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Substance Disorders

Learn about substance disorders, alcoholism, history, models of addiction, and treatment options, including biological, AA, and cognitive/behavioral approaches.

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Substance Disorders

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

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

  3. 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

  4. b) Psychological addiction - drug-seeking behaviors

  5. Types of Psychoactive Substances • Depressants = decrease CNS activity - often physical dependence - death by decreased vital organ functioning & by withdrawal

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

  7. Stimulants = increase CNS activity - most common

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

  9. 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

  10. History • 17th c. US - heavy drinking commonplace • 18th & 19th c. - Change in view of alcohol “Demon Rum”

  11. Levine’s socioeconomic theory • Colonials thought behavior shaped by church (external locus of control) • Less blame for person • Industrialism => rise of individual (internal locus of control) • Alcoholism = loss of self-control

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

  13. Today: more moderate • Alcohol seen as direct cause of deviantbehavior

  14. Models of Alcoholism I. Alcoholism as a Disease A. Rush, M.D. – 18th c. alcoholism as disease & moral problem

  15. Alcohol causes drunkenness (external LOC) • Alcoholism is a disease • Result = lose control of behavior - not from person’s immorality - from alcohol’s addictive nature • Abstinence is only cure -> prohibition

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

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

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

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

  20. 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

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

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

  23. 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

  24. Initial use -> liking -> wanting (incentive value)

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

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

  27. 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

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

  29. 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

  30. 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

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

  32. Overall picture for treatment: 70-80% nothelped long-term by any approach

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