Transcript Day 13.1a: Substance Use Description

Substance Use Disorders:
Overview
Chapter 10
Perspectives on Substance-Related
Disorders: An Overview
 The Nature of Substance-Related Disorders
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Problems related to the use and abuse of psychoactive
substances
Psychoactive substance – any chemical entity or mixture,
not required for the maintenance of health, that alters
mood, thinking, or behavior when administered
 Some Important Terms and Distinctions
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Substance use vs. substance intoxication
Substance abuse vs. substance dependence
Tolerance vs. withdrawal
Route of administration
Substance Use vs. Intoxication
 Substance Use
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Ingestion of psychoactive substance in moderate amounts
that does not significantly interfere with functioning
 Substance Intoxication
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Ingestion of psychoactive substances that produces
significant acute changes in mood, thinking, or behavior
Substance Abuse vs. Dependence
 Substance Abuse
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Maladaptive pattern of substance use, leading to clinically
significant impairment or distress, as manifested by
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failure to fulfill major role obligations
use in hazardous situations
recurrent substance-related legal problems
use despite knowledge of recurrent drug related problems
Does not meet criteria for substance dependence
Substance Abuse v. Dependence
 Substance Dependence
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Maladaptive pattern of substance use, leading to clinically
significant impairment or distress, as manifested by
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Tolerance
Withdrawal
Loss of control over use
Persistent desire or unsuccessful efforts to cut down or quit
Great deal of time devoted to obtaining or using substance
Important activities are sacrificed due to use
Continued use despite knowledge of persistent problems
Specify with or without physiological dependence
Course specifiers reflect current status of disorder
Tolerance vs. Withdrawal
 Tolerance
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need for markedly increased amounts of the substance to
achieve intoxication or desired effect
markedly diminished effect with continued use
 Withdrawal
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the characteristic withdrawal syndrome for the substance
the same (or closely related) substance is taken to relieve
or avoid withdrawal symptoms
Route of Administration
 Route of drug administration affects immediacy of
psychological effects
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Oral  intranasal  inhalant  injection
 Route of administration adds health risks
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Overdose much easier with faster routes of administration
Inhalant – lung cancer
Injection – HIV, hepatitis, infection
Categories of Psychoactive Substances
 Four Main Categories of Substances
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Depressants – Result in behavioral sedation (e.g., alcohol,
sedative, anxiolytic, and hypnotic drugs)
Stimulants – Increase alertness and elevate mood (e.g.,
cocaine, amphetamines, nicotine, caffeine)
Opiates – Primarily produce analgesia and euphoria (e.g.,
heroin, morphine, codeine)
Hallucinogens – Alter sensory perception (e.g., marijuana,
LSD)
The Depressants: Alcohol Use Disorders
 Psychological and Physiological Effects of Alcohol
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Central Nervous system depressant
Influences several neurotransmitter systems, but mainly
GABA
Intoxication effects include slurred speech, loss of
coordination, impaired gait, nystagmus, and memory
problems
 Effects of Chronic Alcohol Use
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Alcohol withdrawal (DT’s)
Physical damage (liver cirrhosis)
Family and relationship distress
Associated brain conditions – Dementia and Wernicke’s
disease
Fetal alcohol syndrome
Alcohol: Some Facts and Statistics
 In the United States
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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
 Facts and Statistics on Problem Drinking
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10% of Americans experience significant problems with
alcohol
Most persons with alcoholism can moderate or cease
drinking on occasion
20% of those with alcohol problems experience spontaneous
recovery
Stimulants: An Overview
 Nature of Stimulants
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Most widely consumed drug in the United States
Such drugs increase alertness and increase energy
Examples include amphetamines, cocaine, nicotine, and
caffeine
Neurobiological effects vary, but all act as
“sympathomimetic” agents and seem to ultimately activate
the “pleasure center” of the brain
Stimulants: Amphetamine Use Disorders
 Effects of Amphetamines
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Produce elation, expansive mood, vigor, reduce fatigue
Enhance the release of dopamine and norepinephrine,
while blocking reuptake
Such effects are followed by a “crash” (e.g., feeling
depressed and tired)
Sedative, Hypnotic, or Anxiolytic Substances
 The Nature of Drugs in This Class
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Sedatives – Calming
Hypnotic – Sleep inducing (e.g., barbiturates)
Anxiolytic – Anxiety reducing (e.g., benzodiazepines)
Intoxication effects of such drugs are similar to large doses
of alcohol
Combining such drugs with alcohol is synergistic
 All Exert Their Influence Via the GABA
Neurotransmitter System
Stimulants: Cocaine Use Disorders
 Effects of Cocaine
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Produce short lived sensations of elation, vigor, reduced
fatigue, self-confidence
Effects result from blocking the reuptake of dopamine
Cocaine is highly addictive, but dependence develops
slowly
Cocaine use in the United States has declined over the last
decade, although experimental use is on the rise again
among adolescents
Stimulants: Nicotine Use Disorders
 Effects of Nicotine
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Stimulates the central nervous system, specifically
nicotinic acetylcholine receptors
Results in sensations of relaxation, wellness, pleasure
although intoxication effects are not described
Nicotine is highly addictive
Nicotine users dose themselves to maintain a steady state
of nicotine
Stimulants: Caffeine Use Disorders
 Effects of Caffeine – The “Gentle” Stimulant
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Found in tea, coffee, cola drinks, and cocoa products
Caffeine blocks the reuptake of the neurotransmitter
adenosine
Small doses elevate mood and reduce fatigue
Used by over 90% of Americans
Regular use can result in tolerance and dependence
Opioids: An Overview
 The Nature of Opiates and Opioids
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Opiate – Natural chemical in the opium poppy with narcotic
effects (i.e., pain relief)
Opioids – 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
 Effects of Opioids
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Activate body’s enkephalins and endorphins
Low doses induce euphoria, drowsiness, and slowed
breathing
High doses can result in death
Withdrawal symptoms can be lasting and severe
Hallucinogens: An Overview
 Nature of Hallucinogens
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Substances that change the way the user perceives the
world
May produce delusions, paranoia, hallucinations, and
altered sensory perception
Specific neurobiological actions are unknown
Examples include marijuana, LSD
 Marijuana
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Active chemical is tetrahydrocannabinol (THC)
May produce several symptoms (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 but can in some individuals
Hallucinogens: An Overview (cont.)
 LSD and Other Hallucinogens
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d-lysergic acid diethylamide
Tolerance tends to be rapid, and withdrawal symptoms are
uncommon
Psychotic delusional and hallucinatory symptoms can be
problematic