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Statistics for substance use
Overall cost of substance in the U.S. = $740 billion
135 million people in the U.S. have used an illegal substance in a year
1 in 4 teens have used an illegal substance in the U.S.
What is a drug?*
Any substance other than food affecting bodies and minds
Why might the term "substance" be preferred over "drug?"
Non-illegal substances are included as well, such as alcohol, tobacco, caffeine
What are substance use disorders?
Long-term maladaptive behavior patterns and reactions caused by repeated substance use
How many receive treatment for substance use disorders?
18.4%
What is the prevalence rate for substance use disorders in the U.S.?
7.4% (more than 20 million people)
Which ethnic/racial groups have the highest and lowest rates of substance use disorders?
Native Americans have the highest rate and Asian Americans have the lowest rates. Non-Hispanic white Americans, Hispanic Americans, and African Americans have similar rates, contrary to racial stereotypes.
What are the categories of substances?*
Depressants, stimulants, hallucinogens, and cannabis
What is the DSM-V criteria for a substance use disorder?*
An individual displays maladaptive behaviors, leading to impairment or distress and shows two of the following symptoms within a one year period:
Spend much time trying to obtain, use, or recover from the effects of substance use
Cravings
Builds tolerance to substance
Withdrawal reactions
Tries to reduce use of substance and struggles to
Causes interpersonal problems, physical risks
Statistics signifying how substance use is causing social problems
32 million in the U.S. have used a substance in the last month
24% of high school seniors have used an illegal drug within the past month
What are some temporary changes resulting from substance use?*
Substance intoxication, a temporary state of poor judgment, mood changes, slurred speech, poor coordination, possibly hallucinosis
Hallucinosis: a particular type of intoxication involving change sin perception distortions, and hallucinations
What are some long-term problems resulting from substance use?*
Substance use disorder, dependence, tolerance and/or withdrawal reactions
What is tolerance?*
The individual required larger doses of the drug to produce the desired effect
What are withdrawal reactions?*
When an individual stops using or reduces the dosage of the drug, they have unpleasant and sometimes dangerous reactions
What are depressants?*
Substances that slow down activity of central nervous system, reducing tension and inhibitions.
What types of substances are classified as depressants?*
Alcohol, sedative-hypnotic drugs (barbiturates and benzodiazepines), and opioids (morphine, heroin)
What is a binge-drinking episode and how does it differ between genders?
When an individual drinks 5 or more drinks at a time
Men binge drink more
Why does drinking alcohol rise the body temperature?
There is a rise in body temperature because the body is metabolizing alcohol, which is why bars often have colder set temperatures
What neurotransmitter does alcohol impact and how?
Alcohol increases activity of GABA for increased relaxation by binding to its receptors
What is the blood alcohol concentration (BAC)?
The concentration/proportion of ethyl alcohol in the blood
What BAC level results in intoxication and what level results in death?
BAC of 0.09 = intoxication
BAC of 0.55 = death
What gets rid of the effects of alcohol?
Time is the only way the effects of alcohol will subside (as alcohol is metabolized by the liver)
How does gender affect one's BAC?
Two ways:
1) Given amount of alcohol has less effect on large ppl than smaller ones -> body mass (have more blood -> requires more alcohol to reach same concentration)
2) Women have less of an enzyme in stomach that metabolizes alcohol before enters bloodstream called alcohol dehydrogenase, so they become more intoxicated than men on equal doses of alcohol
Statistics for alcohol use
Middle schoolers: 25% report some use
High school seniors: 29% drink monthly, 2% drink daily
Statistics of alcohol use disorder
Prevalence rate = 5.4%
Men-women ratio = 2:1
Native Americans display highest rates and Asian Americans display lowest rates
Why do Asian Americans display lower rates of alcohol use disorder?
Biological factor that partly explains why = half of Asian Americans have a deficiency in alcohol dehydrogenase (same enzyme women have less than men of), so they have negative reactions to modest alcohol intake
How do withdrawal reactions look in alcohol use disorder?*
Withdrawal symptoms may include nausea, sweating, and vomiting. Individuals may also experience delirium tremens
Delirium tremens: dangerous withdrawal symptoms consisting of confusion, clouded consciousness, and visual hallucinations (may be fatal)
Statistics for college binge drinking
38% of students binge drink once a month
1 in 3 binge drink 6 or more times monthly
Half of all campus sexual assaults involve alcohol use
What are sedative-hypnotize drugs?
They are anxiolytics, also known as antianxiety medication, and include barbiturates and benzodiazepines
What neurotransmitters do sedative-hypnotic drugs impact and how?
They increase GABA activity by binding to GABA receptors
What do withdrawal reactions look like in barbiturates?*
Withdrawal reactions are dangerous because they could cause convulsions.
Tolerance can also be dangerous because the lethal dosage stays the same even if effects decrease (individuals could overdose if they keep increasing the dosage to feel the drug's effects)
Why are benzodiazepines more commonly prescribed then barbiturates?
They are less likely lead to intoxication, tolerance, and withdrawal reactions. They also relieve anxiety without causing drowsiness and are less likely slow down breathing (lower chance of death in event of an overdose)
Prevalence rate od sedative-hypnotic disorder
1% of US. adults have a sedative-hypnotic disorder related to benzodiazepines
How do opioids work on the body?
They depress the CNS by binding to receptors that receive endorphins (neurotransmitters that naturally help relieve pain and dec emotional tension)
What are some withdrawal reactions from heroin?*
Can quickly develop tolerance and withdrawal reactions for heroin after a few uses (may also develop withdrawal symptoms from reducing the dosage and individuals may increase the dosage just to avoid withdrawal symptoms)
Early withdrawal = anxiety, restlessness, later = twitching, aches, fever, vomiting, weight loss, diarrhea
How may opioid use disorder cause an individual to engage in criminal activity?
Individuals will spend much of their time planning their next dose -> may turn to criminal activity to support habit because opioids are both expensive and illegal
Statistics for opioid use disorder
Current prevalence = 0.7%
39% of people with an opioid use disorder obtained the substance for free from a friend or relative, 37% were prescribed it by one or more physicians
What are some dangers of opioid use?
Most immediate danger = overdose, where it closes down the respiratory center in brain, almost paralyzing breathing
Ignorance of tolerance: take opioid -> develop tolerance -> stop -> cont. at most recent dosage instead of original dosage, resulting in an overdose
Getting impure drugs,
infection from dirty needles
What do stimulants do to the body?*
They increase activity of the CNS, resulting in increased blood pressure, heart rate, alertness, and rapid behavior and thinking
What substances are categorized as stimulants?*
Cocaine, amphetamines (as well as metahmpetamine/meth), caffeine, nicotine
What neurotransmitters do cocaine impact and how?
They increase dopamine, norepinephrine, and serotonin at key receptors, which results in an euphoric rush of wellbeing and confidence and as the effects subside, a depression-like letdown (crashing) follows
What are amphetamines and which neurotransmitters do they impact and how?
They are laboratory-manufactured stimulant drugs that stimulate the CNS by increasing release of dopamine, norepinephrine, and serotonin (like cocaine)
Why is amphetamine misuse particularly common among college students?
Amphetamine is still prescribed for ADHD medication, so people may attain ADHD medications without a prescription from classmates with ADHD
What is methamphetamine (meth)?
A particularly addictive kind of amphetamine that gained popularity as a club drug
What can lead to a stimulant use disorder?*
Regular use of cocaine or amphetamines, where a person's life may become dominated by stimulants and remain under the drug's effects for much of each day
What is the most widely used and legal stimulant?*
Caffeine (90% of the world consumes caffeine daily)
What are some withdrawal symptoms of caffeine?*
Headaches, depression, anxiety, and fatigue
What are hallucinogens?*
Psychedelic drugs that cause changes in sensory perceptions ("trips")
What substances are categorized as hallucinogens?
LSD, mescaline, psilocybin, and MDMA (Ecstasy or Molly)
Why is LSD particularly dangerous among hallucinogens?
Although LSD tolerance and withdrawal reactions are rare, meaning substance use disorders are rare in LSD users, individuals may experience extremely unpleasant reactions to the drug, known as a bad trip
What is MDMA (Ectasy/Molly)?
A stimulant that produces hallucinogenic effects, an energy boost, and feelings of connectedness
Known as a party drug
Similar to LSD, rarely leads to a substance use disorder
Which neurotransmitters do MDMA (Ecstasy/Molly) impact and how?
Causes serotonin (and to a lesser extent), dopamine to be released at at once throughout the brain, which first increases then deplete a person's overall supply of neurotransmitters
What is cannabis?*
Drugs produced from varieties of hemp plants. which causes a mix of hallucinogenic, depressant, and stimulant effects
Includes marijuana
What is the major active ingredient in cannabis?*
THC (tetrahydrocannabinol)
What do low and high doses of cannabis cause?
Low doses = joy, relaxation, anxious, suspicious, irritation
High doses = odd visual experiences, changes in body image, hallucinations
What are some dangers of cannabis use?
Occasional panic reactions, automobile accidents (because of sensorimotor effects), decreased memory while high
Long-term health problems = lung cancer, respiratory problem, reproduction problems)
Statistics of cannabis use disorder
1.7% current prevalence -> have cannabis abuse or dependence, lifetime prevalence = 4-5% (higher than other drugs because more regularly available)
How does cannabis differentiate from other substances?*
Unlike most other drugs, marijuana for recreational use is becoming legalized in multiple U.S. states and more people believe it should be legalized (67% of people in the U.S.)
What is polysubstance use?*
Taking more than one drug at a time
What is cross tolerance?*
When taking a drug, as the person builds tolerance for that drug, they also build tolerance for another drug (from the same category) simultaneously, even if they have never taken that other drug before
What is a synergistic effect?*
Having different drugs in the body at the same time may multiply/potentiate the effects
What are the two types of synergistic effects?*
Similar actions: two or more drugs have similar actions (e.g., depressants)
If mixed together, severely depresses CNS and may lead to death
Opposite (antagonistic) actions: two or more drugs have opposite effects (e.g., stimulants w/alcohol or barbiturates)
May build up toxic or lethal levels of the drugs in their system, possibly leading to death
What are sociocultural views on the causes of substance use disorders?*
People are likely develop substance use disorders when living in stressful socioeconomic conditions
Higher lvls of unemployment are correlated w/alcohol use
SES linked: lower socioeconomic backgrounds are more likely use substances
Families that value or tolerate drug use are also linked: more likely in families and environments where substance use is valued/accepted
People who confronted by other forms of stress are more likely to use substances (as a coping mechanism)
What are psychodynamic views on the causes of substance use disorders?*
1) Powerful dependency needs traced to early years, where a lack of parental nurturing caused individuals to search for outside support as a method of coping
2) Some ppl respond to early deprivations by developing substance abuse personality, which leaves them particularly prone to drug abuse
3) Early impulsivity
Support: only correlational, not causal support
What are cognitive-behavioral views on the causes of substance use disorders?*
1) Operant conditioning
The temporary reduction of tension brought by ingesting a substance is viewed as a reward, expectancy motivates further use (used to expecting reward -> sufficient to inc dosage)
Evidence: substance use increases with tension
Correlation with psychological disorders (22% of all adults who suffer from psychological disorder have displayed a substance use disorder in the past year)
Much higher than substance use disorder rate in general population
2) Classical conditioning
Objects present at the time of substance use may act as classically conditioned stimuli that brings the same pleasure as effects brought on by drugs
What are biological views on the causes of substance use disorders?*
1) Genetic predisposition
Alcoholism concordance rate in identical twins (54% in monozygotic twins vs. 28% in dizygotic twins)
Adoptee whose bio parents abuse alcohol vs. adoptees whose bio parents did not: by adulthood, kids were more likely abuse substances if their biological parents did
Abnormal form of dopamine-2 (D-2) receptor gene common in people w/substance use disorders
2) Neurotransmitters
Drug tolerance and withdrawal symptoms caused by cutbacks in brain's production of particular NTs during excessive and chronic drug use
3) Brain circuits
Reward circuit (a.k.a. reward center or pleasure pathway) with dopamine as the key neurotransmitter
3) Incentive-sensitization theory
When substances repeatedly stimulate the reward center, it develops hypersensitivity to substances, contributing to future desires for them
4) Reward deficiency syndrome
A person's reward center is not readily activated by normal life events, so they seek substances to activate it
What are developmental psychopathology views on the causes of substance use disorders?*
1) Mix of factors
The road to substance use disorders begins with a genetically inherited predisposition, and if the individual is exposed to numerous stressors such as inadequate parenting, rewarding substance use experiences, relationships w/peers who use drugs, and/or significant adult stressors, it will result in substance abuse disorder
2) Temperament
Disinhibited (externalizing) temperament: features impulsivity, aggressiveness, overactivity, limited persistence, low frustration tolerance, and inattention
Inhibition and negative affectivity (internalizing) temperament: characterized by multiple fears, depression, negative thinking, and dependence
What are cognitive-behavioral treatments of substance use disorders?*
Main goal = clients receive help on how to identify and change behaviors and cognitions that contribute to patterns of substance misuse
1) Aversion therapy: clients repeatedly presented with an unpleasant stimulus when they take a drug
Most often used w/alcoholism, where drinking alcohol is paired with a drug that induces nausea
2) Contingency management: give people incentives based on whether they have drug-free urine samples, usually lasts 8-16 weeks
3) Relapse prevention training: clients gain control over substance behaviors and are taught to identify high-risk situations, plan ahead for situations, and learn from past relapses
4) Acceptance and commitment therapy (ACT): mindfulness-based approach for patients to accept their thoughts as events in their minds and not assign meaning to those thoughts. By accepting thoughts instead of trying eliminate them, clients become less upset by them and are less likely act on them w/drugs
What are biological treatments of substance use disorders?*
Main goal = help people withdraw, abstain, or maintain current level of use without increasing the dosage
Limited long-term successful when used alone
1) Detoxification: systemic and medical supervised withdrawal from drug, one strategy is to give clients other drugs to reduce the withdrawal symptoms
High relapse rates if follow-up treatment does not occur
2) Antagonist drugs: block or change effects of the addictive drug
Intended help person resist from falling back into a pattern of chronic use
3) Drug maintenance therapy
Some ppl criticize it as substituting addictions
What are sociocultural treatments of substance use disorders?*
1) Self-help programs and residential treatment
Ex.) Alcoholics Anonymous (AA)
Expanded into residential treatment centers/therapeutic communities (place where people who were formerly addicted to drugs live, work, and socialize in drug-free environments)
What is gambling disorder?
A disorder persistent and recurrent gambling behavior, leading to significant life problems
Defined by more by the addictive nature of gambling and less on amount time or money spent
What is internet use disorder/internet gaming disorder?
A disorder where an individual spends all or most of their waking hours online and there is an uncontrollable urge to be online
Symptoms parallel to substance use disorders and gambling disorder
Not listed in DSM-V
What is psychosis?*
Loss of contact with reality and the ability to perceive and respond to environment is disturbed resulting in impaired functioning
What are hallucinations and delusions?
Hallucinations: false sensory perceptions
Delusions: false beliefs
What is schizophrenia?
A psychotic disorder where functioning deteriorates and is deeply impaired due to unusual perceptions, odd thoughts disturbed behavior, and/or motor abnormalities
Why is schizophrenia more common in lower socioeconomic groups?
Two theories:
1) Stress of poverty leads to the disorder
2) Downward drift theory: people who have schizophrenia and are in higher SES dip into a lower SES and stay at that SES because of the disorder
Statistics for schizophrenia
Lifetime prevalence = 1% (1% = 3.2 million Americans)
Men-women ratio = 1:1
Average age of onset for men is earlier than for women (men = 23, women = 28)*
20% of people w/schizophrenia attempt suicide and 5% succeed
