1. Substance Disorders Psychoactive = alters behavior/mood Use = ingesting psychoactive substances in moderate amounts - no life impairment - not a disorder

2. Intoxication = physiological reaction to ingesting excess substance Abuse = recurrent & maladaptive pattern of use (life impairment/distress)

3. Dependence/addiction a)Physical - tolerance = increasingly greater amounts of drug needed for same desired effect - withdrawal = severe negative physiological reaction to removal of substance, alleviated by the substance

4. b)Psychological addiction - drug-seeking behaviors

5. Types of Psychoactive Substances Depressants = decrease CNS activity - often physical dependence - death by decreased vital organ functioning & by withdrawal

6. Opioids = narcotics (reduce pain & induce sleep) - death by decreased respiration - very unpleasant withdrawal but not life-threatening

7. Stimulants = increase CNS activity - most common

8. Hallucinogenics/Psychodelics = change perception - no evidence of withdrawal - psychological dependence - quick tolerance to most - reverse tolerance to marijuana

9. Alcoholism 10-14% U.S. adults (dependence or abuse) 1983 cost of alcoholism = $117 billion 1/3 medical problems/inpatient care 50-80% traffic injuries & deaths

10. History 17 th c. US - heavy drinking commonplace 18 th & 19 th c. - Change in view of alcohol “Demon Rum”

11. Levine’s socioeconomic theory Colonials thought behavior shaped by church (external locus of control) Less blame for person Industrialism => rise of individual (internal locus of control) Alcoholism = loss of self-control

12. Gusfield Colonial Am. = rich elite & poor masses Industrialization = middle class & “empowering of mass” Temperance movement = keep elite in control Alcohol is evil

13. Today: more moderate Alcohol seen as direct cause of deviant behavior

14. Models of Alcoholism I.Alcoholism as a Disease A.Rush, M.D. – 18 th c. alcoholism as disease & moral problem

15. Alcohol causes drunkenness (external LOC) Alcoholism is a disease Result = lose control of behavior - not from person’s immorality - from alcohol’s addictive nature Abstinence is only cure -> prohibition

16. B.1960 - Jellinek Most prevalent type includes physical tolerance & dependence/withdrawal - the individual (internal LOC) - alcoholics are different - loss of control as key

17. C.Alexander (1988) GeneticEnv. Stress Predisposition SusceptibilityAddiction Life Problems UpbringingExposure to Drugs (Env. Predisp)& Access

18. AA:Life problems -> bottoming out Either die or recover The current, dominant model Disease model allows for tx, reduces stigma (& responsibility)

19. II.Cognitive Model of Alcoholism - Loss of control due to expectancies - AA/mainstream model leads to failure “One drink, one drunk”

20. 3.Behavioral Models of Alcoholism a.Positive Reinforcement - drugs make us feel good - Addiction = recurrent use to recapture the feeling BUT- not all evidence supports

21. b.Negative Reinforcement - drugs to escape unpleasant experiences => tension reduction/self-med Once physically dependent, withdrawal -> increased use But evidence does not support

22. c. Associative learning (cues) - to maintain problem

23. 4.Neural Sensitization - Current theory - Brain cells become sensitized to drug from repeated exposure - Mesolimbic system is involved in motivation - So increased motivation for drug - Systems cause wanting, not liking

24. Initial use -> liking -> wanting (incentive value)

25. Treatment of Alcoholism 1.Biological Treatment a.Agonist substitution - use other, similar drug - can develop tolerance - can become addicted

26. b.Antagonist drugs - block or counteract drug - can reduce craving BUT- must be motivated - can cause withdrawal

27. c.Aversive Treatment - Drugs that cause unpleasantnessif take the addictive drug - Again, must be motivated - Can include behavioral methods d.Classical/associative conditioning - change cues for drinking

28. 2.Alcoholics Anonymous - popular - Self-help group of lay people who provide support - Alcoholism = loss of control from allergy - Solution: total abstinence

29. Results from AA Positive response Negative response Fosters dependency & reduces responsibility Research: little & difficult to conduct more positive outcome however, 75% drop out by 1 year

30. 3.Cognitive/Behavioral Treatment A.Controlled Drinking - Teach some alcoholics to drink in a limited, social way - Expectancies lead to outcomes - Research = better than abstinence

31. B.Relapse Prevention – Current - failure of coping skills - tx = change beliefs & focus on negative consequences - identify high-risk situations & develop strategies

32. Overall picture for treatment: 70-80% not helped long-term by any approach