Transcript Durand and Barlow Chapter 10: Substance

Substance-Related Disorders
Perspectives on Substance-Related Disorders
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The Nature of Substance-Related Disorders
– Problems related to the use and abuse of psychoactive substances
– Produce wide-ranging physiological, psychological, and behavioral
effects
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Some Important Terms and Distinctions
– Substance use vs. substance intoxication
– Substance abuse vs. substance dependence
– Tolerance vs. withdrawal
Perspectives on Substance-Related Disorders (cont.)
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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
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**Ice, LSD, chocolate, TV: Is everything addictive?
Figure 10.1
Easy to get hooked on, hard to get off
Figure 10.2
The Depressants: Alcohol Use Disorders
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Psychological and Physiological Effects of Alcohol
– Central Nervous system depressant
– Influences several neurotransmitter systems, but mainly GABA
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Effects of Chronic Alcohol Use
– Alcohol intoxication
– Alcohol withdrawal
– Associated brain conditions – Demenita and Wernicke’s disease
– Fetal alcohol syndrome
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DSM-IV Criteria for Disordered Alcohol Use
The path traveled by alcohol throughout the body
Figure 10.3
Alcohol: Some Facts and Statistics
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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
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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
Sedative, Hypnotic, or Anxiolytic Substance use Disorders: An
Overview
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The Nature of Drugs in This Class
– Sedatives – Calming
– Hypnotic – Sleep inducing (e.g., barbiturates)
– Anxiolytic – Anxiety reducing (e.g., benzodiazepines)
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Effects of Such Drugs Are Similar to Large Doses of Alcohol
– Combining such drugs with alcohol is synergistic
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All Exert Their Influence Via the GABA Neurotransmitter System
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DSM-IV Criteria for Sedative, Hypnotic, or Anxiolytic Substance Use
Disorders
Stimulants: An Overview
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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
Stimulants: Amphetamine Use Disorders
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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
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DSM-IV Criteria for Amphetamine Intoxication
– Psychological symptoms
– Physiological symptoms
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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
Stimulants: Cocaine Use Disorders
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DSM-IV Criteria for Cocaine Intoxication and Withdrawal
– Psychological symptoms
– Physiological symptoms
– Most cocaine users cycle through patterns of tolerance and
withdrawal
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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
Stimulants: Nicotine Use Disorders
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Effects of Nicotine
– Stimulates the central nervous system, specifically nicotinic
acetylcholine receptors
– Results in sensations of relaxation, wellness, pleasure
– Nicotine is highly addictive
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DSM-IV Criteria for Nicotine Withdrawal Only
– Psychological symptoms
– Physiological symptoms
– Nicotine users dose themselves to maintain a steady state of
nicotine
Relapse rates for nicotine compared to alcohol and heroin
Figure 10.6
Stimulants: Caffeine Use Disorders
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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
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DSM-IV Criteria for Caffeine Intoxication
– Psychological symptoms
– Physiological symptoms
Opiods: An Overview
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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
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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
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DSM-IV Criteria for Opiod Intoxication and Withdrawal
– Psychological symptoms
– Physiological symptoms
– Mortality rates are high for opiod addicts
Hallucinogens: An Overview
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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
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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
Hallucinogens: An Overview (cont.)
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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
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DSM-IV Criteria for Marijuana and Hallucinogen Intoxication
– Psychological and physiological symptoms are similar
Other Drugs of Abuse: Inhalants
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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
Other Drugs of Abuse: Anabolic Steroids
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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
Other Drugs of Abuse: Designer Drugs
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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
Causes of Substance-Related Disorders: Family and Genetic
Influences
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Results of Family, Twin, and Adoption Studies
– Substance abuse has a genetic component
– Much of the focus has been on alcoholism
– Genetic differences in alcohol metabolism
– Multiple genes are involved in substance abuse
Causes of Substance-Related Disorders: Neurobiological Influences
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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
Causes of Substance-Related Disorders: Psychological Dimensions
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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
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Opponent-Process Theory
– Explains why the crash after drug use fails to keep people from
using
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Role of Expectancy Effects
– Expectancies influence drug use and relapse
Causes of Substance-Related Disorders: Social and Cultural
Dimensions
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Exposure to Drugs in a Prerequisite for Use of Drugs
– Media, family, peers
– Parents and the family appear critical
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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
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The Role of Cultural Factors
– Influence the manifestation of substance abuse
An Integrative Model of Substance-Related Disorders
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Exposure or Access to a Drug Is a Necessary, but not Sufficient
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Drug Use Depends on Social and Cultural Expectations
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Drugs Are Used Because of Their Pleasurable Effects
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Drugs Are Abused for Reasons That Are More Complex
– The premise of equifinality
– Stress may interact with psychological, genetic, social, and learning
factors
An integrative model of substance related disorders
Figure 10.7
Biological Treatment of Substance-Related Disorders
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Agonist Substitution
– Safe drug with a similar chemical composition as the abused drug
– Examples include methadone for heroin addiction, and nicotine
gum or patch
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Antagonistic Treatment
– Drugs that block or counteract the positive effects of substances
– Examples include naltrexone for opiate and alcohol problems
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Aversive Treatment
– Drugs that make the injection of abused substances extremely
unpleasant
– Examples include antabuse for alcoholism and silver nitrate for
nicotine addiction
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Efficacy of Biological Treatment
– Such treatments are not generally not effective when used alone
Psychosocial Treatment of Substance-Related Disorders
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Inpatient vs. Outpatient Care
– Data suggest little difference in terms of overall effectiveness
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Community Support Programs
– Alcoholics Anonymous and related groups
– Seem helpful and are strongly encouraged
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Debate Over Controlled Use vs. Complete Abstinence as Treatment
Goals
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
Summary of Substance-Related Disorders
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DSM-IV and DSM-IV TR Substance Related Disorders Cover Four
Classes
– Depressants, stimulants, opiates, and hallucinogens
– Specific diagnoses include dependence, abuse, intoxication, or
withdrawal
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Most Psychotropic Drugs Activate the Dopaminergic Pleasure Pathway
in the Brain
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Psychosocial Factors Interact with Biological Influences to Produce
Substance Disorders
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Treatment of Substance Dependence Is Largely Unsuccessful
– Highly motivated persons do best when part of combined treatment
programs
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Substance-Related Disorders Are 100% Preventable
Summary of Substance-Related Disorders (cont.)
Figure 11.x1 (cont.)
Exploring substance-related disorders
Summary of Substance-Related Disorders (cont.)
Figure 11.x2
Exploring substance-related disorders, treatment
Summary of Substance-Related Disorders (cont.)
Figure 11.x2 (cont.)
Exploring substance-related disorders, treatment
Web sites
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National Clearinghouse for Alcohol and Drug Information
– www.health.org
National Institute on Drug Abuse
– www.nida.nih.gov
Inhalants
– www.inhalants.org
Substance Abuse and Mental Health Services Administration
– www.samhsa.gov
Impulse-Control Disorders
• DSM-IV-TR
– Intermittent explosive disorder
– Kleptomania
– Pyromania
– Pathological gambling
– Trichotillomania
Impulse-Control Disorders (continued)
• Each is Characterized by
– Increased tension/anxiety prior to the act
– A sense of relief following the act
– Impairment of social and occupational
functioning
Impulse-control Disorders:
Intermittent Explosive Disorder
• Intermittent Explosive Disorder
– Rare condition
– Characterized by frequent aggressive
outbursts
– Leads to injury and/or destruction of
property
– Few controlled treatment studies
Impulse-control Disorders:
Kleptomania
• Kleptomania
– Failure to resist urge to steal unnecessary
items
– Seems rare, but it is not well studied
– Highly comorbid with mood disorders
– Also co-occurs with substance-related
problems
Impulse-control Disorders:
Pyromania, Pathological Gambling
• Pyromania
– Involves having an irresistible urge to set
fires
– Diagnosed in less than 4% of arsonists
– Little etiological and treatment research
• Pathological Gambling
– Affect 3-5% adult Americans
– Treatment is similar to that for substance
dependence
Trichotillomania (continued)
• Trichotillomania
– Inability to resist the urge to pull hair
– Observed in 1-5% of college students,
mostly female
– Clomipramine (Anafranil) and CBT have
been shown to be helpful