Transcript SUBSTANCE USE DISORDERS Assumptions of Disease Model

Substance-Related Disorders and
Addictive Disorders
• Levels of involvement
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Substance use
Substance intoxication
Substance abuse
Substance dependence
• Psychoactive substances alter mood,
behavior, or both
Main Categories of Substances
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Depressants
Stimulants
Opiates
Hallucinogens
Marijuana
Other drugs of abuse
• Inhalants
• Anabolic steroids
• Medications
SPECIFIC DRUGS AND RELATED TOPICS
LEGAL DRUGS:
alcohol
(FAS, DUI, violence…)
tobacco / nicotine (health care debate)
caffeine
(addictive? Long-term effects?)
depressants (benzos - Rohypnol; barbiturates)
SUBSTANCE USE DISORDERS
SPECIFIC DRUGS AND RELATED TOPICS
ILLEGAL DRUGS:
cocaine
(“crack babies”)
amphetamines
(Ritalin and ADHD)
hallucinogens
(LSD, Ecstasy…)
marijuana (medical uses; legalization?)
CAN OTHER BEHAVIORS BE ADDICTIVE?
Diagnostic Issues
• The DSM-5 term substance-related
disorders include 11 symptoms that range
from relatively mild (e.g., substance use
results in occasional failure to fulfill major
role obligations) to more severe (e.g.,
occupational or recreational activities are
given up or reduced because of substance
use)
• Substance-related disorders and anxiety and
mood disorders are highly prevalent
Alcohol Use Disorder
Statistics on Use and Abuse
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Most adults: light drinkers or abstainers
Current use = ~50%
Binge drinking = 22.6%
Dependence = 3 million
Males > Females
Statistics on Alcohol Use and Abuse
Cannabis-Related Disorders
• Marijuana
– Most frequently used drug; medical uses
– Tetrahydrocannabinol (THC)
– Variable, individual reactions
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Euphoria
Mood swings
Paranoia
Hallucinations
Cannabis-Related Disorders
Causes of Substance-Related
Disorders
• Once thought to be moral weakness or
willful misconduct
• Combination of factors
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Biological
Psychological
Social
Cultural
Biological Dimensions
• Familial and genetic influences
– Twin, family, and adoption studies
– Use = environmental influences
– Abuse and dependence = polygenetic
vulnerability
Neurobiological Influences
• Pleasure or reward centers
– Dopaminergic system
• Midbrain - ventral tegmental area
• Frontal cortex – nucleus accumbens
– Endorphins/enkephalins
– Rewards system
• Serotonin and norepinephrine
Psychological/Behavioral
Dimensions
• Positive reinforcement
– Repeated pairings with rewards
• Negative reinforcement
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Escape from unpleasantness
Self-medication
Tension reduction
Coping mechanism for negative affect
Avoid withdrawal
Cognitive Factors
• Expectancy effects
– Beliefs about drugs and drug effects
• Cravings
– Cues
– Environmental triggers
Social Dimensions
• Exposure to drugs
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Prerequisite for use
Media
Peers
Family
• Monitoring
• Peer groups
• Models of Addiction
– Moral weakness
– Disease model
- Behavioral/Psychological
SUBSTANCE USE DISORDERS
Assumptions of Disease Model
addiction seen as a “primary” disease process
alcoholics qualitatively different from non
alcoholics: can’t drink in moderation
central symptom of addiction is loss of control
(e.g., one drink, one drunk)
addiction is chronic and progressive; no cure,
can only be arrested with total abstinence
(e.g. progression models)
SUBSTANCE USE DISORDERS
CRITIQUE OF DISEASE MODEL
Strengths
- perception shift: from sin to TX
- eases guilt, self-blame
- disease is a good metaphor that fits the
experience
- 12-step support and framework works for
many (prevalence of meetings; 24-hour
support…)
- Other strengths?
SUBSTANCE USE DISORDERS
Limitations
- not all data-based
- dichotomous thinking dangerous; no middle
ground (you’re an alcoholic or not)
- loss of control and responsibility paradox
SUBSTANCE USE DISORDERS
METHODS OF TREATMENT
Inpatient Detoxification and Rehabilitation
Outpatient Individual, Couple, or Family
Counseling
Self-help Groups (Alcoholics Anonymous;
NA, CA, OA, GA, Al-Anon etc.)
Residential Facilities & Therapeutic
Communities
Medications
Treatment of Substance Use
Disorders - Medications
Treatment of Substance-Related
Disorders
• Relapse prevention
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Learned aspects of abuse primary target after detox
Address distorted cognitions
Identify negative consequences
Identify high risk situations
Reframe relapse
• failure of coping skills, not person
• as learning opportunity
– Increase motivation to change
SUBSTANCE USE DISORDERS
MOTIVATION AND STAGES OF CHANGE
• Pre-Contemplation
(Denial?)
• Contemplation
(Ambivalence)
• Preparation
(Commitment & Goal-setting)
• Action
(explicit change activities)
• Maintenance
(Relapse) **