Untitled

1
(No Transcript)
2
Substance Use Disorders Overview

• Chapter 10

3
Perspectives on Substance-RelatedDisorders An
Overview

• The Nature of Substance-Related Disorders
• Problems related to the use and abuse of
  psychoactive substances
• Psychoactive substance any chemical entity or
  mixture, not required for the maintenance of
  health, that alters mood, thinking, or behavior
  when administered
• Some Important Terms and Distinctions
• Substance use vs. substance intoxication
• Substance abuse vs. substance dependence
• Tolerance vs. withdrawal
• Route of administration

4
Substance Use vs. Intoxication

• Substance Use
• Ingestion of psychoactive substance in moderate
  amounts that does not significantly interfere
  with functioning
• Substance Intoxication
• Ingestion of psychoactive substances that
  produces significant acute changes in mood,
  thinking, or behavior

5
Substance Abuse vs. Dependence

• Substance Abuse
• Maladaptive pattern of substance use, leading to
  clinically significant impairment or distress, as
  manifested by
• failure to fulfill major role obligations
• use in hazardous situations
• recurrent substance-related legal problems
• use despite knowledge of recurrent drug related
  problems
• Does not meet criteria for substance dependence

6
Substance Abuse v. Dependence

• Substance Dependence
• Maladaptive pattern of substance use, leading to
  clinically significant impairment or distress, as
  manifested by
• Tolerance
• Withdrawal
• Loss of control over use
• Persistent desire or unsuccessful efforts to cut
  down or quit
• Great deal of time devoted to obtaining or using
  substance
• Important activities are sacrificed due to use
• Continued use despite knowledge of persistent
  problems
• Specify with or without physiological dependence
• Course specifiers reflect current status of
  disorder

7
Tolerance vs. Withdrawal

• Tolerance
• need for markedly increased amounts of the
  substance to achieve intoxication or desired
  effect
• markedly diminished effect with continued use
• Withdrawal
• the characteristic withdrawal syndrome for the
  substance
• the same (or closely related) substance is taken
  to relieve or avoid withdrawal symptoms

8
Route of Administration

• Route of drug administration affects immediacy of
  psychological effects
• Oral ? intranasal ? inhalant ? injection
• Route of administration adds health risks
• Overdose much easier with faster routes of
  administration
• Inhalant lung cancer
• Injection HIV, hepatitis, infection

9
Categories of Psychoactive Substances

• Four Main Categories of Substances
• Depressants Result in behavioral sedation
  (e.g., alcohol, sedative, anxiolytic, and
  hypnotic drugs)
• Stimulants Increase alertness and elevate mood
  (e.g., cocaine, amphetamines, nicotine, caffeine)
  
• Opiates Primarily produce analgesia and
  euphoria (e.g., heroin, morphine, codeine)
• Hallucinogens Alter sensory perception (e.g.,
  marijuana, LSD)

10
The Depressants Alcohol Use Disorders

• Psychological and Physiological Effects of
  Alcohol
• Central Nervous system depressant
• Influences several neurotransmitter systems, but
  mainly GABA
• Intoxication effects include slurred speech, loss
  of coordination, impaired gait, nystagmus, and
  memory problems
• Effects of Chronic Alcohol Use
• Alcohol withdrawal (DTs)
• Physical damage (liver cirrhosis)
• Family and relationship distress
• Associated brain conditions Dementia and
  Wernickes disease
• Fetal alcohol syndrome

11
Alcohol Some Facts and Statistics

• In the United States
• Most adults consider themselves light drinkers or
  abstainers
• Most alcohol is consumed by 11 of the U.S.
  population
• Alcohol use is highest among Caucasian Americans
• Males use and abuse alcohol more so than females
• Violence is associated with alcohol, but alcohol
  alone does not cause aggression
• Facts and Statistics on Problem Drinking
• 10 of Americans experience significant problems
  with alcohol
• Most persons with alcoholism can moderate or
  cease drinking on occasion
• 20 of those with alcohol problems experience
  spontaneous recovery

12
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
• Neurobiological effects vary, but all act as
  sympathomimetic agents and seem to ultimately
  activate the pleasure center of the brain

13
Stimulants Amphetamine Use Disorders

• Effects of Amphetamines
• Produce elation, expansive mood, vigor, reduce
  fatigue
• Enhance the release of dopamine and
  norepinephrine, while blocking reuptake
• Such effects are followed by a crash (e.g.,
  feeling depressed and tired)

14
Sedative, Hypnotic, or Anxiolytic Substances

• The Nature of Drugs in This Class
• Sedatives Calming
• Hypnotic Sleep inducing (e.g., barbiturates)
• Anxiolytic Anxiety reducing (e.g.,
  benzodiazepines)
• Intoxication effects of such drugs are similar to
  large doses of alcohol
• Combining such drugs with alcohol is synergistic
• All Exert Their Influence Via the GABA
  Neurotransmitter System

15
Stimulants Cocaine Use Disorders

• Effects of Cocaine
• Produce short lived sensations of elation, vigor,
  reduced fatigue, self-confidence
• Effects result from blocking the reuptake of
  dopamine
• Cocaine is highly addictive, but dependence
  develops slowly
• Cocaine use in the United States has declined
  over the last decade, although experimental use
  is on the rise again among adolescents

16
Stimulants Nicotine Use Disorders

• Effects of Nicotine
• Stimulates the central nervous system,
  specifically nicotinic acetylcholine receptors
• Results in sensations of relaxation, wellness,
  pleasure although intoxication effects are not
  described
• Nicotine is highly addictive
• Nicotine users dose themselves to maintain a
  steady state of nicotine

17
Stimulants Caffeine Use Disorders

• Effects of Caffeine The Gentle Stimulant
• Found in tea, coffee, cola drinks, and cocoa
  products
• Caffeine blocks the reuptake of the
  neurotransmitter adenosine
• Small doses elevate mood and reduce fatigue
• Used by over 90 of Americans
• Regular use can result in tolerance and dependence

18
Opioids An Overview

• The Nature of Opiates and Opioids
• Opiate Natural chemical in the opium poppy with
  narcotic effects (i.e., pain relief)
• Opioids Refers to a class of natural and
  synthetic substances with narcotic effects
• Such drugs are often referred to as analgesics
• Examples include heroin, opium, codeine, and
  morphine
• Effects of Opioids
• Activate bodys enkephalins and endorphins
• Low doses induce euphoria, drowsiness, and slowed
  breathing
• High doses can result in death
• Withdrawal symptoms can be lasting and severe

19
Hallucinogens An Overview

• Nature of Hallucinogens
• Substances that change the way the user perceives
  the world
• May produce delusions, paranoia, hallucinations,
  and altered sensory perception
• Specific neurobiological actions are unknown
• Examples include marijuana, LSD
• Marijuana
• Active chemical is tetrahydrocannabinol (THC)
• May produce several symptoms (e.g., mood swings,
  paranoia, hallucinations)
• Impairment in motivation is not uncommon (i.e.,
  amotivational syndrome)
• Major signs of withdrawal and dependence do not
  typically occur but can in some individuals

20
Hallucinogens An Overview (cont.)

• LSD and Other Hallucinogens
• d-lysergic acid diethylamide
• Tolerance tends to be rapid, and withdrawal
  symptoms are uncommon
• Psychotic delusional and hallucinatory symptoms
  can be problematic