abpsych 4: substance use disorders and addiction

intoxication

a pathological psychological and/or physical state caused by a substance

tolerance

a need for increased amounts of a substance to achieve intoxication

withdrawal

the physical and psychological symptoms incurred once after the cessation of a substance that has been used for a prolonged period in time

substance use

the casual or recreational use of a substance with little to no associated consequences

substance abuse

the use of a substance that has associated consequences

substance dependence

a pattern of use that results in tolerance and withdrawal

addiction

typically understood to be characterized by compulsive use of a substance in excess and perpetuated despite negative consequences

alcohol use disorder

a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two symptoms occurring within a 12-month period

delirium tremens

• severe complication due to alcohol withdrawal

• high fever, intense agitation, visual hallucinations, tactile hallucinations

• can lead to death

korsakoff syndrome

deficiency in thiamine (vitamin B-1), impaired memory, prone to confabulation, vision problems, ataxia (balance issues)

moral model of addiction

• views addiction as a moral failing or personal weakness

• holds that drinking and drug use are freely chosen acts for which individuals are responsible

• has influenced social policy whereby individuals actively engaging in substance abuse may face punishment for their behavior (e.g., incarceration)

disease model of addiction

• views addiction as a chronic illness caused by biological and genetic factors

• holds that compulsive behaviors are related to genetic predisposition and neurobiological abnormalities

• has influenced social policy whereby individuals actively engaging in substance abuse may face forced treatment

sociocultural model of addiction

• emphasizes the role of societal, cultural, and environmental factors in addiction

• suggests that addiction rises from external pressures, social norms, and inequities rather than inherent flaws or a diseas

• has influences social policy in which attempts have been made to limit alcohol in advertising and promoting education and community-based interventions

etiology: biological theories

• genetic heritability: 50-60% for alcohol dependence, 40-60% for risk of addiction

• neurobiology: several brain circuits include many different brain areas and are related to a variety of psychological functions

  • “pleasure pathway” is associated with dopamine release: substance misuse is maintained through positive reinforcement

etiology: behavioral theory

operant conditioning: substance use becomes negatively reinforced because anxiety is removed when substances are used

etiology: cognitive theories

• drug misuse is maintained and perpetuated due to the cognitive beliefs (or expectancies) the individual holds around the substance

• one’s beliefs about how a substance will affect them and their beliefs around how well they can refuse a substance influences their substance use behavior

cognitive behavioral therapy (strong EST)

• functional analysis of behavior (antecedents, behaviors, consequences, functions of behaviors)

• relapse prevention

• behavioral activation (activity monitoring and scheduling)

• other: cognitive restructuring, behavioral experiments, response prevention

motivational enhancement therapy (strong EST)

motivational interviewing, assessment and tailored feedback

aversive treatment

• created unpleasant effects when ingesting a substance

• does not significantly improve abstinence rates compared to placebo (compliance is a major issue)

• ex: disulfiram

antagonistic treatment

• blocks or changes the effects of a substance

• can enhance overall treatment approach to alcoholism but as an adjunct to psychotherapy or a structured treatment program

• ex: naltrexone

agonist substitution

• administering a medication with a similar chemical makeup to the drug being abused without the overall negative consequences

• reduce concomitant negative behaviors such as crime and needle-sharing and seems to enable those dependent on opiates to function well enough to maintain employment and social obligations

• reduce heroin use and increase compliance with psychosocial treatments

• ex: methadone

12 steps

• admitting powerlessness

• believing in a higher power

• turning to a higher power

• self-inventory

• admitting wrongs

• being ready for change

• asking for help

• making amends

• making direct amends

• ongoing inventory

• spiritual growth

• carrying the message

alcoholics anonymous

• peer support

• may be beneficial, but there are not well-controlled studies