1 / 39

From Last Class

Substance Use Disorders IV (Chapter 11) April 9 , 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D. From Last Class. Disease model of alcoholism Twelve step treatment. Twelve Steps of Alcoholics Anonymous. Twelve Step treatment critical analysis:

karli
Download Presentation

From Last Class

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Substance Use Disorders IV(Chapter 11)April 9, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

  2. From Last Class • Disease model of alcoholism • Twelve step treatment

  3. Twelve Steps of Alcoholics Anonymous • Twelve Step treatment critical analysis: • http://www.youtube.com/watch?v=8tPNgHrIkgo • http://www.youtube.com/watch?v=5uwx2P5LJgk&feature=related • http://www.youtube.com/watch?v=7PjpOsE3xoY

  4. Exam Review • Chapter 7 (Mood Disorders) • Major depressive and manic episodes • Nature, causes, and treatment of: • Major depressive disorder • Bipolar disorder • Suicide • 15 questions from this section

  5. Exam Review • Chapter 8 (Eating Disorders) • No questions on Sleep Disorders • Anorexia • Bulimia • Causes • Treatment • 9 questions form this section

  6. Exam Review • Chapter 11 (Substance-Related Disorders) • No questions on Impulse Control Disorders • Substance abuse and dependence • Alcohol: effects, cultural patterns, disease model • Addictive properties of different substances • Properties and effects of different substances • Treatments • 16 questions from this section

  7. Addictive Properties of Common Drugs

  8. Drug Addictiveness • Which of the following drugs is most addictive? • 1. Nicotine • 2. Heroin • 3. Cocaine • 4. Alcohol • 5. Caffeine • 6. Marijuana

  9. Addictive Properties of Common Drugs

  10. Brief Review of Different Substances • Sedative, Hypnotics, & Anxiolytics • Stimulants • Opioids • Hallucinogens • Other Drugs of Abuse

  11. Sedative, Hypnotic, or AnxiolyticSubstance use Disorders • Drugs in this class • Sedatives – calming (e.g., barbiturates) • Hypnotic – sleep inducing • Anxiolytic – anxiety reducing (e.g., benzodiazepines)

  12. Sedative, Hypnotic, or AnxiolyticSubstance use Disorders • Effects similar to large doses of alcohol • Synergistic effect when combined with alcohol • Adverse effects • Dependence, tolerance, withdrawal, overdose

  13. Stimulants • Nature of stimulants • Most widely consumed class of drug in the US • Drugs increase alertness and increase energy • Examples include amphetamines, cocaine, nicotine, and caffeine

  14. Stimulants: Amphetamines • Used for all-nighters, weight control, and high • Effects: • Elation, vigor, reduce fatigue • Followed by extreme fatigue and depression • Prescription stimulants (for ADHD) increasing becoming drugs of abuse • The NY Times: When Stimulants Are Bad https://www.madinamerica.com/2012/06/the-ny-times-when-stimulants-are-bad/

  15. Stimulants: Nicotine • Approximately 25% of Americans smoke • Effects: • Stress relief, relaxation, wellness, pleasure • Withdrawal: depression, insomnia, irritability, anxiety, increased appetite • Highly addictive and extremely difficult to quit • Cues that elicit urges to smoke are ubiquitous • Users dose themselves frequently

  16. Stimulants: Caffeine • Used regularly by 90% of Americans • Effects of the “gentle” stimulant • Found in tea, coffee, cola drinks, and cocoa products • Small doses elevate mood and reduce fatigue • Regular use can result in tolerance and dependence

  17. Opioids: An Overview • Opiate – narcotic-like chemical in opium poppy • Examples: heroin, opium, codeine, and morphine • Effects: • Pain relief, euphoria, drowsiness, slowed breathing • High doses can be fatal • Withdrawal symptoms can be lasting and severe • Elevates risk for HIV • High mortality rates for addicts

  18. Hallucinogens: An Overview • Substances that alter perceptions of the world • Examples: Marijuana, LSD • Effects: • Delusions, paranoia, hallucinations, and/or altered sensory perception

  19. Hallucinogens: Marijuana • Active chemical is tetrahydrocannabinol (THC) • Effects: • Heightened sensory experiences, mood swings, paranoia, hallucinations • Varies greatly from person to person • Minimal tolerance, withdrawal, dependence • Medicinal uses and controversies

  20. Hallucinogens: LSD • Derivative of ergot fungus • Effects: • Perceptual changes, depersonalization, hallucinations • Very rapid tolerance • Withdrawal symptoms are rare • Can produce psychotic reactions • Interesting historical note: LSD and the Salem Witch Trials of 1692

  21. Other Drugs of Abuse: Steroids “My lawyers have advised me that I cannot answer these questions without jeopardizing my friends, my family and myself.”-Mark McGwire

  22. Other Drugs of Abuse: Steroids "I did take a banned substance. And for that, I am very sorry and deeply regretful.“ -Alex Rodriguez

  23. Other Drugs of Abuse: Steroids • Synthesized from testosterone • Legitimate medical uses: asthma, anemia, breast cancer, men with inadequate sexual development • Used illegally to increase body mass • Do not produce a high • Long-term mood disturbances and physical problems

  24. Causes of Substance-Related Disorders • Exposure/access to drug is necessary, but not sufficient, for abuse and addiction • Use depends on social and cultural expectations • Drugs are used because of pleasurable and/or reinforcing effects • Reasons for drug abuse are complex

  25. Biological Influences • Drugs affect the pleasure or reward centers in the brain • Biological changes occur with repeated drug use • Unlike substance use, substance abuse and dependence has a genetic component

  26. Psychological Influences • Positive and negative reinforcement • Pleasurable effects • Self-medication (cope with negative affect) • Expectancy effects • Expectancies influence drug use and relapse

  27. Social and Cultural Influences • Exposure to drugs is a prerequisite for use • Media, family, peers • Parents and the family appear critical • Cultural factors • Influence the manifestation of substance use and abuse

  28. Social and Cultural Influences • The importance of context • 42% of Vietnam war soldiers used heroin • Half became dependent in Vietnam • Three years after returning home, only 12% were still using heroin

  29. Social and Cultural Influences • Societal views about drug abuse • Moral weakness • Biological disease model (Twelve Steps) • “War on drugs”

  30. American Culture and Drug Use • Assumptions of America’s “War on Drugs” • 1. Illicit drug use is bad. How bad? Criminal Offense Average Prison Sentence Murder/manslaughter 153 months Drugs 78 months Rape 67 months Burglary 51 months Aggravated Assault 50 months Source: U.S. Bureau of Justice Statistics

  31. War on Drugs • 2. Illicit drug use is unhealthy, uncontrollable, and addictive • 3. Prevention and treatment programs work • Project DARE • Lynam et al. (1999) • 10-year follow-up of 1,000+ 10-year olds • Received either DARE or standard drug ed • Long-term outcomes

  32. American Cultural and Drug Use • 4. People are unable to choose whether or not to take drugs or to regulate their use • Thus, prohibition is necessary • 5. There is an end to the drug war • When is it over exactly?

  33. Biological Treatments • Agonist substitution • Substitute safer drug with similar chemical composition • Examples – methadone, nicotine gum/ patch • Antagonistic treatment • Blocks or counteracts pleasurable drug effects • Examples - naltrexone for opiate and alcohol problems

  34. Biological Treatments • Aversive treatment • Makes drug use extremely unpleasant • Examples - Antabuse for alcoholism • Efficacy of biological treatment • Largely ineffective when used alone

  35. Psychosocial Treatment • Inpatient vs. outpatient care • Comparable efficacy, not cost • Controlled use (Sobell study) • Project MATCH • Compared 12 sessions of twelve step facilitation and CBT, and 4 sessions of motivational enhancement • No differences in outcome • No control group

  36. Psychosocial Treatment • Community support programs • Alcoholics Anonymous and related groups • Extremely popular but little evidence of benefits • From a 2006 literature review: “No experimental studies unequivocally demonstrated the effectiveness of Alcoholics Anonymous or 12-Step approaches for reducing alcohol dependence or problems.”

  37. Interventions • Confrontation by family and friends • Element of surprise, often humiliating • Intended to break down “denial” and persuade client to enter treatment • Confronts individuals with “cataclysmic consequences” if they do not enter treatment

  38. Interventions • Miller and Sovereign (1989) • Two groups: 1) confrontational strategies 2) client-centered motivational interviewing • Clients in confrontational group exhibited MORE resistance to treatment than in client-centered group and were more likely to be drinking a year later • G. Alan Marlatt, Ph.D: “Once you have the person on board and involved and you have a good continued care program, things will happen in a good way. But if you say, ‘Do this or else,’ you take away a person’s choice and the consequences are negative.”

  39. Analysis of Intervention Programs • Not empirically supported • Studies show high rate of entry into treatment following an Intervention, but: • High rate of dropout • Higher relapse following treatment (Loneck, Garrett, & Banks 1996)

More Related