Ch 12 Substance Use and Impulse Control

why is substance abuse rate rising?

increased accessibility of drugs, increased life stresses

Physical Consequences of Substance Abuse

• damage to vital organs

• decreased immune system

• neurological impairment

• overdose (can be fatal, often a miscalculation)

Psychological Consequences of Substance Abuse

• increased anxiety, depression, emotional instability

• impaired judgment and decision-making

• development or worsening of mental health problems

Social Consequences of Substance Abuse

• strained relationships with peers

• social isolation and withdrawal

• difficulties in work

• legal problems

Life Consequences of Substance ABuse

• money issues

• legal issues

• loss of employment or academic opportunities

Substance Use

ingestion of psychoactive substances

Intoxication

physiological reaction to ingestion of a substance

Substance Abuse

loss of control of use of a particular substance

Tolerance

increasingly more of a substance needed to experience the same effect

• or diminished effect with continued use

Withdrawal

negative symptoms from cessation or reduction of use of a drug

Craving

psychological intent to get a drug, drive behavioural responses (drug-seeking behaviour)

Substance Use Disorder- Diagnosis

• loss of control of substance use

• unsuccessful attempts to stop

• significant time spent obtaining & using substance

• craving or strong desires to use

• continued use despite social problems, physical hazards, health problems

• tolerance & withdrawal

Depressants

decrease CNS activity

• sedative, hypnotic, and anxiolytic drugs

What type of drugs are most likely to produce tolerance and withdrawal?

depressants

Alcohol Use Disorder- Diagnosis

• 2 criteria over 12 months

• cravings for alcohol

• impaired control of alcohol use

• preoccupation with using or obtaining alcohol

• tolerance & withdrawal

• neglect of responsibilities due to use

• continued use despite health, social, or interpersonal issues

absorption of alcohol into body

stomach → small intestine → heart → liver

long-term alcohol use- problems

major loss of brain tissue, severe liver damage

Alcohol Withdrawn Delirium

symptoms resulting from alcohol withdrawal: agitation, insomnia, disorientation to time and place, hallucinations

Wernicke-Korsakoff Syndrome

• severe thiamine deficiency → cognitive issues and muscle problems

Wernicke-Korsakoff: Cognitive Issues

• confusion, issues with planning, problem-solving, attention

• confabulation: making stuff up

• speech problems

Fetal Alcohol Syndrome

• excessive alcohol during pregnancy → severe effects on infant

• growth retardation, cognitive/behaviour/learning issues, anatomical abnormalities

sedatives

calming

hypnotic drugs

sleep-inducing

Anxiolytic drugs

anxiety-reducing

barbiturates

• CNS depressants that enhance GABA activity (inhibitory)

• produce sedative and calming effects

• uses: anesthesia, anxiety relief, seizure treatment

• BARBitals

barbiturates risks

dependence, overdose, respiratory depression, withdrawal

Benzodiazepines (benzos)

• enhance GABA activity (GABA-A) → calming, anxiolytic, sedative, muscle-relaxant and anticonvulsant effects

• end in -am

Sedative-, hypnotic-, and anxiolytic-related disorders- Diagnosis

• use despite physical or psychological problems from substance

• repeated unsuccessful attempts to reduce use

• significant impairment or distress from use

• tolerance & withdrawal

• recurrent use in physically hazardous situations

Prescription excess

• overprescription of sedative and hypnotic drugs (benzos, sleeping pills)

• especially to vulnerable populations (elderly, ppl wit substance abuse issues) → may have negative consequences

Stimulants

• caffeine, nicotine, amphetamines, cocaine

What class of drugs is the most commonly consumed?

Stimulants (ie. nicotine, caffeine)

Stimulant Use Disorder- Diagnosis

• excessive stimulation use

• unsuccessful attempts to quit

• time spent using/obtaining stimulants

• cravings, tolerance, withdrawal

• failure to fulfill life roles

• continued use despite health, social or interpersonal problems

Amphetamines- uses

• historically: asthma treatment

• now: weight loss, energy, staying awake/alert

• ADHD treatment

Amphetamine Intoxication- Psychological

• euphoria

• changes in sociability

• anxiety, tension, anger

• stereotyped behaviours

• impaired judgment

• impaired social or occupational functioning

• hallucinations

Amphetamine intoxication- Physiological

• increases in heart rate

• blood pressure changes

• perspiration or chills

• nausea/vomiting

• weight loss

• respiratory depression

• seizures

• coma

respiratory depression

shallow breathing → deprivation of oxygen

• from opioids, benzos, barbiturates

Cocaine- history

• stimulant derived from coca leaves

• high cost - used by wealthy people

Cocaine - ingestion

snorted, crack cocaine is smoked

Cocaine- long term use

• cardiovascular damage

• neurological effects: seizures, strokes, neurotoxicity

• paranoia, hallucinations

• addiction, dependence

• respiratory problems: damaged nasal tissue, chronic runny nose

• GI problems: decreased blood flow and bowel ischemia

• dental decay (“crack mouth”): severe tooth decay and gum disease

• auditory deficits in infants

amphetamine- NT effects

stimulates dopamine & norepinephrine release, blocks reuptake

Cocaine- NT effects

blocks dopamine reuptake

What is the effect of increased dopamine (reuptake blocked) from stimulants?

euphoria

Dopamine Theory of Addiction

people with a genetic predisposition to experience less dopamine release from reward (less satisfaction) → more prone to addiction from dopamine reuptake blockers (stimulants)

Nicotine

psychoactive substance that produces dependence, tolerance, and withdrawal

Tobacco-recent rates

decreases in recent years, approximately 10% of population

Tobacco Withdrawal

depressed mood, insomnia, irritability, anxiety, concentration issues, restlessness, increased appetite and weight gain

Caffeine-Related Disorders

• most commonly used psychoactive substance (90%)

• gentle stimulant- least harmful addictive drug

Caffeine in low doses

increase energy and mood, decrease fatigue

Caffeine-high doses

agitation, sleep disturbances

caffeine withdrawal

headache, drowsiness, irritability

Caffeine- mechanism of action

Influences adenosine (neuromodulator)

Opiates

chemical compounds extracted from natural plant matter

• used as pain medication post-medical procedures

• opium, morphine, codeine, heroin

Opioids

synthetic compounds that mimic opiates

• oxycontin, percoset, demerol, fentanyl

Narcotics

sleep inducing opiates and opioids

Opioid use disorder

• increased opioid use over a long period of period

• unsuccessful efforts to cut down use

• time spent using or obtaining

• cravings, tolerance withdrawal

• failure to fulfill life roles due to opioid use

• continued use despite health, social and interpersonal issues caused by use

• recurrent use in physically hazardous situations

Hallucinogens- Discovery

Albert Hoffman discovered LSD in fungus that grows on grain kernels

LSD (d-lysergic acid diethlyamide)

• aka acid

• Timothy Leary discovered and said he wanted every child and adult try the drug

Psilocybin

magic mushrooms

DMT (dimethyltryptamine)

found in virola tree

Mescalline

found in peyote cactus plant

Phencyclidine (PCP)

synthetic hallucinogen

Cannabis

hallucinogen with both depressant and stimulant effects

Marijuana

name given to dried cannabis or hemp plant

high use rates of cannabis

• people with mental health problems

• can lead to psychosis in at risk individuals (schizo)

cannabis- psychological effects

• humour

• dreamlike state

• heightened sense

  • vivid colours

• distorted time perception

Drug Use- Causes

• genetic

• psychological

• cognitive

• cravings

• conditioning

• denial of problem

• family modelling

• social incluso (peer pressure)

Genetic predisposition to drug use

some people experience greater positive/negative effects of certain drugs

Conditioning of drug use

positive value of drinking (ie. going out and having fun)

family modelling of drug use

family history of alcohol → becomes normative → family models alcohol use

Psychological causes of drug use

reducing distress

• numbed or reduced by substance (positive feelings)

• self-medication of mental health problems

  • short-term gain, but causes long-term problems

Biological Treatments of opioid use disorder

focus on treating cravings & withdrawal symptoms by switching to another drug that does not cause withdrawal, slowly wean off OG drug

• replacement drugs do not produce high

Methadone

long-acting opioid receptor agonist, reduces cravings & withdrawal

Buprenorphine

partial opioid agonist that alleviates withdrawal & diminishes cravings without producing high

Naltrexone

opioid antagonist that blocks the positive effects off opioids, reducing relapse risk

Disulfiram (Antabuse)

causes unpleasant reactions when alcohol is consumed → deters from alcohol use

Naltrexone (Alcohol)

blocks enjoyable effects of alcohol (eliminates positive value) → reduces cravings & rewarding effects

Acamprosate

normalizes brain systems disrupted by chronic alcohol use, reduces symptoms of protracted withdrawal

Nicotine Replacement Therapy

lozenges, patches, gum, nasal spray- slowly reduce nicotine use & break habit of smoking

Buproprion

antidepressant that reduces nicotine cravings & withdrawal suymptoms

varenicline (Chantix)

partial nicotine receptor agonist, reduces cravings & withdrawal

goals of psychological treatments of substance abuse

• teach person better coping mechanisms to reduce reliance on substances, or reduce existing stressors

CBT

• recognize and rework negative cognition patterns related to substance abuse

• developing coping strategies to deal with stress (over substance)

  • developing better emotional regulation

• avoidance of triggering environments that lead to use

Motivational Interview

client-centred approach focusing on building intrinsic motivation to quit

• engagement (personal acknowledgment of wanting to change), focusing (on obstacles to quitting), evoking, planning

12-step facilitation therapy

• group therapy where people share their experiences with the same struggles (AA, NA, etc)

• emphasizes acceptance, surrender, active involvement in group support

Dialectical Behaviour Therapy

focuses on tolerance of distress and decreasing sense of urgency that leads one to turn to substance use

• combines CBT & mindfulness to help people manage negative emotions

drug rehabilitation centers

24/7 care, highly structured program w/ medical supervision, helps manage withdrawal esp in severe cases where going cold turkey would be dangerous

Prevention

public health, education/information about drugs

Intermittent Explosive Disorder

• recurrent aggressive/angry emotional outbursts, out of proportion to situation

Intermittent Explosive Disorder- Causes

• serotonin dysregulation

• family history of aggression

  • childhood trauma

IED- Treatment

• SSRIs or mood stabilizers

• CBT for anger management

Kleptomania

• recurrent stealing

• tension → stealing → relief

Klepto- Causes

• comorbid w/ mood disorders

• deficits in impulse-control and emotional regulation

Klepto- Treatment

• CBT for triggers and steering urges

• SSRIs

• treat comorbid mood disorders

Pyromania

• deliberate fire setting

• tension → fire → pleasure/relief

Pyro- Causes

• very rare, so limited research

• comorbid with other emotional/behavioural disorders

Pyro- Treatment

• CBT for triggers and coping strategies

• fire-safety education

• family interventions in childhood