Essentials of Understanding Abnormal Behavior Chapter Eight

1. Essentials of Understanding Abnormal BehaviorChapter Eight Substance-Related Disorders

2. Substance-Related Disorders • Result from the use of psychoactive substances that affect the central nervous system, cause significant social, occupational, psychological, or physical problems, and sometimes result in abuse or dependence. • User may become a danger to others. • Drug use may result in criminal activities. • Use of one substance may lead to use of other substances.

3. Figure 9.1: Percentage of Persons Who Reported Using Specific Substances at Any Time During Their Lives (Age 12 and Over)

4. Figure 9.2: Disorders Chart: Substance-Related Disorders

5. Figure 9.2: Disorders Chart: Substance-Related Disorders (cont’d)

6. Figure 9.2: Disorders Chart: Substance-Related Disorders (cont’d)

7. Substance-Related Disorders (cont’d) • DSM-IV-TR categories of substance-related disorders: • Substance-use disorders: Those involving dependence and abuse • Substance-induced disorders: Those involving withdrawal and substance-induced delirium • Substance-use disorders differentiated by: • Actual substance used • Whether disorder pattern is substance abuse or substance dependence

8. Substance-Related Disorders (cont’d) • Substance abuse: Maladaptive pattern of recurrent use that • Extends over a period of 12 months • Leads to notable impairment or distress • Continues despite social, occupational, psychological, physical or safety problems

9. Substance-Related Disorders (cont’d) • Substance dependence: Maladaptive pattern of use over 12-month period, characterized by: • Unsuccessful efforts to control use, despite knowledge of harmful effects • Takes more of substance than intended • Devotes considerable time to activities necessary to obtain the substance

10. Substance-Related Disorders (cont’d) • Tolerance: Increasing doses are necessary to achieve desired effect • Withdrawal: Distress/impairment in social, occupational, other areas of functioning or physical or emotional symptoms (e.g., shaking, irritability, inability to concentrate) after reducing or ceasing intake • Tolerance or withdrawal indicates physiological dependence.

11. Substance-Related Disorders (cont’d) • Intoxication: A substance affecting CNS is ingested and causes maladaptive behaviors or psychological changes • Progression to abuse/dependence: • Experimentation • Early regular use (actively seeking substance) • Plan daily activities around drug use • Drugs needed to avoid constant dysphoria; obvious physical and mental deterioration

12. Substance-Use Disorders • Substance abuse, dependence, intoxication, and withdrawal can result from such substances as: • Prescription drugs (e.g., Valium) • Legal substances (e.g., alcohol) • Illegal substances (e.g., cocaine)

13. Substance-Use Disorders (cont’d) • Alcohol and substance abuse: Second leading cause of disability in the U.S., Canada, and Western Europe • Prevalence: 8.2% of population over the age of 11 use illicit drugs (most prevalent among youths and young adults).

14. Substance-Use Disorders (cont’d) • Nine categories of illicit drug use: • Marijuana (including hashish) • Cocaine (including crack) • Heroin • Hallucinogens (including LSD, PCP, etc.) • Inhalants • Nonmedical use of prescription drugs: • Pain relievers • Tranquilizers • Stimulants • Sedatives

15. Table 9.1: Characteristics of Various Psychoactive Substances

16. Figure 9.3: Past-Month Illicit Drug Use Among Persons Aged 12 and Older, by Race/Ethnicity

17. Depressants or Sedatives • Cause generalized depression of the central nervous system and a slowing down of responses • Include, among other substances: • Alcohol • Narcotics • Barbiturates • Benzodiazepines

18. Alcohol-Use Disorders • Alcoholic: Person who abuses/ is dependent on alcohol • Alcoholism: Characterized by abuse of, or dependency on, alcohol, which is a depressant • Binge drinking: Person abstains for a while, but is unable to control/moderate intake when drinking resumes

19. Alcohol-Use Disorders (cont’d) • Pattern of problem drinking: • Finds taste unpleasant; swears never to drink again after first bout of drunkenness • Heavy drinking serves a purpose (e.g., reduces anxiety) • Consumption continues despite negative consequences • Preoccupation with alcohol consumption; deterioration of social and occupational functioning

20. Alcohol Use • Alcohol consumption around the world: • 11% of U.S. adults consume 1 oz or more of alcohol per day; 55% drink more than 3 drinks per week; 35% abstain • In the U.S, 50% of total alcohol consumed is drunk by only 10% of drinkers, especially ages 18-25 • Varies according to cultural traditions and gender (in U.S. men drink 2-5 times as much as women) • In the U.S., problems in social, medical, physical, and financial costs

21. Figure 9.4: Gender, Ethnic, and Age Differences in Self-Reports of Alcohol Use During a One-Month Period

22. The Effects of Alcohol • Short-term and long-term physiological and psychological effects: • Depresses CNS functioning • Depends on such factors as a person’s weight, amount of food in stomach, stress, etc. • Affects mood and behavior

23. The Effects of Alcohol (cont’d) • Long-term: Blackouts, tolerance, destruction of brain cells, cirrhosis of liver and other lethal diseases • Fetal Alcohol Syndrome (FAS): Alcohol consumption during pregnancy can result in mentally retarded, physically deformed children. No amount of alcohol has been proven safe for consumption during pregnancy.

24. Table 9.2: Blood Alcohol Level as a Function of Number of Drinks Consumed and Body Weight

25. Other Depressants or Sedatives • Narcotics (opiates): • Drugs such as opium and its derivatives (morphine, heroin, codeine) that depress the CNS • Provide relief from pain, anxiety, tension • Tolerance builds rapidly; extreme withdrawal symptoms • Prevalence: 0.7% of adult population at some time in their lives; prevalence decreases with age; greater for males than females

26. Other Depressants or Sedatives (cont’d) • Barbiturates (“downers”): Powerful depressant of CNS that are commonly used to induce relaxation and sleep • More lethal than heroin (accidental overdose or combined with alcohol) • Polysubstance dependence: Dependence on repeated use of at least 3 substances (excluding caffeine and nicotine) for a period of 12 months • Benzodiazepines (e.g., Valium)

27. “Club Drugs” • Used by 70% of attendees at dance clubs and raves attended by young people • Stimulants: Ecstasy/MDMA, LSD, GHB, ketamine, methamphetamine (responsible for largest number of emergency room visits) • Benzodiazepines: Rohypnol (“Roofies” or the “date-rape” drug) • Ecstasy can cause cardiovascular failure, higher heart rate and blood pressure, heart wall stress, and cognitive deficits.

28. Stimulants • Stimulant: Central nervous system energizer, inducing elation, grandiosity, hyperactivity, agitation, and appetite suppression • Amphetamines: Drugs that speed up CNS activity and produce increased alertness, energy, and sometimes feelings of euphoria and confidence (“uppers”) • Prevalence: 2% of U.S. adults at some time in their lives suffer amphetamine use/abuse; more male than female (3-4:1), more for low SES • Caffeine is also a stimulant.

29. Stimulants (cont’d) • Nicotine: Most commonly associated with cigarette smoking, which accounts for 1/6 of deaths in the U.S. and is the single most preventable cause of death. 1 in 3 smokers will die from a smoking-related disease. • Prevalence: ~30% Americans over the age of 11 currently use tobacco products • Symptoms of nicotine dependence: • Unsuccessful attempts to stop or reduce use • Attempts to stop lead to withdrawal symptoms • Continued use despite serious physical disorder (e.g., emphysema)

30. Stimulants (cont’d) • Cocaine: Substance extracted from coca plant that induces feelings of euphoria and self-confidence in users (followed by depression) • Chronic abuse: Neurophysiological changes in CNS and premature ventricular heartbeats and death • Crack: Purified, potent form of cocaine produced by heating cocaine with ether

31. Hallucinogens • Hallucinogen: Produces hallucinations, vivid sensory awareness, heightened alertness, or perceptions of increased insight • Marijuana: The mildest and most commonly used hallucinogen • In the US, marijuana is not generally used in a form that is potent enough to cause hallucinations. Hash hish oil, which is 50X more potent than the marijuana usually smoked in the US, does cause hallucinations. • Prevalence: 40% over the age of 12 have used at some point (most commonly: ages 18-30), more common for males • Lysergic Acid Diethylamide (LSD) • Phencyclidine (PCP)

32. Etiology of Substance-Use Disorders • Biological: Heredity and congenital factors • Two types of alcoholism • Familial: Family history of alcoholism, suggesting genetic predisposition • Non-familial: Suggesting environmental factors • Genes have been identified for certain traits in alcoholism. • Risk factors: Neurotransmitters, sensitivity or responsiveness to alcohol, CNS functioning

33. Etiology of Substance-Use Disorders (cont’d) • Psychodynamic: Childhood trauma, especially in oral stage, leads to repression of painful conflicts involving dependency needs • Alcohol allows repressed conflicts to be expressed and offers oral gratification to satisfy dependency needs.

34. Etiology of Substance-Use Disorders (cont’d) • Personality characteristics: • Associated with high activity level, emotionality, goal impersistence, sociability • Life transitions/maturational events • No evidence for “alcoholic personality,” although antisocial behavior and depression are sometimes associated with drinking problems

35. Etiology of Substance-Use Disorders (cont’d) • Sociocultural factors: • More males and young adults than females and older adults • More Catholics than Protestants and Jews • Rates of alcoholism is NOT related to per capita consumption, although France has high rates of both • Parents, peers, and cultural values • Two-way street regarding peers: Users seek out other users, and users influence their friends to use

36. Etiology of Substance-Use Disorders (cont’d) • Behavioral: • Anxiety reduction: Approach-avoidance conflict • Learned expectations • Cognitive influences: Tension-reducing model • Alcohol reduces tension and anxiety; relief of tension reinforces drinking behavior • Coping responses plus expectancy

37. Etiology of Substance-Use Disorders (cont’d) • Relapse: Resume drinking after voluntary abstinence • Negative emotional states, negative physical states, gender differences (women: interpersonal conflict), social pressure, coping responses • Abstinence violation effect: Loss of personal control after drinking begins • Biological: Physical dependence; avoid withdrawal symptoms

38. Figure 9.5: The Relapse Process

39. Theories of the Addiction Process • Solomon’s opponent process theory: Conditions that cause drug experimentation have not been identified. • Best predictor: Availability • Addiction: An acquired motivation (opponent process theory of acquired motivation) • Motivation changes with repeated consumption

40. Theories of the Addiction Process (cont’d) • Wise’s two-factor model: Positive and negative reinforcement • Tiffany’s theory of automatic processes: Drug-use behaviors are largely controlled by “automatic” processes, and once activated, drug-use behaviors are highly resistant to change.

41. Intervention and Treatment of Substance-Use Disorders • Two phases: • Removal of abusive substance • Long-term maintenance without the substance • Detoxification: Alcohol or drug treatment phase characterized by removal of the abusive substance, after which the user is immediately or eventually prevented from consuming the substance

42. Intervention and Treatment of Substance-Use Disorders (cont’d) • Self-help groups: Alcoholics Anonymous helps many alcoholics; Al-Anon and Alateen offer support to adults and teens living with alcoholics • Pharmacological: Use of chemical substances (e.g., Antabuse) to produce aversion to drug • Often combined with psychotherapy to develop coping skills and alternative life patterns

43. Cognitive and Behavioral Interventions and Treatment • Aversion therapy: Response to a stimulus is decreased by pairing the stimulus with an aversive stimulus • Covert sensitization: Imagine a noxious stimulus occurring in the presence of a behavior • Skills training: Learn to resist peer pressure or temptation; resolve emotional conflicts or problems; more effective communication • Reinforcing abstinence: Behavioral reinforcements for abstinence; effective for opioid dependence

44. Cognitive-Behavioral Interventions and Treatment (cont’d) • Behavioral treatment for cigarette smoking: • Aversive procedures have been disappointing, but “rapid smoking” has had positive outcomes. • Nicotine fading (gradual withdrawal) more effective • Scheduled-interval method more effective than “cold turkey” • Relapse prevention: Multicomponent programs effective for quitting smoking

45. Cognitive-Behavioral Interventions and Treatment (cont’d) • Relaxation and systematic desensitization • Motivational: Important and realistic goal setting • Stress management and cognitive restructuring; coping with negative emotions and stress • Response prevention • Controlled drinking: Controversial

46. Other Interventions and Treatments of Substance-Use Disorders • Multimodal treatment • Prevention programs • Discourage use before it begins • Education • Media exposure

47. Effectiveness of Treatment • Effective, but some studies suggest outcomes have been modest • Some individuals recover on their own without treatment • No single “best” treatment: Find the best combination of treatments for particular individuals with substance use disorders