SubstanceRelated Disorders

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Substance-Related Disorders

• Description
• Etiology
• Treatment

Barlow, D.H. Durand, V.M. (2001) Abnormal
Psychology (2ndEd.). Belmont Wadsworth. Chapter
11 pp. 336-373.
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Definitions

• Psychoactive substance chemicals that are
  induced (taken in) to alter mood, behaviour or
  perception.

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Levels of involvement

• Substance Use
• Substance Intoxication
• Substance Abuse
• Substance Dependence

Increasing involvement
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Substance Abuse

• Maladaptive pattern of substance use leading to
  clinically significant impairment or distress
  e.g.
• Failure to fulfil role obligations
• Substance use in hazardous situations
• Substance related legal problems
• Continued substance use despite persistent and
  recurrent social and interpersonal problems
  caused by the substance use.

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Substance Dependence

• Addiction?
• Pattern of repeated substance use despite
  significant substance related problems
• Physiological dependence
• Tolerance
• Withdrawal
• Compulsive substance seeking and taking behaviour
• Physiological vs. psychological dependence?

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Diagnostic issues

• DSM-IV Diagnosis is given according to the
  substance ingested and the level of involvement
• Comorbidity?
• High prevalence chance?
• Substance induced anxiety, mood or psychotic
  disorders
• Differential diagnosis

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Categories of Substances

• Depressants Result in behavioural and cognitive
  sedation e.g. Alcohol, sedatives, hypnotics,
  anxiolytics (e.g.Valium), mandrax.
• Stimulants Lead to one being more active and
  alert e.g. caffeine, nicotine, cocaine,
  amphetamines (e.g. Ecstasy)
• Opiates Produce loss of pain and euphoria e.g.
  heroin, morphine, codeine, opium.
• Hallucinogens Produce alterations in sensory
  perception e.g. Cannabis, LSD.

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Alcohol Use Disorders

• Among the most prevalent mental disorders in the
  population
• More common in Males (up to 5 times!). Females
  characterised by later onset but possibly a more
  rapid progression.
• Abuse dependence have variable course pattern
  of remission relapse.
• Associated with abuse of other substances,
  increased risk of accidents, violence suicide

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Alcohol Immediate effects

• Intoxication
• Reduction of inhibition
• Impaired motor co-ordination slurred speech
• Impaired judgement
• Impaired attention memory
• Reduced reaction time
• Influence on neuroreceptors
• Inhibitory action on GABA (anxiety), Glutamate
  (cognition) Serotonin (mood, sleep eating)
  systems.

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Alcohol Long term effects

• Positive effects?
• Relaxes reduces inhibitions
• Moderate levels may help prevent cardiovascular
  disorders
• Liver disease
• Pancreatitis
• Dementia

• Cardiovascular disorders
• Korsakoffs syndrome
• Foetal alcohol syndrome Cortical atrophy
• Kills brain cells?
• Neural connections
• Regeneration?

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Cannabis use disorders

• Cannabis is most widely used illicit substance.
• Cannabis use disorders most prevalent in males
  aged 18-30 years
• Dependence and abuse usually develop over an
  extended period of time
• Users do not generally develop physiological
  dependence.
• Associated with mild anxiety, depression and
  irritability.

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Cannabis Intoxication

• Euphoria, inappropriate laughter and grandiosity,
  sedation, lethargy, STM impairment, impaired
  judgement, distorted sensory perceptions,
  impaired motor performance and the sensation that
  time is passing slowly.
• Occasionally anxiety (which can be severe),
  dysphoria social withdrawal occur
• Physiological conjuctival injection, increased
  appetite dry mouth.

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Cannabis Effects

• Medical benefits
• reduce nausea associated with chemotherapy
• stimulate appetite of AIDS patients
• treat glaucoma?

• Respiratory ailments
• Reduction in Testosterone levels?
• Suppression of specific immune response?
• Amotivational syndrome?
• Gateway drug?

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Etiology

• Biological
• Genetic
• Neurobiological
• Behavioural
• ve reinforcement
• -ve reinforcement
• Cognitive
• Social
• Cultural

Integrative theory
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Biological dimensions

• Twin studies
• DRD2 gene on chromosome 11 which increases
  sensitivity of dopamine receptors
• 66 alcoholics had gene
• 20 non-alcoholics had gene
• Absence of enzyme aldehyde dehydrogenase which
  metabolises alcohol - 30 to 50 of people of
  Asian descent
• Genetics mediates the experience of taking a
  substance

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Genetics twin studies
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Psychological factors

• Behavioural
• ve reinforcement increase in pleasurable
  experience
• -ve reinforcement Reduction in unpleasant
  experiences
• Cognitive
• Expectancy effects
• Alcohol Myopia

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Social Cultural factors

• Social factors
• mediate exposure to substances
• Family parents who abuse substances may model
  substance abuse
• Socio-economic factors
• moral weakness vs. disease model
• Cultural dimensions
• Cultural norms effect which substances are used
  and how they are used.

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Important factors

• Properties of the Drug
• Availability
• Cost
• Physiological response

Sub Abuse

• Social Environt
• Peer influence
• Life options
• Subculture

• Attributes of User
• Genetic
• Temperament personality
• Biological response
• Conditioning

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Treatment

• Treatment difficult gt very high relapse rate
• Biological Treatments
• Agonist substitution
• safe alternative drug eg. Methadone
• Antagonist treatment
• Blocks or counteracts effects of drug
• Aversive treatments
• makes ingesting substance aversive
• Other Medication to help person cope with
  withdrawal

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Psychosocial treatments

• Inpatient facilities
• Alcoholics Anonymous
• Disease model
• Abstinence
• Higher power
• Social support
• Controlled use
• Sociocultural intervention

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Psychosocial treatments

• Component treatment
• Aversion therapy
• Covert desensitisation
• Community reinforcement
• relationship therapy
• antecedents consequences of behaviour
• employment assistance
• recreational options
• Relapse prevention