Chapter 10 - Substance Use Disorders

Addiction

compulsive, uncontrollable behavior that has severe consequences

• significantly impairs work, health, relationships

• very hard to break

• intense symptoms

Bad Habit

learned, repeated behavior that is typically voluntary and controllable

• negative reinforcement

• mild and manageable consequences

• may feel less effortful to break

Substance use disorder

disorder where a drug is used to an extent that behavior becomes maladaptive, social and occupational functioning are impaired, control/abstinence becomes impossible, and dependence on drug produces tolerance/withdrawal

Prevalence of SUDs

• alcohol use common in college students

• 2018 - 9 million people misused prescription pain meds

• smoking has decreased 83% in college educated people, 39% in those with only high school degree

Gender differences in substance use disorders

• men 1.2x more likely to develop alcohol use disorder

• men use more crack + cocaine

Race differences in substance use disorders

• nicotine use highest in native americans (51.7%)

• hallucinogens highest in white americans

Clinical features of substance use disorders

• abuse of psychoactive substances

• wide ranging psychological, physiological, and behavioral effects

• association with impairment and significant costs

Depressants

behavioral sedation, slow down CNS, increase relaxation, reduce anxiety

• alcohol, anxiolytic drugs, cannabis

Behavioral effects of depressants

lowered sense of control, euphoria

Physiological effects of depressants

fatigue, drowsiness

Cognitive effects of depressants

impaired judgement, memory issues, confusion

Stimulants

increase alertness, elevate mood

• most consumed drug in U.S

• cocaine, nicotine, cannabis

Cannabis

bifacic

• effects similar to depressants in higher doses

• effects similar to stimulants in lower doses

Opiates

analgesia (pain relief) and euphoria

• heroin, morphine, codeine

Halluconigens

alter sensory perception

• mushrooms, LSD, cannabis

Inhalants

behavioral sedation with shorter effects than depressants

• gasoline, paint thinner, cleaners

Use Disorder

symptoms that indicate dysfunction associated with substance use

Intoxication

physical reaction to being inebriated or impaired by a substance

Withdrawal

physical reaction when substance is reduced or discontinued after regular use

Depressant use disorders

• alcohol use disorder

• sedative use disorder

• hypnotic use disorder

• anxiolytic use disorder

Stimulant use disorders

• tobacco use disorder

• stimulant use disorder

Cannabis use disorders

cannabis use disorder

Opiate use disorder

opioid use disorder

Hallucinogen use disorders

hallucinogen dependence - can lead to pyschosis

Gambling use disorder

behavioral disorder that cooccurs with substance use disorders

Caffiene

no substance use disorders, only intoxication and withdrawal

Substance Use

taking moderate amounts of a substance in a way that doesn’t interfere with functioning

Substance Intoxication

physical reaction to being inebriated or impaired by a substance

Substance Abuse

use in a way that is dangerous/causes significant impairement

Substance Dependence

defined by tolerance, withdrawal, drug seeking behavior

Tolerance

needing more of substance to get same/reduced effects from same amount

Withdrawal

physical symptoms when substance is reduced/discontinued after regular use

Abstinence

not using substance for an extended period of time, also known as cessation

Substance use disorder criteria

1. taking more of substance than desired

2. desire/failure to cut down use

3. excessive time spent using/acquiring/recovering (substance dependence)

4. craving for substance

5. role disruption

6. interpersonal problems

7. reduction in important activities

8. use in physically hazardous situations *cannabis

9. continued use despite physical or psychological problems

10. tolerance

11. withdrawal

Severity of substance use disorders

• mild: presence of 2-3 symptoms

• moderate: presence of 4-5 symptoms

• severe: presence of 6+ symptoms

Alcohol

increases inhibitory effects of GABA - makes neural cells worse at firing

Effects of chronic alcohol use

• intoxication and withdrawal

• dementia, werniake-korsakoff syndrome

• fetal alcohol syndrome

Alcohol statistics

• most adults in U.S consider self “light drinker”

• highest use among caucasians

• higher use + abuse in males

• 3 million people alcohol dependent

• 20% with severe alcohol problems experience spontaneous recovery

• variety in use around world - highest in E Europe, lowest in N Africa + Middle East

Binge Drinking

4+ drinks for women or 5+ drinks for men on a given occasion

Heavy Drinking

8+ drinks for women or 15+ drinks for men in a given week

Societal cost of alcohol use disorders

• unemployment

• homelessness

• health care costs

• crime

Sedatives, hypnotic, and anxiolytic use disorders

• sedatives: calming effect

• hypnotic: sleep inducing

• anxiolytic: anxiety reducing - benzodiazapines

• effects similar to alcohol

       - combining drugs with alcohol is synergetic - makes symptoms worse

• affects GABA neurotransmitter system

Stimulant Intoxication

recent stimulant use leading to significant impairment or psychological changes accompanied by physical changes - HR/BP changes, vomiting, weakness, chills, etc

Behavioral effects of stimulant use

euphoria or affective blunting

Physiological symptoms of stimulant use

hr/bp changes, chills, nausea, vomiting, seizures, paranoia, pupil dilation, weight loss

Effects of amphetamines

• increase elation, vigor, alertness

• reduce fatigue + appetite

• immediate high/euphoria

• higher body temp

• intense craving

• agitation after high - crash

Long term effects of stimulant use

• reduced brain volume

• stroke

• death

Amphetamines

• high dependence and abuse potential

• stimulate CNS by enhancing norepinephrine and dopamine release, blocking reuptake

• ecstasy/mdma

• methamphetamine

Cocaine

• elation, reduced fatigue - short lived

• blocks reuptake of dopamine

• irritability and paranoia

• slow developing addiction

• tolerance/withdrawal pattern

Withdrawal

apathy and boredom using to desire to use substance again

Nicotine

difficult to quit use

• addictive because of alkaloid in tobacco plants

Effects of nicotine

• stimulates nicotine acetylcholine receptors in CNS to increase tolerance over time

• relaxation, wellness, pleasure

• relapse rates equal to heroin, alcohol

• difficult to quit use

Nicotine and negative affect

improve mood short term, depression occurs more in those with nicotine dependence

Cannabis

• THC

• 5-15% of people in western countries regularly smoke

• biphasic

• longer lasting effects after habitual use

• impaired motivation + executive functioning - can be fixed after period of abstinence

Cannabis intoxication symptoms

• increased relaxation and sociability

• slowed time perception, fragmented thoughts, dulled attention

• impaired motor skills

• heavier doses: rapid emotional shifts, paranoia, hallucinations

Cannabis withdrawal symptoms

• restlessness

• insomnia

• depression

• anxiety

Opiate

natural chemical in opium plant with narcotic (pain relieving) effect

Opioids

natural and semi synthetic substances with narcotic effects

Effects of opiate/analgesic use

• activate ankephalins + endorphins - modulate pain

• low doses: euphoria, drowsiness, slowed breathing

• high doses: death

• lasting and severe withdrawal symptoms

High mortality rates

• fentanyl overdose

Effects of hallucinogen use

• change way that user perceives world

• delusions, paranoia, hallucinations, altered sensory perception

• act on serotonin pathways

• low dependence risk

• time dilation

• mood swings

• experience of expanded consciousness

• psychosis

• rapidly developing tolerance

Hallucinogen persisting perception disorder

re-experiencing hallucinations, flashes of color, trails of images that were experienced while using hallucinogens

• 4% prevalence rate in hallucinogen users, mainly from LSD

• can be triggered by use of other substances, noise, dark environment

• episodic or continious

Inhalants

common use in adolescents

• found in volatile solvents

• rapid absorption

• similar effects to alcohol

• tolerance + prolonged withdrawal symptoms

Anabolic steroids

used to increase body mass

• derived from testosterone

• do not produce a high

• cycling + stacking periods

• long term mood disturbances, physical problems

Motivation pathway and drugs

part of brain active when reinforcing please or avoiding pain

• dopaminergenic system - midbrain and frontal cortex

Opiates and GABA

inhibit GABA release - leads to uncontrolled dopamine release

Neurobiological effects of stimulants

directly interact with dopamine/motivation pathway

• alcohol has indirect effect

Neurobiological effects of depressants

inhibit neurotransmitters that produce anxiety/negative affect

Heritability of substance use disorders

.40-.60

• stronger between males

Genetic influences on substance use

impacted by multiple genes

• asians less likely to develop AUDs - increased alcohol sensitivity - bc of deficient metabolism enzyme (ADH2, ADH3)

• DAT 1 gene regulates dopamine reuptake - lower likelihood of smoking, increase likelihood of quitting

Societal/cultural influences on substance use disorders

• exposure to drugs

• societal view as moral failure

• risk factors, protective factors

• cultural expectations

       - expecting heavy drinking during certain occasions

       - cultural expectations of behavior after substance use that increase that behavior

Psychological influences on substance use disorders

• positive/negative reinforcement

• personality traits

• cognitive factors

Positive/negative reinforcement and substance use disorders

• positive: early drug use may be seeking a euphoric high

• negative: later, drug use is escape from withdrawal/crash

• substance used to cope with negative affect

- self medicating, tension reducing

Personality traits and substance use disorders

high negative emotionality and low constraint are predictors in both genders

Opponent process theory

theory about why crash after drug use doesn’t stop people from using - drugs themselves are easiest way to alleviate withdrawal effect

Expectancy effect and substance use disorders

people use drugs when they anticipate positive effects

Agonist Treatment

substitute drug for safe drug with similar chemical composition of abused drug 

• methadone, nicotine patch

Antagonistic Treatment

drugs that block positive effects of substance

• naltrexone - for opiates + alcohol

Aversive Treatment

make use of substances unpleasant

• antabuse, silver nitrate

Biological treatment for substance use disorders

usually ineffective when used alone, help with withdrawal symptoms

Psychosocial treatments for substance use disorders

inpatient, outpatient, community support, component treatment, prevention programs

Component Treatment

contingency management, if/then rewards

Balancing Treatment

controversial, allow use of certain amount of drug

Tobacco use ages

half started before 15yo, most started before 18yo

Prevention of substance use disorders

• counter advertisements: truth campaign

• legislative efforts: raise taxes on cigarettes, making smoke free environments

• family interventions for teens - effective for alcohol and nicotine use