490 likes | 629 Views
Substance-Related and Impulse Control Disorders. Levels of Involvement – Substance Disorders Terminology. Rate of use illegal substances: 8% Specific drugs have specific effects, but terminology applies to all. Psychoactive substances: alter mood or behavior
E N D
Levels of Involvement – Substance Disorders Terminology • Rate of use illegal substances: 8% • Specific drugs have specific effects, but terminology applies to all
Psychoactive substances: alter mood or behavior • Substance use: moderate ingestion of psychoactive substances, does not interfere with functioning
Intoxication • Intoxication: physiological reactions resulting from ingestion of psychoactive substance • Impaired judgment • Changes in motor ability • Mood changes
Substance Abuse • Substance abuse: pattern of substance use that leads to significant distress or impairment in roles, and in hazardous situations
Substance Dependence • Substance dependence: characterized by need for increased amounts to achieve desired effect (tolerance) • Negative physical effects when withdrawn (withdrawal)
Substance Dependence • Dependence is also marked by: • Unsuccessful attempts at control • Substantial effort expended to seek • Substantial effort to recover
TAKES more than intended WANTS to cut back, but has failed SPENDS lots of time trying to get or do OFTEN intoxicated or in withdrawal CURTAILS other activities USES substance despite problems it causes NEEDS more and more of substance to achieve effect SUFFERS withdrawal TAKES substance to avoid withdrawal Psychiatric Definition – 3 of 9 required for addiction
Diagnostic Specifics • Diagnoses are given by • Substance • Dependence, abuse, intoxication, withdrawal • Other disorders can complicate picture
Individual Substances • Depressants: sedation, relaxation. Include alcohol, sedative drugs • Stimulants: increase activity, alertness, mood. Amphetamines, cocaine, nicotine, caffeine • Opiods: reduce pain and increase euphoria. Heroin, opium, morphine • Hallucinogens: alter sensory perception. Marijuana, LSD
Depressants • Alcohol • Sedatives
Alcohol Abuse • 23% Americans binge drink (5+) • 15 million Americans are alcohol dependent • Very culturally dependent • Peru: 25% • Shanghai: 0.45% • Dependency is chronic • Earlier age (11-14) = increased risk disorder
Sedative Use Disorders • Calming, sleep-inducing, anxiety reducing • Barbituates ↓ • Common use for suicide (suffocation) • Benzodiazepines ↑ • Less than 1% of treatment seekers
Description & Effects of Alcohol • Initial depression of inhibitory centers • Spreads to motor coordination, reaction time, judgments, etc • Withdrawal can be severe • Hand tremors, nausea & vomiting, anxiety, hallucinations, insomnia, agitation, delirium • Long-term abuse can lead to dementia
Stimulants • Amphetamines • Cocaine • Nicotine • Caffeine
Amphetamine Use Disorders • Elation → Crashing • Man-made • asthma, nasal decongestant • Weight loss, narcolepsy, ADHD
Diagnostic criteria • Behavioral symptoms • Changes in affect • Sociability, interpersonal sensitivity • Anxiety, anger • Impaired judgment • Quick tolerance
Cocaine Use Disorders • Short-lived high, paranoia is common (2/3) • Dependence is different • Inability to resist increases • Few early negative effects • Lack of sleep, paranoia • Withdrawal leads to severe apathy
Opiods • Natural, synthetic, endogenous to body • Euphoria, drowsiness, slowed breathing • Analgesics (e.g., morphine) • Very unpleasant withdrawal • 6-12 hours • Yawning, nausea, vomiting, chills, muscle aches, diarrhea, insomnia (1-3 days) • Poor prognosis
Hallucinogens (LSD) • Synthetically produced • Quick tolerance • Lack of effect over days • Little reported withdrawal • Mechanism unknown • Long-term effects unknown
Other Substances of Abuse • Inhalants • Most common poor adolescent males • Steroids • “Designer drugs”
Causes of Substance Abuse Disorders • Biological Factors • Genetic • Neurobiological • Psychological Factors • Reinforcement • Cognitive Factors • Social Factors • Culture • Integrative Model
Biological Influences - Genes • Drug abuse (particularly alcohol) have genetic influence • Easiest to study alcohol • Common genetics? • Use = environment, abuse = genetic?
Biological Influences - Neurobiology • Positive reinforcement of natural pleasure states neurologically • Dopaminergic system + opiods • How does negative reinforcement work?
Psychological Influences – Positive and Negative Reinforcement • Positive reinforcement can be physical • Also social • Negative reinforcement = relief (Such as anxiety, pain, etc.) • Used to “self medicate”
Cognitive Factors • Expectancy effects • Predict future drinking use by teens • Drinking will improve social behavior, motor, and cognitive abilities • Expectancies might result from us • Cravings • Influenced by cognitions – availability, environment, moods
Social Factors • Exposure to substances influences disorder development • Media exposure, peer exposure • Less monitoring by parents with disorder
Cultural Influences • Cultural expectations for drug use • Economic influences
An Integrative Model • Textbook p. 415 • All influences work together to increase likelihood of substance disorder • Also influences the maintenanceof that disorder • Equifinality: a particular disorder can arise from multiple and different paths
Treatment of Substance-Related Disorders • Personal motivation is essential • Difficult and slow • Individualized • Treatments across type of drug very similar • Biological Treatments • Psychosocial Treatments
Biological Treatments – Agonist Substitution • Patient is provided with safe drug that has similar chemical makeup • E.g. methadone (opiod) for heroin • No high, but same analgesic and sedation • Results are mixed • Cross-tolerance • Abuse of other drugs • Lifelong dependency
Biological Treatments – Antagonist Treatment • Effects of drug are blocked, so no longer produce pleasant results • Naltrexone – produces immediate withdrawal symptoms from opiods • Might also help with alcoholism, with therapy
Biological Treatments – Aversive Treatment • Make ingesting psychoactive drug unpleasant • Associate drug use with side effects • Antabuse • Nausea, vomiting, elevated heart rate, respiration • Noncompliance is large problem
Psychological Treatments • Inpatient treatment • Alcoholics Anonymous (and variants) • Controlled Use • Component Treatment • Relapse Preventions
Inpatient Treatment • Help addicts through initial withdrawal • Expensive • May be no difference between inpatient and outpatient care • Environment is different
Alcoholics Anonymous • Developed 1935 • Alcoholism as a disease that requires lifelong management • High levels of social support • 97,000 groups in 100 countries • 3% of Americans report attending at least 1 meeting in their lifetime • Relies on prayer and belief in higher power • Research on AA is very difficult
Controlled Use • Alternative to total abstinence • Some may become social users • Extremely controversial • both controlled use and abstinence is successful for only 20-30% of patients
Component Treatment • Aversion therapy – use paired with punishment • Covert sensitization • Contingency management – rewards • Community reinforcement – address life • Close other participates • Identify antecedents and consequences • Assistance with social services • New recreational activities
Relapse Prevention • Learned aspects of dependence • Relapse = failure of cognitive and behavioral coping skills • Target ambivalence • Positive aspects • Negative consequences • Identify high risk situations and plan
Impulse-Control Disorders • Intermittent Explosive Disorders • Kleptomania • Pyromania • Pathological Gambling • Trichotillomania • Problematic Internet Use
Intermittent Explosive Disorder • Aggressive impulses • Result in serious assault or destruction of property • Rarely diagnosed • Symptoms often accounted for by another disorder
Kleptomania • Urges to steal things • Not needed for personal use or monetary value • Rare? (Difficult to study) • Urge brings sense of tension, which is relieved by stealing
Pyromania • Urge to set fires • Pattern similar to kleptomania (tension & relief) • Less than 4% of arsonists • Very little research
Pathological Gambling • Increasing number of patients • 3-5% of adult Americans • Increasing among adolescents • Similar criteria to substance abuse • Increasing amounts for “high” • Withdrawal • Interference with functioning
Pathological Gambling • fMRIs show decreased activation in regions of brain that regulate impulses, while gambling • Abnormalities in dopamine and serotonin • Gambler’s Anonymous • 70-90% drop out • Need high motivation
Trichotillomania • Urge to pull out one’s hair • 1-5% of college students • Greater incidence in females • Antidepressants & Cognitive therapy seem to have effect • Research is very scarce
Internet Addiction • Excessive gaming, sexual preoccupation, and/or email/text use • Excessive Use • Loss of time, neglect of basic drives • Withdrawal • Anger, tension, depression when inaccessible • Tolerance • Better equipment, new software, longer times • Negative Repercussions • Lying, arguments, academic achievements, social isolation
Internet Addiction • Difficult to research • In US, Internet and computers are accessed from home • 86% estimated to have comorbidity • Shame, denial, motivation, lack of awareness • Estimated 0.3-0.7% prevalence in US