Chapter 10 SubstanceRelated Disorders

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Chapter 10Substance-Related Disorders
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Perspectives on Substance-RelatedDisorders An
Overview

• The Nature of Substance-Related Disorders
• Problems related to the use and abuse of
  psychoactive substances
• Produce wide-ranging physiological,
  psychological, and behavioral effects
• Some Important Terms and Distinctions
• Substance use vs. substance intoxication
• Substance abuse vs. substance dependence
• Tolerance vs. withdrawal

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Perspectives on Substance-RelatedDisorders An
Overview (cont.)

• Five Main Categories of Substances
• Depressants Result in behavioral sedation
  (e.g., alcohol, sedative, anxiolytic drugs)
• Stimulants Increase alertness and elevate mood
  (e.g., cocaine, nicotine, caffeine)
• Opiates Primarily produce analgesia and
  euphoria (e.g., heroin, morphine, codeine)
• Hallucinogens Alter sensory perception (e.g.,
  marijuana, LSD)
• Other drugs of abuse Include inhalants,
  anabolic steroids, medications

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Perspectives on Substance-RelatedDisorders An
Overview (cont.)

• Figure 11.1
• Ice, LSD, chocolate, TV Is everything
  addictive?

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Perspectives on Substance-RelatedDisorders An
Overview (cont.)

• Figure 11.1 (cont.)
• Ice, LSD, chocolate, TV Is everything addictive?

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Perspectives on Substance-RelatedDisorders An
Overview (cont.)

• Figure 11.2
• Easy to get hooked on, hard to get off

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Perspectives on Substance-RelatedDisorders An
Overview (cont.)

• Figure 11.2 (cont.)
• Easy to get hooked on, hard to get off

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The Depressants Alcohol Use Disorders

• Psychological and Physiological Effects of
  Alcohol
• Central Nervous system depressant
• Influences several neurotransmitter systems, but
  mainly GABA
• Effects of Chronic Alcohol Use
• Alcohol intoxication
• Alcohol withdrawal
• Associated brain conditions Dementia and
  Wernickes disease
• Fetal alcohol syndrome
• DSM-IV Criteria for Disordered Alcohol Use

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The Depressants Alcohol Use Disorders (cont.)

• Figure 11.3
• The path traveled by alcohol throughout the body

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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

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Alcohol Some Facts and Statistics (cont.)

• Facts and Statistics on Problem Drinking
• 10 of Americans experience problems with alcohol
• Most persons with alcoholism can moderate or
  cease drinking on occassion
• 20 of those with alcohol problems experience
  spontaneous recovery
• Anhedonia Lack of pleasure, or indifference to
  pleasurable activities
• Affective flattening Show little expressed
  emotion, but may still feel emotion

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Sedative, Hypnotic, or AnxiolyticSubstance use
Disorders An Overview

• The Nature of Drugs in This Class
• Sedatives Calming
• Hypnotic Sleep inducing (e.g., barbiturates)
• Anxiolytic Anxiety reducing (e.g.,
  benzodiazepines)
• 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
• DSM-IV Criteria for Sedative, Hypnotic, or
  Anxiolytic Substance Use Disorders

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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
• Enhance the release of dopamine and
  norepinephrine, while blocking reuptake
• Such effects are followed by a crash (e.g.,
  feeling depressed and tired)
• DSM-IV Criteria for Amphetamine Intoxication
• Psychological symptoms
• Physiological symptoms
• Ecstasy and Ice
• Produces effects similar to speed, but without
  the crash
• 2 of college students report using Ecstasy
• Both drugs can result in dependence

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Stimulants Cocaine Use Disorders

• Effects of Cocaine
• Produce short lived sensations of elation, vigor,
  reduce fatigue
• Effects result from blocking the reuptake of
  dopamine
• Cocaine is highly addictive, but addiction
  develops slowly
• Cocaine use in the United States has declined
  over the last decade
• DSM-IV Criteria for Cocaine Intoxication and
  Withdrawal
• Psychological symptoms
• Physiological symptoms
• Most cocaine users cycle through patterns of
  tolerance and withdrawal

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Stimulants Nicotine Use Disorders

• Effects of Nicotine
• Stimulates the central nervous system,
  specifically nicotinic acetylcholine receptors
• Results in sensations of relaxation, wellness,
  pleasure
• Nicotine is highly addictive
• DSM-IV Criteria for Nicotine Withdrawal Only
• Psychological symptoms
• Physiological symptoms
• Nicotine users dose themselves to maintain a
  steady state of nicotine

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Stimulants Nicotine Use Disorders (cont.)

• Figure 11.8
• Relapse rates for nicotine compared to alcohol
  and heroin

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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
• DSM-IV Criteria for Caffeine Intoxication
• Psychological symptoms
• Physiological symptoms

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Opiods An Overview

• The Nature of Opiates and Opiods
• Opiate Natural chemical in the opium poppy with
  narcotic effects (i.e., pain relief)
• Opiods Refers to a class of nature and
  synthetic substances with narcotic effects
• Such drugs are often referred to as analgesics
• Examples include heroin, opium, codeine, and
  morphine
• Effects of Opiods
• 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

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Opiods An Overview (cont.)

• DSM-IV Criteria for Opiod Intoxication and
  Withdrawal
• Psychological symptoms
• Physiological symptoms
• Mortality rates are high for opiod addicts

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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
• 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

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Hallucinogens An Overview (cont.)

• LSD and Other Hallucinogens
• LSD is most common form of hallucinogenic drug
• Tolerance tends to be rapid, and withdrawal
  symptoms are uncommon
• Psychotic delusional and hallucinatory symptoms
  can be problematic
• DSM-IV Criteria for Marijuana and Hallucinogen
  Intoxication
• Psychological and physiological symptoms are
  similar

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Other Drugs of Abuse Inhalants

• Nature of Inhalants
• Substances found in volatile solvents that are
  breathed into the lungs directly
• Examples include spray paint, hair spray, paint
  thinner, gasoline, nitrous oxide
• Such drugs are rapidly absorbed with effects
  similar to alcohol intoxication
• Tolerance and prolonged symptoms of withdrawal
  are common
• DSM-IV criteria for inhalant intoxication

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Other Drugs of Abuse Anabolic Steroids

• Nature of Anabolic-Androgenic Steroids
• Steroids are derived or synthesized from
  testosterone
• Used medicinally or to increase body mass
• Users may engage in cycling or stacking
• Steroids do not produce a high
• Steroids can result in long-term mood
  disturbances and physical problems

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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
• Such drugs heighten auditory and visual
  perception, sense of taste/touch
• Becoming 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
• Neurotransmitters responsible for
  anxiety/negative affect may be inhibited

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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
• Most see substance abuse as a means to cope with
  negative affect
• Opponent-Process Theory
• Explains why the crash after drug use fails to
  keep people from using
• 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 Drug abuse is a failure
  of self-control
• Sign of a disease Drug abuse is caused by some
  underlying process
• 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
• 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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An Integrative Model ofSubstance-Related
Disorders (cont.)

• Figure 11.11
• An integrative model of substance related
  disorders

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Biological Treatment of Substance-Related
Disorders

• Agonist Substitution
• Safe drug with a similar chemical composition as
  the abused drug
• Examples include methadone for heroin addiction,
  and nicotine gum or patch
• Antagonistic Treatment
• Drugs that block or counteract the positive
  effects of substances
• Examples include naltrexone for opiate and
  alcohol problems

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Biological Treatment ofSubstance-Related
Disorders (cont.)

• Aversive Treatment
• Drugs that make the injection of abused
  substances extremely unpleasant
• Examples include antabuse for alcoholism and
  silver nitrate for nicotine addiction
• Efficacy of Biological Treatment
• Such treatments are generally not effective when
  used alone

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Psychosocial Treatment of Substance-Related
Disorders

• Debate Over Controlled Use vs. Complete
  Abstinence as Treatment Goals
• Inpatient vs. Outpatient Care
• Data suggest little difference in terms of
  overall effectiveness
• Community Support Programs
• Alcoholics Anonymous and related groups
• Seem helpful and are strongly encouraged

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Psychosocial Treatment ofSubstance-Related
Disorders (cont.)

• Components of Comprehensive Treatment and
  Prevention Programs
• Individual and group therapy
• Aversion therapy and convert sensitization
• Contingency management
• Community reinforcement
• Relapse prevention
• Preventative efforts via education

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Summary of Substance-Related Disorders

• DSM-IV and DSM-IV TR Substance Related Disorders
  Cover Four Classes
• Depressants, stimulants, opiates, and
  hallucinogens
• Specific diagnoses include dependence, abuse,
  intoxication, or withdrawal
• Most Psychotropic Drugs Activate the Dopaminergic
  Pleasure Pathway in the Brain
• Psychosocial Factors Interact with Biological
  Influences to Produce Substance Disorders
• Treatment of Substance Dependence Is Largely
  Unsuccessful
• Highly motivated persons do best when part of
  combined treatment programs
• Substance-Related Disorders Are 100 Preventable

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Summary of Substance-Related Disorders (cont.)

• Figure 11.x1
• Exploring substance-related disorders

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Summary of Substance-Related Disorders (cont.)

• Figure 11.x1 (cont.)
• Exploring substance-related disorders

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Summary of Substance-Related Disorders (cont.)

• Figure 11.x2
• Exploring substance-related disorders, treatment

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Summary of Substance-Related Disorders (cont.)

• Figure 11.x2 (cont.)
• Exploring substance-related disorders, treatment