Transcript Subtance Abuse - Warren Wilson Inside Page

Chapter 17
Substance-Related
Disorders – Focus on
Alcoholism
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Substance Abuse

A substance is any natural or synthesized
product that has psychoactive effects—it
changes perceptions, thoughts, emotions,
and behaviors.
Chapter 17
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Substance-Related Conditions Recognized
by the DSM-IV-TR
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Substance intoxication: Experience of significant
maladaptive behavioral and psychological symptoms
due to the effect of a substance on the central
nervous system.
Substance withdrawal: Experience of clinical
significant distress in social, occupational, or other
areas of functioning due to the cessation or
reduction of substance use.
Chapter 17
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Substance-Related Conditions Recognized
by the DSM-IV-TR, continued
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Substance abuse: Diagnosis given when recurrent
substance use leads to significant harmful
consequences.
Substance dependence: Diagnosis given when
substance use leads to physiological dependence or
significant impairment or distress.
Chapter 17
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
DSM-IV-TR Criteria for Substance
Abuse
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One or more of the following occurs during a 12month period, leading to significant impairment or
distress:
1.
2.
3.
4.
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Failure to fulfill important obligations at work, home, or school
as a result of substance abuse.
Repeated use of the substance in situations in which it is
physically hazardous to do so.
Repeated legal problems as a result of substance use.
Confirmed use of the substance despite repeated social or
legal problems as a result of use.
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
DSM-IV-TR Criteria for Substance
Dependence

Maladaptive pattern of substance use, leading to
three or more of the following:

1. Tolerance, as defined by either: the need for
markedly increased amounts of the substance to achieve
intoxication or desired effect; markedly diminished effect with
continued use of the same amount.
2. Withdrawal, as manifested by either: the
characteristic withdrawal syndrome for the substance; the same
or closely related substance is taken to relieve or avoid
withdrawal symptoms.
3. The substance is often taken in larger amounts or
over a longer period than was intended.
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Chapter 17
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
DSM-IV-TR Criteria for Substance
Dependence, continued
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4. There is a persistent desire or unsuccessful efforts
to cut back or control use.
5. A great deal of time is spent in activities necessary
to obtain the substance, use the substance, or recover from its
effects.
6. Important social, occupational, or recreational
activities are given up or reduced because of substance use.
7. The substance use is continued despite knowledge
of having a persistent or recurrent physical or psychological
problem caused or exacerbated by the substance.
Chapter 17
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Biological Theories

Turning on the
pleasure circuit
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Addictive drugs as
different as cocaine,
marijuana, nicotine,
and alcohol all seem
to affect the “reward
circuit”
Dopamine is key
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Drugs hijack the brain
Repeated drug exposure changes brain function. (PET) images are illustrated showing similar brain
changes in dopamine receptors resulting from addiction to different substances. The striatum (which contains
the reward and motor circuitry) shows up as bright red and yellow in the controls (in the left column),
Chapter
17 dopamine D2 receptors. Conversely,Copyright
© 2007
The McGraw-Hill
Companies,(in
Inc.the
All rights
indicating
numerous
the brains
ofbyaddicted
individuals
rightreserved.
column) show a less intense signal, indicating lower levels of dopamine D2 receptors.
Biological Theories

Genetic Factors
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Collaborative Study on the Genetics of Alcoholism (COGA)
began in 1989 (play Itunes interview with Laura Jean Bierut Science Talk
3/28/07)
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Family history, adoption, and twin studies all suggest that
genetics may play a substantial role in at least some forms of
addiction.
Genes
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ALDH1 codes an enzyme which breaks down acetaldehyde.
People with a slow-metabolizing gene variant have a decreased
risk, by up to sixfold, for alcoholism. Asian populations (e.g., 44%
of Japanese, 53% of Vietnamese) are much more likely to have
this gene variant.
Other genes (next slide)
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Chapter 17
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Chapter 17
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Behavioral and Cognitive
Theories
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Children and adolescents learn alcohol-related
behaviors from the modeling of their parents and
important others in their culture.
Early use of drugs predicts addiction.
People who expect alcohol to reduce their distress
and who do not have other, more adaptive means of
coping available to them are more likely than others
to drink alcohol when they are upset and are more
likely to have social problems related to drinking.
Chapter 17
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
PsychoSocioCultural
Approaches
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Childhood trauma is a risk factor.
Chronic stress combined with an environment
that supports and even promotes the use of
substances as an escape is a recipe for
widespread substance abuse and
dependence.
Substance use, particularly alcohol use, is
much more acceptable for men than for
women in many societies.
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Treatment Approaches
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Handout (NIDA principles of effective treatment)
Combination of therapies (evidence-based)
Medications
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disulfiram (Antabuse)
acamprosate (seems to quiet the glutamate system and
improve abstinence rates)
naltrexone (opioid receptor antagonist, which also seems to
reduce craving for alcohol)
topiramate (experimental -- appears to enhance early
abstinence, stabilize mood and anxiety symptoms, and
promote long-term abstinence)
antidepressants
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Treatment Approaches

Psychosocial approaches
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CBT
Stress management
Relapse prevention (identifying triggers)
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