agonists that flood synapses with DA
and overshadow normal rewarding activities
attempt to restore homeostasis
downregulating DA receptors on post-synaptic neurons
upregulating MAO
lower levels of DA in synapses during “non-use” periods
craving for more of the dopamine-agonist substance

6. Criteria for Substance Abuse
A maladaptive pattern of substance use leading to clinically
significant impairment or distress as manifested by one or
more of the following:
recurrent substance use resulting in failure to fulfill major role
obligations at work, school, or home
recurrent substance use in which it is physically hazardous
recurrent substance-related legal problems
continued substance use despite having persistent interpersonal
problems caused by substance
Symptoms have never met criteria for Substance dependence for this drug

7. Criteria for Substance Intoxication
The development of a reversible substance-specific syndrome due
to recent ingestion of (or exposure to) a substance.
B. Clinically significant maladaptive behavioral or psychological
changes due to effect of substance on central nervous system
belligerence
mood lability
cognitive impairment
impaired judgment
impaired social/occupational
functioning
C. Symptoms are not due to a medical condition or mental disorder

8. Alcohol-Related Disorders

9. Criteria for Alcohol Intoxication
A. Recurrent ingestion of alcohol
B. Significant maladaptive behavioral or psychological changes
inappropriate sexual behavior
inappropriate aggression
mood lability
impaired judgment
C. One or more of the following signs shortly after ingestion:
slurred speech
incoordination
unsteady gait
nystagmus (involuntary eye movements)
impairment in attention or memory
stupor or coma
D. The symptoms are not better accounted for by a medical
condition or by another mental disorder.

10. Criteria for Alcohol Withdrawal
A. Cessation of alcohol use that has been heavy and prolonged.
B. Two or more of the following developing after cessation:
autonomic hyperactivity (e.g., sweating, pulse over 100)
increased hand tremor
insomnia
nausea or vomiting
transient hallucinations or illusions
psychomotor agitation
anxiety
grand mal seizures
C. Symptoms cause significant distress or impairment in social/
occupational functioning
D. The symptoms are not better accounted for by a medical
condition or by another mental disorder.

11. Bad Stuff Associated with Alcohol Abuse
Short-term:
25,000 highway deaths per year
industrial accidents, public transportation accidents
over one-half of all murders involve alcohol
child and spouse abuse
one-half of all suicides involve alcohol
fetal alcohol syndrome
Long-term:
increased risk of heart disease
increased risk of throat and stomach cancer
cirrhosis of the liver
Korsakov Syndrome (amnestic disorder)
depression
marital breakup
loss of job and school failure

12. Why Do People Drink? (Cooper et al., 1995)
To enhance positive feelings
celebrations, social gatherings
increase arousal, energy, joy
desire for psychomotor activation
associated with extraversion, sensation-seeking
B. To cope with negative feelings
reduce anxiety, depression
avoidance or denial negative life event
forget problems
avoidance of responsibility
associated with neuroticism, low self-esteem

13. Why Do People Drink? Dual-Pronged Method of Action
interacts with mesolimbic dopamine and opioid systems
initial buzz (and psychomotor activation)
feelings of mild euphoria, self-confidence, sociability
interacts with glutamate and GABA systems
decreases glutamate
increases GABA
decreases anxiety and self-consciousness
decreases negative mood and irritability
suppresses CNS activation
Note that there is a dose-dependent response to alcohol

14. Is There a Genetic Basis to Alcoholism?
twin studies and adopted away studies
indicate a genetic component
adopted away SOMAs 4 times as likely to be alcoholic
as adopted nonSOMAs
twin studies show inheritance in males
polygenetic

15. Cloninger’s Type I and Type II Alcoholics
later onset
more likely to be triggered by specific event
more environmental influence
equal number of males and females
Type II
early onset
physical problems
much larger heritability
associated with antisocial acts
more likely to be aggressive
much more common in males

16. Factors Affecting Alcoholism

17. Social/Cultural Factors Affecting Alcoholism
society’s attitude toward drinking
peer pressure (group ID)
media portrayal
low SES
high availability
high EE in families

18. Psychological Factors Affecting Alcoholism
expectancies
sensation-seeking
anxiety-proneness
lack of other coping mechanisms

19. Biological Factors Affecting Alcoholism
genetic predisposition
low frontal arousal
Aldehyde dehydrogenase (ALDH) deficit
HR reactivity to alcohol
MAO abnormalities

20. Is Alcohol a Disease?
Disease model asserts that alcoholism is caused by a physiological
defect similar to diabetes.
Alternate model characterizes alcoholism as a character flaw
Advantages of Disease Model
brought problem to public
awareness
got funding to study alcoholism
removes stigma
got treatment developed and
funded
Disadvantages of Disease Model
reduces addict’s accountability
removes incentive to abstain
places addict in victim role
inconsistent with data that say
“controlled” use may be achieved
self-fulfilling prophesy

21. Treatment of Alcoholism
Biological
detoxification (benzodiazapines)
disulfiram (Antabuse)
Naltrexone
acamprosate (Campral)
Psychological
Alcoholics Anonymous
Cognitive Behavioral treatments
Controlled Drinking
Social
token economy

22. The COMBINE Study Best outcome: Naltrexone plus medical management or
JAMA (2006)
Best outcome:
Naltrexone plus medical management or
10-20 session CBT plus medical management

23. Questions of the Week:
1. Do you feel that alcoholism is a disease or a failure
of will power and self-control? Why?
2. Can alcoholics successfully achieve controlled drinking,
or is total abstinence the only option? Justify your
answer with information from the readings and lecture.
Recommended Movie of the Week:
Days of Wine and Roses starring Jack Lemon
Lee Remick