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Substance Use Disorder
combines abuse + dependence
different severities
mild 2-3sx
moderate 4-5sx
severe 6+ sx
alcohol prevalence
general
10% of 18-25 meet criteria
more men than women
lifetime = 29%
racial
more common in Native Americans and Hispanics
less in Black
Asian is lower than white
Alcohol physical effects
depresses the CNS
impairs judgement and inhibition
impaired fine motor skills
incoherent speech
effects on brain
stimulates GABA receptors (like benzos)
relax
increases serotonin and dopamine
pleasure
inhibits glutamine receptors
cognitive effects
long term alcohol use
impairment
social
occupational
liver cirrhosis
malnutrition
korsakoff’s
amnestic syndrome
deficiency in b-complex vitamins
damage to other organs (heart, pancreas, etc.)
erectile dysfunction
stroke
hypertension
nicotine prevalence
lifetime 18%
higher for
Native Americans
less education
lower SES
Nicotine effects
stimulates the sympathetic NS
release of NE and DOP
activates the CNS
activates the reward system
feeling of relaxation
use removes withdrawl sx
accompanying activities are relaxing
time with friends, being outside
nicotine dangers
health risks
lung cancer, bronchitis, stroke, heart disease, etc.
don’t know how much is really in e-cigarettes
marijuana prevalence
most widely used illegal drug in the US
8% of the population over 12 use
20% of 18-25
6.5% of over 25
no gender difference
~ equal across racial and ethnic groups
THC content is increasing
marijuana dangers
increases risk of EVALI = e-cigarette or vaping use associated lung injury
THC concentrations are increasing A LOT esp in vaping products
large increase in highschoolers vaping it
cognitive decificts
esp loss of short term memory
impaired motor skills needed for driving
impairs lungs
reduced ability to expel air
affects reproduction
for chronic users
marijuana effects - low dose
joy
relaxation
possible anxiety, suspicion, or irritability
sharpened perceptions (sights and sounds)
increase heart rate and BP
increased appetite
dry mouth
marijuana effects - high doses
visual distortions
hallucinations
confusion
paranoid delusions
marijuana benefits
reduced nausea and vomiting in cancer pts
improves appetite in AIDS pts
treat glaucoma
reduces intraocular pressure therefore prevents optic nerve damage
decrease seizures
decrease migraines
slows down plaque development in Alzheimer’s
opioid prevalence
0.3% of adults used heroid
1-1.5% misused prescription pain meds
opioid dangers
overdoses
used to be marketed as not addictive
leads to Heroin use when starting with prescription pain meds
opioid effects
pain relief
euphoria
drowsiness
slowed breathing
ecstasy
high lasts 4-6hrs, feel with drawl within 8hrs
build up a tolerance
methamphetamine prevalence
0.6%
more men
emerging as a major drug in the last 2 decades
methamphetamine effects
increased DOP
longer high than cocaine and cheaper than other drugs
methamphetamine dangers
destruction of tissues and blood vessels
decreased ability to heal
skin loses elasticity
meth mouth
rotted teach due to dried out salivary glands
problems with learning and memory
damage to hippocampus and limbic system
paranoid thinking and hallucinations
etiology - genetics
runs in families (esp alcohol)
high concordance rates
more likely to get addiction if
low response to alcohol
etiology - neurobiological factors
Mesocorticolimbic Dopamine Pathway (MCLP)
in the ventral tegmental area connected to the nucleus accumbens and the prefrontal cortex
rewards increase DOP here
involved in emotions, memory, and gratification
drugs overstimulate it by flooding it with DOP
Role of DOP
too few receptors increases vulnerability
toxic effect model: problems in the DOP system due to drug use damaging it
etiology - psychological
expectancies
if you believe that drugs are dangerous you are less likely to use them
get attitudes from
parents
society
friends
media
etiology - sociocultural factors
alcohol use is normalized leads to increased prevalence
2 theories
social influence model
social network can be used to predict how early and how much they will do drugs
social selection
people who are inclined to use select social networks that conform to their pattern of use
inpatient hospital treatment
starts with detox
can provide a safe space and decrease negative effects such as nausea
isn’t more effective than outpatient
provided you have good social support
CBT
3 goals
contingency management
reinforce behaviors inconsistent with drinking and avoid situations associated with drinking
community reinforcement
address multiple areas as there is more than one reason someone uses
coping skills
relationship therapy
replace substance use with new activities
identify antecedents and consequence of drug use
relapse prevention
view relapse as a failure of cognitive and behavioral skills
identify high risk situations and change mindset about drug use and view relapse as learning experienceal
alcoholics anonymous
12 step program where you make amends and admit you are powerless to alcohol
attend regular meetings (Esp at the beginning) and work with a sponsor
isn’t more effective than other treatments
controlled drinking vs abstinence
what is best for everyone varies on the type of drinker you are
older = abstinence
younger = moderation
some say abstinence leads to relapse bc with one drink you all ready blew it
others say that moderation isn’t possible for addicts
treatment - medication
antagonist drugs
block the effects of an addictive drug
antabuse → alcohol
naltrexone → opioids
treatment - drug maintenance program
lifestyle is worse than the drugs themselves
methadone programs
give heroin users methadone (synthetic opioid) and a safe space to use it
suboxone
buprenorphine (agonist) + naloxone/narcan (antagonist)
doesn’t produce a strong high but is mildly addictive
used to help transition to being clean
pretty effective! esp when combined with other therapies