Transcript Lecture Notes

WHY A COURSE ON ADDICTIVE BEHAVIORS?
• Study of Drug Use and Misuse Important
• A part of life in our culture - pervasive
• Affects everyone: we all have choices to make about what
we do and don’t do, what we ingest and what we avoid
• Can have harmful consequences for individual, family,
community, and society
• Substance use disorders are both preventable and
treatable
• We are constantly being presented with information about
licit and illicit substances and activities - how do we
evaluate it?
OVERARCHING PRINCIPLES
• Study of Drug Use and Misuse has Experiential and
Scientific Basis
• The Continuum: Drug Use, Misuse, and Dependence
• All Drugs and Potentially Addictive Behaviors Have a
History and Cultural Context:
Drugs neither good nor bad per se
• e.g., religious, spiritual usage; use for health /
medical reasons
Dependence Potential of Psychoactive Drugs
Very High:
High:
Moderate/High:
Moderate:
Moderate/Low:
Low:
Very Low:
Heroin (IV)
Crack cocaine
Morphine
Opium (smoked)
Cocaine powder
Tobacco cigarettes
PCP (smoked)
Diazedpam (Valium)
Alcohol
Amphetamines (oral)
Caffeine
MDMA(Ecstasy”)
Marijuana
Ketamine
LSD, Mescaline
Psilocybin
Influences on Drug Use
Figure 1-4
1-5
(a) Relationship of Risk Factors (b) Relationship of Protective Factors
Figure 1-3
1-4
Drug Use, Misuse, and “Addiction”
• What is a drug?
• What is an addiction? An addict?
___________
• Themes associated with “addiction”
______________________________
______________________________
______________________________
MODELS OF ADDICTION:
A SUMMARY
Moral / Temperance Model *
Addiction as Sin or Crime
Personal Irresponsibility
Disease Model *
Genetic and Biological Factors **
12-Step Framework; Abstinence
Education as Treatment
Behavioral and CognitiveBehavioral Models *
Conditioning and Reinforcement
Social Learning and Modeling
Drug Expectancies and other
Cognitive Factors / RP
Family Models
Family Disease
Family Systems
Behavioral Marital/Family Tx
MODELS OF ADDICTION:
A SUMMARY
Psychological / Psychoanalytic
Disordered /Addictive Personality
Sociocultural Models
Cultural Factors
Socioeconomics/ Social Policy
Drug Subcultures
Public Health Model
Agent, Host, Environment
Interactions
THE BIOPSYCHOSOCIAL MODEL:
AN INTEGRATION
SUBSTANCE USE DISORDERS
DSM-IV CRITERIA FOR SUBSTANCE DEPENDENCE
- need at least 3 of the following within 12-month period
-symptoms present at least 1 month or occur repeatedly
over time
 _______________________________
 _______________________________
 _______________________________
 _______________________________
SUBSTANCE USE DISORDERS
CRITERIA FOR SUBSTANCE DEPENDENCE
 _________________________________
_________________________________
_________________________________
 _________________________________
_________________________________
_________________________________
 Substance use is continued despite:
_________________________________
_________________________________
_________________________________
SUBSTANCE USE DISORDERS
NEW DSM-V CRITERIA FOR SUBSTANCE
ADDICTION (DEPENDENCE)
DSM-V SUBSTANCE CLASSES
(p. 482 in DSM-5)
Diagnoses Associated with Substance Class
Psychotic
Alcohol
Caffeine
Cannabis
Hallucinogens
Phencylidine
Other Hallucinogens
Inhalants
Opioids
Sedatives, hypnotics, or
anxiolytics
Stimulants**
Tobacco
Other
I/W
Bipolar Depressive Anxiety
I/W
I/W
I
I
I*
I
I
I
OCD &
Sleep
related
I/W
I
I
I
I
I
I/W
I
I
I
W
I/W
I/W
I/W
I/W
I
I/W
I/W
I/W
I/W
W
I/W
I/W
I/W
I/W
I/W
I/W
I/W
Sexual
I/W
Delirium
I/W
NeuroSbst. use
cognitive
I/W/P
I
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
I/W
I/W
I
I
I
I/W
I/W
I/W
W
I/W
I/W
I/W
I/W
I
I/W/P
I/W
I/W
I/W/P
X = category is recognized in DSM-5
I = specifier "with onset during intoxication" may be noted for the category
W = specifier "with onset during withdrawal" may be noted for the category
I/W = either of the above specifiers may be noted
P = the disorder is persisting
*also hallucinogen persisting perception disorder (flashbacks)
**includes amphetamine-type substances, cocaine, & other or unspecified stimulants
I/P
X
Intoxication Withdrawal
X
X
X
X
X
X
X
X
X