substance abuse disorder

substances

any ingested materials that caused temporary cognitive, beahvioral, or psychiological symptoms within the individual

• Alcohol

• Caffeine

• Cannabis

• Hallucinogens

• Inhalents

• Opioids

• Sedatives

• Stimulants

• Tobacco

substance abuse

 reapeated use of these substances or frequent substance intoxication—-occurs when an individual consumes the substance for an extended period or must ingest large amounts of the substance to get the same effect a substance provided previously

the phrase “drug addiction” is not____

an applicable diagnostic term and, instead, we use “substance disorder” or say “this person has addictive behaviors”

tolerance

need to continually increase the amount of ingested substance—as tolerance builds, additional physical and psychological symptoms present—-there are differences in the depending on the substance

• Metabolic tolerance

• Pharmacodynamic tolerance

• Behavioral conditioning mechanisims

withdrawal

a syndrome that occurs when blood or tissue concentrations of a sbstance decline in an individual who had maintained prolonged, heavy use of the substance

• May include symptoms such as:

  • Milder—sweating, nausea, anxiety, insomnia, or hand tremors

  • Severe—-convulsions and hallucinations

withdrawal symptoms may vary____

•  depending on the substances (like headaches from caffeine withdrawal)

  • Alcohol withdrawal delirium—disturbances in consciousness and changes in cognitive processes (lack of awareness of the environment or inability to sustain attention)

  • Not generally found after repeated use of PCP or other halllucinogens

substance use disorder

 cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using th esubstance despite significant substance-related problems

• Distress or impairment can be described as any of the following:

  • Inability to complete or lack of participation in work, school, or home activities

  • Increased time spent or activities obtaining, using, or recovering from substance use

  • Impairment in social or interpersonal relationships

  • Use of a substance in a potential hazardous situation

  • Difficulty reducing the amount of substance used despite a desire to reduce or stop

substance intoxication

the individual must have recently ingested a substance

non substance-related (behavioral) disorders

examples include gambling disorder, sex addiction, exercise addiction, etc

-behavioral addictions that have not med standard for their own specific diagnosis (no enough peer-reviewed research)-

“conditions for further study”

provisional type of diagnosis that doesn’t yet but can be problematic

• Internet faming

• Caffeine use disoreder

• Neurobehavioral disorder associated with prenatal alcohol exposure

impaired control

the individual may take the substance in larger ampounts or over a longer period than was originally intended

social impairment

may have problems at work, school, or in social situations as a result of substance use

risky use

the individual may continue to use the substance despite the physical or psychological risks

pharmacological

tolerance and/or withdrawal symptoms possible but not required for a diagnosis

drugs can ____

mimic, block, or enhance neurotransmitters

dopamine pathway

Mesolimbic and mesocortical pathways—memory, motivation, emotion reward, desire, and addition

serotonin pathway

some drugs interfere with serotonin signaling

• Serotonin plays a role in body temp, sleep, mood, appetite, and pain

• Signaling problems are linked to OCD, anxiety, and depression—-We take SSRI’s to regulate the following disorders

gaba

among glutamate, some of the most plentiful neurotransmitters in the brain

****inhibitory (like our stoplight)——sedatives shift balance towards this

glutamate

among gaba, some of the msot plentiful neurotransmitters in the brain

***excitatory (like a greenlight)——stimulants shift towards this

drug use over time

the dopamine levels increase—jolt of pleasure

• Synapse activity decreases—-tolerance

• Brain connections are rewired—changes make the drug-seeking behavior a habit (almost a reflex)

• Changes last long after use—changes in the brain lead to cravings and possible relapse

depressants

include alcohol, sedative-hypnotic drugs, and opioids

***inhibits your central nervous system—-used to alleviate tension and stress

in large amount they impair an individual’s judgement and motor activity

ethyl alcohol

the active substance of alcohol——a chemical that is absorbed quicly into the blood via the stomach lining——travels to the CNS and produces depressive symptoms

sedative-hypnotic drugs

also called anxiolytic drugs

have a calming and relaxing effect——sedative effect

barbiturates

introduced in the early 1900s as the main sedative and hypnotic drug——-highly addictive and caused repsiratory issues

benzodiazepines

replaced barbituarates——considered a safer alternative that has less addictive qualities

***have a similar effect to alcohol as they too bind to the GABA receptors and increase GABA activity—→produces a sedative and calming effect

While they do not produce respiratory distress in large dosages, they can cause intoxication and addictive behaviors

Commonly prescribed benzodiazepines

Xanax, Ativan, and Valium

opioids

naturally occurring, derived from the sap of the opium poppy

provide both euphoria and drowsiness——tolerance builds quicky and results in an increased need of the medication

morphine

isolated from opium——-produces anaglesic effect——hihgly addictive

in an effort to alleviate the addictive nature of morphine___

heroin was synthesized by the German chemical company Bayer in 1898 and was offered in a cough suppressant

the two most common stimulants are____

cocaine and amphetamines

stimulants

increase CNS activity—-increases blood pressure, heart rate, pressured thinking, and rapid, often jerky behaviors

cocaine

extracted from the coca plant——-makes you high energy and euphoric——the most potent stimulant known to date

Low doses can produce feelings of excitement, talkativeness, and euphoria——— physiological changes such as rapid breathing, increased blood pressure, and excessive arousal can be observed

cocaine’s psychological and physiological effects are due to_____

an increase of dopamine, norepinephrine, and serotonin in various brain structures

freebasing

the most common way to ingest cocaine——involves heating cocaine with ammonia to extract the cocaine base

crack

a derivative of cocaine formed by combining cocaine with water and another substance (commonly baking soda) —-highly addictive

amphetamines

***ritalin, adderall, and dexerdrine

produce an increase in energy and alertness and reduce appetite when taken at clinical levels———-when consumed at larger dosages, they can produce intoxication similar to psychosis, including violent behaviors

caffeine

the most widely consumed substance in the world, with approximately 90% of Americans consuming some form of caffeine each day

an increase in caffeine intoxication and withdrawal have been observed with the simultaneous popularity of energy drinks

cannabis

derived from a natural plant and produces psychoactive effects

hallucinogens

come from natural sources and produce powerful changes in sensory perception

****Ketamine, LSD, and Ectasy——-Depending on the type of drug ingested, effects can range from hallucinations, changes in color perception, or distortion of objects

tetrahydrocannabinol (THC)

***active chemical in cannabis

binds to cannabinoid receptors in the brain, which produces psychoactive effects

combination

it is not uncommon for substance abusers to consume more than one type of substance at a time——-can have dangerous results depending on the interactions between substances

men outnumber women in alcohol abuse___

2 to 1

ethnically, Native Americans have the ____

highest rate of alcoholism, followed by White, Hispanic, African, and Asian Americans

cocaine is more prevalent in ___

suburban neighborhoods due to its cost and methamphetamine is used equally by men and women

substance abuse has a high comorbidity____

within itself and with other mental disorders such as mood, anxiety, PTSD, and personality disorders

substance abuse is genetically influenced but____

it is different than other mental health disorder in that if the individua is NOT exposed to the substance, they will not develop substance abuse

substance abuse disorder has both___

genetic and familial influence at play

drug abuse begins and is maintained through the ____

brain reward system

reward

any event that increases the likelihood of a response and has a pleasurable effect

mesocorticolimbic dopamine system

most researched brain reward system

appears this area is the primary reward system of most substances that are abused

As research has evolved in the field of substance abuse, five additional neurotransmitters have also been implicated in the reinforcing effect of addiction: dopamine, opioid peptides, GABA, serotonin, and endocannabinoids

alcohol

affects virtually every organ and system in the body—-absorbed through membranes in the stomach, small intestine, and colon——metabolized in the liver

alcohol intoxication depends on

• the type of alcohol

• volume and rate of consumption

• presence of food in teh digestive system

• size of the person

• sex (men and women metabolize differentialy)

delerium tremens is the most severe ____

form of alcohol withdrawal——altered status (global confusion) and sympathetic overdrive (autonomic hyperactivity) which can lead to a heart attack——GO TO THE HOSPITAL IMMEDIATEY

delerium tremens symptoms

• autonomic hyperactivity

• increased hand tremors

• insomnia

• nausea or vomiting

• transient visual, tactile or auditory hallucinations or illusions

• psychomotor agitation

• anxiety

• generalized tonic-clonic (grand mal) seizures)

remission

the symptoms do not currently meet criteria for a diagnosis, but there is a history

relapse

when a person who was in remission goes back to using th substance or having

when can we call a person recovered

depends on the person—-most say NEVER and believe that one they are an alcoholic, always an alcoholic

what is the goal?—-total abstinence or just not drinking excessively

alcohol use disorder tends to ___

run in families with 40-60% of the variance of risk is explained by genetic influences—-likely to start in mid-teens

expectancy effect

***drug-seeking behavior is presumably motivated by the desire to attain a particular outcome by ingesting a substance

• positive

• negative

positive expectations

thought to increase drug-seeking behavior

negative experiences

decrease susbtance use

behavioral causes of substance-related and addictive disorders include____

positive and negative reinforcement

sociocultural causes of substance-related disorders include____

friends and the immediate environment (familial, etc)——-also stressful life events, such as financial instability

detoxification

the medical supervision of withdrawal from a specified drug

while most detoxification programs are ____

inpatient for increased monitoring, some programs allow for outpatient detoxification, particularly if the addiction is not as severe

two main theories of detoxification

****gradually decreasing the amount of the substance until the individual is off the drug completely

OR

***eliminating the substance entirely while providing additional medications to manage withdrawal symptoms

relapse rates are ___

high for those engaging in detoxification programs, particularly if they lack any follow-up psychological treatment

agonist drugs

provide the individual with a “safe” drug that has a similar chemical make-up to the addicted drug

***One common example of this is methadone, an opiate agonist that is often used in the reduction of heroin use

antagonist drugs

Unlike agonist drugs, they block or change the effects of the addictive drug

***Disulfiram (alcohol) and Naxolone (opioid)

aversion therapy

based on respondent condition——form of treatment for substance abuse that pairs the stimulus with some type of negative or aversive stimulus

contingency management

emphasizes operant condition——-increasing sobriety and adherence to treatment programs through rewards (vouchers)

treatment for alcohol substance abuse

• CBT, motivation enhancement therapy, and marital and family counseling

SUPPORT GROUPS

***prescription medications to reduce the urge to drink

alcohol intoxication

slurred speech, lack of coordination, unsteady gait, nystagmus, impaired attention or memory, stupor, or coma

cannabis use disorder

a problematic pattern of cannabis use leading to clinically significant impairment or distress occurring——12-month period

• cannabis is often taken in larger amounts or over a longer period than was intended

• There is a persistent desire or unsuccessful efforts to cut down or control cannabis use

• A great deal of time is spent on activities necessary to obtain cannabis, use cannabis, or recover from its effects

• craving, or a strong desire or urge to use cannabis

• recurrent cannabis use failing to fulfill major role obligations at work, school, or home

• continued cannabis use despite having persistent or recurrent social or interpersonal problems caused pr exacernatedby the effects of cannabis

cannabis tolerance

a need for markedly increased amounts of cannabis to achieve intoxictation or the desired effect

• markedly diminished effect with continued use of the same amount of cannabis

cannabis withdrawal

a cessation of cannabis use that has been heavy and prolonged——-leads to irritability, anger, or aggression—-anxiety—-decreased appetite (weight loss)—-sleep difficulty——depressed mood—-restlessness

***shakiness, tremors, sweating, fever, chills

cannabis hyperemesis syndrome

repeated and severe bouts of nausea, vomiting, and abdominal pains—-long time (10+ years) of cannabis use

caffeine intoxication

recent consumption of caffeine——typically a high dose well in excess of 250 mg

• restlessness

• nervousness

• excitement

• insomia

• flushed face

• diuresis

• gastrointestinal disturbance

• muscle twitching

• rambling flow of through

panera’s charged lemonades

reported having 237 mg caffeine (previously listed as 390 mg)——2 wrongful death lawsuits

caffeine withdrawal

prolonged daily use of caffeine with an abrupt cessation of or reduction in caffeine use—-folowed within 24 hours of by three or more of the following:

• headache

• marked fatigue/drowsiness

• dysphoric mood, depressed mood, or irritability

• difficulty concentratiung

• flu-like symptoms

tobacco

active ingredient is nicotine

***previously called nicotine us disorder

tobacco use disorder

includes tolerance and withdrawal

****smoking/ingesting within 30 minutes of waking is associated with this disorder——serious medical conditions are associated with long-term use of tobacco products such as cancer and heart disease

****relapse is common

tobacco withdrawal

irritability, frustration, or anger

anxiety

difficulty concentrating

increase appetite

restlessness

depressed mood

insomnia

***causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

methods of tobacco ingestion

cigarettes, cigars, chewing tobacco, pipes, snuff, electronic nicotine (e-cigs), nicotine gum, patches

inhalants

are invisible, volatile substances found in common household products that produce chemical vapors that are inhaled to induce psychoactive or mind-altering effects

• glue, paint thinners, dry cleaning fluid, hair spray, deodorants, spray paint, whipped cream dispensers, and felt-tip marker fluid

inhalant usage

sniffing, snorting the substance from a container or dispenser

• “bagging'“—-sniffing or inhaling fumes from substances sprayed or deposited from a plastic or paper bag

• “huffing” from an inhalant-soaked rag stuffed in the mouth

• inhaling from balloons filled with nitrous oxide

purdue pharma and the sacklers family

figured out that if there is “breakthrough pain”, they would just double the dose until there is no end——-promoted that their drug was less addictive than other painkillers (fucking lied)

2023, more than 107,000 people in the US died from opioid overdose

inhalant’s effects on the body

-euphoria

-slurred speech and loss of coordination

-brain

-irritability, depression

-sores around the mouth

-possible over dose (the effects are brief which causes people to do it more)

sedative-, hypnotic, and anxiolytic

examples include: benzodiazepines (valium, ativan, halcion) and benzo-like drugs (zolpidem), carbamates, barbituarates

****brain depressants (along with opioids and alcohol)

• very significant levels of tolerance and withdrawal is possible

phencyclidine

PCP or “angel dust” ***ketamine (weaker and shorter lasting)

***most commonly smoked or taken orally—-can be snorted or injected

First developed as a dissociative anesthetic in the 50s and quickly became a street drug

• high doses can lead to stupor and coma

***can remain in the body for up to 8 days even though the psychoactive effects only last a few hours

phencyclidine intoxication

***vertical or horizontal nystagmus (rapid, uncontrollable eye movements)

• hypertension or tachycardia

• numbness or diminished responsiveness to pain

• ataxia

• dysarthria

• muscle rigidity

• seizures or coma

• hyperacusis (when sounds become unbearable loud)

hallucinogen intoxication

clinically significant problematic behavior or psychological changes——perceptual changes in a state of full wakefulness or alterness

• pupillary dilation

• tachycardia

• sweating

• palpitations

• blurring of vision

• tremors

• incoordination

hallucinogen persisting mental disorder

reexperiencing one or more of the perceptual symptoms that were experienced while intoxicated with the hallucinogen (hallucinations, false perceptions of movement in your peripheral, flashes of color, trails of images of moving objects, etc.)

relapse prevention training

identifying potentially high-risk situations for relapse and then learning behavioral skills and cognitive interventions to prevent the occurrence of relapse

****guides the patient to identify inter- and intra-personal, environmental, and physiological risks for relapse——-works with patient on cognitive and behavioral strategies and effective coping skills——psychoeducation on substance abuse, etc.

AA (alcoholics anonymous)

began in 1935—-two men suffering from alcohol abuse met and discussed their treatment options and the group slowly grew——-overarching goal is alcohol abstinence and “taking one day at a time”

****developed the twelve step traditions to help guide members n spiritual and character development—-led to other programs for other substance abuse

residential treatment centers

similar to self-help——-individuals are completely removed from their environment and live, work, and socialize within a drug-free community while also attending regular individual, group, and family therapy

***treatment varies from program to program——most focus on CBT and BT techniques——also incorporate a 12-step program into treatment