Substance-Related Disorders Chapter 9

1. Substance-Related DisordersChapter 9

2. Substance-Related Disorders Result from the use of psychoactive substances that affect the central nervous system, cause significant social, occupational, psychological, or physical problems, and sometimes result in abuse or dependence. User may become a danger to others. Drug use may result in criminal activities. Those things are expensive! Use of one substance may lead to use of other substances. Most prevalent among youths and young adults.

3. Substance Related Disorders -Figure 9.1: Percentage of Persons Who Reported Using Specific Illicit Substances at any Time During Their Lives. As you can see, the vast majority of Americans have used psychoactive substances, particularly alcohol and tobacco.-Figure 9.1: Percentage of Persons Who Reported Using Specific Illicit Substances at any Time During Their Lives. As you can see, the vast majority of Americans have used psychoactive substances, particularly alcohol and tobacco.

4. Substance-Related Disorders DSM-IV-TR categories of substance-related disorders: Substance-Use Disorders: Those involving dependence and abuse. Substance-Induced Disorders: Those involving withdrawal and substance-induced delirium. Substance-use disorders differentiated by: Actual substance used Whether disorder pattern is substance abuse or substance dependence.

5. Substance-Related Disorders Substance Abuse: Maladaptive pattern of recurrent use that: Extends over a period of 12 months. Leads to notable impairment or distress. Continues despite social, occupational, psychological, physical or safety problems.

6. Substance-Related Disorders Substance Dependence: Maladaptive pattern of use over 12-month period, characterized by: Unsuccessful efforts to control use, despite knowledge of harmful effects. Takes more of substance than intended. Devotes considerable time to activities necessary to obtain the substance.

7. Substance-Related Disorders Tolerance: Increasing doses are necessary to achieve desired effect. -Tolerance or withdrawal indicates physiological dependence.-Tolerance or withdrawal indicates physiological dependence.

8. Substance-Related Disorders Withdrawal: Distress/impairment in social, occupational, other areas of functioning or physical or emotional symptoms (e.g., shaking, irritability, inability to concentrate) after reducing or ceasing intake. Intoxication: A substance affecting CNS is ingested and causes maladaptive behaviors or psychological changes. -Progression to abuse/dependence: -Experimentation -Early regular use (actively seeking substance) -Plan daily activities around drug use -Drugs needed to avoid constant dysphoria; obvious physical and mental deterioration -Progression to abuse/dependence: -Experimentation -Early regular use (actively seeking substance) -Plan daily activities around drug use -Drugs needed to avoid constant dysphoria; obvious physical and mental deterioration

9. Substance Related Disorders -Tolerance and Withdrawal may Result from Compensation. Repeated administration of a drug often leads to compensating effects, or opponent processes, as the body attempts to maintain homeostasis, or balance. To counteract these effects, the user must take larger quantities of the drug to achieve the same behavioral outcomes (tolerance). When the drug is removed (withdrawal), only the compensating behaviors remain. As a result, withdrawal appears to have the opposite effects of the formerly used drugs. -During withdrawal, the user is motivated to remove the aversive feeling rather than gain the pleasure.-Tolerance and Withdrawal may Result from Compensation. Repeated administration of a drug often leads to compensating effects, or opponent processes, as the body attempts to maintain homeostasis, or balance. To counteract these effects, the user must take larger quantities of the drug to achieve the same behavioral outcomes (tolerance). When the drug is removed (withdrawal), only the compensating behaviors remain. As a result, withdrawal appears to have the opposite effects of the formerly used drugs. -During withdrawal, the user is motivated to remove the aversive feeling rather than gain the pleasure.

10. Substance-Use Disorders Physical Dependence: State of body such that bodily processes become modified & produce physical withdrawal symptoms when drug is removed. Psychological Dependence: A compulsion which requires continued use of a drug for some pleasurable effect.

11. Characteristics of Various Psychoactive Substances -Table 9.1: Characteristics of Various Psychoactive Substances.-Table 9.1: Characteristics of Various Psychoactive Substances.

13. Past-Month Illicit Drug Use Among Persons Aged 12 and Older, by Race/Ethnicity -Figure 9.3: Past-month Illicit Drug Use Among Persons Aged 12 and Older, by Race/Ethnicity.-Figure 9.3: Past-month Illicit Drug Use Among Persons Aged 12 and Older, by Race/Ethnicity.

17. Depressants or Sedatives Cause generalized depression of the central nervous system and a slowing down of responses. Include, among other substances: Alcohol Narcotics Barbiturates Benzodiazepines

18. Substance Abuse DisordersAlcohol-Use Disorders Alcoholic: Person who abuses/ is dependent on alcohol. Alcoholism: Characterized by abuse of, or dependency on, alcohol, which is a depressant. Binge Drinking: Person abstains for a while, but is unable to control/moderate intake when drinking resumes.

19. Substance Abuse DisordersAlcohol-Use Disorders Pattern of problem drinking: Finds taste unpleasant; swears never to drink again after first bout of drunkenness. Heavy drinking serves a purpose (e.g., reduces anxiety). Consumption continues despite negative consequences. Preoccupation with alcohol consumption; deterioration of social and occupational functioning. -Experimenter�s created �neurosis� in a cat by administering electric shock whenever they approached the food. -The cats stopped eating and exhibited anxiety and other neurotic symptoms. -When the cats were given alcohol, their symptoms diminished and they ate the food despite the shock. -As the alcohol wore off, the cats� symptoms returned. -The cats came to prefer alcohol spiked milk. -Once the shocks were terminated, the preference for alcohol disappeared. -The alcohol seemed to serve a purpose, reduction of anxiety.-Experimenter�s created �neurosis� in a cat by administering electric shock whenever they approached the food. -The cats stopped eating and exhibited anxiety and other neurotic symptoms. -When the cats were given alcohol, their symptoms diminished and they ate the food despite the shock. -As the alcohol wore off, the cats� symptoms returned. -The cats came to prefer alcohol spiked milk. -Once the shocks were terminated, the preference for alcohol disappeared. -The alcohol seemed to serve a purpose, reduction of anxiety.

20. Alcohol Use Alcohol consumption around the world: 11% of U.S. adults consume 1 oz or more of alcohol per day; 55% drink more than 3 drinks per week; 35% abstain. In the U.S, 50% of total alcohol consumed is drunk by only 10% of drinkers, especially ages 18-25. Varies according to cultural traditions and gender (in U.S. men drink 2-5 times as much as women). In the U.S., problems in social, medical, physical, and financial costs. Psychological effects of alcohol depend on the context of drinking.

21. Gender, Ethnic, and Age Differences in Self-Reports of Alcohol Use During a One-Month Period -Figure 9.4: Gender, Ethnic, and Age Differences in Self-Reports of Alcohol Use During a One-month Period. Important gender, ethnic, and age differences are shown in the self-reports of alcohol use during �the past month.� Men, whites and individuals ages 18 to 34 reported relatively greater consumption than other groups.-Figure 9.4: Gender, Ethnic, and Age Differences in Self-Reports of Alcohol Use During a One-month Period. Important gender, ethnic, and age differences are shown in the self-reports of alcohol use during �the past month.� Men, whites and individuals ages 18 to 34 reported relatively greater consumption than other groups.

22. Blood Alcohol Level as a Function of Number of Drinks Consumed and Body Weight -Table 9.2: Blood Alcohol Level as a Function of Number of Drinks Consumed and Body Weight.-Table 9.2: Blood Alcohol Level as a Function of Number of Drinks Consumed and Body Weight.

23. Other Depressants or Sedatives Narcotics (Opiates): Drugs such as opium and its derivatives (morphine, heroin, codeine) that depress the CNS. Provide relief from pain, anxiety, tension Tolerance builds rapidly; extreme withdrawal symptoms Prevalence: 0.7% of adult population at some time in their lives; prevalence decreases with age; greater for males than females

24. Other Depressants or Sedatives Barbiturates (�Downers�): Powerful depressant of CNS that are commonly used to induce relaxation and sleep. More lethal than heroin (accidental overdose or combined with alcohol) Polysubstance Dependence: Dependence on repeated use of at least 3 substances (excluding caffeine and nicotine) for a period of 12 months Benzodiazepines (e.g., Valium)

25. �Club Drugs� Used by 70% of attendees at dance clubs and raves attended by young people. Stimulants: Ecstasy/MDMA, LSD, GHB, ketamine, methamphetamine (responsible for largest number of emergency room visits) Benzodiazepines: Rohypnol (�Roofies� or the �date-rape� drug) Ecstasy can cause cardiovascular failure, higher heart rate and blood pressure, heart wall stress, and cognitive deficits.

26. Stimulants Stimulant: Central nervous system energizer, inducing elation, grandiosity, hyperactivity, agitation, and appetite suppression. Amphetamines: Drugs that speed up CNS activity and produce increased alertness, energy, and sometimes feelings of euphoria and confidence (�uppers�). Prevalence: 2% of U.S. adults at some time in their lives suffer amphetamine use/abuse; more male than female (3-4:1), more for low SES Caffeine is also a stimulant.

27. Stimulants Nicotine: Most commonly associated with cigarette smoking, which accounts for 1/6 of deaths in the U.S. and is the single most preventable cause of death. Prevalence: ~30% Americans over the age of 11 currently use tobacco products Symptoms of nicotine dependence: Unsuccessful attempts to stop or reduce use Attempts to stop lead to withdrawal symptoms Continued use despite serious physical disorder (e.g., emphysema)

28. Stimulants -Concentration of a Drug in the Blood Supply Depends on the Method of Administration. Drug effects are dependent on the concentration of the drug in the blood supply, and some methods of administration produce effective concentrations faster than others. In the case of nicotine, smoking a cigarette produces a much faster increase in blood nicotine concentration than chewing an equivalent does of tobacco, however, chewing tobacco produces higher sustained concentrations of nicotine than smoking does.-Concentration of a Drug in the Blood Supply Depends on the Method of Administration. Drug effects are dependent on the concentration of the drug in the blood supply, and some methods of administration produce effective concentrations faster than others. In the case of nicotine, smoking a cigarette produces a much faster increase in blood nicotine concentration than chewing an equivalent does of tobacco, however, chewing tobacco produces higher sustained concentrations of nicotine than smoking does.

29. StimulantsNicotine The physiological effects of nicotine -Health problems associated with using nicotine-containing products -Cancer -Emphysema -Heart disease -Stroke -Many of these are actually caused by other chemicals in cigarette smoke or in smokeless tobacco products. The biggest problem with nicotine is how easily you become dependent on smoking or chewing tobacco. -To help quit smoking, nicotine patches and gums allow us to spread out the withdrawal into two pieces, first psychological, then physical. -Zyban, a commonly used stop smoking drug, is actually an antidepressant. Removal of the regularly ingested stimulant can produce a deep depression.-Health problems associated with using nicotine-containing products -Cancer -Emphysema -Heart disease -Stroke -Many of these are actually caused by other chemicals in cigarette smoke or in smokeless tobacco products. The biggest problem with nicotine is how easily you become dependent on smoking or chewing tobacco. -To help quit smoking, nicotine patches and gums allow us to spread out the withdrawal into two pieces, first psychological, then physical. -Zyban, a commonly used stop smoking drug, is actually an antidepressant. Removal of the regularly ingested stimulant can produce a deep depression.

30. Stimulants Cocaine: Substance extracted from coca plant that induces feelings of euphoria and self-confidence in users (followed by depression). Chronic abuse: Neurophysiological changes in CNS and premature ventricular heartbeats and death. Crack: Purified, potent form of cocaine produced by heating cocaine with ether.

31. -Cocaine prevents the reuptake of neurotransmitters so that the receiving neuron receives constant stimulation. -Mice have been genetically bred so that they do not reuptake. -These mice act very similar to normal mice after ingesting cocaine (hyperactive). -The behavior of these mice is virtually unchanged by cocaine.-Cocaine prevents the reuptake of neurotransmitters so that the receiving neuron receives constant stimulation. -Mice have been genetically bred so that they do not reuptake. -These mice act very similar to normal mice after ingesting cocaine (hyperactive). -The behavior of these mice is virtually unchanged by cocaine.

32. Hallucinogens Hallucinogen: Produces hallucinations, vivid sensory awareness, heightened alertness, or perceptions of increased insight. Marijuana: The mildest and most commonly used hallucinogen. Prevalence: 40% over the age of 12 have used at some point (most commonly: ages 18-30), more common for males Lysergic Acid Diethylamide (LSD) Phencyclidine (PCP)

35. Substance Use DisordersEtiology Biological: Heredity and congenital factors Two types of alcoholism Familial: Family history of alcoholism, suggesting genetic predisposition Non-familial: Suggesting environmental factors Sociocultural factors Behavioral Factors Anxiety Reduction Learned expectancies Reduces tension -Biological factors -In studies using quantitative trait analysis, animals are bred for specific behaviors, then genetic differences are sought between them. -Sociocultural factors: -More males and young adults than females and older adults -More Catholics than Protestants and Jews -Rates of alcoholism is NOT related to per capita consumption, although France has high rates of both -Parents, peers, and cultural values -Two-way street regarding peers: Users seek out other users, and users influence their friends to use -Biological factors -In studies using quantitative trait analysis, animals are bred for specific behaviors, then genetic differences are sought between them. -Sociocultural factors: -More males and young adults than females and older adults -More Catholics than Protestants and Jews -Rates of alcoholism is NOT related to per capita consumption, although France has high rates of both -Parents, peers, and cultural values -Two-way street regarding peers: Users seek out other users, and users influence their friends to use

36. Substance Use DisordersEtiology -Marijuana uniquely distorts a person�s sense of time, distance, and speed. -Airline pilots given a single dose of marijuana were landing the airplanes off the runway in a simulator 48 hours later. -Marijuana use may raise the risk of a schizophrenia diagnosis.-Marijuana uniquely distorts a person�s sense of time, distance, and speed. -Airline pilots given a single dose of marijuana were landing the airplanes off the runway in a simulator 48 hours later. -Marijuana use may raise the risk of a schizophrenia diagnosis.

37. Substance-Use DisordersEtiology Ainslie-Rachlin Model Assumes that value functions can be best described parabolically. -Describe the SS vs. LL options using a graph. -A lack of self-control? -This model predicts that commitment mechanisms should work well to eliminate unwanted behaviors.-Describe the SS vs. LL options using a graph. -A lack of self-control? -This model predicts that commitment mechanisms should work well to eliminate unwanted behaviors.

38. Substance-Use DisordersEtiology Relapse: Resume drinking after voluntary abstinence. Negative emotional states, negative physical states, gender differences (women: interpersonal conflict), social pressure, coping responses. Abstinence Violation Effect: Loss of personal control after drinking begins. Biological: Physical dependence; avoid withdrawal symptoms

39. The Relapse Process -Figure 9.5: The Relapse Process. Shown here is Marlatt�s model illustrating why some recovering alcoholics or drug abusers either remain abstinent or relapse. Those who encounter high-risk situations (ones that encourage consumption) and have good coping skills develop feelings of self-efficacy and confidence in their ability to avoid consumption and, therefore, have a decreased probability of relapse. On the other hand, those without good coping responses lose confidence and feelings of self-efficacy, which could lead to a relapse. Once this occurs, Marlatt suggests, they feel weak, powerless, or guilty and give up trying to abstain.-Figure 9.5: The Relapse Process. Shown here is Marlatt�s model illustrating why some recovering alcoholics or drug abusers either remain abstinent or relapse. Those who encounter high-risk situations (ones that encourage consumption) and have good coping skills develop feelings of self-efficacy and confidence in their ability to avoid consumption and, therefore, have a decreased probability of relapse. On the other hand, those without good coping responses lose confidence and feelings of self-efficacy, which could lead to a relapse. Once this occurs, Marlatt suggests, they feel weak, powerless, or guilty and give up trying to abstain.

40. Substance-Use DisordersIntervention and Treatment Two phases: Removal of abusive substance Long-term maintenance without the substance Detoxification: Alcohol or drug treatment phase characterized by removal of the abusive substance, after which the user is immediately or eventually prevented from consuming the substance.

41. Substance-Use DisordersIntervention and Treatment Self-help Groups: Alcoholics Anonymous helps many alcoholics; Al-Anon and Alateen offer support to adults and teens living with alcoholics. Pharmacological: Use of chemical substances (e.g., Antabuse) to produce aversion to drug. Often combined with psychotherapy to develop coping skills and alternative life patterns.

42. Substance-Use DisordersIntervention and Treatment Methadone is used to wean heroin addicts by preventing withdrawal symptoms, but not producing the euphoric effects. Disulfiram is used for alcohol addiction, it interferes with the metabolism of alcohol, thus producing unpleasant effects when alcohol is consumed. The rat on right has been given a drug which interferes with the action of the drug, thus eliminating the motivation for drinking. -Future Treatments for Addiction May Include Drug Antagonists. One approach to drug treatment is the administration of substances that interfere with the action of the drug. Other treatments may produce unpleasant symptoms when combined with the abused drug. Both of these rats received large injections of alcohol, but the �sober� rat also received an antagonist that blocks the alcohol binding site on the GABAA receptor.-Future Treatments for Addiction May Include Drug Antagonists. One approach to drug treatment is the administration of substances that interfere with the action of the drug. Other treatments may produce unpleasant symptoms when combined with the abused drug. Both of these rats received large injections of alcohol, but the �sober� rat also received an antagonist that blocks the alcohol binding site on the GABAA receptor.

43. Substance-Use DisordersCognitive-Behavioral Interventions and Treatment Aversion Therapy: Response to a stimulus is decreased by pairing the stimulus with an aversive stimulus. Covert Sensitization: Imagine a noxious stimulus occurring in the presence of a behavior Skills Training: Learn to resist peer pressure or temptation; resolve emotional conflicts or problems; more effective communication. Reinforcing Abstinence: Behavioral reinforcements for abstinence; effective for opioid dependence. -Aversion therapy, putting a kid in a closet with a whole box of cigars.-Aversion therapy, putting a kid in a closet with a whole box of cigars.

44. Substance-Use DisordersCognitive-Behavioral Interventions and Treatment Behavioral treatment for cigarette smoking: Aversive procedures have been disappointing, but �rapid smoking� has had positive outcomes. Nicotine fading (gradual withdrawal) more effective Scheduled-interval method more effective than �cold turkey� Relapse prevention: Multicomponent programs effective for quitting smoking.

45. Substance-Use DisordersCognitive-Behavioral Interventions and Treatment Relaxation and systematic desensitization Motivational: Important and realistic goal setting Stress management and cognitive restructuring; coping with negative emotions and stress Response prevention Controlled drinking: Controversial

46. Substance-Use DisordersOther Interventions and Treatments Multimodal treatment Prevention programs Discourage use before it begins Education Media exposure

47. Substance-Use DisordersEffectiveness of Treatment Effective, but some studies suggest outcomes have been modest. Some individuals recover on their own without treatment. No single �best� treatment: Find the best combination of treatments for particular individuals with substance use disorders.