Substance Related Disorders - Module 11

Physiological dependence

body comes to depend on a steady supply of the substance for normal functioning, a risk for people on strong pain meds

psychological dependence

an emotional/attentional compulsion to keep using a drug

this is possible not just for substances, but for experiences

Tolerance

a condition wherein the drugs lead to progressively less of an effect

• often leads to intake of larger quantities

• use of siilar drugs can lead to cross-tolerance

Synergeistic effect

can multiply effects of similar drugs used together

drugs in combination can be fatal:

• oxycodone (OxyContin, opiod)

• hydrocodone (Vicodin, opiod)

• diazepam (Valium, benzo tranq)

• alprazolam (Xanax, benzo tranq)

• temazepam (Restoril, benzo tranq)

• doxylamine (OTC Unisom, antihistamine, used for insomnia)

Withdrawal

in absence of higher doses, person feels aversive symptoms

Psychological Effects

the psychological effect of any drug is dependent on:

• physical factors

• previous experience with the drug (tolerance)

• environmental setting

• mental set (what you expect it to do; culture/religious practice, can lead to placebo effect)

Substance Related Disorders

alc, caffeine, cannabiis, hallucinogens, inhalants, opiods, sedative, hypnotics/anxiolytics, stimulants, tobacco

Substance Use Disorders

focused on patterns of usage and loss of control over usage

specify current severity based on the following guidelines:

• mild: presence of 2 or 3 symptoms

• moderate: 4 or 5

• severe: 6+

Substance Induced Disorders

intoxication, withdrawal, other states induced by usage (psychosis)

Depressants

• slow down activity in the CNS heightening sensitivity of GABA receptors (GABA agonists)

• can be fatal in large doses or in combination

• physiological and psychological dependence

• used legally in sleeping pills, tranquilizers, alcoholic beverages

• often abused in tranquilizers, barbiturates, benzodiazepines (Xanax, Valium)

  • withdrawal from these can be fatal

Alcohol

dependence over 16M americans, including 600K adolescents age 12-17

• 30-40% of hoomeless pop.

• plays a role in about half of all sexual assault cases

risk factors

• men twice as likely as women

• depemdence usually develops in early adulthood

• family history, both biologically and socially

• lower SES

Alcohol and physical health

• linked to liver disease (cirrhosis) and digestive system cancers

• cognitive disorders; Korsakoff’s (amnesia), Wernicke’s (delirium and tremors, balance)

• fetal alcohol syndrome in pregnant women

• very moderate use ahs some health benefits: red wine may raise HDL (good cholesterol) levels

Stimulants

• increase overall levels of neural activity by functioning as dopamine agents

• do not create energy, but use it more quickly; thus, there’s an inevitable crash later

• people may benefit from increased energy, but suffer from decreased focus

• used legally in cigarettes, treatment of ADHD

• used illegally in amphetamines, cocaine

• physiological and psychological dependence

Cocaine

• most widely abused illegal stimulant, but in decline

• inhibits reuptake of dopamine and norepinephrine

Amphetamines

• stimulates excess production/blocks reuptake of dopamine

• meth abuse increasing in prevalence

  • longer high than cocaine, cheaper, domestic production

• crashes are severe, leading to depression and suicidal thoughts

symptoms of amphetamine and cocaine addiction

similar to schizophrenia

Opiates

pain drugs second only to marijuana in abuse rates

• relieve pain in legal use (Oxycodone, hydrocodone, morphine, Fentanyl)

• Methadone for legal heroin dependence reduction

• mimic the effect of natural endorphins, to give a euphoric feeling

• illegally abused in heroin or prescription dependence

• severe physiological withdrawal

Endorphin

short for “endogenous morphine”

Hallucinogenic drugs (psychedelics)

• disrupt normal thought or sensory processes, induce hallucinations

• often work as serotonin and/or glutamate agonists, but more biochemically diverse than other categories

• bad trip might lead to paranoia, panic attack

• dependence is largely psychological, though potnetial for building tolerance

• long cultural history, especially within creative communities

LSD (Lysergic Acid Diethylamide)

• controversial claim: “can be beneficial when used by a stable individual in a controlled environment,” based on a study of 400 by a Harvard psychologist, Timothy Leary

• flashbacks found in 20-30%, though chronic in fewer

  • recent research suggests much lower incifence

  • likely perceptual learning or PTSD, though not really known and difficult to study

• revived interest in development of these (ketamine) for therapeutice use,though legal hurdles remain

Marijuana

active ingredient: THC (tetrahydrocannabinol)

• sometimes grouped with hallucinogens, but doesn’t bring about true hallucinogenic effects

• most widely used illegal drug (over 30% have tried, 20M+ active users)

• has long-term physical symptoms similar to smoking unfiltered cigarettes (though often more serious, as less refined)

• chronic use can interfere with short-term memory

• dependence is primarily psychological

Biological Perspective

• primarily rooted in neurotransmitter levels and patterns of inheritance

  • genetic inheritance may be tied to dopamine receptivity

• doesn’t go as deeply into psychological dependence, focuses on reduction of physiological dependence

Treatments

detoxification

antagonist drugs: antabuse (disulfram)

• inhibits metabolism of alcohol

• based on taste aversion learning

antidepressants to reduce withdrawal symptoms

replacement therapy, “nicotine patch,” mathadone

Narcan (naloxone) for opiate overdose

Operant conditioning

social, personal, and physical rewards

tension reduction and removal of withdrawal symptoms reward continued drinking via negative reinforcement

classical conditioning model of cravings

associations betwen positive feelings and drug

social learning

emulation of parents, peers

Treatments (Learning perspectives)

• behavioral self-control training

  • involves use of diaries to become aware of usage patterns and triggers

• aversion learning

• social skills training to avoid association scenarios

• cue exposure method

  • progressive exposures to train to refuse alcohol

Expectancy model

• we expect certain effects based on our own beliefs, both correct and incorrect

• also based on stated beliefs of peers

(people can go on binges after one drink based on expectancy any slip triggers a binge)

self-efficacy expectancies

• stimulants enhance belief in our abilities

Relapse prevention training

trains people to put relapses in perspective, to not overreact, and to not expect a relapse

Psychodynamic perspective

alcoholism and smoking are manifestations of oral fixation

sociocultural perspective

• cultural factors affect likelihood of drinking, drug use

• cultural expectations vary

  • some cultures reward binge behavior

  • some cultures use hallucinogens as part of religious rituals

Alcoholics Anonymous

100K groups with over 2M members in 150 countries

• claims highest success rate

  • alternatives have fared poorly, but success of AA is hard to quantify given lack of formal data

  • research suggests AA is successful in developing long-term sobriety in only 5-10% who enter