UIUC PSYC 238 QUIZ 6: Substance Abuse, Eating Disorder, Childhood and Mental Health

Psychoactive Substance

substance that alters mental ability, mood, or behavior

ex. nicotine, LSD, alcohol

Substance use disorder

A pattern of substance use leading to clinically significant impairment or distress

Symptoms: at least 2, occurring within a 12 month period

number of symptoms of substance abuse

11 symptoms fit into 4 categories

4 categories of substance abuse symptoms

• Impaired control

• Social impairment

• Risky use

• Tolerance/Withdrawal

Substance abuse severity

Determined by the number of criteria/symptoms met

• mild: 2-3

• moderate: 4-5

• severe: 6+

Category: Impaired control

• Substances used in larger amounts or for a longer amount of time than intended

• Wants to stop, reports that they can't

• Spends a lot of time getting/using/recovering from effects of substances

• Craves substances often

Category: Social impairment

• Recurrent substance abuse results in failure to fulfill major obligations (work, school, home etc.)

• Continued use despite issues it causes

• Important activities might be given up due to substance use

Category: Risky Use

• Recurrent substance use in situations where its physically harmful

• Continued use of substance use despite knowing that substance may be physiologically or psychologically impairing

Category: Tolerance and Withdrawal

• Tolerance:

  • Marked increased dose of the substance to get the same effect

  • Reduced effect when the usual dose is consumed

• Withdrawal: a set of physiological symptoms a person experiences when drug use is stopped or decreased

  • Ex. throwing up, feeling sick

• These are indicators of physiological dependence

How does cocaine interact with the brain?

It blocks the reabsorption (reuptake) of dopamine

Substance use at UIUC

• 67.8% of UIUC drank alcohol in the last year (2018)

Alcohol use disorder: prevalence

Age

• Highest among young adults (18-29)

• Lowest among elderly (65+)

Gender

• Men are 5x more likely to chronically use alcohol

• Trans individuals show higher use than gen pop

  • Substance use disorder comorbid with anxiety and depression

Race/ethnicity

• Indigenous Americans have highest rates of alcohol abuse and dependence

Alcohol use disorder: etiology - genetic factors

Gender

• Males: MZ = 56%, DZ = 33%

• Females: MZ = 30%, DZ = 17%

• Binary gender differences in alcoholism for MZ and DZ twins could be attributed to:

  • Women have lower physical tolerance

  • Negative social attitudes towards public intoxication for women

Cloninger adoption study

• Type 1: bio parents had later onset of drinking problems with absence of criminal behavior

• Type 2: bio parents had early onset of drinking problems and had undergone treatment or presence of criminal behavior

• Children of Type 1 and Type 2 parents were adopted into 2 kinds of homes: heavy drinking and absence of heavy drinking; also had a control group

• Results: Type 1 genes increase risk of alcoholism only in the presence of an alcohol household, whereas alcoholism is primarily genetically determined whenever Type 2 genes are present

Results of Cloninger Study (Type 1)

- Without genes, environment didn't make much of a difference in STABLE homes
- Environment played bigger role in Type 1 than Type 2
- High percentage of genetically predisposed had alcoholism in UNSTABLE homes
**G x E Environment**

Results of Cloninger Study (Type 2)

- Having Type 2 genes increased risk for alcoholism REGARDLESS of adoptive father's drinking habits
- Very high rates of alcoholism in children in unstable homes, still larger percentage in stable homes
**PRIMARILY GENETIC EFFECT**

Substance use disorder: etiology - social factors

• Cultural/religious influence on early exposure/attitudes

• Initial experimentation more likely in rebellious and extraverted or if peers/parents encourage

• Increased risk with affiliate with peers who use drugs if unstable home environment, low parental monitoring, systematic problems

• Gateway Hypothesis: using one psychoactive substance increases the likelihood of using others

  • NOT supported by research

Substance use disorder: etiology - psychological factors

Expectations of alcohol

• enhances social and physical pleasure

• enhances sexual performance

• improves mood

• reduces tension

• increases social assertiveness

Positive expectations have a stronger influence

Operant conditioning: drug use is more likely to continue through positive reinforcement and negative reinforcement

Classical conditioning: “drug cues” elicit conditioned responses through repeated pairings with drug use

Substance use disorder: etiology - common liabilities model

• Study followed 7-9th graders into adulthood

• Teens who later developed substance abuse were also likely to exhibit other “problem behaviors”

• Might stem from the same underlying factors (ex. common liabilities to neurological, psychological, or social factors)

• This model tries to explain comorbidity between substances and between psychopathology

What drug seems to be the most addictive?

Tobacco

DARE Program (Drug Abuse Resistance Education)

• a common prevention program

• not effective in reducing substance use

Pediatric substance abuse

Higher risks than adult substance use:

• impacts on developing brain

• more likely to cooccur with other risky behaviors

• likely to influence future behaviors

Substance abuse disorder: Treatment considerations

• most people don't seek treatment

• compliance in treatment is low and attrition is high

• high comorbidity rate of alcoholism and mental disorders → makes treatment more challenging
  (ex: individual with social anxiety disorder might feel more comfortable in social situations after having a few drinks)

• detoxification and antabuse

Treatment goals: abstinence vs harm reduction

• abstinence: stop taking substance entirely

• harm reduction: trying to reduce the harm to the individual and society that may come from substance abuse and dependence

Detoxification (Medical Detox)

- specific to alcoholism
- medically assisted withdrawal
- gradual decrease of alcohol usage over time

Goal of Detoxification

to help wean a person off of alcohol by slow decrease of usage to avoid severe withdrawal symptoms, under doctor's care

Antabuse

medication (pill) that makes body unable to process alcohol, taking Antabuse makes person throw up + other violent symptoms

Why does Antabuse work?

CLASSICAL CONDITIONING
- brain pairs negative outcome of consuming alcohol with violent symptoms, person less likely to consume alcohol

What type of therapy is Antabuse?

Aversion therapy; decreases appeal of drinking through physiological effects

Which of the following is NOT true about Antabuse?
a. It blocks the processing of alcohol by the body.
b. It reduces alcohol cravings by pairing alcohol use with a negative response.
c. It is administered to prevent lethal withdrawal symptoms.
d. It operates under the principles of classical conditioning.

c. It is administered to prevent lethal withdrawal symptoms.

Treatment Goals: Harm Reduction

- minimize harm associated with drug use for the individual or society, valid way to treat
- Ex: recovery programs that distribute clean needles or other things that encourage safe use if individual is going to continue usage, take-home Narcan, supervised consumption facilities
**IDEA: there will always be people that use dangerous substances, would rather create a safe environment to reduce death, no pressure to stop or slow usage**

Motivational Interviewing

A non-judgmental, non-confrontational, non-adversarial approach that attempts to increase clients' awareness of:

• potential problems

• consequences

• risks faced as a result of behavior

Based on 5 general principles:

• expressing empathy

• developing discrepancy

• rolling with resistance

• supporting self-efficacy

• avoiding argumentation (and direct confrontation)

Other Treatments for Substance Abuse Disorder

• CBT

• 12-step program

• Residential treatment

• Family therapy

12 Step Program for Substance Abuse

- three main ideas:
1. acceptance: drug addiction is a chronic illness, life has become unmanageable
2. person must surrender giving themselves over to a higher power, big turn-off for a lot of people because many people do not believe in a higher power
3. active involvement with others, have to go to your meetings

Residential Treatment

- dealing with things currently and making plans to help in the future, what it feels like waking up without drinking, removes them from access to substance

Family Therapy

- targeting adolescents, highlights need to introduce family into treatment, address a wide variety of problems in addition to drug problem, how they address conflict, communication, problems with school/peer conflicts

Treatment Outcomes for Substance Abuse

• relapse is not uncommon

• no one treatment is superior to others

• improvements in general health, social, and occupational functioning usually accompany reduction in drug use

• positive long-term outcomes are most favorable when:

  • high degree of coping resources

  • available social support

  • low stress situations

Opioid epidemic

Quick summary

• 700,000 deaths from a drug overdose → 68% of which were opioids

What’s being done:

• national public awareness campaign

• big fight between law enforcement vs education

Feeding and Eating Disorders

- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder

Binge Eating

- someone eats a large amount of food in a short amount of time
- DSM-5 lists as two hours
- larger amount of food being consumed than the average during same time period
- loss of control must be present to meet criteria for a binge in DSM-5

Objective Binge

- eating a lot of food according to scientific standards
- is associated with a loss of control

Subjective Binge

- someone feels loss of control
- person feels that they are eating a lot for THEIR own standards, in reality, not a lot of food

Compensatory Behaviors

- bunch of different behaviors aimed at offsetting food consumption for weight loss
- could be over-exercising
- present in both anorexia and bulimia

Purging

- any behaviors someone participates in to try and get rid of food right after consumption in order to lose weight
- Ex: throwing up, misusing laxatives

The eating behaviors that the young woman in the video describes appear to be an example of...
a. An objective binge
b. A subjective binge
c. Compensatory behaviors
d. Purging

a. An objective binge

Anorexia Nervosa

- Restriction of energy intake, SIGNIFICANTLY low body weight
- Intense fear of gaining weight that does not diminish
- Distorted sense of body shape, undue influence of body weight or shape on self-evaluation, OR lack or recognition of seriousness of low body weight

Anorexia Types

- Restricting type
- Binge-eating/purging type

Restricting type

- Limit the amount of food eaten
- No recurrent episodes of binge eating or purging in the last 3 months

Binge-eating/purging type

- Recurrent episodes of binge eating or purging in the last 3 months

Bulimia Nervosa

- Binge eating (objective)
- Inappropriate compensatory behaviors to prevent weight gain
- Binge eating and compensatory behaviors must occur ONCE a week for 3 months
- Self-evaluation is unduly influenced by body shape and weight
**NOT UNDERWEIGHT, usually normal weight or overweight**

Anorexia Bodily Functions

- low blood pressure
- cold and lethargic
- no energy from starvation
- no fat to keep warm

Lanugo

thin white hair that develops all over the body, body's last resort to maintain body hear because there us little to no fat on body
**ANOREXIA**

Amenorrhea

no menstruation, no symptoms of period aside from blood, used to be required for diagnosis
- PROLONGED AMENORRHEA CAN LEAD TO INFERTILITY
**ANOREXIA**

Pollinia

- electrolyte imbalance that can cause heart failure, kidney failure, and can lead to seizures
- most dangerous part of anorexia

Bulimia Bodily Functions

- repeated vomiting can lead to erosion of tooth enamel, dentist may be first to know
- overly sensitive gag reflex even when not intentional
- swelling in face
- electrolyte imbalance

Further health issues occur from bulimia because...

electrolytes regulate nerve and muscle function and rebuilding damaged tissues, same consequences in anorexia

Electrolyte Imbalance in Bulimia

electrolytes interact with water and hydration over time; someone vomiting and using diuretics will often throw off electrolytes and lose water

Binge Eating Disorder

1. Recurrent binge eating (same as bulimia)
2. Episodes associated with 3 (or more) of there following:
- eating more rapidly that normal
- eating until uncomfortably full
- eating large amounts of food when not physically hungry
- eating alone because of embarrassment
- feeling disgusted with self after binge
3. Marked distress from binge eating is present
4. The binge eating occurs at least ONCE a week for 3 months
*NOT associated with obesity*

Anorexia-Restricting Type Common Features

- Significantly underweight
- No binge eating
- Compensatory behaviors

Anorexia-Binge/Purge Type Common Features

- Significantly underweight
- Binge eating
- Compensatory behaviors

Bulimia Nervosa Common Features

- Normal or overweight
- Binge eating
- Compensatory behaviors

Binge Eating Disorder Common Features

- Normal or overweight
- Binge eating
- No compensatory behaviors

For the last few years, 25 y/o Lauren has struggled with her weight. She constantly wants to lose weight but is never satisfied when she does lose weight. If and when she does eat, she eats large quantities of food. She then exercises for 5 hours and throws up after. Her current BMI is 16 and she is beginning to have issues with her physical health. What eating disorder would she likely be diagnosed with?
(Note: a BMI of 18 to 24.9 is considered healthy for adults)
a. Bulimia Nervosa
b. Binge Eating Disorder
c. Anorexia Nervosa, Restrictive subtype
d. Anorexia Nervosa, Binge Purge subtype

d. Anorexia Nervosa, Binge Purge subtype

For the last few years, 23 y/o Chelsea has been struggling with her body image. At least once a week, she will eat large quantities of food (> 3,000 calories) in one sitting and then will exercise for 5 hours and take laxatives in order to prevent weight gain. Her current BMI is 27. What eating disorder would she likely be diagnosed with?
(Note: a BMI of 18 to 24.9 is considered healthy for adults)
a. Bulimia Nervosa
b. Binge Eating Disorder
c. Anorexia Nervosa, Restrictive subtype
d. Anorexia Nervosa, Binge Purge subtype

a. Bulimia Nervosa

Eating Disorder Social Factors

- Prevalence in U.S. increased with thin ideals
- Media effects
- More common in career fields emphasizing thinness
- Gender stereotypes
- Standards of beauty
- Peer groups
- Pro-Ana websites, #thinspo

Pro-Ana

blogs, chat forms, TikTok pages, any online source that supports a form of disordered eating; these websites strengthen disease of anorexia and praise weight-loss, discourage healthy body shapes and sizes

Eating Disorders Biological Factors

- Genetics; high heritability, weight set points
- Brain differences; decreased functioning of hypothalamus, differences in serotonin
- Poor interoceptive awareness

Decreasing functioning of the hypothalamus is associated with

hunger

Decreased seratonin can lead to

cravings of carbs; more likely to engage in binge

Interoceptive

being aware of internal body cues

Eating Disorders Personality and Cognition

- excessive concern of opinions of others, need to please (socialized for women)
- struggle with control
- high perfectionism
- neuroticism
- impulsivity

Which of the following is NOT a health complication often associated with bulimia?
a. Electrolyte imbalance
b. Lanugo
c. Dehydration
d. Eroded tooth enamel

b. Lanugo

Eating Disorders - Family

- Low parental warmth and high demands
- Enmeshment
- Overprotectiveness
- Rigidity: Avoid dealing with events that require change
- Conflict avoidance or lack of resolution
- Modeling preoccupations or direct messages about thinness

Enmeshment

an extreme form of over-involvement and intimacy in family
*more common in anorexia
Ex: parents do not allow closed doors in house

Overprotectiveness

an extreme level of concern for each other's welfare
*more common in anorexia

Eating Disorders Maintenance Factors: Emotion

- Binge eating is a way to deal with negative emotions (NEGATIVE REINFORCEMENT)
- Research shows that negative emotions are higher immediately after binge eating

Eating Disorders Dieting

Dietary restraint - overly restrictive eating predicts binge eating
- overly restrictive diet -> hunger, frustration -> increased risk of binge eating
*strict dieting is likely to contribute to subsequent binge-eating especially in those with bulimia*

Lucas has episodes 2x a week in which he orders 3 chili cheese dogs, French fries, 2 large chocolate cake shakes, and a strawberry shortcake. He eats everything in 1 hour. After each episode, he spends the rest of that day running on a treadmill (5+ hours) and spends the next few days fasting and avoiding all food in order to avoid weight gain. His BMI is 23. What eating disorder best represents Lucas' experiences?
a. Bulimia Nervosa
b. Binge Eating Disorder
c. Anorexia Nervosa, Restrictive subtype
d. Anorexia Nervosa, Binge Purge subtype
e. None of the above

a. Bulimia Nervosa

Anorexia Nervosa Epidemiology

- Cisgender women: ~1% lifetime prevalence
- Cisgender men: ~0.3% lifetime prevalence
- Trans folks: 2x-4x the prevalence
- Non-binary folks: mixed results; greater or comparable risk to trans folks

Bulimia Nervosa Epidemiology

- Cisgender women: ~1.5% lifetime prevalence
- Cisgender men: ~0.5% lifetime prevalence
(trans/non-binary stats consistent across all ED's)

Binge Eating Disorder Epidemiology

- Cisgender women: ~3.5% lifetime prevalence
- Cisgender men: ~2% lifetime prevalence
(trans/non-binary stats consistent across all ED's)

Eating Disorders Intersectionality

- Higher risk for individuals who identify as having experienced marginalization or discrimination
- Racial identity and gender identity interact in U.S.
- Only difference in binge eating disorder in Asian Americans/Pacific Islanders

Eating Disorder Epidemiology and Culture

- Anorexia found in many cultures throughout history
- Bulimia occurs in same frequencies in industrialized countries
- White women at greatest risk for disordered eating
- Culture appears to have a stronger effect on the prevalence of bulimia versus anorexia

Necessary Steps for Treating Eating Disorders

- Multidisciplinary approach is necessary
- Dietician, psychiatrist, general practitioner
- Need to make sure dietary needs are met
- Hospitalization is often necessary for anorexia

Goals of Treatment of Anorexia

2 major goals
- weight gain
- address difficulties that maintain the problem
- Interpersonal relationships

Challenges to Treatment of Anorexia

- Ego-syntonic issues of pride; fear of weight gain

Which of the following is the etiological factor for eating disorders that describes family members' excessive togetherness and weak family boundaries?
a. Interoceptive awareness
b. Rigidity
c. Enmeshment
d. Overprotectiveness

c. Enmeshment

As a teenager, Cori began perceiving their body negatively, fearing weight gain, and spending much of their time researching "fat-burning" exercise, restrictive diets, and "cleanses". Cori began denying themself enough food and excessively exercising such that their BMI went from 25 to 20 within a school year. At this time, they would be diagnosed with ______________. However, over the next 12 months they start to misuse laxatives after eating and their BMI drops to 17. Following, they would receive a diagnosis of ______________.
(Note: a BMI of 18 to 24.9 is considered healthy for adults.)

a. No diagnosis; Anorexia Nervosa - binge/purge type
b. Anorexia Nervosa - restricting type; Anorexia Nervosa - binge/purge type
c. No diagnosis; Anorexia Nervosa - restricting type
d. Bulimia Nervosa; Anorexia Nervosa - binge/purge type

a. No diagnosis; Anorexia Nervosa - binge/purge type

Two Primary Family Intervention Approaches for Anorexia

- Maudsley approach
- Minuchin approach

Maudsley Approach

- separates child from illness, provide support to parents
- MULTIPLE PHASES:
- First phase: parents take complete control over child's eating
- Second phase: control is gradually shifted back to child
- Third place: child gains proper autonomy towards eating

Minuchin Approach

- (ENMESHMENT) therapy that specifically focuses on enmeshment; helps parents adopt developmentally appropriate behaviors
- Ex: parents originally did not allow closed doors in house; parents now allow closed doors in house
**AIMS TO CHANGE FAMILY BEHAVIOR TO HELP HEAL EATING DISORDERS**

Common Outcomes of Eating Disorders

9% die from eating disorder illness

Bulimia Nervosa: Treatment

- Occurs mostly in outpatient settings in individual, group, or combination therapy
- Nutritional intervention (instructions on modifying eating patterns) and meal planning

Bulimia Nervosa Treatment Goals

- Stabilization of eating patterns
- Address maintenance factors such as emotional dysregulation, interpersonal relationships, etc.

Bulimia Nervosa CBT Example

works to collaboratively identify maintenance factors, introduce regular eating
(ex:
BEFORE therapy: breakfast-skip;
lunch-green salad;
snack-skip;
dinner-binge.
AFTER therapy:
breakfast-cereal w/ milk;
lunch-green salad;
snack-granola;
dinner-steak and potatoes)

Abstinence Violation Effect

negative effects when someone has been avoiding an activity, "cheats", and then engages in indulging too much

Bulimia Nervosa CBT

1. Collaboratively identity maintenance factors, introduce regular eating
2. Address maintenance factors
3. Focus on the future
- exposure to "forbidden" foods and preventing purging behaviors; similar treatment in OCD
- Abstinence violation effect

Bulimia Nervosa Interpersonal Therapy

- originally developed for depression
- focus on themselves and their lives

Biological Treatment for Eating Disorders

antidepressants are somewhat effective

Comparing Treatments for Eating Disorders

- Success rates treating bulimia higher than anorexia treatment rates
- 70% of people with bulimia show complete improvement from symptoms
- CBT is superior to medication at preventing relapse for BN and BED
- For youth, family therapy superior to individual therapy for treating youth with eating disorders
**COMBINATION THERAPY IS THE BEST APPROACH**

Childhood and Mental Health Disorders

- Autism Spectrum Disorder
- Attention-Deficit/Hyperactivity Disorder