Abnormal Psych Substance Abuse and Addictive Disorders

What is a substance?

Anything besides food (legal or illegal) that affects our bodies or minds

Substance use disorder

A pattern of maladaptive behaviors and reactions (impaired functioning and distress) brought about by repeated use of substances

Criteria for diagnosis of Substance Use Disorder

Must lead to significant impaired functioning or distress; and also 2+ self-destructive and/or addictive behaviors over a 12 month period

Substance Use disorder feature

intoxication, tolerance, dependence, withdrawl

Intoxication

Typically involves impaired judgment, mood changes, lowered motor ability

Tolerance

needing increasing doses to get an effect

Dependence

Needs the drug to avoid withdrawal symptoms

Withdrawal

Unpleasant or dangerous symptoms when substance use is stopped or cut down

Substance Use Prevalence

9% of all teens and adults in the U.S. display substance use disorders
11% of teens who abuse substances receive treatment from a mental health professional

substances categories

Depressants, Stimulants, Hallucinogens, Cannabis

Depressants

slow the activity of the central nervous system (CNS)

Reduce tension and inhibitions

May interfere with judgment, motor activity, and concentration

3 most widely used depressants

Alcohol, Sedative-hypnotic drugs, Opioids

Depressants: Alcohol

Absorbed into the blood through the stomach lining and takes effect in the bloodstream and CNS

Blood Alcohol Concentration

The extent of the effect of ethyl alcohol is determined by its concentration (proportion) in the blood

BAC levels

BAC = 0.06: Relaxation and comfort

BAC = 0.09: Intoxication

BAC > 0.55: Death

Effects of BAC depends on other factors

amount of alcohol has a lesser effect on a large person than on a small one, Women have less alcohol dehydrogenase

alcohol use disorder

Destroys families, social relationships, careers; plays a role in suicides,

homicides, assaults, rapes, and accidents, fetal alcohol syndrome

Alcohol Use Disorder: Prevalence

9% of people within a given year

Men outnumber women 2:1

highest in native American ethnicities

Long-term excessive drinking

damaged is the liver, cause major nutritional problems and

Dementia

Alcohol Tolerance

Steadily builds, greater amounts needed to feel its effects; which tends to increase consumption levels

Alcohol Withdrawal

Nausea and vomiting

Delirium Tremens (“the DTs”)- Consists of confusion, clouded consciousness, and terrifying visual hallucinations

Depressants: Sedative-Hypnotic Drugs

A drug used to reduce anxiety and to help people sleep binded to GABA

Sedative-Hypnotic Drugs Doses

At low doses, they have a calming or sedative effect

High doses = sleep inducers

Sedative-hypnotic drugs include

barbiturates and benzodiazepines

Barbiturates

no longer prescribed for anxiety due to problems they cause
can halt breathing, lower blood pressure, and can lead to coma and death

Benzodiazepines

have been proposed as a safer alternative

less likely to slow breathing and lead to death by overdose

relieve anxiety without causing drowsiness

Depressants: Opioids

also known are narcotics, include opium, and drugs derived from opium

Opium

a highly addictive substance made from the plant opium poppy

Morphine and Heroin

ddictive substances derived from opium

How narcotics are consumed

smoked, inhaled or injected

Opioids Side Effects

nausea, narrowing of the pupils, and constipation, induce feelings of euphoria

Opiod Withdrawal

Early withdrawal symptoms -> include anxiety and restlessness;

Later withdrawal symptoms -> include twitching, aches, fever, vomiting, diarrhea, and weight loss from dehydration

Opioid Use Disorder prevalence and danger

0.5-1%, Death by overdose

Street Opiods

Opioids are often “cut” with noxious chemicals

Dirty needles and other equipment can spread infection

dying of overdose is possible with opiods

Drug closes down the respiratory center in the brain, paralyzing breathing

Death is particularly likely during sleep

Stimulants

substances that increase the activity of the central nervous system (CNS)

Srimulaints can cause

increases in blood pressure, heart rate, and alertness, rapid behavior and thinking

4 most common stimulants are

Caffeine, Cocaine, Amphetamines, Nicotine

Stimulants: Cocaine

Derived from the leaves of the coca plant, most powerful natural substance

Cocaine Affects

Produces a euphoric rush of well-being, followed by letdown (crashing)

Increases the supply of dopamine at key neurons throughout brain as well as norepinephrine and serotonin levels

Cocaine Low Doses

Increase energy, alertness, reduced appetite.

Crash – Depression-like letdown as the effects of the drug subside

Cocaine High Doses

Heart failure, Cocaine Intoxication,Cocaine-Induced Psychosis, Overdose

Cocaine Intoxication

Symptoms include mania, paranoia, and impaired

Cocaine-Induced Psychosis

Hallucinations and/or delusions

What are the physical dangers of cocaine?

overdose, over 10,000 persons in the United States die from a cocaine

overdose each year

Excessive doses

depress the brain's respiratory function and stop breathing

Heart irregularities and brain seizures

Excessive doses often cause death

Stimulants: Amphetamines

Stimulate the CNS by increasing dopamine, norepinephrine, and serotonin

Methamphetamine

type of amphetamine, causes brain damage in long term use, known as club drug

Neurotoxicity

meth severely damages nerve endings

Stimulant Use Disorder

Regular use of either cocaine or amphetamine, 0.4-0.6% of all people

Stimulants: Caffeine

facilitates release of dopamine, serotonin, and norepinephrine in the brain, 80% of the world consumes daily

Caffeine small doses

educe fatigue and elevate mood

Caffeine regular use

Tolerance, dependence, and no gains in mood/energy

Caffeine Withdrawal

Headaches, depression, anxiety, and fatigue

Hallucinogens

Produce delusions, hallucinations, and other sensory changes

Cannabis

produces sensory changes, but have both depressant and stimulant effects

Hallucinogens

psychedelic drugs, cause powerful changes in sensory perceptions (sometimes called “trips”)

Hallucinogen intoxication (hallucinosis)

Increased/altered sensory perception; sweating; blurred vision; hallucinations

May induce extremely strong emotions, effects within 2 hours

Negative effects of Hallucinogens

“bad trip”, Flashbacks” – can occur days or months after last use

Cannabis

drugs produced from varieties of the hemp plant , major active ingredient: (THC), effects last 2-6 hours

Cannabis Intoxication low doses

joy and relaxation

Some may become anxious, suspicious, or irritated

being “high”

Cannabis Intoxication at high doses

produces odd visual experiences, changes in body image, and hallucination

Cannabis Use Disorder

users develop tolerance and withdrawal, experiencing flulike symptoms, restlessness, and irritability when drug use is stopped

Between 4-5% will engage in dependence or misuse at some point in their lives

marijuana dangerous?

May cause panic reactions similar to those caused by hallucinogens

linked to poor concentration and impaired memory

Can result in fatal car accidents while driving under the influence

Long term marijuana use

Weekly users of marijuana have a 5-point decrease in IQ by the time they reach their 40s

May cause respiratory problems and lung cancer

May affect reproduction

Marijuana addiction

withdrawal symptoms (insomnia, anxiety, stomach pains, tension)

Polysubstance Use

Taking more than one drug at a time

Synergistic Effects

When different drugs are in the body at the same time the impact is often greater than the sum of the effects of each drug taken alone

Agonist Synergistic Effects

When two or more drugs have similar actions (ex: alcohol, barbiturates, benzodiazepines, and opioids)

Antagonistic synergistic effect

When one drug impedes the processing of the other drug, leading to the build up of lethal doses

Antagonistic synergistic effect example

Stimulants interfere with the liver’s ability to dispose barbiturates/alcohol, making overdose more likely

Factors Related to Substance Abuse

Clinical theorists have developed sociocultural, psychological, and

biological explanations for substance abuse and dependence

Causes: Sociocultural View

people are more likely to develop substance use disorders when living in stressful socioeconomic conditions

substance use disorders are more likely to appear in families and social environments where substance use is valued or accepted

stressful socioeconomic conditions for substance use disorder research

Higher levels of unemployment correlate with higher rates of alcohol use

Stressful family environments

Have higher levels of stress

People of lower SES have higher rates of substance use in general

Cause for substance use disorder: social acceptance research support

rates of alcohol use vary among cultures

High problem drinking among teens whose parent’s drink

Low drinking among groups in which drinking is acceptable within clear limits

Causes: Cognitive-Behavioral Views

reinforcement and Expectancy of relief of tension

Causes: reinforcement (CB)

Drug has a tension-reducing, rewarding effect (self-medication), and rewards increase likelihood of behavior re-occurring

Similarly, the rewarding effects may also lead users to try higher doses or more powerful methods of ingestion

Causes: Expectancy of relief of tension (CB)

Such rewards produce an expectancy that substances will be rewarding, and therefore during tension this motivates individuals to increase drug use

Research Support for Cognitive Behavioral View

Many subjects do in fact use substances when they feel tense

People with psychological disorders more likely to use substances (i.e., self- medicate)

Causes: Biological Views

Research with “alcohol-preferring” animals has demonstrated that their

offspring have similar alcohol preferences, compared to a control group

Genetic linkage strategies and molecular biology techniques provide more direct evidence

abnormal form of the dopamine-2 (D2) receptor gene was found in the majority of research participants with substance use disorders, but in less than 20% of participants who do not display such disorders

Causes: Biological Views Brain Circuitry

The brain has a reward center (or reward circuit) which produces

pleasurable feelings (by releasing dopamine) when activated

Brain Circuitry: Reward-Deficiency Syndrome

term used to describe the fact that for some people, the reward circuit may not be readily activated by “normal” life events

Brain Circuitry: Incentive-Sensitization Theory

Theory that when substances repeatedly stimulate the reward center, the center develops a hypersensitivity to the substances

This leads to more pleasure derived from the substances, more likely to abuse the substances. (strong research support)

Causes: Developmental psychopathology view

1. Externalizing Temperament

2. Internalizing Temperament

has research support

Externalizing Temperament

Characterized by low frustration tolerance, overactivity, impulsivity, and inattention

family conflicts, school difficulties, behavioral problems, and undesirable peer group combine to produce substance use disorder

Internalizing Temperament

Characterized by multiple fears, depression, negative thinking
emotional pain, low self-esteem, sense of hopelessness, and interpersonal rejections combine to produce substance use disorder

Treatments: Psychodynamic

Seeks to find the root cause and internal conflicts which produced the

addiction

By itself, entirely useless since the primary cause of addiction is irrelevant to those factors

Treatments: Biological

Detoxification, Antagonist drugs, Drug maintenance therapy

Biological Treatment: Detoxification

Systematic and medically supervised withdrawal from a drug

Relapse rates are high for those who don’t receive psychotherapy after withdrawal.

2 Detoxification Strategies

Gradual withdrawal by tapering doses of the substance

Complete withdrawal but give additional medication to block symptoms

Antagonist drugs

As an aid to resist falling back into a pattern of substance abuse or dependence, antagonist drugs block or change the effects of the addictive substance

Antagonist drugs examples

disulfiram (Antabuse) produces unpleasant symptoms if alcohol is taken while on it

naloxone for opioids, naltrexone for alcohol prevent euphoric effects

Drug maintenance therapy

Methadone maintenance programs are designed to provide a safe, legally and medically supervised substitute for heroin.

Methadone

is a laboratory-manufactured opioid with a long half-life, taken orally once a day. It can be as dangerous as other opioids when not taken under safe medical supervision.

Clients become addicted to Methadone

(substituting their addiction), but much of the dangers of opioid use (contaminated needles, overdoses) are no longer present

Treatments: Behavioral Techniques

Aversion Therapy, Contingency Management Programs

Aversion Therapy

CS drug (alcohol, cigarettes) presented with an unpleasant stimulus (US)

After repeated pairings, the CS becomes aversive and they lose their craving

Contingency Management Programs

Offer clients incentives (prizes) for to remain drug-free

Research Support for Behavioral Treatment

Main limitation of these techniques is that clients need to stay motivated despite treatment’s unpleasantness or demands

Overall, behavioral techniques have some (limited) effect, but best when combined with cognitive or biological therapies