Substance-Related Disorders

Important terms

• Substance abuse: negative problems

• Substance dependence:

• Tolerance: need for larger dose to take into effect

• Withdrawals: physical and psychological symptoms that are felt when not used the substance

Examples of substance that can be abused

• Alcohol

• Nicotine

• Barbiturates

• Tranquilizers

• Amphetamines

• Heroin

• Ecstasy

• Marijuana

DSM-V: Substance-related and addictive disorders

• 10 categories of substances plus gambling disorder

• Individual’s use is associated with:

  • impaired control: constant feedback loop

  • Social impairment: someone uses alc and after a few more drinks it is difficult to engage in conversations

  • Risky use: getting to the point of abuse and dependence

  • Tolerance and/ or withdrawals: Present in a lot of substance use disorders

The prevalence, comorbidity, and demographics of alcohol abuse and dependence

• Alcohol abuse cuts across all demographics

• Lifetime prevalence in U.S. is 13%

• Huge detrimental physical effects

• Linked to accidents, violent crime

• More common in men

• More than 37% of alcohol abusers suffer from least one coexisting mental disorder

Alcohol: Effects

• Lower levels stimulate and activate brain’s “pleasure areas”

• High levels depress brain functioning

• Intoxication

• Hangover

Alcohol Abuse and Dependence: Chronic Effects

• Physical effects

• Psychosocial effects

• Psychoses with severe use: auditory and visual illusions

Alcohol Abuse and Dependence: Casual Factors

Biological

• Neurobiology of addiction

  • MCLP center of psychoactive drug activation

• Genetic vulnerability

• Learning

Psychosocial

• Failures in parenting guidance

• Psychological vulnerability

• Stress, tension reduction and reinforcement

• Expectations of social success

• Marital or relationship crisis

Sociocultural

• Religion

• The cultural tradition of aggression

• Geographic location

Alcohol Use and Dependence: Treatments

Medication

• Disulfiram (Antabuse) and Naltrexone block the desire to drink

• Valium lower side effects of acute withdrawals

Psychotherapy

• group therapy

• Environmental intervention

• Behavioral, CBT, motivational interviewing

Other approaches

• Controlled drinking

• Alcoholics Anonymous

Alcohol Use and Dependence: Success of Treatment

• “Project MATCH” success rates

• Relapse prevention programs

Drug Abuse and Dependence

Psychoactive drugs most commonly associated with abuse and dependence

• Opiates

• Stimulants

• Sedatives

• Hallucinogens

• Antianxiety

• Pain medications

Opiates

• Opium, morphine, codeine, and heroin

  • Alleviate pain, anxiety, tension

  • Induce relaxation

Opiates: Effects

• Immediate biological effects

  • Alleviation of pain, anxiety, tension

  • Relaxation and pleasant reverie

  • Euphoric spasm

• Long-term biological effects

  • Physiological craving for the drug

  • Withdrawal symptoms

  • Gradual deterioration of well-being

• Social effects

  • Maladaptive behaviors

  • Antisocial personality

  • Narcotics subculture

Opiate Abuse and Dependence: Casual Factors

• Pleasure

• Curiosity

• Peer Pressure

• Stress relief

• Personal maladjustment

• Sociocultural conditions

• Nueral bases

  • Bind to opiate receptors

  • Dopamine theory of addiction

  • Reward deficiency syndrome

Opiate abuse and dependence: Treatment

• Initially similar to that for alcohol addiction

• Methadone and buprenophine program

Stimulants

• Cocaine and amphetamines

  • increase feelings of alertness and confidence

  • Decrease feelings of fatigue

Cocaine: Effects

Immediate effects

• Blocks presynaptic dopamine transporter ( increase availability of dopamine)

• Euphoric state

• Chronic abuse leads to hallucinations

Long-term amphetamine addictive

• Psychologically and physically addictive

• May result in brain damage and psychopathology

Cocain: Treatment

• Medications

  • Naltrexone

  • Methadone

• Psychotherapy

  • CBT

  • Contingency management

Amphetamines: Effects and Treatment

Abuse

• Leads to hazardous fatigue

• Psychologically and physically addictive

• Brain damage, “amphetamine psychosis”

Treatment

• Withdrawal from drugs

• May lead to depression, GI symptoms, personality deteriation

Sedatives

Barbiturates

• CNS depressants, similar to alcohol

• Once widely used to induce sleep

Barbiturate: Casual Factors and Treatments

• Physiological and psychological dependence

• Lethal overdoses

• Dependence tends to be middle-aged people

• Withdrawal is a key treatment issue

Hallucinogems

• LSD, mescaline, psilocybin, ecstasy, marijuana

  • induce changes in mood, though, behavior, induce stupor

  • Treatment for marijuana abuse and dependency:

    • psychological treatment methods have been shown to be effective

Gambling Disorder

• Similar to chemical addiction in several ways

  • Personality factors

  • Difficulties attributable to compulsive gambling

  • Treatment problems