Substance Use Disorders III April 6, 2011 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.

1. Substance Use Disorders IIIApril 6, 2011PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

2. From Last Class • Disease model • Alcoholics Anonymous/Twelve Steps • Note: Exam #3 is Friday 4/8

3. In the News • Actress Ashley Judd on the Today Show http://today.msnbc.msn.com/id/26184891/vp/42431047#42431047 • Sought treatment at Shades of Hope in Texas for depression • Twelve Step Model used for all disorders • Covert sexual abuse in childhood • Repressed memories of childhood sexual abuse

4. Motivational Interviewing • Chapter 7 (Mood Disorders) • Major depressive and manic episodes • Nature, causes, and treatment of: • Major depressive disorder • Bipolar disorder • Suicide

5. Exam Review • Chapter 8 (Eating Disorders) • pp. 256-282 only (not Sleep Disorders section) • Anorexia • Bulimia • Causes • Treatment

6. Exam Review • Chapter 11 (Substance-Related Disorders) • Not pp. 413-414 (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

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. Fetal Alcohol Syndrome • CDC estimates rate of 2.7/1000 live births • Fetal growth retardation, cognitive deficits, behavior problems, learning difficulties • Occurs in 2%-10% of children of alcohol abusers • More common in African Americans and Native Americans than Caucasians

12. Fetal Alcohol Syndrome • Effects of low-moderate maternal alcohol consumption (< 1 drink per day average) on the fetus • Henderson et al. (2007) http://www3.interscience.wiley.com/cgi-bin/fulltext/118523339/PDFSTART • Combined results from 46 studies • Examined effects on miscarriage, stillbirth, intrauterine growth restriction, prematurity, birthweight, small for gestational age at birth and birth defects including fetal alcohol syndrome • Findings: “This systematic review found no convincing evidence of adverse effects of prenatal alcohol exposure at low–moderate levels of exposure. At low–moderate levels of consumption, there were no consistently significant effects of alcohol on any of the outcomes considered.”

13. Fetal Alcohol Syndrome • Plenty of evidence that repeated abusive heavy drinking is associated with FAS and related problems • FAS usually occurs with chronically alcoholic mother who binged during pregnancy • Third variable problem – smoking, malnutrition, poor health care

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

15. 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

16. 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

17. Stimulants: Amphetamines • Used for all-nighters, weight control, and high • Effects: • Elation, vigor, reduce fatigue • Followed by extreme fatigue and depression • Ecstasy and Ice • Produces effects similar to speed, but no “comedown” • Used by 2% of college students • Very high risk of dependence

18. 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

19. 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

20. 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

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

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

23. Hallucinogens: LSD • Derivative of ergot fungus • Effects: • Perceptual changes, depersonalization, hallucinations • Very rapid tolerance • Withdrawal symptoms are rare • Can produce psychotic reactions

24. 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

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

26. 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

27. 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

28. 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

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

30. 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

31. 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

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

33. 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

34. 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

35. 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?

36. 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

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

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

39. 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.”

40. 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 • Why isn’t this approach used with depression, anxiety, etc.?

41. 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.”

42. 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)