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CHAPTER 13
SUBSTANCE-RELATED
DISORDERS
SUBSTANCE-USE DISORDERS
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Problems associated with
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Substance dependence
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using and abusing drugs like alcohol, cocaine, and
heroin,
which alter the way people think, feel, and behave.
Maladaptive pattern of substance use that leads to
clinically significant impairment or distress
Substance abuse
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Recurrent and significant adverse consequences related
to substance use
SUBSTANCE DEPENDENCE
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Tolerance
Withdrawal
Ingestion of more than intended
Persistent desire or unsuccessful effort to use less
Spending a lot of time on obtaining, using, or
recovering from the substance
Reduced social, occupational, or recreational
activities due to use of substance
Continued use despite knowledge of the
psychological and/or physical problems caused
Presence of 3 or more of the above in a 12-month
period
SUBSTANCE ABUSE
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Recurrent substance use leading to failure to fulfill
work, school, home obligations
Recurrent substance use in hazardous situations,
like driving
Recurrent substance-related legal problems, like
arrests
Continued substance use despite persistent social
or interpersonal problems caused by using the
substance, such as getting in fights
The presence of three or more of the above within
a 12-month period
SUBSTANCE INTOXICATION
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Disturbances of
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perception
wakefulness
attention
thinking
judgment
motor behavior
interpersonal behavior
Level of intoxication depends on
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the substance
the dose
history of use
person’s tolerance
person’s expectation of use
environment or setting in which substance is ingested
ALCOHOL-RELATED DISORDERS
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Ethyl alcohol, or ethanol, is the alcohol in beer,
wine, hard liquor
Alcohol blocks messages between nerve cells
First affects frontal lobes where reasoning,
memory, judgment, and inhibitions take place
Next affects cerebellum, seat of motor and
muscle control, balance, five senses
Finally affects the spinal cord and medulla,
which governs breathing, heart rate, and body
temperature
BAC of 0.5% or more can lead to death
ALCOHOL USE AND RISK
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70% of Americans drink occasionally
21- to 34-year olds drink the most
Half of all alcohol is consumed in binge sprees (5 or
more drinks at a time)
Alcohol use in US implicated in
 40% of traffic fatalities
 50% of deaths from falls
 52% of fire-related deaths
 38% of drowning deaths
 20% of health-related expenditures
THEORIES OF ALCOHOL DISORDERS
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Biological
 Metabolic, genetic, and neural processes
Psychodynamic
 Effort to change negative emotional states
Behavioral
 Learned from modeling and social reinforcement
Cognitive
 Expectations about effects of alcohol
Interactional
 Stress precipitates use in people with
predisposition to use
TREATMENT OF ALCOHOL DISORDERS
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Biological
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Psychodynamic
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Psychotherapy provides little benefit unless family
contexts of drinking explored
Cognitive-behavioral
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Drug
Management of withdrawal symptoms
Aversive conditioning
Covert sensitization
Controlled drinking
Relapse prevention
Community-based treatment
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Alcoholics Anonymous most widely used
ALCOHOL-RELATED DISORDERS: RISK
FACTORS
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Poverty
Neighborhood disorganization
Childhood behavior problems
Poor family management practices
Family conflict
Lack of family cohesion
Academic failure
Social pressure to use
Alienation and rebelliousness
Rejection by peers
OTHER DRUGS
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Barbiturates
Tranquilizers
Opioids
Cocaine
Amphetamines
Hallucinogens
Phencyclidine (PCP)
Inhalants
Cannabis
Nicotine
Caffeine
BARBITURATES AND TRANQUILIZERS
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Depressing effect on central nervous system
Dangerous in combination with alcohol
Barbiturates often prescribed to relieve
anxiety and prevent convulsions
Tranquilizers can lead to tolerance and thus
overuse
OPIOIDS
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Drugs with morphine-like effect that bind to brain’s
opioid receptors
Sometimes called narcotics
Heroin and morphine most commonly used
Endorphins, enkephalins, and polymorphins are
body’s endogenous opioids
Cause change in mood, sleepiness, mental clouding,
constipation, slow respiratory system
Withdrawal can be severe
Methadone maintenance is most widely used
treatment
COCAINE
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From leaves of coca bush
Stimulates central nervous system and
decreases appetite
Can produce mania, paranoia, and
impaired judgment
Crack is more potent form and is highly
addictive
Treatment focuses on self-help and social
support (AA-type programs)
AMPHETAMINES
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Psychomotor stimulants
 Affect central nervous system and cardiovascular
system
Moderate use
 Wakefulness, alertness, elevated mood
High dosage
 Nervousness, dizziness, confusion, elevated blood
pressure
Tolerance develops rapidly
Methamphetamines
 Chemically similar but has greater impact on
central nervous system
HALLUCINOGENS
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Also known as psychedelics
Central nervous system action produces alterations
in consciousness
Natural hallucinogens
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Synthetic hallucinogens
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Mescaline
Psilocybin
STP
LSD
Abuse leads to respiratory or cardiovascular
collapse and psychotic behavior
Treatment consists of support groups of enhancing
social skills
PHENCYCLIDINE (PCP)
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Synthetic chemical
Causes disorientation and
hallucination
User may feel dissociated
Users may develop severe
depression or psychosis
Effects may be irreversible
INHALENTS
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Volatile substances or organic solvents
(gasoline, spray paint)
Produce changes in perception
Use may lead to withdrawal from social,
occupational, or recreational activities
More commonly used by young people
Use can lead to dependence with tolerance
and withdrawal symptoms
CANNABIS
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Most often used in marijuana form
Hashish is the solidified resin of the cannabis
plant
Major active ingredient in cannabis is THC
Marijuana use
 Impairs motor coordination and perception
 Affects short-term memory and learning
Treatment
 Relapse prevention
 Social support groups
NICOTINE
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Chemical found in tobacco
Stimulates acetylcholine receptors
Increases heart rate and blood pressure
Can be highly addictive
Cessation requires
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commitment to change
implementation of change
relapse prevention
Nicotine gum and patch may be helpful if
used with counseling.