Substance Disorders

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Substance Disorders

• Psychoactive alters behavior/mood
• Use
• ingesting psychoactive substances in moderate
  amounts
• - no life impairment
• - not a disorder

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• Intoxication
• physiological reaction to ingesting excess
  substance
• Abuse
• recurrent maladaptive pattern of use (life
  impairment/distress)

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• 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

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• b) Psychological addiction
• - drug-seeking behaviors

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Types of Psychoactive Substances

• Depressants
• decrease CNS activity
• - often physical dependence
• - death by decreased vital organ functioning
  by withdrawal

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• Opioids narcotics
• (reduce pain induce sleep)
• - death by decreased respiration
• - very unpleasant withdrawal
• but not life-threatening

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• Stimulants
• increase CNS activity
• - most common

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• Hallucinogenics/Psychodelics
• change perception
• - no evidence of withdrawal
• - psychological dependence
• - quick tolerance to most
• - reverse tolerance to marijuana

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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

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History

• 17th c. US - heavy drinking commonplace
• 18th 19th c. - Change in view of alcohol
• Demon Rum

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• Levines socioeconomic theory
• Colonials thought behavior shaped by church
  (external locus of control)
• Less blame for person
• Industrialism gt rise of individual (internal
  locus of control)
• Alcoholism loss of self-control

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• Gusfield
• Colonial Am. rich elite poor masses
• Industrialization middle class empowering of
  mass
• Temperance movement keep elite in control
• Alcohol is evil

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• Today more moderate
• Alcohol seen as direct cause of deviantbehavior

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Models of Alcoholism

• I. Alcoholism as a Disease
• A. Rush, M.D. 18th c.
• alcoholism as disease moral problem

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• Alcohol causes drunkenness (external LOC)
• Alcoholism is a disease
• Result lose control of behavior
• - not from persons immorality
• - from alcohols addictive nature
• Abstinence is only cure -gt prohibition

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• B. 1960 - Jellinek
• Most prevalent type includes physical tolerance
  dependence/withdrawal
• - the individual (internal LOC)
• - alcoholics are different
• - loss of control as key

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• C. Alexander (1988)
• Genetic Env. Stress
• Predisposition
• Susceptibility Addiction Life
  Problems
• Upbringing Exposure to Drugs
• (Env. Predisp) Access

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• AA Life problems -gt bottoming out Either die
  or recover
• The current, dominant model
• Disease model allows for tx, reduces stigma (
  responsibility)

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• II. Cognitive Model of Alcoholism
• - Loss of control due to expectancies
• - AA/mainstream model leads to failure
• One drink, one drunk

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• 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

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• b. Negative Reinforcement
• - drugs to escape unpleasant experiences
• gt tension reduction/self-med
• Once physically dependent, withdrawal -gt
  increased use
• But evidence does not support

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• c. Associative learning (cues)
• - to maintain problem

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• 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

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• Initial use -gt liking
• -gt wanting (incentive value)

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Treatment of Alcoholism

• 1. Biological Treatment
• a. Agonist substitution
• - use other, similar drug
• - can develop tolerance
• - can become addicted

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• Antagonist drugs
• - block or counteract drug
• - can reduce craving
• BUT - must be motivated
• - can cause withdrawal

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• c. Aversive Treatment
• - Drugs that cause unpleasantness if take the
  addictive drug
• - Again, must be motivated
• - Can include behavioral methods
• Classical/associative conditioning
• - change cues for drinking

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• 2. Alcoholics Anonymous - popular
• - Self-help group of lay people who
  provide support
• - Alcoholism loss of control from allergy -
  Solution total abstinence

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• 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

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• 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

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• B. Relapse Prevention Current
• - failure of coping skills
• - tx change beliefs
• focus on negative consequences
• - identify high-risk situations develop
  strategies

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• Overall picture for treatment 70-80 nothelped
  long-term by any approach