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Chapter 12
Substance-Related Disorders
Ch 12
Perspectives on Substance-Related
Disorders: An Overview
• 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
Definitions of SubstanceRelated Disorders
• Substance dependence is characterized by
– Tolerance to drug action occurs (greater doses,
diminished drug action)
– Withdrawal symptoms occur with drug cessation
– Person recognizes excessive use of the drug
– Much of the person’s time is spent getting the drug or
recovering from its effects
– Substance use continues despite physical or
psychological problems caused by the drug
Ch 12.1
Definitions of SubstanceRelated Disorders
• Substance abuse is characterized by
– Failure to fulfill major obligations (e.g. work or child
care)
– Exposure to physical dangers (e.g. driving while
intoxicated)
– Legal problems brought on by drug use
– Persistent social or interpersonal problems (e.g.
arguments with spouse)
Ch 12.2
Perspectives on Substance-Related
Disorders: An Overview
Figure 11.1 Barlow/Durand, 3rd Edition
Ice, LSD, chocolate, TV: Is everything addictive?
Perspectives on Substance-Related
Disorders: An Overview (cont.)
Figure 11.1 (cont.)
Perspectives on Substance-Related
Disorders: An Overview (cont.)
Figure 11.2 Barlow/Durand, 3rd. Edition
Easy to get hooked on, hard to get off
Perspectives on Substance-Related
Disorders: An Overview (cont.)
Figure 11.2 (cont.)
Easy to get hooked on, hard to get off
Alcohol: Some Facts and
Statistics
• 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
Alcohol: Some Facts and
Statistics (cont.)
• Facts and Statistics on Problem Drinking
– 10% of Americans experience problems with alcohol
– Most persons with alcoholism can moderate or cease
drinking on occasion
– 20% of those with alcohol problems experience
spontaneous recovery
– Anhedonia – Lack of pleasure, or indifference to
pleasurable activities
– Affective flattening – Show little expressed emotion,
but may still feel emotion
Alcohol Abuse and Dependence
• Alcohol dependence can include tolerance and
withdrawal reactions
– Abrupt cessation can lead to anxiety, depression,
weakness, and an inability to sleep
– Delirium tremens (DTs) is a severe alcohol withdrawal
reaction that includes hallucinations
– Alcohol tolerance is common in alcoholism
• Alcohol abuse can be part of polydrug abuse (8085% of alcohol abusers smoke)
Ch 12.3
Short-term Actions of Alcohol
• Alcohol is absorbed from the stomach into the
blood
– Alcohol is metabolized by the liver (1 oz/hr)
• Alcohol is a drug, a CNS depressant
• Alcohol acts within brain to
– Stimulate GABA receptors (reduces tension)
– Increases dopamine/serotonin levels (pleasurable
aspects of intoxication)
– Inhibits glutamate receptors (cognitive actions)
Ch 12.4
Long-term Actions of Alcohol
• Alcoholics reduce their food intake when
consuming alcohol
– Alcohol has no nutrient value
– Alcohol impairs food digestion
– Result is vitamin deficiency (B-complex)
• Can lead to brain damage and amnesia
• Alcohol kills brain cells, leading to loss of gray
matter from the temporal lobes
• Alcohol suppresses the immune system
• Fetal alcohol syndrome risk in offspring
Ch 12.5
Nicotine and Tobacco Smoking
• Smoking tobacco results in absorption of nicotine
into the blood
– Nicotine reaches brain receptors that control dopamine
release
– Dopamine action of nicotine mediate its addictive
properties
• Cigarette smoking is responsible for 1 of every 6
deaths in the US
– Smoking is THE SINGLE MOST PREVENTABLE cause
of early death
Ch 12.6
Prevalence of Smoking
• Rates of smoking among American adults have dropped
since 1965, but 57 million smoke.
– Smoking rates higher in Asia and South America
• Rates for white adolescents have been increasing since
1992.
– Rates of smoking are higher for Hispanic and white
adolescents than for African American teens.
• Rates for African American teens have been increasing since 1992.
• Lowest prevalence rates for college graduates and people
over 75.
• Highest prevalence rates for blue-collar workers, Native
Americans, and individuals with less education.
• Prevalence has declined more for men than for women.
Race, Ethnicity, & Smoking
• African Americans
– Retain nicotine in their blood longer than whites.
– Because of a greater preference for mentholated
cigarettes than whites, African Americans may take
more puffs & inhale more deeply
• May explain lower rates of quitting and increased
likelihood of developing lung cancer.
• Chinese Americans metabolize less nicotine than
whites or Hispanics
– May explain lower rates of lung cancer among Asians
Marijuana
• Marijuana consists of the dried and crushed
leaves of the hemp plant Cannabis sativa
• Smoking marijuana results in
– Relaxation
– Shifts in attention
– Impaired memory
• Marijuana effects depend on dose and potency
Ch 12.7
Adverse Actions of Marijuana
• Marijuana
– Interferes with cognitive function including loss of shortterm memory
– Interferes with the operation of complex equipment
(e.g. an automobile)
– Contributes to psychological problems in adulthood
– Elevates heart rate
– Impairs lung structure and function
– Can produce reverse tolerance
Ch 12.8
Therapeutic Actions of
Marijuana
• Marijuana
– Reduces the nausea and loss of appetite
associated with chemotherapy
– Can reduce pain signaling (via THC)
– Can be used to treat the discomfort of AIDS
– Can reduce the pressure increases in the eye
associated with glaucoma
Ch 12.9
Sedatives
• Sedatives slow the activities of the body and
reduce its responsiveness
– Opiates relieve pain and induce sleep
• Include opium, morphine, heroin
• Opiates are physiologically addictive
– Barbiturates induce relaxation and sleep
• Act by stimulating GABA receptors
• Can result in tolerance and severe withdrawal reactions
Ch 12.10
Stimulants
• Stimulants act on the brain to increase alertness
and motor activity
– Amphetamines release norepinephrine and dopamine
in brain to produce alertness and to reduce appetite
• Tolerance quickly develops to amphetamine use
– Ephedrine is a variant of amphetamine that induces
alertness and reduces appetite (found in herbal weight
loss preparations)
– Cocaine blocks the reuptake of dopamine to produce
alertness and produce euphoria
– Ecstasy and Ice produce effects similar to speed, but
without the crash; 2% of college students report using
Ecstasy; Both drugs can result in dependence
Ch 12.11
Hallucinogens
• Hallucinogenic drugs alter sensory perception and
create sensory experiences
• Hallucinogenic drugs include
– LSD, mescaline, ecstasy and phencyclidine
• General effects of LSD include
–
–
–
–
Synesthesia: blending of sensory information
Subjective time is altered (slowed)
Rapid shifts in mood
Effects depend on set and setting
Ch 12.12
Other Drugs of Abuse:
Inhalants
• 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
Other Drugs of Abuse:
Designer Drugs
• 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
Development of Substance
Abuse
Ch 12.13
Fig 12.3
Etiology of Substance Use
• Biological / Genetic factors (alcoholism is heritable, twin &
adoptee studies)
• Sociocultural variables include family, friends, media
(television, billboards)
• Psychological variables include
– Mood alteration (enhance positive, reduce negative
moods)
– Beliefs/expectancies about prevalence and risks
(harmful actions of drug)
– Personality variables include
• High levels of negative affect
• Enduring desire for arousal, increased positive affect
Ch 12.14
An Integrative Model of
Substance-Related Disorders
• Exposure or Access to a Drug Is Necessary, but
not Sufficient
• Drug Use Depends on Social and Cultural
Expectations
• Drugs Are Used Because of Their Pleasurable
Effects
• Drugs Are Abused for Reasons That Are More
Complex
– The premise of equifinality
– Stress may interact with psychological, genetic, social,
and learning factors
Biological Treatment of
Substance-Related Disorders
• Agonist Substitution
– Safe drug with a similar chemical composition as the
abused drug
– Examples include methadone for heroin addiction, and
nicotine gum or patch
• Antagonistic Treatment
– Drugs that block or counteract the positive effects of
substances
– Examples include naltrexone for opiate and alcohol
problems
Biological Treatment of
Substance-Related Disorders (cont.)
• Aversive Treatment
– Drugs that make the ingestion of abused
substances extremely unpleasant
– Examples include antabuse for alcoholism and
silver nitrate for nicotine addiction
• Efficacy of Biological Treatment
– Such treatments are generally not effective
when used alone
Psychosocial Treatment of
Substance-Related Disorders
• Debate Over Controlled Use vs. Complete
Abstinence as Treatment Goals
• Inpatient vs. Outpatient Care
– Data suggest little difference in terms of overall
effectiveness
• Community Support Programs
– Alcoholics Anonymous and related groups
– Seem helpful and are strongly encouraged
Psychosocial Treatment of
Substance-Related Disorders (cont.)
• Components of Comprehensive Treatment and
Prevention Programs
–
–
–
–
–
–
–
Individual and group therapy
Aversion therapy and covert sensitization
Contingency management
Community reinforcement
Relapse prevention
Preventative efforts via education
NIAA“Project Match” comparative study
Fig 12a
Therapy for Cigarette Smoking
• The long-term efficacy of psychological
treatments for smoking are not good
– Making smoking unpleasant
– Scheduled smoking involves gradual reduction of
number of cigarettes smoked and controls when
smoking will happen
– Advice from a physician
• Biological treatments for smoking involve
substitution of nicotine for smoking
– Use of a nicotine patch or gum
Ch 12.16