Perspectives on SubstanceRelated Disorders: An Overview

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Perspectives on Substance-RelatedDisorders An
Overview

• The Nature of Substance-Related Disorders
• Use and abuse of psychoactive substances
• Wide-ranging psychophysiological and behavioral
  effects
• Associated with significant impairment and costs
• 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
• 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. ( 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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Sedative, Hypnotic, or AnxiolyticSubstance use
Disorders An Overview

• The Nature of Drugs in This Class
• Sedatives Calming (e.g., barbiturates)
• Hypnotic Sleep inducing
• Anxiolytic Anxiety reducing (e.g.,
  benzodiazepines)
• Effects Are Similar to Large Doses of Alcohol
• Combining such drugs with alcohol is synergistic
• All Influence the GABA Neurotransmitter System

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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
• 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
• Most Cycle Through Patterns of Tolerance and
  Withdrawal

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Stimulants Nicotine Use Disorders

• Effects of Nicotine
• Stimulates nicotinic acetylcholine receptors
• Results in sensations of relaxation, wellness,
  pleasure
• Nicotine is highly addictive
• Relapse rates exceed those for alcohol and heroin
  users
• Nicotine Users Dose Themselves
• Maintain a steady level of nicotine in the
  Bloodstream
• Examples include smoking before sleep or after
  waking

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Stimulants Caffeine Use Disorders

• Effects of Caffeine The Gentle Stimulant
• Found in tea, coffee, cola drinks, and cocoa
  products
• 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

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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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Hallucinogens An Overview

• Nature of Hallucinogens
• Substances that alter perceptions of the world
• Produce delusions, paranoia, hallucinations,
  and/or altered sensory perception
• Examples include marijuana, LSD
• Marijuana
• Active chemical is tetrahydrocannabinol (THC)
• Symptoms Mood swings, paranoia, hallucinations
• Impairment in motivation is not uncommon
• Withdrawal and dependence are uncommon

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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
• Withdrawal symptoms are uncommon
• Can produce psychotic delusions hallucinations

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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 --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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• Figure 11.11 An integrative model of
  substance-related disorders.

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Biological Treatment of Substance-Related
Disorders

• Agonist Substitution
• Substitute safer drug with a similar chemical
  composition
• Examples include methadone and nicotine gum or
  patch
• Antagonistic Treatment
• Drugs that block or counteract pleasurable drug
  effects
• Examples include naltrexone for opiate and
  alcohol problems

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Biological Treatment ofSubstance-Related
Disorders (cont.)

• Aversive Treatment
• Drugs that make use of drugs extremely unpleasant
• Examples include Antabuse for alcoholism and
  silver nitrate for nicotine addiction
• Efficacy of Biological Treatment
• Generally ineffective when used alone

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Psychosocial Treatment of Substance-Related
Disorders

• Inpatient vs. Outpatient Care
• Overall efficacy is comparable
• Controlled Use vs. Complete Abstinence as
  Treatment Goals
• Community Support Programs
• Alcoholics Anonymous and related groups
• Seem helpful and are strongly encouraged

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Stages of Change Model

• Pre-Contemplation "I have no intention of
  changing my drug use
• Contemplation "I am considering changing my drug
  use
• Preparation "I am intending to stop or cut down
  on my drug use
• Action "I have stopped or cut down my drug use
• Maintenance "I have remained free of problem
  drug use and am doing something else as an
  alternative, healthy choice."
• Termination "I am coping confidently with
  temptation and have successful strategies for
  managing high-risk situations."

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Psychosocial Treatment ofSubstance-Related
Disorders (cont.)

• Comprehensive Treatment and Prevention Programs
• Individual and group therapy
• Aversion therapy and covert sensitization
• Contingency management
• Community reinforcement
• Relapse prevention
• Preventive 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
• Diagnoses include dependence, abuse,
  intoxication, or withdrawal
• Most Activate the Dopaminergic Pleasure Pathway
• Psychosocial factors interact with biological
  influences to produce substance disorders
• Treatment of Substance Dependence
• Largely unsuccessful Highly motivated persons
  do well
• Important to use a comprehensive treatment
  approach