[ABPSY] Substance Use Disorders

current news

Current News

• Mood is really low and motivation 

• Bring up with your psychiatrist 

• Not seeing it holistically

  • Not just because there’s access io it but because there are underlying factors 

• E.g. Duterte ICC 

  • Crimes against humanity

  • Mayor until Presidency 

nonverbatim conversations with friends

• They have a choice not to use drugs

• They should be held accountable for their actions 

• Users getting killed is a necessary sacrifice to create fear and restore order

• Remembering the victims of EJK is equated to supporting drug users

• Not taking into account the background 

substance-related and addictive disorders

• Patterns of maladaptive use of substances that lead to significant levels of impaired functioning or personal distress

types of substance-related and addictive disorders

1. substance use disorder

2. what to notice

3. abused drugs

substance use disorder

• Duration: symptoms should be present for 12 months

• Abuse of or dependence on a mood or behavior altering drug

• Substance 

  • Anything ingested in order to produce a high, to alter one’s senses or affect one’s functioning 

• Vision, mood, emotion, even the way we interact with each other 

• Ingestion: oral, intravenously, intranatally depending on substance used

characteristics of substance use disorder

1. impaired control

2. social impariment

3. risky use

4. pharmalogical criteria

[charac] impaired control

• Hard to stop on their own 

• Can’t just tell them to stop using the substance

• Tolerance and withdrawal

[charac] social impairment

• Know that it continues to affect relationships 

• Changes the way you behave

• E.g. aggression, recklessness

[charac] risky use

during duterte’s reign

[charac] pharmacological criteria

• Tolerance

• Withdrawal

• Symptoms: present for 12 months 

withdrawal

• Withdrawal: symptoms that manifest after stopping or reducing the amount of the drug or substance that has been used regularly over a prolonged period (instant effect)

• Excessive sweating, muscle tension, anxiety, overthinking, low mood

• Don’t like feeling withdrawal so take substances

• Prevents stopping them from using substance

• Body gets used to having the substance in your system

• Removal should be done gradually and slowly -> withdrawal symptoms are more tolerable

• E.g.drinking alchol -> lead to withdrawal symptoms -> not realistic expectation to ask them to stop 

• Multiple times a week 

tolerance

• Needing more dose of the substance 

• Depending on it to continue the function

cycle of substance use

LOOP: Use the substance -> minimal dose -> desired effect -> decline in the effect so you use more -> try to stop -> withdrawal symptoms -> repeat

• How will you recover if in body?

• Solely not possible on your own 

• Mental health problem 

• The recovery would be the family support and mental health professional 

what to notice

• First few months

• Persistent problems cutting back or controlling use 

• Developing a tolerance or withdrawal syndrome

• Spending an excessive amount of time seeking/using the substance

• Risky use

abused drugs

1. depressants

2. stimulants

3. hallucinogens

4. narcotics

[drugs] depressants

1. Depressants 

• Curbs CNS activity

• barbiturates, alcohol

Barbiturates 

• Morbabital (Amytal), BUtabarbital (Butisol) 

  • An old class of drug

  • Effects: dizziness, sedation, slow breathing 

• Relaxation

[drugs] stimulants

• Enhances states of alertness, produces feelings of pleasure of euphoric highs 

• Caffeine, cocaine, nicotine, amphetamines, MDMA 

• MDMA (ecstasy or molly):  methylenedioxy-methamphetamine

• Depends on how the substance is received in culture

• Not a lot of diagnosis who are addicted to caffeine

[drugs] hallucinogens (psychedelics)

• Produce sensory distortions 

• E..g major alternations in colo perception and hearing 

• Experiencing things not in reality

• Types

  • Lysergic Acid diethylamide (LSD)

  • phenylcyclohexyl piperidine

  • phencyclidine (PCP)

  • ecstasy 

  • Marijuana

  • Tetrahydrocannabinol (THC)

[drugs] narcotics

• Painkillers but addicting 

• For pain relief but have strong addictive potential 

• Types: Fentanyl, Opium, morphine, heroin 

• E..g. medical history -> what medication to give

on substance use disorders

1. alcohol

2. cigarettes

3. barbiturates

4. opiates

5. marijuana

6. amphetamines

7. methamphetamines

8. LSD and other hallucinogens

9. MDMA and ecstacy

alcohol short-term effects

• Increased serotonin and dopamine -> pleasure

• Stimulates GABA receptors -> tension reduction 

• Inhibits glutamate -> cognitive slowing 

• Slowing of reflexes

• Impairment in motor functioning 

• Impulsivity and poor decision making 

• Poor error monitoring 

• E.g. we can’t say no

• Easy to take alcohol because of the instant/initial effects -> facilitates better interactions 

alcohol long-term effects

• Malnutrition

• Liver cirrhosis 

• Pancreatitis, heart failure, erectile dysfunction, hypertension, stroke, capillary hemorrhage

• Compromises body

on cigarettes

• Nicotine: addictive agent, includes carcinogens like carbon monoxide and tar

  • Can increase cerebral blood flow, causing a short term increase in attention and concentration 

  • Stimulates dopamine neurons 

• Smoking: in US, single most preventable cause of premature death (emphysema, cancer)

• THS: third hand smoke 

  • When it sticks to clothes = then hold babies

[cigs] why use

• Bonding

• A lot of consumers 

• Industry

• Reduce life expectancy

• don

on barbiturates

• Sedative-hypnotics, together with benzodiazepines

• Stimulates the GABA system, causing relaxation and a mildly euphoric state

• Withdrawal symptoms: anxiety, delirium, convulsions 

• Depressant substance: deal with anxious mood

on opiates

• Poppy, plant of joy

• Fall under sedatives, relieves pain and induces sleep

• Synthetic derivatives

  • Opium (7000 BC)

  • Morphine (1806)

  • Hoerin (1874)

  • Codeine (pain meds) 

• Releases endorphins and enkephalins 

• Stimulates dopamine system 

• Highly addictive - rush 

  • Dual reinforcement pathways: pleasure and withdrawal

• withdrawal

• Opioids: opiates and synthetic opiates (ie. vicodin, oxycodone, fentanyl)

• Desired effect (pleasure) -> leads to withdrawal (negative effects) -> use substance again

[opiates] withdrawal symptoms

• acute muscle pain

• Sneezing

• sweating

• Yawning

• muscle spasms

• Cramps

• instability to sleep

• Hypertension

• Vomiting

• Diarrhea

on marijuana

• Gateway drug 

• Therapeutic effects

• Decriminalization 

• There’s tolerance

• Eventually body will want marijuana and want something more intense

• Even if medicinal benefits, it could also lead to more problems eventually

on amphetamines

• Synthetic stimulants initially used to relieve stuffy noses, control appetite, and treat mild depression 

• Affects neurotransmitters

• Mechanisms: causes the release of norepinephrine and dopamine and blocks reuptake of NE and Dopa

• Tolerance develops rapidly

• Migrant workers in US who are working multiple jobs -> need to sleep but rely on these to say awake

[amphetamines] physiological effects

1. Heightened wakefulness

2. Low appetite 

3. High heart rate

4. Construction of blood vessels

5. Hypertension 

6. Insomnia

7. Headaches 

[amphetamines] psychological effects

1. High alertness

2. High sociability

3. Euphoria

4. High energy and self-confidence 

5. In large doses, agitation, confusion, and paranoia

on methamphetamines

• Crystal meth, ice, shabu

• Amphetamine derivative: taken orally, intranasally, intravenously 

• Chronic use -> brain damage 

  • fMRI: smaller hippocampi 

  • Reduction in the dopamine transporter gene

  • Lower activation in areas involved in decision making

• Impaired hearing, bald spots

• E.g. under influence in unprotected group sex with drugs

on LSD and other hallucinogens

• 1938: LSD first manufactured by a swiss chemist

• Other hallucinogens: mescaline, (peyote cactus), psilocybin (mushroom)

• Produce a subjective expansion of consciousness and hallucinations

• May induce: panic attacks, psychosis 

• Can lead to almost permanent changes in perception of reality, especially if taken over a year

• HPPD: hallucinogen persisting perception disorder, flashbacks can occur after drug has worn off

on MDMA and ecstacy

• Type of hallucinogen also

• Synthetic hallucinogen and amphetamines 

• Ups the presynaptic release of serotonin 

• Party drug (hug drug) 

  • Enhances intimacy and insight

  • Improves interpersonal relationship 

  • Elevates moods and self-confidence 

  • Promotes aesthetic awareness

• LT effects: serotonin depletion

  • Important in emotion regulation -> damage to nerve terminals 

• They start using more then tolerance and withdrawal will develop

substance use disorders: take note

• Take note of the initial medicine/positive effects

• Detrimental long-term effects on functioning

• The issue of choice

etiology of SUD

1. biological

2. psychodynamic

3. psychological

4. learning

5. socio-cultural influences

[etio] biological

• Easily metabolize drugs = more impact on them

• Inherited genetic vulnerability

  • Sensitivity to drug

  • Ability to metabolize drug

• Drug activates reward center in brain (pleasure pathway, dopamine)

  • When it’s targeted, it has struck the brain 

  • Addiction -> all they can feel 

  • Focus on the positive impact of the drug and don’t see the LT effects

• Neuroplasticity increases drug-seeking and relapse

  • Brain adapts and gets used to have it in system 

• E.g. debt, before he was gonna send it to the bank, gambling

  • Illogical 

  • Bad decision making

[etio] psychodynamic

• Oral-dependent personality

• Fixated in oral stage -> fixation in mouth, ingested thru mouth

[etio] psychological

• Make them feel like they are in control 

  • To control anxiety

  • Calms them down -> more confident

  • When you’er down, helps them to alter the mood instantly

• Mood alteration 

• Expectancies about alcohol and drug effects

• Feeling of being in control

  • Boosts self-efficacy expectations 

• Presence of other psychological disorders

[etio] learning

• Against use: fear of effects of drug use, decision not to use drugs, feeling of confidence and self-esteem without drug use

• For use

  • Operant & classical conditioning 

  • Associated with feeling good 

  • To avoid pain and escape unpleasantness (numbing) 

  • Avoidance of withdrawal symptoms 

• Observational learning: the people you surround yourself with can really matter

  • Stems from peer pressure 

• Use the substances/depressants

  • Halluciongens; escape difficult reality

  • If aware of social realities

[etio] socio-cultural influences

• Exposure to drug use through media and social networks

  • Social influence model

  • Social selection model

• Family influences 

• Social expectations and cultural norms

  • Availability of substances

  • Attitude towards use

1. social influence model

2. social selection

[etio; socio] social influence model

• Depicts the impact of social constructs

  • Peer pressure

  • Conformity

  • Networks of people’ families and friends 

  • Recognizing that we are a collectivist culture: pakikipagkapwa, pakikisama

• Cognition has a relatively minor explanatory role

[etio; socio] social selection

• Occurs when people associate with others who share similar interests, beliefs and behaviors

  • Necessary survival mechanism, but reason why people who use drugs gravitate towards each other

  • Go towards people who are similar to them 

treatment of SUD

1. alcohol abuse and dependence

2. biological

3. skills training

4. cognitive behavioral approaches

5. support groups

6. statistics

[treatment] biological

1. detoxification

2. medication

3. inpatient hospital treatment

4. nicotine replacement therapy

5. methadone maintenance programs

[biological] medication

• Medication: can help with alcohol use, increase sensitivity to drug use, speed up the effects of the substances -> associates it with that bad feeling/aversive -> uses less

  • Antabuse 

  • Naltrexone 

  • Acamprosate

  • Antidepressants

[biological] inpatient hospital treatment

•  if their cognitive functioning is already compromised, 

• Be stabilized first the physical functioning since nutrition is affected

• Before receiving LT psychotherapy

[bio] nicotine replacement therapy

• Nicotine replacement therapy

  • Cigarettes

  • Replace it with other sources of nicotine in smaller doses

[bio] methadone maintenance programs

• Programs for recovery of substance use

• Gradual removal of substance use from system

[treatment] skills training

1. Social skills training 

• Resist pressure to drink 

• Pressure to conform 

2. Controlled drinking and use

• Gradual process of removing alcohol

3. Relapse prevention training

• Rehabilitation programs 

• Teach clients to teach e motions 

  • HALT: to remember emotions 

  • Hungry, Angry, Lonely, Tired: feel craving for a substance 

  • Label emotions so they don’t use  it 

• Not very clearcut -> overwhelming emotions and helps when we label

[treatment] cognitive behavioral approaches

1. self-control strategies

2. contingency management

3. aversive conditioning

4. motivational interviewing

[CB] contingency management

• Reward chosen behaviors

• Substances active reward systems of brain

• Focus on their interests/physical that make them feel good

[CB] aversive conditioning

• Associative shocks with drinking, nausea with cocaine use

• Associate it with aversive feeling vs. pleasure

• Medical considerations 

[CB] motivational interviewing

• Affecting physical functioning

• Focus: help them find their own motivation why they want to stop using substance

• More sustainable 

[treatment[ support groups

1. Nonprofessional support groups (AA=alcoholics anonymous)

• Follow a buddy system 

  • Sponsors; completed the program of AA -> guide new members and prevent relapse

2. Residential approaches

• Isolate patients when they relapse

3. Community reinforcement 

• katatagan program: psychoeducation for community based approaches

4. Psychoeducation and family interventions 

• When they’re involved, they can set expectations properly

statistics on drug use and infectitoous

• 10% of population uses drugs 

• 24.6 million individuals

• 93% of those experience drug use and abuse rate 

• 22.7 million

Drug Use

• 2010 HIV transmissions cases by IDU (injection drug use) 8%

• Globally 1 in 10 new HIV cases annually is due to IDU 

• 16 million injection drug users in the world, about 3 million live with HIV 

• 10-59% of drug abusers may have dormant tuberculosis

other behavioral addiction disorder: gambling disorder

• Recognized in DSM5 

• Nonsubstance addiction 

• Craving manifests in constant preoccupation with gambling 

  • Same as ingesting a substance 

• Withdrawal: irritable when trying to stop gambling 

• Tolerance is an increase in the frequency of gambling behavior

  • Increases the stakes

• Something to do with parts of the brain that have been activated

• Inability to stop despite several efforts

• Symptoms should be present for 12  months

• Ex. slot machines

what about compulsive behaviors

• Other internet-related behaviors: social media, pornography, shopping 

• Compulsive shopping 

• Exercise addiction 

• Food addiction 

• Work addiction 

• Relationship addiction

red flags for gambling

• Cravings- preoccupation and obsession 

• Increased frequency 

• Psychological problems 

• Persistence to continue 

• Chaotic life

common principles of prevention programs

• Peer pressure resistance training 

• Correction on beliefs and expectations 

• Inoculation against mass media messages

• Peer leadership

• Ex. Rat Park Experiment - LLoyd Sederer 

  • Cage 1: rat is isolated in a cage; put clean water and one has addictive substance

  • Overdose

  • Cage 2: they have a park and play together in community, not one of them drank from contaminated source

    • Supports the community and belongingness

questions to ask from Dr. Lloyd Sederer

• Who do you care about in your life?

• Who cares about you?

• When was the last time you spent time with people who are good for you instead of those who hurt you and foster your drug taking?

• The opposite of addiction is not sobriety, but connection

• mental health is political