psychoactive substances
alter mood, behaviour, or both; include:
commonplace legal drugs, such as alcohol, nicotine found in tobacco, the caffeine in coffee and tea
substance use
ingestion of psychoactive substances in moderate amounts
does not significantly interfere with social, educational, or occupational functioning
substance intoxication
our physiological reaction to ingested substances-drunkenness or getting high
interaction of variables: type of drug taken, amount ingested, persons individual biological reaction
intoxication experienced as impaired judgment, mood changes and lowered motor ability
substance use disorder
disorder described as an addiction
physiological dependence: tolerance, withdrawal
psychological dependence
polysubstance use (using multiple substances)
tolerance
greater amounts of drug needed to experience same effect
withdrawal
negative physical response when the substance is no longer ingested
psychological dependence
behavioural reactions to substance dependence
dependence can be present without misuse
diagnostic issues with substance related and addictive disorders
substance use might occur concurrently with other disorders
drug intoxication and withdrawal cause increased risk taking
mental health disorders cause substance use disorder
DSM-5 diagnostic criteria alcohol use disorder
at least two symptoms in the 12 month period
mild 2-3 symptoms
moderate: 4-5 symptoms
severe: 6 or more symptoms
what are the three most widely used drugs in North America?
alcohol
nicotine
caffeine
five general categories of substances:
depressants
opioids
stimulants
hallucinogens
other drugs
alcohol-related disorders
alcohol use marked by tolerance, withdrawal, and a drive to continue problematic use:
people who are physically dependent on alcohol tend to have more severe symptoms of the disorder
reverse tolerance
often part of polysubtance/polydrug use
reverse tolerance
when regular users experience more pleasure from the drug after repeated use
clinical description of alcohol-related disorders
depressant, inhibitory centres in the brain are depressed, or slowed
low-dose: reduces inhibition
high-dose: acts as a potent sedative continued drinking depresses more areas of the brain
impaired motor coordination, slower reaction time, confused, poor judgments, reduces self-awareness and self control, vision and hearing affected, memory blackouts
ingestion
stomach
small intestine
heart
liver
effects of alcohol-related disorders
influences several neuroreceptor systems
GABA, inhibitory neurotransmitter
glutamate systems-memory blackouts
DA systems-pleasurable feelings
releases natural analgesics
long term effect of alcohol-related disorders
chronic drinking causes severe biological damage and psychological deterioration
almost every tissue and organ is adversely affected:
malnutrition
cirrhosis of the liver
damage to the endocrine glands and pancreas
heart failure, hypertension, stroke, and capillary hemorrhages, which in turn can produce brain damage`
2 types of brain syndromes (alcohol related disorders)
dementia: general loss of intellectual abilities
Wenicke-Korsakoff syndrome: confusion, loss of muscle coordination, and incomprehensional speech
fetal alcohol syndrome (FAS)
affects child whose mother drank while she was pregnant
chronic use of alcohol
hand tremors, nausea, or vomiting, anxiety, hallucinations, agitation, insomnia
delirium tremens (DTs) (alcohol)
frightening hallucinations and body tremors
progression of alcohol
fluctuations between heavy drinking and abstinence
early consumption can predict dependence/abuse in later years-people who do not develop the sedative symptoms, slurred speech, staggering, etc. are more likely to abuse it in the future
sedative
calming
hypnotic
sleep-inducing
anxiolytic
anxiety-reducing
sedative, hypnotic, and anxiolytic related disorders include:
barbiturates: synthesized sedatives (seconal)
benzodiazepines: anxiety-reducing (valium, xanax)
act on GABA NT system mode of action--> diff
clinical description of barbiturates
(downers) relax muscles, induce sleep
low doses produce mild feeling of well-being
large doses - effects similar to heavy drinking
overdosing is common means of suicide
clinical description of benzodiazepines
calming, induce sleep
tolerance and dependence with repeated use
DSM-5 criteria of sedative-, hypnotic-, and anxiolytic-related disorders
similar to alcohol related disorders
maladaptive behaviours, variable moods, impaired judgment, impaired social or occupational functioning, impaired motor functioning, slurred speech
opiate
natural chemicals in opium poppy having a narcotic effect (heroin, morphine, codeine, oxycodone)
temporarily lessen pain and anxiety; high doses quality; produce a feeling of pleasure that is almost like floating on a cloud or being in a dream like state
constricts pupils, slow breathing, and cause lethargy
sleep-inducing, pain-relieving (analgesic)
amphetamines (stimulant)
"uppers" leading to a "down" and crash
DSM-5 diagnostic criteria for intoxication in amphetamine use disorders include:
behavioural symptoms: euphoria or affective blunting anxiety, tension, tension, anger, impaired judgment, and impaired social or occupational functioning
physiological symptoms: heart rate or blood pressure changes, perspiration or chills, nausea or vomiting, weight loss, chest pain, seizures, or coma
methamphetamines (stimulant)
(the most abused form of amphetamines) intense exhilaration followed by euphoria that can last for 12-16 hours and carries a high risk of overdose and dependence
MDMA or "ecstasy" (stimulant)
recreational drug that stimulates the CNS, produces euphoria and can lead to hallucinations and delusions
cocaine (stimulant)
increases alertness, blood pressure; causes insomnia; produces a quick rush of euphoria, indifference to pain and sense of well-being; a crash of agitated depression occurs within 15 to 30 minutes after neurotransmitter levels drop
tabacco-related disorders (stimulant)
nicotine in tobacco is a psychoactive substance which produces dependence, tolerance, withdrawal
single most preventable cause of premature death (1 in every 5 deaths)
stimulates pleasure pathwaya`
caffeine-related disorders (stimulant)
"gentle stimulant" found in tea, coffee, many soda drinks, cocoa products. caffeine elevates mood, decreases fatigue, but can cause insomnia
caffeine use disorder: problematic caffeine use that causes significant distress and impairment
LSD (hallucinogen)
psilocybin (mushrooms), lysergic acid amide, dimethyltryptamine (DMT), mescaline (Peyote), phencyclidine (PCP
DSM-5 diagnostic criteria for LSD include:
perceptual changes: subjective intensification of perceptions, depersonalization, and hallucinations
physical symptoms: pupillary dilation, rapid heartbeat, sweating, blurred vision
2 long term effects of LSD
persistent psychosis: a long lasting psychotic like state after the trip has ended
hallucinogen persisting perception disorder (HPPD or Flashbacks: a re-experiencing of the sensations originally produced by the LSD hours, weeks, or even years after its initial use
cannabis (hallucinogen)
dried and crushed leaves and flowering tops of cannabis sativa; major active chemical is delta-9-tetrahydrocannabinol (THC); causes impairment in memory, concentration, motivation, self-esteem, relationship with others
reverse tolerance with repeated use
psychological effects of cannabis
feeling more relaxed and sociable, can dull attention, fragment thoughts and impair memory; extremely heavy doses can induce hallucinations
somatic effects of cannabis
specific cannabinoid receptors in brain (CB) have been located in various brain regions; receptors in hippocampus may account for short term memory loss effects following marijuana use
inhalant use disorder key symptoms
recurrent use and constant craving of inhalents such as spray paint, paint thinner, amylnitrate
biological causes of substance use and related disorders
genetic vulnerability to drug abuse, alcoholism
genes on chromosomes 1, 2, 7, 11
neurobiological causes of substance use and related disorders
psychoactive drugs activate reward centre of the brain
dopamine system and the opioid releasing neurons known as MOP-r implicated
sensitization
negative reinforcement
sensitization
repeated exposure to stimulant drugs leads to increased dopamine release when taking the drug
psychological causes of substance use and related disorders
positive reinforcement: psychoactive drugs provide a pleasurable experience, use increase leads to tolerance increase
negative reinforcement: psychoactive drugs provide escape from physical pain, stress, panic or anxiety
opponent process theory (psychological dimension)
an increase in positive feelings will be followed by an increase in negative feelings a short time after
an increase in negative feelings will be followed by a period of positive feelings
expectancy effect (cognitive factor)
what people expect to experience when they use drugs influence their reaction
alcohol myopia (cognitive factor)
a state of shortsightedness in which superficially understood, immediate aspects of experience have a disproportionate influence on behaviour and emotions
conditioning theory of tolerance (cognitive factor)
underscores need to jointly consider biological processes and environmental stimuli
based on notion that tolerance is a learned response
environmental cues present influence behaviours because these cues come to be associated with substance use (classical conditioning)-signal the drug effect is coming
Shep Seigel
feed-forward mechanisms (cognitive factor)
regulatory responses made in anticipation of a drug; we learn to anticipate drug effect even before they actually occur
2 views of subtance-related disorders (social dimension)
moral weakness view
disease model of physiological dependence
an integrative model for subtance-related disorders
multiple influences interact to account for substance use disorders
access to a drug; exposure
psychological influences and stressors
biological influences
social and cultural expectations
drug use, abuse, dependence
biological treatments for subtance-related disorders
agonist substitution: chemical makeup of a drug similar to addictive drug (methadone, buprenorphine, nicotine substitution)
antagonist treatments: block or counteract the effects of psychoactive drugs (naltrexone=opioid-antgonist drugs)
sedatives to minimize discomfort for people withdrawing
desipramine: increases abstinence rates for cocaine
psychological treatments for substance-related disorder
inpatient facilities: detoxification
alcoholics anonymous: 12 step philosophy; effective with motivated individuals
cognitive and behavioural treatments
cognitive and behavioural treatments (psychological)
aversion therapy: prescribed drugs make ingesting abused substances extremely unpleasant
covert sensitization: imagining unpleasant scenes
contingency management: clinical and client select behaviour that needs to change and decides on reinforcers to reward reaching goals
community reinforcement approach: establishing relationships with people who is not a substance user
motivational enhancement therapy (MET): increase motivation to change behaviour
psychosocial treatments for substance-related disorders
relapse prevention: helping people remove any ambivalence about stopping their drug
harm reduction: controlled use of a substance rather than abstinence (not a cure) or prevention (education-based programs)
gambling disorder
persistent and recurrent problematic gambling behaviour -> significant distress or impairment
tolerance, withdrawal, craving; job loss, bankruptcy, arrests
intermittent explosive disorder
aggressive impulses resulting in serious assaults, destruction of property
kleptomania
recurrent failure to resist urges to steal things; rare; stigma associated
pyromania
having an irresistible urge to set fires
treatment for impulse-control disorders
CBT