Transcript abnormal PSYCHOLOGY Third Canadian Edition

abnormal
psychology
Fourth Canadian Edition
Chapter 12
Substance-Related Disorders
Prepared by:
Tracy Vaillancourt, Ph.D.
Modified by: Réjeanne Dupuis, M.A.
Chapter Outline
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Alcohol Abuse and Dependence
Inhalant Use Disorder
Sedatives and Stimulants
LSD and Other Hallucinogens
Etiology of Substance Abuse and Dependence
Therapy for Alcohol Abuse and Dependence
Therapy for the Use of Illicit Drugs
Treatment for Cigarette Smoking
Prevention of Substance Use
Substance Abuse and Dependence
• Pathological use of substances falls into two
categories:
– Substance abuse
– Substance dependence
Substance Dependence
• Substance dependence—presence of at least
three of the following + duration of 12 months:
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Development of tolerance
Withdrawal symptoms
Uses > of substance or uses it for longer time
Recognizes excessive use of the substance
Much of time is spent in efforts to obtain the
substance or recover from its effects
– Use continues despite psychological or physical
problems
– Person gives up or cuts back participation in many
activities
Substance Abuse
• Substance abuse—must experience one of
the following as a result of recurrent use of
the drug + duration of 12 months:
– Failure to fulfill major obligations
– Exposure to physical dangers
– Legal problems
– Persistent social or interpersonal problems
Alcohol Abuse and
Dependence
• Alcohol dependence may include tolerance or
withdrawal reactions
– People who are physically dependent on alcohol tend
to have more severe symptoms of the disorder
• Alcohol abuse does not include physically
dependence or tolerance
• Alcohol abuse or dependence is often part of
polydrug (or polysubstance) abuse
– Using or abusing more than one drug at a time
– Example: 80 to 85% of alcohol abusers are smokers
Prevalence and Comorbidity
• In the U.S. prevalence rates
– Lifetime prevalence rate for alcohol abuse: 17.8% and
4.7%
– 12-month prevalence rate for alcohol dependence:
12.5% and 3.8%
– Dependence  with advancing age
• Comorbid with mood and anxiety disorders,
other drug use and schizophrenia
– Factor in 25% of suicides
– Comorbid psychiatric disorders predicts high relapse
rates and less initial treatment improvement
Binge Drinking at University
• 1 in 6 Canadian university students is a heavy-frequent
drinker
• 1 in 4 American university students are frequent binge
drinkers
• 32% of undergraduate report hazardous or harmful
patterns of drinking (17% in the general population)
• More Canadian students drink; more American students
are heavy drinkers
• First experience of drunkenness prior to age 16 is more
likely to lead to heavy drinking later
• 1 in 4 Ontarians in grades 7 to 12 admit binge drinking
within last month – no gender differences was found
Short-Term Effects of Alcohol
• Metabolized by enzymes after swallowed and
reaching stomach
• Most goes into small intestines where absorbed into
blood
• Broken down in liver
– can metabolize about 30 millilitres of 100-proof (50%
alcohol) whisky/hour
– quantities in excess of this amount stay in the
bloodstream
• Biphasic effect
– Initial effect of alcohol is stimulating then acts as a
depressant
Mechanism
• Produces effects through interactions with
several neural systems in the brain
– Stimulates GABA receptors
• Reducing tension
– Increases levels of serotonin and dopamine
• Pleasurable effects
– Inhibits glutamate receptors
• Cognitive effects of alcohol intoxication, such as
slurred speech and memory loss
Long-Term Effects
• Chronic drinking causes severe biological
damage and psychological deterioration
– Almost every tissue and organ is adversely
affected
• Malnutrition
• Deficiency of B-complex vitamins → amnestic
syndrome
• Cirrhosis of the liver
• Damage to the endocrine glands and pancreas
• Heart failure, hypertension, stroke, and capillary
hemorrhages, which are responsible for
• Brain damage
Fetal Alcohol Syndrome
• Leading cause of mental
retardation— heavy
alcohol consumption
during pregnancy
– growth of the fetus is
slowed
– cranial, facial, and limb
anomalies are produced
– known as fetal alcohol
syndrome
– see also partial fetal
alcohol syndrome and
alcohol-related
neurodevelopmental
disorder (ARND)
Inhalant Use Disorder
• Although use not confined to children and
adolescents, alarming # of young people
begin their substance abuse by inhaling
substances
– Glue, correction fluid, spray paint, cosmetics,
gasoline, household aerosol sprays, nitrous
oxide found in spray cans of whipped cream
– Abuse among young people = 17.3%
Nicotine and Cigarette
Smoking
• Nicotine— addictive agent of tobacco
• Stimulates nicotinic receptors in brain
– Then active neural pathways stimulate
dopamine neurons in mesolimbic area
• Seem to be involved in producing reinforcing
effects of most drugs
Prevalence and Health Consequences
• Estimated that smoking causes > 47,000 deaths
per year Canada
• Medical problems associated with cigarette
smoking include:
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Lung cancer
Emphysema
Cancer of larynx and esophagus
Cardiovascular diseases
• Harmful components
– Nicotine, carbon monoxide, and tar (which includes
carcinogens)
Smoking Statistics
• In 2009, ~17% of Canadians aged 15 > are
current smokers
– But fewer Canadians are smoking and smokers are
smoking fewer cigarettes on a daily basis
• Men smoke > cigarettes on a daily basis than
women
• Rates of smoking have been  among
teenagers
• 13% of Canadian university students smoke
daily
Second-Hand Smoke
• Second-hand smoke (or environmental tobacco smoke)
– Contains higher concentrations of ammonia, carbon monoxide,
nicotine, and tar than does the smoke inhaled by smoker
– 2/3rd of smoke not inhaled by the smoker but enters air around
smoker
– Has at least 2X the nicotine and tar as smoke inhaled by smoker
– Regular exposure  lung disease by 25% and heart disease by
10%
– Aggravates symptoms in people with allergies and asthma
– Infants and children exposed to second-hand smoke are more
likely to suffer:
• Chronic respiratory illness, impaired lung function, middle ear
infections, and food allergies, and can even succumb to sudden
infant death syndrome
• In Canada, 2.4 million homes with children under 12
years of age report regular exposure
Marijuana
• Marijuana—dried and crushed leaves and flowering tops
of Cannabis sativa
– Major active chemical is delta-9-tetrahydrocannabinol (THC)
• Psychological Effects of Marijuana
– Feel more relaxed and sociable
– Can dull attention, fragment thoughts, and impair memory
– Extremely heavy doses can induce hallucinations and extreme
panic
• Somatic Effects
– Specific cannabinoid receptors in brain (CB) have been located
in various brain regions
• Believed receptors in hippocampus account for short-term
memory loss
• Therapeutic Effects
Sedatives
• Sedatives (downers) slow activities of body
and reduce responsiveness.
– Includes opiates—opium and its derivatives,
morphine, heroin, and codeine
– and synthetic barbiturates and tranquilizers,
such as secobarbital (Seconal) and diazepam
(Valium)
• Opidates— sedatives that relieve pain and
induce sleep
Psychological and Physical
Effects
• Opium and derivatives (morphine and heroin) produce:
– Euphoria, drowsiness, daydream, and lack of coordination
– Heroin has an additional initial effect— the rush
• Effects produced by stimulating neural receptors of the
body’s own opioid system
– Heroin (example) converted into morphine in brain and then
binds to opioid receptors
– Body produces opioids (endorphins and enkephalins)
– Opium and derivatives fit into receptors and stimulate them
• In 24-year follow-up of 500 heroin addicts
– 28% had died by age 40
Stimulants
• Stimulants (uppers) such as cocaine, act on brain and
sympathetic nervous system to increase alertness and
motor activity
• Amphetamines
– Originally used to control control mild depression and
appetite
– Today used to treat hyperactive children
– Examples: Benzedrine, Dexedrine, and Methedrine
• Produce effects by causing the release of norepinephrine and
dopamine and blocking the reuptake of these neurotransmitters
• Cocaine
– Pleasure induced by cocaine related to has blocked
dopamine reuptake
LSD and Other Hallucinogens
• LSD= d-lysergic acid diethylamide
• LSD is a hallucinogen
– Main effect of drug is hallucinations
– Other effects include flashbacks
• Other important hallucinogens are:
– Mescaline
– Psilocybin
– Synthetic compounds MDA and MDMA
Etiology
Biological Variables
• Evidence for genetic predisposition for alcohol abuse
• Adoption studies add further support
See also Shep Sigel’s Work from McMaster University
• Conditioning theory of tolerance— underscores need to
jointly consider biological processes and environmental
stimuli
– Based on notion that tolerance is a learned response
– Environmental cues present when addictive behaviours are
developed influence behaviours via Pavlovian conditioning
• Feedforward mechanisms— regulatory responses made
in anticipation of a drug
– Anticipating drug effects before they actually occur
Therapy
• Admitting the Problem
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Do you sometimes feel uncomfortable when alcohol is not available?
Do you drink more heavily than usual when you are under pressure?
Are you in more of a hurry to get to the first drink than you used to be?
Do you sometimes feel guilty about your drinking?
Are you annoyed when people talk about your drinking?
When drinking socially, do you try to sneak in some extra drinks?
Are you constantly making rules for yourself about what and when to
drink?
• Traditional Hospital Treatment
– Detoxification
• Biological Treatments
– Example: disulfiram (Antabuse)
• Alcoholics Anonymous
12 Steps of AA
Therapy (cont.)
• Couples and Family Therapy
• Adolescent Treatment Centre
• Cognitive and Behavioural Treatment
– Aversion Therapy
• Covert sensitization
– Contingent-Management Therapy
• emphasizes patient control and includes:
– Stimulus control
– Modification of the topography of drinking
– Reinforcing abstinence
– Moderation in Drinking
• Controlled drinking
• Harm reduction therapy
Therapy for Use of Illicit Drugs
• Detoxification—central to treatment of people
who use addicting drugs
• Biological Treatments
– Heroin substitutes
• Drugs chemically similar to heroin that replace body’s craving
• Example: methadone, levomethadyl acetate, bupreorphine
– Heroin antagonists
• Drugs that prevent user from experiencing heroin high
• Psychological Treatments
– CBT and Motivational Interviewing
Treatment for Smoking
• Biological Treatment
– Nicotine replacement therapy
• Nicotine gum, patches, inhalers etc.
• Psychological Treatment
Prevention
• Peer-pressure resistance
training
• Correction of normative
expectations
• Inoculation against massmedia messages
• Information about
parental and other adult
influences
• Peer leadership
• Affective education, selfimage enhancement.
• Other components
– Providing information about
harmful effect
– Encouraging students to
make public commitment
not to smoke
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