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CHAPTER 13

CHAPTER 13. SUBSTANCE-RELATED DISORDERS. SUBSTANCE-USE DISORDERS. Problems associated with using and abusing drugs like alcohol, cocaine, and heroin, which alter the way people think, feel, and behave. Substance dependence

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CHAPTER 13

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  1. CHAPTER 13 SUBSTANCE-RELATED DISORDERS

  2. SUBSTANCE-USE DISORDERS • Problems associated with • using and abusing drugs like alcohol, cocaine, and heroin, • which alter the way people think, feel, and behave. • Substance dependence • Maladaptive pattern of substance use that leads to clinically significant impairment or distress • Substance abuse • Recurrent and significant adverse consequences related to substance use

  3. SUBSTANCE DEPENDENCE • Tolerance • Withdrawal • Ingestion of more than intended • Persistent desire or unsuccessful effort to use less • Spending a lot of time on obtaining, using, or recovering from the substance • Reduced social, occupational, or recreational activities due to use of substance • Continued use despite knowledge of the psychological and/or physical problems caused • Presence of 3 or more of the above in a 12-month period

  4. SUBSTANCE ABUSE • Recurrent substance use leading to failure to fulfill work, school, home obligations • Recurrent substance use in hazardous situations, like driving • Recurrent substance-related legal problems, like arrests • Continued substance use despite persistent social or interpersonal problems caused by using the substance, such as getting in fights • The presence of three or more of the above within a 12-month period

  5. SUBSTANCE INTOXICATION • Disturbances of • perception • wakefulness • attention • thinking • judgment • motor behavior • interpersonal behavior • Level of intoxication depends on • the substance • the dose • history of use • person’s tolerance • person’s expectation of use • environment or setting in which substance is ingested

  6. ALCOHOL-RELATED DISORDERS • Ethyl alcohol, or ethanol, is the alcohol in beer, wine, hard liquor • Alcohol blocks messages between nerve cells • First affects frontal lobes where reasoning, memory, judgment, and inhibitions take place • Next affects cerebellum, seat of motor and muscle control, balance, five senses • Finally affects the spinal cord and medulla, which governs breathing, heart rate, and body temperature • BAC of 0.5% or more can lead to death

  7. ALCOHOL USE AND RISK • 70% of Americans drink occasionally • 21- to 34-year olds drink the most • Half of all alcohol is consumed in binge sprees (5 or more drinks at a time) • Alcohol use in US implicated in • 40% of traffic fatalities • 50% of deaths from falls • 52% of fire-related deaths • 38% of drowning deaths • 20% of health-related expenditures

  8. THEORIES OF ALCOHOL DISORDERS • Biological • Metabolic, genetic, and neural processes • Psychodynamic • Effort to change negative emotional states • Behavioral • Learned from modeling and social reinforcement • Cognitive • Expectations about effects of alcohol • Interactional • Stress precipitates use in people with predisposition to use

  9. TREATMENT OF ALCOHOL DISORDERS • Biological • Drug • Management of withdrawal symptoms • Psychodynamic • Psychotherapy provides little benefit unless family contexts of drinking explored • Cognitive-behavioral • Aversive conditioning • Covert sensitization • Controlled drinking • Relapse prevention • Community-based treatment • Alcoholics Anonymous most widely used

  10. ALCOHOL-RELATED DISORDERS: RISK FACTORS • Poverty • Neighborhood disorganization • Childhood behavior problems • Poor family management practices • Family conflict • Lack of family cohesion • Academic failure • Social pressure to use • Alienation and rebelliousness • Rejection by peers

  11. OTHER DRUGS • Barbiturates • Tranquilizers • Opioids • Cocaine • Amphetamines • Hallucinogens • Phencyclidine (PCP) • Inhalants • Cannabis • Nicotine • Caffeine

  12. BARBITURATES AND TRANQUILIZERS • Depressing effect on central nervous system • Dangerous in combination with alcohol • Barbiturates often prescribed to relieve anxiety and prevent convulsions • Tranquilizers can lead to tolerance and thus overuse

  13. OPIOIDS • Drugs with morphine-like effect that bind to brain’s opioid receptors • Sometimes called narcotics • Heroin and morphine most commonly used • Endorphins, enkephalins, and polymorphins are body’s endogenous opioids • Cause change in mood, sleepiness, mental clouding, constipation, slow respiratory system • Withdrawal can be severe • Methadone maintenance is most widely used treatment

  14. COCAINE • From leaves of coca bush • Stimulates central nervous system and decreases appetite • Can produce mania, paranoia, and impaired judgment • Crack is more potent form and is highly addictive • Treatment focuses on self-help and social support (AA-type programs)

  15. AMPHETAMINES • Psychomotor stimulants • Affect central nervous system and cardiovascular system • Moderate use • Wakefulness, alertness, elevated mood • High dosage • Nervousness, dizziness, confusion, elevated blood pressure • Tolerance develops rapidly • Methamphetamines • Chemically similar but has greater impact on central nervous system

  16. HALLUCINOGENS • Also known as psychedelics • Central nervous system action produces alterations in consciousness • Natural hallucinogens • Mescaline • Psilocybin • Synthetic hallucinogens • STP • LSD • Abuse leads to respiratory or cardiovascular collapse and psychotic behavior • Treatment consists of support groups of enhancing social skills

  17. PHENCYCLIDINE (PCP) • Synthetic chemical • Causes disorientation and hallucination • User may feel dissociated • Users may develop severe depression or psychosis • Effects may be irreversible

  18. INHALENTS • Volatile substances or organic solvents (gasoline, spray paint) • Produce changes in perception • Use may lead to withdrawal from social, occupational, or recreational activities • More commonly used by young people • Use can lead to dependence with tolerance and withdrawal symptoms

  19. CANNABIS • Most often used in marijuana form • Hashish is the solidified resin of the cannabis plant • Major active ingredient in cannabis is THC • Marijuana use • Impairs motor coordination and perception • Affects short-term memory and learning • Treatment • Relapse prevention • Social support groups

  20. NICOTINE • Chemical found in tobacco • Stimulates acetylcholine receptors • Increases heart rate and blood pressure • Can be highly addictive • Cessation requires • commitment to change • implementation of change • relapse prevention • Nicotine gum and patch may be helpful if used with counseling.

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