Addiction and Substance Use Disorders: Definitions, Theories, and College Drinking Risks

Addiction

Done regularly, habitually, or repeatedly; Compulsive (i.e., out of one's conscious control); Most common association = drugs; "Addiction" itself is not a diagnosis.

Substance Use Disorder (SUD)

Current DSM-V removed abuse/dependence distinction in favor of a single Substance Use Disorder diagnosis with severity levels.

Evolution from DSM-I to DSM-V

Changes in DSM conceptualizations progressed to separate abuse and dependence diagnoses.

Standard drink

Definition not provided in the note.

Heavy Alcohol Use

Men: >4 drinks any day or >14 drinks per week; Women: >3 drinks any day or >7 drinks per week.

Binge Drinking

5+ drinks (males) or 4+ drinks (females) at least once in 30 days.

12 oz regular beer

A standard serving size of beer.

8-9 oz malt liquor

A serving size of malt liquor.

5 oz wine

A standard serving size of wine.

1.5 oz 80-proof spirits

A standard serving size of distilled spirits.

Drinking Behaviors

Variations in substance use rates based on age, race/ethnicity, and gender.

Biological/Genetic Model

Genetic factors account for 35-70% of variance in vulnerability to substance use disorders.

Gateway Model

Proposes progression from nicotine/alcohol to marijuana to harder drugs.

Self-Awareness Model

Alcohol impairs information encoding and reduces self-relevance of environmental stimuli.

Externalizing Perspective

Conduct disorder and ADHD; behavioral disinhibition strongly predicts early-onset substance use.

Internalizing Perspective

People use substances to relieve psychological distress; mood and anxiety disorders related to substance use disorders.

Developmental Perspectives

By early adulthood, majority of people have experimented with substances; early initiation strongly predicts later substance use disorder risk.

Risk Factors for Adolescent Drinking

Environmental influences stronger in adolescence than adulthood; social and peer influences particularly important.

Alcohol Myopia Theory

Creates 'tunnel vision' where immediate aspects have disproportionate influence.

Expectancy Theory

Beliefs about what will happen when using substances; reliably differentiates heavy users from light/nonusers.

Impulsivity

Preference for immediate over delayed rewards; difficulty inhibiting behavioral responses predicts later substance abuse.

Social Learning Theory

We learn about drug use from observing the use of people around us; norms teach us when and where drug use is appropriate.

At-risk individuals

Children of people with substance use disorders develop expectations about the negative reinforcing benefits of drugs by watching parents.

Routes of Administration

Different methods through which substances are consumed.

Definition of Addiction

Done regularly, habitually, or repeatedly

Compulsive Behavior

Out of one's conscious control

Most common association

Drugs

Addiction diagnosis

"Addiction" itself is not a diagnosis

Initial grouping of Addiction

Initially grouped with personality disorders

Evolution of DSM

From DSM-I (1950s) through DSM-V (2013)

Changes in DSM Conceptualizations

Progressed to separate abuse and dependence diagnoses

Current DSM-V diagnosis

Removed abuse/dependence distinction in favor of a single Substance Use Disorder diagnosis with severity levels

Risky Drinking

Men: >4 drinks any day or >14 drinks per week; Women: >3 drinks any day or >7 drinks per week

Substance Use Rates

Age differences show highest rates among young adults

Racial/ethnic differences

Show varying patterns of use

Gender differences

Men generally use more than women, except for prescription tranquilizers/sedatives

Biological/Genetic Factors

Alcohol impairs information encoding and reduces self-relevance of environmental stimuli

Vulnerability variance

Accounts for 35-70% of variance in vulnerability

Psychological Perspectives of Substance Use

Externalizing: Conduct disorder and ADHD; Internalizing: People use substances to relieve psychological distress

Developmental Perspectives of Substance Use

By early adulthood, majority of people have experimented with substances

Alcohol dehydrogenase (ADH)

Converts alcohol to acetaldehyde

Aldehyde dehydrogenase (ALDH)

Breaks down acetaldehyde

Half-life

Time to reduce drug level by 50%

Two half-life periods

Eliminate 75%

Women metabolize alcohol differently than men

On average, compared to men, women have a greater percentage of body fat, less stomach ADH, and a less active form of liver ADH.

Antagonists

Blocks receptor

Agonists

Most drugs of abuse are agonists

Peaks

Sought after effects of intoxication

Valleys

Rebound period, usually opposite of peaks

Stimulants

Peak: Euphoria, sense of power; Valley: Anxiety, depression, fatigue

Sedatives

Peak: Reduced anxiety, mild euphoria; Valley: Agitation, anxiety, insomnia

Opiates

Peak: Euphoria, pain relief; Valley: Flu-like symptoms

Fetal Alcohol Syndrome

Causes mental & growth retardation, birth defects of face and limbs, behavioral problems including ADHD, cognitive delays

Wernicke-Korsakoff Syndrome

Caused by thiamine deficiency; Symptoms: Difficulty forming new memories, memory loss, confabulation, hallucinations

Cross Tolerance

Resistance to the effects of one substance because of exposure to another similar substance; Example: high tolerance of alcohol → high tolerance of other sedatives

Drug Interactions

Potentiation: Drugs in the same class amplify effects; Example: Alcohol + benzodiazepines = stronger than sum of parts; Can be lethal

Opioid Epidemic

Deadliest drug crisis in American history; More deaths in 2016 than entire Vietnam War; ~64,000 overdose deaths per year; Faster death rate than HIV epidemic at peak

Racial Demographics

Chart shows overdose deaths by race; Highest rates: White, Native American populations; Increasing rates among Black populations; Lower rates: Hispanic and Asian populations

US vs Other Countries

US consumes more opioids than any other country; Average days of opioid use per resident per year: US: 17.4 days, Canada: 12.6 days, Germany: 11.2 days; Other developed nations significantly lower

Carfentanil

Specific Opioid; Elephant tranquilizer; Extremely potent: few grains lethal; All US zoos need only 18g/year total

OxyContin

Absorbed through skin; FDA approved 1995 claiming reduced abuse potential; Hard to detect in toxicology; Actually had higher narcotic levels than Fentanyl

Fentanyl

Synthetic opioid made in 1960s; Could be snorted or injected; Medical uses: spray, patch, lollipop; Purdue Pharma knew about significant abuse by 1996; 2mg (salt shaker shake) can be lethal; Often mixed unknown into heroin

Pharmaceutical Companies

Purdue Pharma concealed abuse information; Continued marketing as safer option; Paid $600 million settlement

Doctors' Role

Pressured to treat pain more seriously; Limited time/resources led to quick pill solutions; Current US prescription rate still triple 1999 levels

Barriers to Reducing Prescriptions

Essential for legitimate medical needs; Sudden removal pushes people to illegal drugs; Still necessary for cancer/acute pain; Limited access to alternative treatments

Medical Assisted Treatment (MAT)

1. Methadone: Long-acting synthetic opioid; Prevents withdrawal; Requires careful supervision; Available through licensed programs

Buprenorphine

Partial agonist

Naltrexone

Opioid antagonist

Balloon Effect

When the supply of one drug is restricted, users shift to alternatives

Naloxone

Rapidly reverses overdose

College Drinking - General Patterns

79.2% drank in the past year

Moderate Drinkers

46% moderate drinkers (no binges in the past month)

Problem Drinkers

54% 'problem drinkers'

Super Bingers

7% 'super bingers' (>15 drinks)

Heavy Drinking

21% had at least 10-14 drinks once

Academic Performance

Declines with drinking

Victimization - Ethnic/Racial Harassment

6.4% reporting rate, 14.2% involved alcohol

Victimization - Physical Violence

4.0% reporting rate, 54.7% involved alcohol

Victimization - Theft with Force

1.7% reporting rate, 33.5% involved alcohol

Victimization - Sexual Assault

20-25% of women experience attempted or completed rape while in college

At-Risk Groups for Heavy Drinking/SUD

Inexperienced drinkers