chapter 11 substance-related and impulse-control disorders

1. Chapter 11

3. 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

4. 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 & Wernicke�s disease Fetal alcohol syndrome DSM-IV-TR Criteria for Disordered Alcohol Use

5. Fighting Addiction

6. 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 Alcohol: Some Facts and Statistics

7. 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 DSM-IV-TR Criteria for this Class of Disorders Main criteria and distinguishing features

8. 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

9. Stimulants: Amphetamine Use Disorders Effects of Amphetamines Produce elation, vigor, reduce fatigue Effects are followed by extreme fatigue and depression DSM-IV-TR Criteria for Amphetamine Intoxication 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

10. 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 DSM-IV-TR Criteria for Cocaine Intoxication and Withdrawal Psychological symptoms Physiological symptoms Most Cycle Through Patterns of Tolerance and Withdrawal

11. Stimulants: Nicotine Use Disorders Effects of Nicotine Stimulates nicotinic acetylcholine receptors Results in sensations of relaxation, wellness, pleasure Nicotine is highly addictive Relapse rates equal those for alcohol and heroin users DSM-IV-TR Criteria for Nicotine Withdrawal Only Psychological symptoms Physiological symptoms Nicotine Users Dose Themselves Maintain a steady level of nicotine in the Bloodstream Examples include smoking before sleep or after waking

12. 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 DSM-IV-TR Criteria for Caffeine Intoxication Psychological symptoms Physiological symptoms

13. 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 body�s enkephalins and endorphins Low doses � Euphoria, drowsiness, and slow breathing High doses can be fatal Withdrawal symptoms can be lasting and severe

14. DSM-IV-TR Criteria for Opioid Intoxication and Withdrawal Psychological symptoms Physiological symptoms Mortality rates are high for opioid addicts Users at increased risk for HIV infection Opioids: Diagnostic Criteria and Associated Features

15. 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

16. 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 DSM-IV-TR Criteria Marijuana and Hallucinogen Intoxication Psychological and physiological symptoms are similar

17. Marijuana Brains

18. Other Drugs of Abuse: Inhalants Nature of Inhalants Found in volatile solvents Breathed into the lungs directly Examples include spray paint, hair spray, paint thinner, gasoline, nitrous oxide Such drugs are rapidly absorbed Effects similar to alcohol intoxication Produce tolerance and prolonged withdrawal symptoms DSM-IV-TR Criteria for Inhalant Intoxication

19. 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 Long-term mood disturbances and physical problems

20. 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 All heighten auditory and visual perception (taste and touch) Popular in nightclubs, raves, or large social gatherings All designer drugs can produce tolerance and dependence

21. 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

22. Causes of Substance-Related Disorders:Neurobiological 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 Inhibition of neurotransmitters for anxiety / negative affect

23. Causes of Substance-Related Disorders:Psychological 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

24. Causes of Substance-Related Disorders:Social 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

25. 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 An Integrative Model of Substance-Related Disorders

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

27. 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

28. 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

29. 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

30. Psychosocial Treatment ofSubstance-Related Disorders (cont.) Comprehensive Treatment and Prevention Programs Individual and group therapy Aversion therapy and convert sensitization Contingency management Community reinforcement Relapse prevention Preventative efforts via education

31. 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

32. Impulse-Control Disorders DSM-IV-TR Intermittent explosive disorder Kleptomania Pyromania Pathological gambling Trichotillomania Each is Characterized by the Following Increased tension/anxiety prior to the act A sense of relief following the act Impairment of social and occupational functioning

34. Impulse-control Disorders (cont�d.) Pyromania Involves having an irresistible urge to set fires Diagnosed in less than 4% of arsonists Little etiological and treatment research Pathological Gambling Estimated to affect 3-5% adult Americans Treatment is similar to that for substance dependence Treatment studies are currently underway Trichotillomania Inability to resist the urge to pull hair Observed in 1-5% of college students, mostly female Clomipramine and CBT have been shown to be helpful