Chp. 12: Substance Abuse Disorders

Drug

Any substance other than food that affects our bodies or minds (e.g., alcohol, tobacco, caffeine)

Substance intoxication

A cluster of temporary undesirable behavioral or psychological changes that develop during or shortly after the ingestion of a substance.

Substance use disorders

A pattern of maladaptive behaviors and reactions brought about by repeated use of a substance, sometimes also including tolerance for the substance and withdrawal reactions.

Tolerance

The brain and body’s need for ever-larger doses of a drug to produce earlier effects.

Withdrawal

Unpleasant, sometimes dangerous reactions that may occur when people who use a drug regularly stop taking it or reduce the dosage.

Checklist for substance use disorder

1. Individual displays a maladaptive pattern of substance use leading to significant impairment or distress

2. presence of at least 2 of the following substance-produced symptoms within a 1-year period:

• substance is often taken in larger amounts

• unsuccessful efforts to reduce or control substance use

• much time spent trying to obtain, use, or recover from effects of substance

• failure to fulfill major role obligations

• continued use despite persistent interpersonal problems

• reduction of important activities

• continued use in dangerous situations

• continued use despite worsening of physical or psychological problems

• craving for substance

• tolerance effects

• withdrawal reactions

Depressants

• slow activity of central nervous system (reduce tension and inhibitions, may interfere w/ judgment, motor activity, concentration

• most widely used: alcohol, sedative-hypnotic drugs, opioids

Alcohol (depressant)

Any beverage containing ethyl alcohol, including beer, wine, and liquor. Effects subside only after it’s been metabolized by liver

• increases activity of GABA

• gender affects blood concentration

Alcohol use disorder: clinical picture

• regular consumption and reliance affects cognition, social life, and work behaviors

• individual alcoholism patterns vary (type or environment consumed)

• damage in various structures of brain, and correspondingly in memory, speed of thinking, attention, balance

Alcohol use disorder: tolerance and withdrawal

• tolerance increases consumption levels

• variety of negative withdrawal symptoms (e.g., delirium tremens, etc.)

Delirium tremens (DTs)

A dramatic alcohol withdrawal reaction that consists of confusion, clouded consciousness, and visual hallucinations.

Personal and social impacts of alcoholism

• destroys families, social relationships, and careers

• plays role in suicides, homicides, assaults, rapes, car accidents, etc.

• pregnant women - FAS

Fetal alcohol syndrome

A cluster of problems in a child, including lower intellectual functioning, low birth weight, and irregularities in the head and face, that results from a fetus’s exposure to excessive alcohol during the pregnancy.

Sedative-hypnotic (anxiolytic) drugs (depressants)

Drugs that calm people at lower doses and help them fall asleep at higher doses.

Barbiturates

Addictive sedative-hypnotic drugs that reduce anxiety and help people sleep. (replaced by benzos)

Benzodiazepines

The most common group of antianxiety drugs, which includes Valium and Xanax.

• safer, less likely to lead to intoxication, tolerance effects, and withdrawal reactions

• increase GABA

Opioids (depressants)

Opium, drugs derived from opium, and similar synthetic drugs. Includes natural (heroin, morphine, codeine) and synthetic (methadone) blended drugs

Morphine (opioid)

A highly addictive substance derived from opium that is particularly effective in relieving pain.

Heroin (opioid)

One of the most addictive substances derived from opium.

Endorphins

Neurotransmitters that help relieve pain and reduce emotional tension. They are sometimes referred to as the body’s own opioids. Opioids cause CNS depression - drugs attach to endorphin-related brain receptors

Opioid use disorder

• after just a few weeks, users may become caught in pattern of abuse

• tolerance for drug quickly builds and withdrawal occurs when ingestion stops

• early withdrawal symptoms: anxiety, restlessness

• later withdrawal symptoms: twitching, aches, fever, vomiting, diarrhea, weight loss form dehydration

• increased does are required to avoid withdrawal

• most are legally prescribed by medical professionals

Danger of opioid use

• most immediate danger is overdose

• ignorance of tolerance

• impure drugs (unaware of different dosage)

• infection from dirty needles and other equipment

Stimulants

• increase activity of CNS: increases blood pressure, heart rate, and alertness, rapid behavior and thinking

Cocaine (stimulant)

An addictive stimulant obtained from the coca plant. It is the most powerful natural stimulant known.

• produces euphoric rush of well-being, followed by letdown (crashing)

• increases supply of dopamine at key neurons in brain as well as norepinephrine serotonin levels

• snorted, injected, or smoked

Freebasing

A technique for ingesting cocaine in which the pure cocaine basic alkaloid is chemically separated from processed cocaine, vaporized by heat from a flame, and inhaled with a pipe. (cheaper)

Crack

A powerful, ready-to-smoke freebase cocaine. (also cheaper)

Effects of high doses of cocaine

• fast acting

• cocaine intoxication

• cocaine-induced psychotic disorder (e.g., depression-like letdown, have bad experience w/ cocaine

Dangers of cocaine

• overdose: greatest risk

• excessive doses: depress brain’s respiratory function

• heart irregularities or brain seizures: death

• increased likelihood of pregnancy complications

• combination w/ alcohol can be very dangerous

Amphetamines

A stimulant drug that is manufactured in the laboratory.

• mostly taken in pill or capsule form

• used recreationally

Effects of amphetamines

• small doses: thinking faster, rapid movement

• high doses: euphoric, hallucinatory/psychotic symptoms

Methamphetamine (meth/crank)

A powerful amphetamine drug that has surged in popularity in recent years, posing major health and law enforcement problem

Dangers of methamphetamines

• serious negative effects on physical, mental, and social life

• linked to increased ER visits

• may cause neurotoxicity (impure drug); induced-psychosis

• more euphoric than cocaine - easier to get

Stimulant use disorder

• dominates individual’s life

• leads to poor functioning in social relationships and at work (can tell the impact on the outside)

• tolerance and withdrawal reactions tied to increased doses

Caffeine (stimulant)

The world’s most widely used stimulant, most often consumed in coffee.

• triggers release of dopamine, serotonin, and norepinephrine into brain

Caffeine effects

• enhances physical stamina and reduces fatigue

• can disrupt mood, fine motor movement, reaction time, and sleep

• increases gastric acid secretions and breathing rate at high doses

Caffeine reduction

Sudden stop or cutback of usual intake can cause withdrawal symptoms

Hallucinogens

A substance that causes powerful changes primarily in sensory perception, including strengthening perceptions and producing illusions and hallucinations. Also called a psychedelic drug.

LSD (hallucinogen)

A hallucinogen derived from ergot alkaloids.

• binds to serotonin receptors

• increased and altered sensory perception, psychological changes and physical symptoms

• hallucinations and/or synesthesia

• effects wear off in about 6 hours

Danger of long-term LSD use

• self-injury

• bad trips

• flashbacks

MDMA (hallucinogen)

A popular stimulant drug that also produces hallucinogenic effects and so is typically viewed as a hallucinogenic drug. Also called Ecstasy.

Cannabis

Drugs produced from the varieties of the hemp plant Cannabis sativa. They cause a mixture of hallucinogenic, depressant, and stimulant effects.

• major active ingredient: THC

• most effects last 2-6 hours

Marijuana

One of the cannabis drugs, derived from the buds, leaves, and flowering tops of the hemp plant

Dangers of cannabis use disorder

• tolerance and withdrawal symptoms

• occasional panic reactions, car accidents, and decreased memory while high

• long-term health problems (depending on ingestion) - reproduction problems

Vaping

Using handheld battery-powered vaporizers that enable user to inhale aerosol rather than cigarette smoke

Combinations of substances

• people often take more than one drug at a time, known as polysubstance use

• each year many people are hospitalized because of polysubstance use (either accidental or intentional)

Synergistic effect

An increase of effects that occurs when more than one substance is acting on the body at the same time.

• similar actions: multiple depressants (shuts body down)

• opposite (antagonistic) actions: depressant and stimulant

Treatment for substance use: psychodynamic treatments

• clients helped to become aware of and correct underlying needs and conflicts related to drug use

• not highly effective (better w/ other forms of treatment)

Treatment for substance use: cognitive-behavioral treatments

• clients are helped to identify and change behaviors and cognitions that contribute to patterns of substance misuse

• interventions: aversion therapy, contingency management (positive reinforcement), relapse-prevention training, acceptance and commitment therapy (ACT)

Treatment for substance use: biological treatments

• help people withdraw, abstain, or maintain level of use without further increases

• drug maintenance therapy

Detoxification

Systematic and medically supervised withdrawal from a drug.

• high relapse rates without follow-up treatment

Antagonist drugs

Drugs that block or change the effects of an addictive drug.

• help person resist falling back into pattern of substance us disorder/dependence

Methadone maintenance program

A treatment in which clients are given legally and medically supervised doses of methadone — a heroin substitute — to treat various opioid use disorders.

Treatment for substance use: sociocultural treatments

Psychological problems emerge in a social setting and best treated in a social context

• self-help and residential treatment programs

• culture and gender-sensitive programs

• community prevention programs

Gambling disorder

A disorder marked by persistent and recurrent gambling behavior, leading to a range of life problems.

• treatment: relapse-prevention training, opioid antagonists, gamblers anonymous