Transcript Slides Chapter 11 - Substance Disorders

Substance Disorders
Psychoactive = alters behavior/mood
• Use
= ingesting psychoactive substances in
moderate amounts
- no life impairment
- not a disorder
• Intoxication
= physiological reaction to ingesting excess
substance
• Abuse
= recurrent & maladaptive pattern of use
(life impairment/distress)
• Dependence/addiction
a) Physical
- tolerance = increasingly greater amounts
of drug needed for same desired effect
- withdrawal = severe negative
physiological reaction to removal of
substance, alleviated by the substance
b) Psychological addiction
- drug-seeking behaviors
Types of Psychoactive
Substances
• Depressants
= decrease CNS activity
- often physical dependence
- death by decreased vital organ functioning
& by withdrawal
• Opioids = narcotics
(reduce pain & induce sleep)
- death by decreased respiration
- very unpleasant withdrawal
but not life-threatening
• Stimulants
= increase CNS activity
- most common
• Hallucinogenics/Psychodelics
= change perception
- no evidence of withdrawal
- psychological dependence
- quick tolerance to most
- reverse tolerance to marijuana
Alcoholism
•
•
•
•
10-14% U.S. adults (dependence or abuse)
1983 cost of alcoholism = $117 billion
1/3 medical problems/inpatient care
50-80% traffic injuries & deaths
History
• 17th c. US - heavy drinking commonplace
• 18th & 19th c. - Change in view of alcohol
“Demon Rum”
Levine’s socioeconomic theory
• Colonials thought behavior shaped by
church (external locus of control)
• Less blame for person
• Industrialism => rise of individual
(internal locus of control)
• Alcoholism = loss of self-control
Gusfield
• Colonial Am. = rich elite & poor masses
• Industrialization = middle class &
“empowering of mass”
• Temperance movement = keep elite in
control
• Alcohol is evil
• Today: more moderate
• Alcohol seen as direct cause of deviant
behavior
Models of Alcoholism
I. Alcoholism as a Disease
A. Rush, M.D. – 18th c.
alcoholism as disease & moral problem
• Alcohol causes drunkenness (external LOC)
• Alcoholism is a disease
• Result = lose control of behavior
- not from person’s immorality
- from alcohol’s addictive nature
• Abstinence is only cure -> prohibition
B. 1960 - Jellinek
Most prevalent type includes physical
tolerance & dependence/withdrawal
- the individual (internal LOC)
- alcoholics are different
- loss of control as key
C. Alexander (1988)
Genetic
Env. Stress
Predisposition
Susceptibility
Addiction
Upbringing
(Env. Predisp)
Exposure to Drugs
& Access
Life
Problems
• AA:
Life problems -> bottoming out
Either die or recover
• The current, dominant model
• Disease model allows for tx, reduces stigma
(& responsibility)
II.
Cognitive Model of Alcoholism
- Loss of control due to expectancies
- AA/mainstream model leads to failure
“One drink, one drunk”
3.Behavioral Models of Alcoholism
a. Positive Reinforcement
- drugs make us feel good
- Addiction = recurrent use to recapture
the feeling
BUT - not all evidence supports
b. Negative Reinforcement
- drugs to escape unpleasant experiences
=> tension reduction/self-med
Once physically dependent,
withdrawal -> increased use
But evidence does not support
c. Associative learning (cues)
- to maintain problem
4.Neural Sensitization - Current theory
- Brain cells become sensitized to drug from
repeated exposure
- Mesolimbic system is involved in
motivation
- So increased motivation for drug
- Systems cause wanting, not liking
Initial use -> liking
-> wanting (incentive value)
Treatment of Alcoholism
1.Biological Treatment
a. Agonist substitution
- use other, similar drug
- can develop tolerance
- can become addicted
b. Antagonist drugs
- block or counteract drug
- can reduce craving
BUT - must be motivated
- can cause withdrawal
c.
Aversive Treatment
- Drugs that cause unpleasantness
take the addictive drug
- Again, must be motivated
- Can include behavioral methods
d. Classical/associative conditioning
- change cues for drinking
if
2.Alcoholics Anonymous - popular
- Self-help group of lay people who provide
support
- Alcoholism = loss of control from allergy Solution: total abstinence
Results from AA
• Positive response
• Negative response
Fosters dependency & reduces responsibility
• Research: little & difficult to conduct
more positive outcome
however, 75% drop out by 1 year
3.Cognitive/Behavioral Treatment
A. Controlled Drinking
- Teach some alcoholics to drink in a
limited, social way
- Expectancies lead to outcomes
- Research = better than abstinence
B.
Relapse Prevention – Current
- failure of coping skills
- tx = change beliefs
& focus on negative consequences
- identify high-risk situations
& develop strategies
• Overall picture for treatment: 70-80% not
helped long-term by any approach