Ch10 Concepts: Substance-Related Disorders

What’s substance use? 🚬

• Moderate use, but may not interfere w/ functioning

• Negative consequences: too many smoke breaks 🚬

• Disorder: negative pattern of substance use that causes major distress and impairment (do you need those gummies everyday to function?) 😰

  • Symptoms must be greater than 2 of 11 in 4 areas: impaired control (increased cravings), social impairment (failing grades), risky use (drunk driving, bad decisions), physical dependence (tolerance; NEED nicotine in your system)

What’s substance abuse? 🚗 🧒

Dangerous use causing major impairment: child neglect, drunk driving

What’s substance dependence? 😍

• Can’t physically function without substance 😵‍💫

• Feels normal with the drug. Often includes tolerance and withdrawal.

Physical tolerance means? 🔼

Needing higher amounts of drug to achieve the same effect 📈

Withdrawal means? 😰 ⚫

• Negative physical symptoms when drug’s not in use

• Can be severe, including cold sweats, blackouts, seizures

Which of the major substances are associated with physical dependence, tolerance, and withdrawal?

• Physical dependence

  • Cannabis: rare

  • Alcohol: 3 million Americans report if they stopped drinking it’d impact their ability to study, work, etc. Worldwide it’s varied: Peru, Korea, Taiwan, China (most to least)

  • Inhalants: significant dependence

• Tolerance

  • LSD: very rapid

  • Inhalants: significant tolerance

• Withdrawal ❌

  • LSD: very rare

  • Cannabis: very rare

  • Opiates: severe, lasting withdrawal symptoms

Major changes by DSM-5 to improve diagnoses of substance disorders?

• Diagnose if a “use”, “intoxication”, or “withdrawal” disorder

  • Ex: opioid use disorder

• Rate level of severity (number of 11 symptoms)

  • Mild: 2-3 symptoms; Moderate: 4-5; Severe: higher than 6 of the 11 symptoms

• Rate if in “remission” state (cravings, but no other symptoms)

  • Early (3-12 months) vs Sustained (more than 12 months)

Major types, patterns of use, and specific impact of DEPRESSANTS🔽

• Effect is sedative, calming/relaxing ☺(barbiturates, alcohol🍺)

• Synergistic effect: multiplies effect, increases risk of death 💀

• Antidepressants, alcohol, and cold medications SLOW breathing and heart rate 🔽

Major types, patterns of use, and specific impact of STIMULANTS 📈

• Effect: increased alertness, mood, energy 🔼

• Major types of stimulants

  • Legal: caffeine blocks adenosine (NT) receptors and increases reuptake, increasing sleepiness and decreasing arousal. Regular use is more than 250 mg daily!

  • Symptoms more than 5 of 12:

    • Overexcitement: restless, insomnia 😄

    • Physiological response: diuresis, tachycardia 💧

    • Cognitive/motor response: twitchy, rambling 🦜

  • Illegal: cocaine blocks reuptake of dopamine, highly addictive!

    • Amphetamines increase norepinephrine and dopamine, blocking reuptake of both and exciting the CNS 🔼

      • Milder (Ritalin) + potent form (crystal meth) creates high dependence and tolerance!

  • Chronic use: permanent CNS damage

    • Increased heart attacks, seizures leads to greater risk of death 💀

  • DSM-5: Cocaine intoxication disorder. Intoxication leads to major physical changes, causing dysfunction/distress 😰

    • Increased heart rate/blood pressure, weight loss, body weakness, chills

Major types, patterns of use, and specific impact of OPIATES 💊

• Effect: Pain relief and narcotic

  • Opiate: poppy plant (opium, morphine) 🪴

  • Opioid: synthetic or partly synthetic (FAKE)

• Activates enkephalins and endorphins in brain

  • Low doses: increased euphoria, decreased drowsiness

  • High doses: decreased heart rate and breathing 🔽

  • Severe, lasting withdrawal symptoms

• Increased mortality: increased heart failure, HIV risk from injections, infections 💉 🫀

Specific medical conditions and disorders associated with long-term chronic use of excessive alcohol?

1. Wernicke-Korsakoff syndrome: brain damage, severe thiamine depletion 🧠

2. Neurotoxicity: brain cells die = dementia 💀❓

Main differences between “sedative”, “hypnotic”, and “anxiolytic” drugs?

1. Sedatives: calming, relaxing (barbiturates) ☺

2. Hypnotic: increase sleepiness (sleeping pills) 💤

3. Anxiolytic: decrease anxiety (benzodiazepines) 🔽

How do inhalants, other drugs of abuse, influence certain bodily symptoms and functions? 🌬

• Solvents and aerosols inhaled through lungs (spray paint, gas, nitrous oxide) ⛽😮‍💨

• Huffing: quickly inhale/huff through mouth

  • Rapid transfer: lungs to blood to brain 🫁🩸🧠

  • Rapid absorption: faster than alcohol ⏩

• Significant tolerance and dependence; prolonged withdrawal symptoms!

Main statistics and demographic characteristics associated with alcohol use including sex, age, etc. effects? 🍺

• Regular alcohol use: over 50% (1 out of 4 users)

  • Binge drinking = more than 4-5 drinks every 2 hours: 23%

• Ethnicity 🏈

  • Frequent use: Whites (57%) vs Asians (40%)

  • Binge drinkers: American Indians (24%) vs Asians (12%)

• Men report more alcohol abuse than women 👨

• College: drinks a week and grades 📚

  • A students average 3 drinks a week

  • D/F students average 11 drinks a week

• Physical dependence: 3 million Americans report that if they stopped drinking, it’d impact their ability to study, work, etc. Worldwide, it’s highly varied!

  • Peru: 36% (1 out of 3)

  • Korea: 22% (1/5)

  • Taiwan: 4%

  • China: 0.5%

• Alcohol use DOES NOT lead to greater violence or aggression. It DOES affect your impulsivity, poor judgment, disinhibition, etc. by increasing it. Effects your brain that says, “you’re angry, just walk it off” 🚶‍♂

Distinct features of hallucinogens? 😵‍💫

• Cannabis increases euphoria and sensory distortions. Mood swings, paranoia, and hallucinations/delusions may decrease motivation

  • Dependence and withdrawal VERY RARE!

  • Most commonly used hallucinogen (5-15%)

• LSD is much stronger than cannabis! Increased psychotic delusions and hallucinations (bugs eating skin, paranoia)

  • Tolerance: very rapid 🏃⏩

  • Withdrawal: very rare ❌

Biological contributions to substance abuse/dependence? 🧬

1. Family, twin, adoption studies show that Latinx and Blacks have greater risk for heroin abuse 💉

2. Asians have alcohol sensitivity and lack enzyme to break down blood alcohol 🇰🇷

   1. Increased blood toxicity leads to more flushing, nausea, heart rate, sweating 🥵

3. Genetics research show substance abuse is caused by multiple genes. You also may do well w/ 1 med and not another.

Psychological contributions to substance abuse/dependence? 🧠

1. Positive reinforcement: early use increases euphoria and high

2. Negative reinforcement in later use to avoid crash & withdrawal; used to feel normal, get thru day due to chronic use.

3. Self-medication for coping with negative mood and affect; decreases tension and stress. Escape from life stressors.

4. Opponent-Process Theory: negative withdrawal should lead to stop using. Use drugs to decrease withdrawal symptoms (negative reinforcement)

5. Expectancy beliefs: cognitive influences anticipate positive effects of use, leading to more continued use

6. Cravings create physical changes in the brain, triggered by multiple cues (images, smells, mood, environment, drug availability) 👃

Neurobiological contributions to substance abuse/dependence? 🧠🧬

• Dopaminergic system affects pleasure, overacting reward pathways 🔼

  • Stimulants increase dopamine release!

• GABA acts as brain police by inhibiting/slowing down reward-pleasure system 👮 ❌

  • Increased calmness, relaxation, sleepiness

  • Alcohol is a GABA agonist (mimics effect on brain)

Psychological treatments for substance disorders? Overall effectiveness? 🧠

1. Inpatient VS Outpatient treatment both effective

2. Community support programs often effective but requires abstinence

3. Balancing treatment goals: controlled drinking instead of abstinence

4. Component treatment: using different types of treatment strategies, like psychotherapy and contingency management (behavioral therapy) 

5. Comprehensive treatment: IND/GRP format

   1. Aversion therapy and covert sensitization: pair unpleasant/negative experiences with drug cues and urges 

   2. Contingency management: using reward system to reward positive behaviors, but punishes negative drug behaviors ⭐

   3. Community reinforcement: increase positive non-drug social support & relationship networks 

6. Relapse prevention: identify cues/triggers (increase cravings), avoid high-risk situations 

7. Recent policy to decrease drug rehab and division

Medical treatments for substance disorders? Overall effectiveness? 🏥

1. Agonist substitution: using a safer drug or method for similar effect 💊

   1. Nicotine gum/patch. Methadone for opioids.

2. Antagonistic treatment: blocks/counters POS effect of drug at brain’s receptors ❌

   1. Naltrexone decreases effect of opiate/alcohol

3. Aversive treatment causes negative reaction if drug is used

   1. Antabuse w/ alcohol causes vomiting, cramping, seizures!

4. Effect: decreased withdrawal

Social influences associated w/ substance disorders? 💭

• Exposure to substances

  • Social media and advertising shows it’s fun and popular 📱

  • Family & peers: recreational drug use, acceptance

  • Parents/family: poor supervision & role models

• Societal views believe we can voluntarily control, believing only the morally weak become addicts!

  • Disease model: biological predisposition means inevitable substance use 🧬

Cultural influences associated w/ substance disorders? 🇰🇷 🇯🇵

• Different cultural norms may support substance use (ex: heavy drinking for Asian business cultures) 🍻

  • Strong drinkers = more manly, better leaders/workers

• Cultural expectancies lead to drug-related behaviors

  • Liquid courage: increased confidence, sexual prowess 🥵

How do steroids, other drugs of abuse, influence certain bodily symptoms and functions?

• Anabolic-androgenic steroids

  • Medical use: increase body mass, muscle repair 💪

  • Cycling: multiple doses, stop use, multiple doses to avoid drug testing

  • Stacking: combined different types but lower levels

  • No physical high: long-term mood issues and physical problems = increased irritability/aggression, mood swings, infections; compromise cognitive ability 😡

  • Prescribed for asthma too!

How do designer/party drugs, other drugs of abuse, influence certain bodily symptoms and functions? 🥳

• Initially, Big Pharma created for other uses to sell on market

  • Ketamine (Special K) & Nexus (2C-B)

• Major effects (party drugs)

  • Induces drowsiness, decreased pain 😴

  • More dissociative or sensory perceptions

  • Tolerance, Dependence: high

What activates enkephalins and endorphins in the brain? 🪴

Opiates

Most commonly-used hallucinogen? 🌿

Cannabis

Which drug involves “huffing”? 😮‍💨

Inhalants 🌬

_____ is when a person needs higher doses of a substance to achieve the same effect.

Tolerance

Which depressant reduces anxiety?

Anxiolytics 🔽