Chapter 12 Substance-Related Disorders

1. Chapter 12 Substance-Related Disorders Ch 12

2. Perspectives on Substance-RelatedDisorders: An Overview • Five Main Categories of Substances • Depressants – Result in behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs) • Stimulants – Increase alertness and elevate mood (e.g., cocaine, nicotine, caffeine) • Opiates – Primarily produce analgesia and euphoria (e.g., heroin, morphine, codeine) • Hallucinogens – Alter sensory perception (e.g., marijuana, LSD) • Other drugs of abuse – Include inhalants, anabolic steroids, medications

3. Definitions of Substance-Related Disorders • Substance dependence is characterized by • Tolerance to drug action occurs (greater doses, diminished drug action) • Withdrawal symptoms occur with drug cessation • Person recognizes excessive use of the drug • Much of the person’s time is spent getting the drug or recovering from its effects • Substance use continues despite physical or psychological problems caused by the drug Ch 12.1

4. Definitions of Substance-Related Disorders • Substance abuse is characterized by • Failure to fulfill major obligations (e.g. work or child care) • Exposure to physical dangers (e.g. driving while intoxicated) • Legal problems brought on by drug use • Persistent social or interpersonal problems (e.g. arguments with spouse) Ch 12.2

5. Perspectives on Substance-RelatedDisorders: An Overview Figure 11.1 Barlow/Durand, 3rd Edition Ice, LSD, chocolate, TV: Is everything addictive?

6. Perspectives on Substance-RelatedDisorders: An Overview (cont.) Figure 11.1 (cont.)

7. Perspectives on Substance-RelatedDisorders: An Overview (cont.) Figure 11.2 Barlow/Durand, 3rd. Edition Easy to get hooked on, hard to get off

8. Perspectives on Substance-RelatedDisorders: An Overview (cont.) Figure 11.2 (cont.) Easy to get hooked on, hard to get off

9. Alcohol: Some Facts and Statistics • In the United States • Most adults consider themselves light drinkers or abstainers • Most alcohol is consumed by 11% of the U.S. population • Alcohol use is highest among Caucasian Americans • Males use and abuse alcohol more so than females • Violence is associated with alcohol, but alcohol alone does not cause aggression

10. Alcohol: Some Facts and Statistics (cont.) • Facts and Statistics on Problem Drinking • 10% of Americans experience problems with alcohol • Most persons with alcoholism can moderate or cease drinking on occasion • 20% of those with alcohol problems experience spontaneous recovery • Anhedonia – Lack of pleasure, or indifference to pleasurable activities • Affective flattening – Show little expressed emotion, but may still feel emotion

11. Alcohol Abuse and Dependence • Alcohol dependence can include tolerance and withdrawal reactions • Abrupt cessation can lead to anxiety, depression, weakness, and an inability to sleep • Delirium tremens (DTs) is a severe alcohol withdrawal reaction that includes hallucinations • Alcohol tolerance is common in alcoholism • Alcohol abuse can be part of polydrug abuse (80-85% of alcohol abusers smoke) Ch 12.3

12. Short-term Actions of Alcohol • Alcohol is absorbed from the stomach into the blood • Alcohol is metabolized by the liver (1 oz/hr) • Alcohol is a drug, a CNS depressant • Alcohol acts within brain to • Stimulate GABA receptors (reduces tension) • Increases dopamine/serotonin levels (pleasurable aspects of intoxication) • Inhibits glutamate receptors (cognitive actions) Ch 12.4

13. Long-term Actions of Alcohol • Alcoholics reduce their food intake when consuming alcohol • Alcohol has no nutrient value • Alcohol impairs food digestion • Result is vitamin deficiency (B-complex) • Can lead to brain damage and amnesia • Alcohol kills brain cells, leading to loss of gray matter from the temporal lobes • Alcohol suppresses the immune system • Fetal alcohol syndrome risk in offspring Ch 12.5

14. Nicotine and Tobacco Smoking • Smoking tobacco results in absorption of nicotine into the blood • Nicotine reaches brain receptors that control dopamine release • Dopamine action of nicotine mediate its addictive properties • Cigarette smoking is responsible for 1 of every 6 deaths in the US • Smoking is THE SINGLE MOST PREVENTABLE cause of early death Ch 12.6

15. Prevalence of Smoking • Rates of smoking among American adults have dropped since 1965, but 57 million smoke. • Smoking rates higher in Asia and South America • Rates for white adolescents have been increasing since 1992. • Rates of smoking are higher for Hispanic and white adolescents than for African American teens. • Rates for African American teens have been increasing since 1992. • Lowest prevalence rates for college graduates and people over 75. • Highest prevalence rates for blue-collar workers, Native Americans, and individuals with less education. • Prevalence has declined more for men than for women.

16. Race, Ethnicity, & Smoking • African Americans • Retain nicotine in their blood longer than whites. • Because of a greater preference for mentholated cigarettes than whites, African Americans may take more puffs & inhale more deeply • May explain lower rates of quitting and increased likelihood of developing lung cancer. • Chinese Americans metabolize less nicotine than whites or Hispanics • May explain lower rates of lung cancer among Asians

17. Marijuana • Marijuana consists of the dried and crushed leaves of the hemp plant Cannabissativa • Smoking marijuana results in • Relaxation • Shifts in attention • Impaired memory • Marijuana effects depend on dose and potency Ch 12.7

18. Adverse Actions of Marijuana • Marijuana • Interferes with cognitive function including loss of short-term memory • Interferes with the operation of complex equipment (e.g. an automobile) • Contributes to psychological problems in adulthood • Elevates heart rate • Impairs lung structure and function • Can produce reverse tolerance Ch 12.8

19. Therapeutic Actions of Marijuana • Marijuana • Reduces the nausea and loss of appetite associated with chemotherapy • Can reduce pain signaling (via THC) • Can be used to treat the discomfort of AIDS • Can reduce the pressure increases in the eye associated with glaucoma Ch 12.9

20. Sedatives • Sedatives slow the activities of the body and reduce its responsiveness • Opiates relieve pain and induce sleep • Include opium, morphine, heroin • Opiates are physiologically addictive • Barbiturates induce relaxation and sleep • Act by stimulating GABA receptors • Can result in tolerance and severe withdrawal reactions Ch 12.10

21. Stimulants • Stimulants act on the brain to increase alertness and motor activity • Amphetamines release norepinephrine and dopamine in brain to produce alertness and to reduce appetite • Tolerance quickly develops to amphetamine use • Ephedrine is a variant of amphetamine that induces alertness and reduces appetite (found in herbal weight loss preparations) • Cocaine blocks the reuptake of dopamine to produce alertness and produce euphoria • Ecstasy and Ice produce effects similar to speed, but without the crash; 2% of college students report using Ecstasy; Both drugs can result in dependence Ch 12.11

22. Hallucinogens • Hallucinogenic drugs alter sensory perception and create sensory experiences • Hallucinogenic drugs include • LSD, mescaline, ecstasy and phencyclidine • General effects of LSD include • Synesthesia: blending of sensory information • Subjective time is altered (slowed) • Rapid shifts in mood • Effects depend on set and setting Ch 12.12

23. Other Drugs of Abuse: Inhalants • Nature of Inhalants • Substances found in volatile solvents that are breathed into the lungs directly • Examples include spray paint, hair spray, paint thinner, gasoline, nitrous oxide • Such drugs are rapidly absorbed with effects similar to alcohol intoxication • Tolerance and prolonged symptoms of withdrawal are common

24. 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 • Such drugs heighten auditory and visual perception, sense of taste/touch • Becoming popular in nightclubs, raves, or large social gatherings • All designer drugs can produce tolerance and dependence

25. Development of Substance Abuse Ch 12.13

26. Fig 12.3

27. Etiology of Substance Use • Biological / Genetic factors (alcoholism is heritable, twin & adoptee studies) • Sociocultural variables include family, friends, media (television, billboards) • Psychological variables include • Mood alteration (enhance positive, reduce negative moods) • Beliefs/expectancies about prevalence and risks (harmful actions of drug) • Personality variables include • High levels of negative affect • Enduring desire for arousal, increased positive affect Ch 12.14

28. An Integrative Model of Substance-Related Disorders • Exposure or Access to a Drug Is Necessary, but not Sufficient • 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

29. Biological Treatment of Substance-Related Disorders • Agonist Substitution • Safe drug with a similar chemical composition as the abused drug • Examples include methadone for heroin addiction, and nicotine gum or patch • Antagonistic Treatment • Drugs that block or counteract the positive effects of substances • Examples include naltrexone for opiate and alcohol problems

30. Biological Treatment ofSubstance-Related Disorders (cont.) • Aversive Treatment • Drugs that make the ingestion of abused substances extremely unpleasant • Examples include antabuse for alcoholism and silver nitrate for nicotine addiction • Efficacy of Biological Treatment • Such treatments are generally not effective when used alone

31. Psychosocial Treatment of Substance-Related Disorders • Debate Over Controlled Use vs. Complete Abstinence as Treatment Goals • Inpatient vs. Outpatient Care • Data suggest little difference in terms of overall effectiveness • Community Support Programs • Alcoholics Anonymous and related groups • Seem helpful and are strongly encouraged

32. Psychosocial Treatment ofSubstance-Related Disorders (cont.) • Components of Comprehensive Treatment and Prevention Programs • Individual and group therapy • Aversion therapy and covert sensitization • Contingency management • Community reinforcement • Relapse prevention • Preventative efforts via education • NIAA“Project Match” comparative study

33. Fig 12a

34. Therapy for Cigarette Smoking • The long-term efficacy of psychological treatments for smoking are not good • Making smoking unpleasant • Scheduled smoking involves gradual reduction of number of cigarettes smoked and controls when smoking will happen • Advice from a physician • Biological treatments for smoking involve substitution of nicotine for smoking • Use of a nicotine patch or gum Ch 12.16