The Spectrum of Use and the Historical Context

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The Spectrum of Use and the Historical Context

• Lecture 2
• Chapter 1 2

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Drugs Are Old
Drugs have been around since the dawn of time
Probably
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Coming on the Scene

• Alcohol as early as 6400 years BC (Middle East)
• Cannabis 3000 years BC (Middle East)
• Opium 5000 BC (China)
• Tobacco 100 BC (Mexico)
• Coca 3000 BC
• Cocaine Extracted 1855
• Heroin 1874
• MDMA (XTC) 1912
• LSD 1938

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Despite the Laws People Still Use
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Does Use Mean Abuse?
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The Spectrum of Use

• Use Periodic non-problematic use
• Misuse Periodic Use
• Abuse A pattern of misuse
• Dependence Compulsive problematic use often
  with physiological dependence

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Use

• Many drugs can be used relatively safely
• Most people who use drugs do not develop
  problems, however this depends on the drug
• Drugs are used for many reasons
• Social
• Religious
• Coping
• Experimentation

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Misuse

• Periodic circumscribed negative consequences
• College students and alcohol
• It only happened once.
• Sometimes the consequences are catastrophic

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DSM-IV Abuse
1. Failure to fulfill major role obligations 2.
Use in hazardous situations 3. Legal Problems 4.
Use despite problems
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DSM-IV Dependence
1. Tolerance 2. Withdrawal 3. Larger
amounts/longer period than intended 4. Inability
to, or persistent desire to, cut down or
control 5. A great deal of time spent obtaining,
using, or recovering 6. Important activities
given up or reduced 7. Use despite problems
caused or exacerbated by use
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How Does One Move Through the Spectrum?
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Public Health Model

• Agent Factors Properties of the drug or
  substance
• Host Factors Characteristics of the person
• Environment Factors Context/Situation

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Perspectives on Substance-RelatedDisorders An
Overview (cont.)

• Five Main Categories of Substances
• Depressants Result in behavioral sedation
• Stimulants Increase alertness and elevate mood
• Opiates Primarily produce analgesia and
  euphoria
• Hallucinogens Alter sensory perception
• Other drugs of abuse Include inhalants,
  anabolic steroids, medications

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The Depressants Alcohol Use Disorders

• Psychological and Physiological Effects of
  Alcohol
• Central Nervous system depressant
• Affects several neurotransmitter systems
• Specific target is GABA
• Effects of Chronic Alcohol Use
• Alcohol intoxication withdrawal
• Associated conditions Dementia Wernickes
  disease
• Fetal alcohol syndrome

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Alcohol Some Facts and Statistics

• In the United States
• Most adults view themselves light drinkers or
  abstainers
• Over 50 of the U.S. (gt 12 years age) report
  current use
• 15 million Americans are alcohol dependent
• Rates are highest among Caucasian Native
  Americans
• Males use and abuse alcohol more than females
• Violence is associated with alcohol
• Alcohol alone does not cause aggression

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Stimulants An Overview

• Nature of Stimulants
• Most widely consumed drug in the United States
• Such drugs increase alertness and increase energy
• Examples include amphetamines, cocaine, nicotine,
  and caffeine

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Stimulants Amphetamine Use Disorders

• Effects of Amphetamines
• Produce elation, vigor, reduce fatigue
• Effects are followed by extreme fatigue and
  depression
• DSM-IV-TR Criteria for Amphetamine Intoxication
• Ecstasy and Ice
• Produces effects similar to speed, but no
  comedown
• 2 of college students report using Ecstasy
• Both drugs can result in dependence
• Amphetamines stimulate CNS by
• Enhancing release of norepinephrine and dopamine
• Reuptake is subsequently blocked

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Stimulants Cocaine Use Disorders

• Effects of Cocaine
• Short lived sensations of elation, vigor, reduce
  fatigue
• Blocks reuptake of dopamine
• Highly addictive, but addiction develops slowly
• DSM-IV-TR Criteria for Cocaine Intoxication and
  Withdrawal
• Psychological symptoms
• Physiological symptoms
• Most Cycle Through Patterns of Tolerance and
  Withdrawal

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Opioids An Overview

• The Nature of Opiates and Opioids
• Opiate Narcotic like chemical in the opium
  poppy
• Opioids Substances that produce narcotic
  effects
• Often referred to as analgesics (i.e., help
  relieve pain)
• Examples include heroin, opium, codeine, and
  morphine
• Effects of Opioids
• Activate bodys enkephalins and endorphins
• Low doses Euphoria, drowsiness, and slow
  breathing
• High doses can be fatal
• Withdrawal symptoms can be lasting and severe

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Other Drugs of Abuse Designer Drugs

• Designer Drugs
• Drugs produced by pharmaceutical companies for
  diseases
• Ecstasy, MDEA (eve), BDMPEA (nexus), ketamine
  (special K) are examples
• All heighten auditory and visual perception
  (taste and touch)
• Popular in nightclubs, raves, or large social
  gatherings
• All designer drugs can produce tolerance and
  dependence

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Causes of Substance-Related Disorders Family
and Genetic Influences

• Results of Family, Twin, and Adoption Studies
• Substance abuse has a genetic component
• Much of the focus has been on alcoholism
• Genetic differences in alcohol metabolism
• Multiple genes are involved in substance abuse

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Causes of Substance-Related DisordersNeurobiolog
ical Influences

• Results of Neurobiological Research
• Drugs affect the pleasure or reward centers in
  the brain
• The pleasure center Dopamine, midbrain, frontal
  cortex
• GABA turns off reward-pleasure system
• Inhibition of neurotransmitters for anxiety /
  negative affect

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Causes of Substance-Related DisordersPsychologic
al Dimensions

• Role of Positive and Negative Reinforcement
• The self-medication and the tension reduction
  hypotheses
• Substance abuse as a means to cope with negative
  affect
• Opponent-Process Theory
• Why the crash after drug use fails to stop drug
  use
• Role of Expectancy Effects
• Expectancies influence drug use and relapse

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Causes of Substance-Related DisordersSocial and
Cultural Dimensions

• Exposure to Drugs is a Prerequisite for Use of
  Drugs
• Media, family, peers
• Parents and the family appear critical
• Societal Views About Drug Abuse
• Sign of moral weakness Failure of self-control
• Sign of a disease Caused by underlying
  processes
• The Role of Cultural Factors
• Influence the manifestation of substance abuse

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An Integrative Model of Substance-Related
Disorders

• Exposure or Access to a Drug
• Is necessary, but not sufficient for abuse and
  addiction
• Drug Use Depends on Social and Cultural
  Expectations
• Drugs Are Used Because of their Pleasurable
  Effects
• Drugs Are Abused for Reasons that are More
  Complex
• The premise of equifinality
• Stress may interact with psychological, genetic,
  social, and learning factors

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From A Psychological Standpoint

• Drug abuse and dependence are disorders of
  behavior
• Not only do each have health implications, abuse
  and dependence have extreme psychosocial
  implications
• People make changes in their alcohol/drug abuse
  behavior in the same way they make changes in all
  other behaviors
• Much alcohol and drug abuse/dependence is related
  to psychopathology
• Most people stop on their own

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Substance Abuse Treatment

• Self-Help (AA NA CA Rational Recovery)
• Psychosocial Interventions
• Medications

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Self-Help 12 Step Fellowships

• Alcoholics Anonymous Narcotics Anonymous
• View of Problem Spiritual disease
• Tools 12 steps to recovery
• Mechanism Powerful social support
• Issues Effective for those who stick. Can be
  difficult to stick

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Psychosocial Interventions

• Behavioral and Cognitive Behavioral
• View of Problem Behavioral disorder.
• Tools Functional analysis, contingency
  management and cognitive interventions as well as
  relapse prevention
• Mechanisms Skills improvement, attitude change,
  coping w/psychopathology
• Issues Highly researched treatments. Very
  effective. Not sure how they work actually.

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Psychosocial Interventions

• Motivational Interviewing
• Alternative to confrontational approach
• Designed to move individual through stages of
  change
• Brief (1-4 sessions)
• Effective as stand-alone and a booster to
  treatment

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Pharmacotherapy

• Alcohol Dependence
• Antabuse
• Naltrexone
• Drug Dependence
• Methadone Naltrexone (Heroin)
• Antidepressants (Cocaine)
• Cocaine vaccine?????

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Outcome

• Abstinence vs. Harm Reduction
• AA/NA, CBT, MI are all effective
• Meds can be as well
• Stage-matched interventions
• The longer people stick the better they do
• Most often takes multiple treatments
• Social support after treatment is critical
• Treatment works better than jail in the short and
  long run