SUBSTANCE-RELATED DISORDERS

1
CHAPTER 13

• SUBSTANCE-RELATED DISORDERS

2
SUBSTANCE-USE DISORDERS

• Problems associated with
• using and abusing drugs like alcohol, cocaine,
  and heroin,
• which alter the way people think, feel, and
  behave.
• Substance dependence
• Maladaptive pattern of substance use that leads
  to clinically significant impairment or distress
• Substance abuse
• Recurrent and significant adverse consequences
  related to substance use

3
SUBSTANCE DEPENDENCE

• 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

4
SUBSTANCE ABUSE

• 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

5
SUBSTANCE INTOXICATION

• Disturbances of
• perception
• wakefulness
• attention
• thinking
• judgment
• motor behavior
• interpersonal behavior
• Level of intoxication depends on
• the substance
• the dose
• history of use
• persons tolerance
• persons expectation of use
• environment or setting in which substance is
  ingested

6
ALCOHOL-RELATED DISORDERS

• 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

7
ALCOHOL USE AND RISK

• 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

8
THEORIES OF ALCOHOL DISORDERS

• 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

9
TREATMENT OF ALCOHOL DISORDERS

• Biological
• Drug
• Management of withdrawal symptoms
• Psychodynamic
• Psychotherapy provides little benefit unless
  family contexts of drinking explored
• Cognitive-behavioral
• Aversive conditioning
• Covert sensitization
• Controlled drinking
• Relapse prevention
• Community-based treatment
• Alcoholics Anonymous most widely used

10
ALCOHOL-RELATED DISORDERS RISK FACTORS

• 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

11
OTHER DRUGS

• Barbiturates
• Tranquilizers
• Opioids
• Cocaine
• Amphetamines
• Hallucinogens
• Phencyclidine (PCP)
• Inhalants
• Cannabis
• Nicotine
• Caffeine

12
BARBITURATES AND TRANQUILIZERS

• 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

13
OPIOIDS

• Drugs with morphine-like effect that bind to
  brains opioid receptors
• Sometimes called narcotics
• Heroin and morphine most commonly used
• Endorphins, enkephalins, and polymorphins are
  bodys endogenous opioids
• Cause change in mood, sleepiness, mental
  clouding, constipation, slow respiratory system
• Withdrawal can be severe
• Methadone maintenance is most widely used
  treatment

14
COCAINE

• 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)

15
AMPHETAMINES

• 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

16
HALLUCINOGENS

• Also known as psychedelics
• Central nervous system action produces
  alterations in consciousness
• Natural hallucinogens
• Mescaline
• Psilocybin
• Synthetic hallucinogens
• STP
• LSD
• Abuse leads to respiratory or cardiovascular
  collapse and psychotic behavior
• Treatment consists of support groups of enhancing
  social skills

17
PHENCYCLIDINE (PCP)

• Synthetic chemical
• Causes disorientation and hallucination
• User may feel dissociated
• Users may develop severe depression or psychosis
• Effects may be irreversible

18
INHALENTS

• 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

19
CANNABIS

• 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

20
NICOTINE

• Chemical found in tobacco
• Stimulates acetylcholine receptors
• Increases heart rate and blood pressure
• Can be highly addictive
• Cessation requires
• commitment to change
• implementation of change
• relapse prevention
• Nicotine gum and patch may be helpful if used
  with counseling.