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Addictive Disorders
Substance Use and Addiction
Related Terminology and Rates
I. Substance-Use Disorders (a.k.a. Addictive
Disorders): patterns of maladaptive use of
psychoactive substances that are identified by
the particular drug associated with problematic
use (e.g., “alcohol use disorder”).
Persistent problems cutting back or controlling use of the substance.
Developing tolerance or a withdrawal syndrome.
Spending an excessive amount of time seeking/using the substance.
Using the substance in situations that pose a risk to the person’s safety
or the safety of others (such as repeatedly drinking and driving).
A. Substance Withdrawal Disorder (a.k.a. Withdrawal
Syndrome): a cluster of symptoms following the sudden
reduction or cessation of use of a psychoactive substance after
physiological dependence has developed.
B. Tolerance: physical habituation to a drug such that with
frequent use higher doses are needed to achieve the same
effects or the same amount of substance has a diminished
effect.
II. When Does Use Become Abuse?
According to the DSM, drug use becomes abuse when it negatively
impacts daily functioning.
About 10% of U.S. adults develop substance use disorders involving an
illegal drug at some point in their lives with 25% of those people
developing substance dependence.
Lifetime Prevalence of Drug Dependence Disorder By Type of Illicit Drug
Sex and Age Differences in Substance Use Disorders: Lifetime prevalence of
substance use disorders in the United States.
III. Addiction and Dependency
A. Addiction: impaired control over the use of a chemical
substance, accompanied by physiological dependence.
B. Physiological Dependence: a condition in which the drug
user’s body comes to depend on a steady supply of the
substance.
C. Psychological Dependence: compulsive use of a
substance to meet a psychological need.
D. Pathways to Drug Dependence
1) Experimentation
2) Routine use
3) Addiction or dependence
Drugs Related to Abuse
I. Depressants: drugs that slow down or curb
the activity of the central nervous system. They
reduce feelings of tension and anxiety, cause
slow movement, and impair cognitive
processes. In high doses, they can arrest vital
functions and cause death.
A. Alcohol: a depressant found in liquor, wine and beer.
It’s by far the most commonly abused drug in the world.
Alcohol appears to work by heightening activity of the neurotransmitter
GABA which is an inhibitory neurotransmitter. Increasing GABA activity
produces feelings of relaxation.
1) Emotional and Behavioral Characteristics of Intoxicated
Individuals
2) Binge Drinking: drinking an excessive amount of alcohol in a short
period of time.
B. Alcoholism: the addiction to or dependency upon drinking
excessive amounts of alcohol.
1) Denial: refusal to acknowledge a problem or believe any information
that causes anxiety.
C. Delirium Tremens: symptoms associated with the abrupt
discontinuation of alcohol consumption among severe alcoholics.
1) heart arrhythmias
2) confusion
3) diarrhea
4) insomnia
5) disorientation
6) extreme agitation
7) muscle convulsions (shaky hands)
8) hallucinations (insects, snakes, rats)
D. Risk Factors for Alcoholism
1) new found freedoms in college
2) stress in life
3) family history (genetics & environment)
4) addictive personality
5) mental illness
6) cultural influences
7) age
8) sex
E. Long Term Medical Consequences of Alcoholism
1) Alcoholic Liver Disease: arises from the excessive
ingestion of alcohol. When excessive alcohol is consumed
chronically, it can eventually result in liver scarring or what is
known as cirrhosis or end-stage alcoholic liver disease.
2) Korsakoff’s Syndrome: a form of dementia leading to
memory loss that results from a deficiency of vitamin B1,
typically brought on by chronic alcoholism.
F. Barbiturates: sedative drugs with high addictive potential
(e.g. phenobarbital)
G. Benzodiazepines: sedatives that operate similarly to alcohol
by enhancing the effectiveness of GABA transmission in the
central nervous system (e.g. clonazepam).
II. Opioids: drugs that are used medically for
pain relief but that have strong addictive
potential.
Opioids include both naturally occurring opiates (morphine, heroin,
codeine) derived from the juice of the poppy plant and synthetic
drugs (e.g., Demerol, Darvon) that have opiate like effects.
They directly target the brain’s pleasure centers and create the
euphoria similar to a satisfying meal or an orgasm. People lose
themselves in bliss and forget about all of their problems.
A. Endorphins: natural substances that function as
neurotransmitters in the brain and are similar in their effects to
opioids.
B. Morphine: a strongly addictive narcotic derived from the
opium poppy that relieves pain and induces feelings of wellbeing.
C. Heroin: a narcotic derived from morphine that has strong
addictive properties.
Heroin, the most widely used opiate, can create a euphoric rush that
supposedly is so pleasurable, that it can eradicate any thought of food
or sex.
As with most drugs, the withdrawal symptoms are opposite the effect
of the drug and can be devastatingly painful: flu-like symptoms, body
aches, fever, vomiting, etc.
III. Stimulants: are psychoactive substances
that increase the activity of the central
nervous system, which enhances states of
alertness and can produce feelings of
pleasure or even euphoric highs.
A. Amphetamines: a class of synthetic stimulants that
activate the central nervous system, producing heightened
states of arousal and feelings of pleasure (e.g.
methamphetamine).
About 5% of Americans 12 or older have tried methamphetamine.
Methamphetamine causes your dopamine levels to sky-rocket, thereby
making you feel really good.
Reduces inhibitions and significantly reduces appetite.
Increases risky behaviors, especially sexual activity.
Can cause permanent memory and cognitive processing deficits.
More common among girls/women than boys/men (likely due to weight
loss effect).
Most common among Whites and Latinos.
Least common among African Americans.
1) Amphetamine Psychosis: a psychotic state characterized by
hallucinations and delusions, induced by ingestion of amphetamines.
B. Cocaine: is a natural stimulant extracted from the leaves of
the coca plant; the plant from which the soft drink obtained its
name.
Overdoses can produce restlessness, insomnia, headaches, nausea,
convulsions, tremors, hallucinations, delusions, and even sudden death
due to respiratory or cardiovascular collapse.
Regular snorting of cocaine can lead to serious nasal problems, including
ulcers in the nostrils.
About 15% of Americans 12 or older have tried cocaine.
C. Nicotine: a powerfully addictive stimulant (most commonly
found in cigarettes).
Smoking is experienced as relaxing because between cigarettes the
smoker begins to experience withdrawal, which a subsequent cigarette
will temporarily alleviate.
Smoking cigarettes can also cause impotency.
Ethnicity, Sex, and Smoking
D. Ecstasy: acts as a stimulant at low doses and a
hallucinogen at high doses.
Ecstasy can produce adverse psychological effects, including depression,
anxiety, insomnia, paranoia and psychosis.
IV. Hallucinogens: drugs that produce sensory
distortions or hallucinations, including major
alterations in color perception and hearing.
People can have “bad trips”. One’s state of mind when using a
hallucinogen can often determine what kind of experience one will
have when taking hallucinogens. Anxiety and stress have been linked
to “bad trips”.
A. Peyote: a naturally derived hallucinogen that has played an
important role in Native American religious ceremonies.
B. LSD: a synthetic hallucinogenic drug (a.k.a. acid).
Flashbacks, which can cause you to sort of relive the experience you
had while under the influence of the drug, can occur days, weeks, and
even years later. Typically something in the environment triggers a
flashback (lighting, music, stress, the use of other drugs, etc.)
C. Phencyclidine (PCP): referred to as “angel dust” on the
streets, was developed as an anesthetic in the 1950s but was
discontinued as such when its hallucinatory side effects were
discovered.
Its popularity has waned, largely because of its unpredictable effects.
It can cause delirium, horrifying hallucinations, the sense that there is
some kind of barrier between you and your environment, convulsions,
paranoia, and death.
D. Marijuana: intensifies sensory experiences and has a
calming effect, although it may cause panic.
About 40% of Americans 12 or older have tried marijuana.
THC is the primary chemical at work in marijuana.
Cannabinoid receptors are activated by a neurotransmitter called
anandamide.
THC mimics the actions of anandamide, meaning that THC binds with
cannabinoid receptors and activates neurons.
High doses can lead to distortions in time, loss of motor control, and a
surreal experience of the environment.
It has possible medical uses as a mild painkiller and nausea
suppressant.
It appears to impair learning and memory.
Theoretical Perspectives on
Drug Use and Abuse
I. Biological Perspectives
II. Learning Perspectives
A. Operant Conditioning
B. Classical Conditioning
C. Social Learning
III. Cognitive Perspectives
Treatment of Substance Use
Disorders
I. Biological Approaches
A. Detoxification: a program of supervised recovery provided
in a hospital setting.
B. Disulfiram (a.k.a. Antabuse): a drug that discourages
alcohol consumption because the combination of the two
produces a violent response consisting of nausea, headache,
heart palpitations, and vomiting.
C. Naltrexone: a drug that blocks the high from alcohol,
amphetamines, and opioids.
D. Other Drug Treatments
Antidepressants may be prescribed for cocaine and meth addicts.
Nicotine replacements, such as patches that go on the arm, may be
prescribed for cigarette smokers.
Methadone may be prescribed for heroin addicts.
II. Residential and Self-Help Approaches
A. Alcoholics Anonymous (AA): a self-help group comprised
of people who abstain from alcohol use and offer help and
support to each other. While there is no therapist involved, a
member usually leads the group during meetings.
1) Admitting that one cannot control one's addiction.
2) Recognizing a higher power that can give one strength.
3) Making amends for things you’ve done wrong or with the people
you’ve hurt because of your addiction.
4) Helping others who suffer from the same addictions.
III. Behavioral Approaches
A. Contingency Management Programs: the clinician
determines which reinforcers sustain an undesirable behavior
and then tries to change the behavior by reducing the
opportunities for reinforcement of the unwanted behavior and
providing reinforcers for a more acceptable behavior.
B. Behavioral Aversion Therapy: an attractive stimulus is
paired with a noxious stimulus in order to elicit a negative
reaction to the target stimulus.
C. Controlled Drinking: reducing consumption of alcohol from
dependent/abusive to moderate levels.
D. Relapse-Prevention Training: training designed to help
substance abusers to identify high-risk situations and learn
effective coping skills for handling these situations.