Substance-Related Disorders

1. Substance-Related Disorders

2. Perspectives on Substance-Related Disorders • The Nature of Substance-Related Disorders • Problems related to the use and abuse of psychoactive substances • Produce wide-ranging physiological, psychological, and behavioral effects • Some Important Terms and Distinctions • Substance use vs. substance intoxication • Substance abuse vs. substance dependence • Tolerance vs. withdrawal

3. Perspectives on Substance-Related Disorders (cont.) • 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

4. Figure 10.1 • **Ice, LSD, chocolate, TV: Is everything addictive?

5. Figure 10.2 Easy to get hooked on, hard to get off

6. The Depressants: Alcohol Use Disorders • Psychological and Physiological Effects of Alcohol • Central Nervous system depressant • Influences several neurotransmitter systems, but mainly GABA • Effects of Chronic Alcohol Use • Alcohol intoxication • Alcohol withdrawal • Associated brain conditions – Demenita and Wernicke’s disease • Fetal alcohol syndrome • DSM-IV Criteria for Disordered Alcohol Use

7. Figure 10.3 The path traveled by alcohol throughout the body

8. 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 • Statistics on Abuse and Dependence • 10% of Americans experience problems with alcohol • Most persons with alcoholism can moderate or cease drinking • 20% of those with alcohol problems experience spontaneous recovery

9. Sedative, Hypnotic, or Anxiolytic Substance use Disorders: An Overview • The Nature of Drugs in This Class • Sedatives – Calming • Hypnotic – Sleep inducing (e.g., barbiturates) • Anxiolytic – Anxiety reducing (e.g., benzodiazepines) • Effects of Such Drugs Are Similar to Large Doses of Alcohol • Combining such drugs with alcohol is synergistic • All Exert Their Influence Via the GABA Neurotransmitter System • DSM-IV Criteria for Sedative, Hypnotic, or Anxiolytic Substance Use Disorders

10. 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

11. Stimulants: Amphetamine Use Disorders • Effects of Amphetamines • Produce elation, vigor, reduce fatigue • Such effects are followed by a “crash” (e.g., feeling depressed and tired) • Enhance the release of dopamine and norepinephrine, while blocking reuptake • DSM-IV Criteria for Amphetamine Intoxication • Psychological symptoms • Physiological symptoms • Ecstasy and Ice • Produces effects similar to speed, but without the crash • 2% of college students report using Ecstasy • Both drugs can result in dependence

12. Stimulants: Cocaine Use Disorders • DSM-IV Criteria for Cocaine Intoxication and Withdrawal • Psychological symptoms • Physiological symptoms • Most cocaine users cycle through patterns of tolerance and withdrawal • Effects of Cocaine • Produce short lived sensations of elation, vigor, reduce fatigue • Cocaine use in the United States has declined over the last decade • Effects result from blocking the reuptake of dopamine • Cocaine is highly addictive, but addiction develops slowly

13. Stimulants: Nicotine Use Disorders • Effects of Nicotine • Stimulates the central nervous system, specifically nicotinic acetylcholine receptors • Results in sensations of relaxation, wellness, pleasure • Nicotine is highly addictive • DSM-IV Criteria for Nicotine Withdrawal Only • Psychological symptoms • Physiological symptoms • Nicotine users dose themselves to maintain a steady state of nicotine

14. Figure 10.6 Relapse rates for nicotine compared to alcohol and heroin

15. Stimulants: Caffeine Use Disorders • Effects of Caffeine – The “Gentle” Stimulant • Used by over 90% of Americans • Found in tea, coffee, cola drinks, and cocoa products • Small doses elevate mood and reduce fatigue • Regular use can result in tolerance and dependence • Caffeine blocks the reuptake of the neurotransmitter adenosine • DSM-IV Criteria for Caffeine Intoxication • Psychological symptoms • Physiological symptoms

16. Opiods: An Overview • The Nature of Opiates and Opiods • Opiate – Natural chemical in the opium poppy with narcotic effects (i.e., pain relief) • Opiods – Refers to a class of natural and synthetic substances with narcotic effects • Such drugs are often referred to as analgesics • Examples include heroin, opium, codeine, and morphine • Effects of Opiods • Low doses induce euphoria, drowsiness, and slowed breathing • High doses can result in death • Withdrawal symptoms can be lasting and severe • Activate body’s enkephalins and endorphins • DSM-IV Criteria for Opiod Intoxication and Withdrawal • Psychological symptoms • Physiological symptoms • Mortality rates are high for opiod addicts

17. Hallucinogens: An Overview • Nature of Hallucinogens • Substances that change the way the user perceives the world • May produce delusions, paranoia, hallucinations, and altered sensory perception • Examples include marijuana, LSD • Marijuana • Active chemical is tetrahydrocannabinol (THC) • May produce several systems (e.g., mood swings, paranoia, hallucinations) • Impairment in motivation is not uncommon (i.e., amotivational syndrome) • Major signs of withdrawal and dependence do not typically occur

18. Hallucinogens: An Overview (cont.) • LSD and Other Hallucinogens • LSD is most common form of hallucinogenic drug • Tolerance tends to be rapid, and withdrawal symptoms are uncommon • Psychotic delusional and hallucinatory symptoms can be problematic • DSM-IV Criteria for Marijuana and Hallucinogen Intoxication • Psychological and physiological symptoms are similar

19. 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 • DSM-IV criteria for inhalant intoxication

20. 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 • Steroids can result in long-term mood disturbances and physical problems

21. 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

22. 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

23. 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 • Neurotransmitters responsible for anxiety/negative affect may be inhibited

24. Causes of Substance-Related Disorders: Psychological Dimensions • Role of Positive and Negative Reinforcement • Most see substance abuse as a means to cope with negative affect • The self-medication and the tension reduction hypotheses • Opponent-Process Theory • Explains why the crash after drug use fails to keep people from using • Role of Expectancy Effects • Expectancies influence drug use and relapse

25. Causes of Substance-Related Disorders: Social and Cultural Dimensions • Exposure to Drugs in a Prerequisite for Use of Drugs • Media, family, peers • Parents and the family appear critical • Societal Views About Drug Abuse • Sign of moral weakness – Drug abuse is a failure of self-control • Sign of a disease – Drug abuse is caused by some underlying process • The Role of Cultural Factors • Influence the manifestation of substance abuse

26. An Integrative Model of Substance-Related Disorders • Exposure or Access to a Drug Is a 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

27. Figure 10.7 An integrative model of substance related disorders

28. 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 • Aversive Treatment • Drugs that make the injection of abused substances extremely unpleasant • Examples include antabuse for alcoholism and silver nitrate for nicotine addiction • Efficacy of Biological Treatment • Such treatments are not generally not effective when used alone

29. Psychosocial Treatment of Substance-Related Disorders • 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 • Debate Over Controlled Use vs. Complete Abstinence as Treatment Goals

30. Psychosocial Treatment of Substance-Related Disorders • Components of 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 • Specific diagnoses include dependence, abuse, intoxication, or withdrawal • Most Psychotropic Drugs Activate the Dopaminergic Pleasure Pathway in the Brain • Psychosocial Factors Interact with Biological Influences to Produce Substance Disorders • Treatment of Substance Dependence Is Largely Unsuccessful • Highly motivated persons do best when part of combined treatment programs • Substance-Related Disorders Are 100% Preventable

32. Summary of Substance-Related Disorders (cont.) Figure 11.x1 (cont.) Exploring substance-related disorders

33. Summary of Substance-Related Disorders (cont.) Figure 11.x2 Exploring substance-related disorders, treatment

34. Summary of Substance-Related Disorders (cont.) Figure 11.x2 (cont.) Exploring substance-related disorders, treatment

35. Web sites • National Clearinghouse for Alcohol and Drug Information • www.health.org • National Institute on Drug Abuse • www.nida.nih.gov • Inhalants • www.inhalants.org • Substance Abuse and Mental Health Services Administration • www.samhsa.gov

36. Impulse-Control Disorders • DSM-IV-TR • Intermittent explosive disorder • Kleptomania • Pyromania • Pathological gambling • Trichotillomania

37. Impulse-Control Disorders (continued) • Each is Characterized by • Increased tension/anxiety prior to the act • A sense of relief following the act • Impairment of social and occupational functioning

38. Impulse-control Disorders: Intermittent Explosive Disorder • Intermittent Explosive Disorder • Rare condition • Characterized by frequent aggressive outbursts • Leads to injury and/or destruction of property • Few controlled treatment studies

39. Impulse-control Disorders: Kleptomania • Kleptomania • Failure to resist urge to steal unnecessary items • Seems rare, but it is not well studied • Highly comorbid with mood disorders • Also co-occurs with substance-related problems

40. Impulse-control Disorders: Pyromania, Pathological Gambling • Pyromania • Involves having an irresistible urge to set fires • Diagnosed in less than 4% of arsonists • Little etiological and treatment research • Pathological Gambling • Affect 3-5% adult Americans • Treatment is similar to that for substance dependence

41. Trichotillomania (continued) • Trichotillomania • Inability to resist the urge to pull hair • Observed in 1-5% of college students, mostly female • Clomipramine (Anafranil) and CBT have been shown to be helpful