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Drugs and Substance Abuse

Drugs and Substance Abuse. on the DSM. Drug and Substance Abuse on the DSM. Diagnosis: Substance-induced disorder (effect) Substance-related disorder (cause) ... dependence and abuse. Drug and Substance Abuse on the DSM. Why drugs?

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Drugs and Substance Abuse

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  1. Drugs and Substance Abuse on the DSM

  2. Drug and Substance Abuseon the DSM Diagnosis: • Substance-induced disorder (effect) • Substance-relateddisorder (cause) ... dependence and abuse

  3. Drug and Substance Abuseon the DSM Why drugs? “Life as we find it, is too hard for us; it brings too many pains, disappointments and impossible tasks. In order to bear it, we cannot dispense with palliative measures: powerful deflection, which causes to make light our misery; substantive satisfaction, which diminish it; and Intoxication, which makes us insensitive to it.” - Freud

  4. Drug and Substance Abuseon the DSM Stress: Task-oriented, problem solving vs. Defense oriented, emotion-focused response

  5. Drug and Substance Abuseon the DSM • Powerful deflection,which causes to make light our misery; • Substantive satisfaction,which diminish it; • Intoxication,which makes us insensitive to it

  6. Drug and Substance Abuseon the DSM Forms of intoxication: 1. Sedation: alcohol, barbituates, benzodiazepines... 2. Stimulation: caffeine, nicotine, amphetamine... 3. Fantasy: psychedelics, hallucinogenics, cannabis... 4. Narcotics: opium, morphine, heroin...

  7. Drug and Substance Abuseon the DSM Alcohol: BR: 6  8  10%+ LTR: 12  18  20%+ Genetics: concordance and adoption studies (“modelling is a factor”)

  8. Drug and Substance Abuseon the DSM Alcohol, biologically: • Increase in some neural activity (e.g. monoamine and endorphin) • Decrease in other neural activity (e.g. GABA and glutamate)

  9. Drug and Substance Abuseon the DSM Alcohol, psychologically: • Elevation of positive emotionality • Reduction of negative emotionality

  10. Drug and Substance Abuseon the DSM The conditioning perspective: “Alcohol is consumed because it is reinforcing...” • Positive reinforcement • Negative reinforcement

  11. Drug and Substance Abuseon the DSM “Types” of alcoholism: • Type I - binge type • Type II – persistent type

  12. Drug and Substance Abuseon the DSM Treatment: • Recovery and relapse rates • AA and relapse prevention • “apparently irrelevant decisions” • “abstinence violation effect” • controlled drinking

  13. Drug and Substance Abuseon the DSM Comorbidity: • Drug as primary (“primary alcoholism”) • Drug as secondary (“dual diagnosis”)

  14. Drug and Substance Abuseon the DSM Related organic disorder: • Alcohol amnestic disorder • “Wernicke-Korsakoff Syndrome” • Vitamin B1 (thiamin) • Alcohol withdrawal delirium • “Delirium tremens” • Fetal alcohol syndrome • “Fetal alcohol spectrum disorder” • BR and other issues

  15. Sex on the DSM IV

  16. Sexand the DSM IV • Sexual dysfunctions: • desire • arousal • orgasm • pain • Variants and deviations: • paraphilias, • gender identity disorders (and sexual orientation)

  17. Sexand the DSM IV History: • Reverend Sylvester Graham and Dr. John Harvey Kellogg • Kinsey, Masters & Johnson, Money and NORC • The old “Barbie Doll” approach and the newer evolutionary one: mental and physical aspects

  18. Sexand the DSM IV Understanding our sexuality: Back to basics : Why sex? • What is different about sexual motivation, in evolutionary history? • The adaptive functions of sex: reproduction and beyond

  19. Sexand the DSM IV Understanding our sexuality: The design of sexual systems: • “Releasers” (cues and rituals) • “Boundary conditions” (internal and external)

  20. Sexand the DSM IV Understanding our sexuality: The process: a. partner location elicit desire b. pretactile sexual interaction  maintain arousal c. tactile sexual interaction  “acception” d. intercourse  “conception” The problem: The invocation and maintenance of motivation (“proception”)

  21. Sexand the DSM IV : Sexual Dysfunction I. Sexual Dysfunction Base rates: Men: 31% Women 43%

  22. Sexand the DSM IV : Sexual Dysfunction • Desire: hypoactive sexual desire and sexual aversion (diagnosis) Dx issues: • “dysfunction” vs. problem • medical factors

  23. Sexand the DSM IV : Sexual Dysfunction • Arousal: SADF and SADM (diagnosis) Dx issues: • “erectile insufficiency” for men • vaginal lubrication for women • the relevance of negative emotional states (anxiety) • the relevance of the autonomic nervous system. (PNS/SNS)

  24. Sexand the DSM IV : Sexual Dysfunction • Orgasmic: orgasmic dysfunction and “premature ejaculation” (diagnosis) Dx issues: • the ejaculation for men • the “satisfaction” for women

  25. Sexand the DSM IV : Sexual Dysfunction “Premature ejaculation” (diagnosis) Dx issues: comparative and personal criteria

  26. Sexand the DSM IV : Sexual Dysfunction • Pain: dyspareunia and vaginismus (diagnosis) Also: “Sexual dysfunction NOS”

  27. Sexand the DSM IV : Sexual Dysfunction Sexual Dysfunction Summary: the problematic nature of the human sexual response and its ramifications in society

  28. Sexand the DSM IV : Sexual Dysfunction Theories: Masters & Johnson, and beyond Tx issues: • success and spontaneous remission • relationships and individualized assessment

  29. Sexand the DSM IV II. Variants and Deviations A. Paraphilias and their relation to “sexual” offenses B. Gender identity and its disorders C. Sexual orientation and the controversy over diagnosis The concept of the “lovemap”

  30. Sexand the DSM IV : Variants and Deviations A. Paraphilia: Definition: “. . . reiteratively responsive to and dependent on atypical or forbidden stimulus imagery, in fantasy or practice, for the initiation and maintenance of erotosexual arousal and achievement or facilitation of orgasm.” Note: paraphilias and phobias, as opposed to “fetishes” and “irrational fears”

  31. Sexand the DSM IV : Paraphilias Examples: • voyeurism • exhibitionism • fetishes • fetishistic transvestism • pedophilia • zoophilia • frotterism • sexual sadism and masochism • and others . . .

  32. Sexand the DSM IV : Paraphilias Theories:(and what is wrong with them) • Psychodynamic Theory management of impulses • Learning Theory A. Classical conditioning: stimulus associations problems: extinction and real life? B. Operant conditioning: reinforcements problems: extinction and real life? • Cognition: • “arousal transference/misattribution” • problems: self-correction and real life?

  33. Sexand the DSM IV : Paraphilias What is wrong with learning theories for paraphilias? e.g. • retrospective observations of paraphilias • prospective observations of the rest of us Asking the right question: “the vandalized lovemap”

  34. Sexand the DSM IV : Paraphilias • The limitations of behavior therapies • Modern approaches to treatment • Notes: preadaptation and multiplicity • Factors that “scramble lovemaps” • Summary and review • Antiandrogens and the problem of relapse

  35. Sexand the DSM IV Beyond the paraphilias: sexual offences in society 1. Rape: • reported rape ... and all the rest • convicted cases ... and all the rest • power, anger, pain ... and “narcissistic reactance” • the social problem, here, today

  36. Sexand the DSM IV : Beyond the paraphilias 2. Child molestation and incest: • Reported rates • Why child molestation? • convicted cases and the context • the case of incest • Notes: • issue of child testimony and “recovered memories” • how harmful is childhood sexual abuse?

  37. Sexand the DSM IV : Beyond the paraphilias 3. Sexual sadism and masochism: • “sex is seldom just about sex” • modern diagnostic practice

  38. Sexand the DSM IV :Variants and Deviations B. Gender Identity Disorder (GID) Your sex and your gender Development of the “gendermap”: “the relay race” 1. genes 2. prenatal hormones 3. physical aggression 4. learning

  39. Sexand the DSM IV : Gender Identity • Unusual results: “intersexual syndromes” A. Androgenital syndrome (XX) B. Androgen insensitivity syndrome (XY) • Prenatal hormonal variations and “biasing the brain” • Cross-species comparisions • Culture and the “transgendered” population

  40. Sexand the DSM IV : Gender Identity Disorders Child GID Diagnosis: discordance, distress and the desire to change Prognosis: e.g. “the sissy boy syndrome”

  41. Sexand the DSM IV : Gender Identity Disorders Adult GID Diagnosis:discordance, distress and the desire for change A. Women • FMT, masculinity and gynephilia • “Gender atypicality” among women B. Men • MFT, femininity and androphilia • i.e “Classic / Homosexual TS” • “Gender atypicality” among men • Note: MTF and and “autogynephilia” • i.e “non-classic / Heterosexual TS”

  42. Sexand the DSM IV : Gender Identity Disorders Therapy:... three possibilities 1. Body  mind ... the transsexual solution ... and the debate 2. Mind  body ... modifying gender identity ... and the debate 3. The alternative ... reduce the distress ... and the debate

  43. Sexand the DSM IV : Sexual Orientation C. Sexual Orientation and the DSM What is “sexual orientation”? “Erotosexual attractions only to someone who has the same external body morphology as your own” - John Money

  44. Sexand the DSM IV : Sexual Orientation Sexual Behavior, desire and romantic attraction • e.g. the Sambians and the rest of us • cross-cultural comparisons • cross-species considerations

  45. Sexand the DSM IV : Sexual Orientation The surveys: Kinsey and beyond • same-sex sexual behavior? 37%, 13%  20%? • same-sex sexual desire? 50%, 28%  about 40%? • same-sex romantic attraction? males: 3 - 4% females: 1 – 2 %

  46. Sexand the DSM IV : Sexual Orientation The modern results: e.g. NORC • behavior? 9%, 4%  maybe 10%? (not 20%) • desire? 8%, 8%  maybe 10%? (not 40%) • attraction? males: 2.8% females: 1.4 %

  47. Sexand the DSM IV : Sexual Orientation Development of Sexual Orientation: • Psychodynamic Theory ... and its problems • Learning Theory ... and its problems • Biology (e.g. prenatal androgenization) ... and its problems

  48. Sexand the DSM IV : Sexual Orientation What is wrong with sexual orientation? • Theoretical criterion (disease, defect) and DSM I • Social criterion (difference, deviance) and DSM II • Personal criterion (distress, dysphoria) and DSM III • Maladaptation (dysfunction, disorder) and DSM IV

  49. Sexand the DSM IV : Sexual Orientation The Diagnosis: “Sexual disorder NOS” • discordance, • distress • and the desire for change

  50. Sexand the DSM IV : Sexual Orientation Therapy: three possibilities • Sex life  sexual orientation • “Conversion” and “reparative” therapy • The alternative ... reducing the distress ... and the debate

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