Transcript Alcoholic

Substance-Related Disorders
• Psychoactive substances
– Affecting the central nervous system
– Causing significant social, occupational,
psychological, or physical problems
– Can result in abuse or dependence
• User may
– Become a danger to others
– Engage in criminal activities
• Gateway Theory
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Percentage of Persons Who Reported
Using Specific Substances at Any Time
During Their Lives (Age 12 and Over)
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Substance-Related Disorders
• DSM-IV-TR
– Substance-use disorders
• Dependence and abuse
– Substance-induced disorders
• Withdrawal
• Substance-induced delirium
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Substance-Related Disorders
• Substance abuse
– Maladaptive pattern of recurrent use that
• Extends over a period of 12 months
• Leads to notable impairment or distress
• Continues despite social, occupational, psychological,
physical or safety problems
• Substance dependence
– Maladaptive pattern of use over 12-month period
• Unsuccessful efforts to control use
• Takes more of substance than intended
• Devotes considerable time to activities necessary to
obtain the substance
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Substance-Related Disorders
– Tolerance
• Increasing doses are necessary to achieve desired
effect
– Withdrawal
• Distress/impairment in social, occupational, other
areas of functioning or physical/emotional
symptoms persist after reducing/ceasing intake
– shaking, irritability, inability to not think about the drug
– Tolerance or withdrawal indicates
physiological dependence
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Depressants or Sedatives
• Caused generalized depression of the central
nervous system and a slowing down of
responses
• Alcoholic
– Person who abuses/ is dependent on alcohol
• Alcoholism
– Characterized by abuse of, or dependency on,
alcohol, which is a depressant
• Binge drinking
– Person abstains for a while, but is unable to
control/moderate intake when drinking resumes
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Alcohol-Use Disorders
• Pattern of problem drinking
– Finds taste unpleasant
– Swears never to drink again
– Heavy drinking serves a purpose
– Use continues despite negative
consequences
– Preoccupation with alcohol consumption
– Deterioration of social and occupational
functioning
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The Effects of Alcohol
• Physiological and psychological effects
– Depends on such factors as a person’s weight,
amount of food in stomach, stress, etc.
– Depresses CNS functioning
– Affects mood and behavior
– Long-term
• Blackouts, tolerance, destruction of brain cells, cirrhosis
of liver and other lethal diseases
– Fetal Alcohol Syndrome (FAS)
• Can result in mentally retarded, physically deformed
children
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Other Depressants or Sedatives
• Narcotics
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Opiates – opium, morphine, heroin, methadone
Relieves pain, anxiety, tension
Tolerance builds rapidly
Withdrawal Syndrome
• Barbiturates
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“downers”
Depresses the CNS
Commonly used to induce relaxation/sleep
Accidental overdose when combined with alcohol
• Benzodiazepines (e.g., Valium)
– Rohypnol
• “Roofies”
• “date-rape” drug
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“Club Drugs”
• Used by 70% of attendees at dance
clubs/raves
– Stimulants
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•
•
•
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Ecstasy/MDMA
LSD
GHB
Ketamine
methamphetamine
– Cardiovascular failure
• High heart rate and blood pressure
• Heart wall stress
– Cognitive deficits
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Stimulants
• Stimulant
– Central nervous system energizer
• elation, grandiosity, hyperactivity, agitation, and
appetite suppression
– Amphetamines
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•
•
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Increased CNS activity
Increased alertness, energy
Feelings of euphoria and confidence
“uppers”
– Caffeine
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Stimulants
• Nicotine
– Cannot stop or reduce use
– Cold turkey can cause withdrawal symptoms
– Continued use despite serious physical disorder
• Cocaine
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From the coca plant
Feelings of euphoria and self-confidence
Followed by depression
Chronic abuse
• Changes in CNS
• Premature ventricular heartbeats and death
– Crack
• Purified, potent form of cocaine produced by heating cocaine with
ether
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Hallucinogens
• Hallucinogen
– Produces hallucinations
– Vivid sensory awareness
– Heightened alertness
– Perceptions of increased insight
– Marijuana
• The mildest and most commonly used
– Lysergic Acid Diethylamide (LSD)
– Phencyclidine (PCP)
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Causes of Substance-Use Disorders
• Biological
– Heredity and Congenital factors
– Two types of alcoholism
• Familial
– Family history of alcoholism
– Genetic predisposition
» Identified for certain traits in alcoholism.
» Neurotransmitters sensitivity/responsiveness to alcohol
» Changes in CNS functioning
• Non-familial
– Suggesting environmental factors
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Causes of Substance-Use Disorders
• Psychodynamic
– Childhood trauma
• Especially in oral stage
• Leads to repression of painful conflicts involving dependency
needs
– Alcohol allows repressed conflicts to be expressed and
offers oral gratification to satisfy dependency needs.
• Personality characteristics
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High activity level
Emotionality
Goal impersistence
Sociability
Life transitions/maturational events
No evidence for “alcoholic personality,”
• Antisocial behavior
• Depression
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Causes of Substance-Use Disorders
• Sociocultural factors
– More males than females
– More young adults than older adults
– More Catholics than Protestants or Jews
– Parents
– Peers
• Two-way street regarding peers:
– Users seek out other users
– Users influence their friends to use
– Cultural values
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Causes of Substance-Use Disorders
• Behavioral
– Anxiety reduction
• Approach-avoidance conflict
– Learned expectations
– Cognitive influences
• Tension-reducing model
– Alcohol reduces tension and anxiety
– Relief of tension reinforces drinking behavior
• Coping responses plus expectancy
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Causes of Substance-Use Disorders
– Relapse
• Resume drinking after voluntary abstinence
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Negative emotional states
Negative physical states
Gender differences (women: interpersonal conflict)
Social pressure
Coping responses
• Abstinence violation effect
– Loss of personal control after drinking begins
• Biological
– Physical dependence
– Avoid withdrawal symptoms
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Figure 9.5: The Relapse Process
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Theories of the Addiction Process
• Solomon’s opponent process theory
– Conditions that cause drug experimentation
have not been identified.
– Best predictor
• Availability
– Addiction
• An acquired motivation
• Opponent process theory of acquired motivation
• Motivation changes with repeated consumption
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Theories of the Addiction Process (cont’d)
• Wise’s two-factor model
– Positive and negative reinforcement
• Tiffany’s theory of automatic processes
– Drug-use behaviors are controlled by
“automatic” processes
– Once activated, drug-use behaviors are
resistant to change.
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