Psychopathology Ch 11, 10, & 9

Substance abuse

excessive use of substance

Substance dependence

physiological need for increasing amounts

Tolerance

the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect

Withdrawal

physical symptoms from abstinence

DSM-5 Substance-Related Disorders

pathological pattern of behavior related to particular substance use

DSM-5 Criteria for all substance-related disorders (except caffeine)

Has 2 or more of 11 addiction symptoms associated with:

Withdrawal,

tolerance,

difficulty controlling consumption amount,

failure to abstain from using after making attempts, failure to fulfill major obligations,

giving up or significant reduction in important life activities,

social conflict due to cost

repeatedly, in dangerous situations

takes up a significant amount of time

cravings

continue use despite causing or worsening another condition

Specifiers for substance-related disorders

mild: 2-3 symptoms

moderate: 4-5 symptoms

severe: 6+ symptoms

substance-related disorders should be specified if

in early remission (0 criteria [craving can stay] for 3-12 months)

in sustained remission (0 criteria [craving can stay] for 12+ months)

Alcohol use and dependence

5-6+ drinks on one occasion (SAMHSA, 2016; WHO, 2014)

This does not consider individual differences in processing alcohol and tolerance levels (% blood alcohol level)

Excessive drinking includes

binge drinking: 4 for women and 5 for men on one occasion

heavy drinking: 8 for women and 15 for men in a week

any drinking during pregnancy

any drinking by people under 21

Lifetime prevalence for alcohol abuse or AUD in US is both

~30%

More than 37% of alcohol abusers

suffer from at least one coexisting mental disorder

Alcohol abuse

do not appear to be significant differences between Black and white Americans.

People indigenous to Americas have higher rates of alcohol use problems.

Rates vary across countries

Gender difference for AUD

Men:women risk for AUD is currently 2:1

alcohol has

complex effects on the brain:

At lower levels, alcohol stimulates certain brain cells and activates brain's dopaminergic "pleasure areas"

Gives a false sense of well-being/euphoria

At higher levels, alcohol depresses NS functioning

Inhibits glutamate (an excitatory neurotransmitter) and therefore judgement and decision making

Impacts the cerebellum, affecting balance and coordination.

Passing out (around .50% BAC) usually occurs right before the body reaches lethal levels (around .55%)- but alcohol % can still rise when someone is unconscious and is a red flag for alcohol poisoning

Physical effects of chronic alcohol use

-malnutrition (because alcohol is high in calories but low in nutritional content, causing reduction in appetite)

-cirrhosis of liver (caused by overworking the liver, which eliminates alcohol from body)

-15-30% of heavy drinkers develop cirrhosis

-stomach pains are common

neurobiology of AUD

MCLP center of psychoactive drug activation ("pleasure pathway")

Genetic vulnerability

inheritance of risk from biological parent(s)

personality (impulsivity, risk-taking, emotional lability)

race/ethnicity and alcohol metabolites

Lapses in parental guidance in AUD

A lack of stable family relationships can impact substance abuse

Exposure to negative models and family dysfunction can also contribute

Comorbidity in AUD

alcohol use is often correlated with mental disorders and should be considered in potential treatment paradigms

psychological factors in aud

lapses in parental guidance, comorbidity, motives/expectancies for use, marital and other intimate relationships

sociocultural factors in aud

group attitudes: negative vs. positive attitudes about consuming alcohol

common social lifestyles - eg, college campuses and binge drinking; social networks. some may under- or over-estimate the "commonality" of heavy drinking

Themes of female-focused alcohol marketing

friendships, motherhood, weight/health consciousness, femininity, female empowerment, independence

Themes of male-alcohol

humor, relaxation, friendship, and masculinity as well as sexual themes which often portray them exerting power

Medications to block desire to drink

Disulfiram (Antabuse) causes vomiting when followed by ingesting alcohol

Naltrexone helps to reduce the cravings for alcohol by blocking euphoria

tranquilizers (has its concerns) to lower side effects of acute withdrawal

dopamine agonists for motivation without drugs

Group therapy

person is held responsible for recognizing and confronting pattern

Environmental intervention

social changes, residential living

Behavioral and cognitive-behavioral therapy

aversion therapy, skills training, self-monitoring triggers

controlled drinking

an extremely controversial treatment approach to alcohol dependence, in which severe abusers are taught to drink in moderation

Alcoholics Anonymous

-abstinence model and "disease model"

-a "spiritual program"

-support groups/"meetings"

-Program of steps (12), typically done 1:1 with a mentor

-focuses on topics such as excessive need for control, resentment, accountability, acceptance, humility, and service to others

heroin

narcotic drug derived from opium that is extremely addictive

codeine

opiate with relatively low potency often prescribed for minor pain

biological effects of morphine and heroin

Morphine binds to mu-opioid receptors in the brain and spinal cord, blocking pain signals and triggering dopamine release, which creates feelings of pleasure and calm.

Short-Term Effects: Pain relief Euphoria Drowsiness Slowed breathing and heart rate Nausea or vomiting

Long-Term Effects: Tolerance (requiring higher doses for the same effect) Physical dependence and withdrawal symptoms Hormonal imbalances (e.g., reduced testosterone) Constipation and suppressed immune function

Clinical Use: Morphine is widely used in hospitals for severe pain management, especially post-surgery or in cancer care.

Heroin is a chemically modified form of morphine (diacetylmorphine). It crosses the blood-brain barrier more rapidly, converting back to morphine and binding to the same mu-opioid receptors.

Short-Term Effects: Intense euphoria ("rush") Dry mouth Warm flushing of the skin Heaviness in limbs Clouded mental function

Long-Term Effects: Severe addiction and compulsive drug-seeking behavior Collapsed veins (from injection) Liver and kidney disease Brain damage due to hypoxia (low oxygen from slowed breathing) Increased risk of infectious diseases (e.g., HIV, hepatitis)

Potency and Risk: Heroin is 4-8 times more potent than morphine and is illegal in most countries. Its rapid onset and intense effects make it highly addictive

Neural bases for physiological addiction

- Bind to opiate receptors: heroin plugs in, replacing natural endorphins

- Dopamine theory of addiction: addiction is dysfunction of dopamine reward pathway

- Reward deficiency syndrome: addiction result of genetic deviations in reward pathway

Treatment for opiate disorders

initially like that for alcohol addiction. methadone and buprenorphine program

Prevention of secondary health issues for opiates

access to clean syringes, access to withdrawal maintenance with medical oversight

stimulants

Drugs (such as caffeine, nicotine, and the more powerful amphetamines, cocaine, and Ecstasy) that excite neural activity and speed up body functions. Increases feelings of alertness and confidence. decreases feelings of fatigue

cocaine

a plant product discovered in ancient times. Once very expensive, it became more affordable and experienced widespread use. Creates a 4-6 hour euphoric state. "Crack" cocaine (processed from cocaine hydrochloride to a free base for smoking) for much cheaper

Amphetamines

drugs that stimulate neural activity, causing speeded-up body functions and associated energy and mood changes. Chronic use leads to tolerance. Methedrine ("speed") is a potent stimulant of the CNS-can be lethal. Does not actually "give energy" but rather tells CNS to use up more of its own energy, to excess.

Clinical Picture of Alcohol-Related Disorders

At higher levels, alcohol depresses brain functioning. At lower levels, alcohol stimulates certain brain cells and activates brain's pleasure areas

alcohol's effects on the brain

1. Frontal lobe = judgment/reasoning

2. Midbrain = speech/vision

3. Cerebellum = voluntary muscular control

4. Pons, Medulla oblongata = Respiration/heart action

hangover

A term used to describe the after effects of drinking too much alcohol. Occurs 8-24 hours after consuming alcohol

glutamate dump

after a person stops drinking, the body makes up for lost time by producing a lot of glutamate

legal intoxication

0.08%

alcohol dependence

alcohol use marked by tolerance, withdrawal if suspended, and a drive to continue use

fetal alcohol syndrome

physical and cognitive abnormalities in children caused by a pregnant woman's heavy drinking

development of alcohol dependence

Excessive drinking can be viewed as progressing from early-to middle-to late-stage alcohol-related disorder

physical effects of chronic alcohol use

-malnutrition (because alcohol is high in calories but low in nutritional content, causing reduction in appetite)

-cirrhosis of liver (caused by overworking the liver, which eliminates alcohol from body)

-15-30% of heavy drinkers develop cirrhosis

-stomach pains are common also

psychological effects of alcohol abuse and dependence

poor judgement, less responsibility, less pride in appearance, deteriorating overall health, impaired reasoning, irritability, impaired memory, organic damage

psychoses associated with severe alcohol abuse

- Alcohol withdrawal delirium

-- Disorientation, hallucinations

-- May last 3-6 days

- Alcohol amnestic disorder

-- Memory loss, disorientation

--Untreated, can lead to irreversible brain damage

alcohol withdrawal delirium

acute delirium associated with withdrawal from alcohol after prolonged heavy consumption; characterized by intense anxiety, tremors, fever and sweating, and hallucinations

alcohol-induced psychotic disorders

-alcohol withdrawal delirium

-alcohol amnestic disorder

delirium tremens

a disorder involving sudden and severe mental changes or seizures caused by abruptly stopping the use of alcohol

mesocorticolimbic dopamine pathway (MCLP)

Center of psychoactive drug activation in the brain. This area is involved in the release of dopamine and in mediating the rewarding properties of drugs.

genetic vulnerability of alcohol addiction

Genome-wide association studies have identified numerous genes that are consistently associated with alcohol use disorders.

Alcohol Flush Reaction

-unpleasant physiological response to drinking alcohol

-facial flushing that may be accompanied by nausea, hives, tachycardia, low BP, worsening asthma, migraine

-40% of east Asian descent

-inherited deficiency of aldehyde dehydrogenase2 enzyme

-deficiency has been linked to increased esophageal cancer risk

psychosocial causal factors in alcohol abuse and dependence

failure in parental guidance

alcohol comorbidities

stress, tension reduction and reinforcement,

expectations of social success

marital and other intimate relationships

sociocultural causal factors in alcohol abuse and dependence

Muslims and Mormons forbid alcohol in their religions. The highest rates if consumption rates are found in eastern Europe, followed by western Europe, then America

Treatment of Alcohol-Related Disorders

-controlled drinking rather than abstinence

-alcoholics anonymous

-medications to block the desire to drink (like Disulfiram, causes violent vomiting by ingestion of alcohol)

-deterrent therapy (though it is seldom advocated)

medications to reduce the side effects of acute withdrawal

valium, diazepam, mild tranquilizers to reduce anxiety

aversive conditioning therapy

removing a behavior by pairing it with an unwanted stimulus

cognitive behavioral therapy

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

bmi procedure

Measure the subjects standing height and body weight

environmental intervention

attempt to change the home environment that the drinker returns to

controlled drinking vs. abstinence

- Two positions hotly debated

o Some believe people can continue to drink in moderation

o AA position says no alcohol at all

- "Moderation management" program

- Research says: both goals can be appropriate and depends on the person

o If you are a younger drinker and not physically dependent on alcohol yet controlled drinking can work

o Matters a lot on your own valuable belief system

outcome studies

designed to evaluate whether a particular treatment works, often in relation to some other treatment or a control condition

project MATCH

-Evaluated three forms of psychological treatments:

Cognitive behavior therapy

12-step facilitation therapy

Motivational enhancement therapy

Relapse Prevention

Extending therapeutic progress by teaching the client how to cope with future troubling situations.

psychoactive drugs most commonly associated with substance abuse disorders

sedatives, stimulants, opiates, hallucinogens

opium

substance derived from the opium poppy from which all narcotic drugs are derived

morphine

narcotic drug derived from opium, used to treat severe pain

social effects of morphine and heroin

-maladaptive behaviors

-antisocial personality

-narcotics subculture

-lowering of ethical and moral restraints

causal factors in opiate use and dependence

they are pleasurable to use and it is cheaper to get heroin than other opiates. desire to escape stress. sensation seeking personality

Neural Bases for Physiological Addiction

- Bind to opiate receptors: heroin plugs in, replacing natural endorphins

- Dopamine theory of addiction: addiction is dysfunction of dopamine reward pathway

- Reward deficiency syndrome: addiction result of genetic deviations in reward pathway

endorphins

"morphine within"--natural, opiatelike neurotransmitters linked to pain control and to pleasure.

how heroin works

molecules bind to endorphin-receptor sites on the post-synaptic membrane of the synapse, blocking transmission, which mimics the function of natural endorphins & causes initial euphoria

how morphine works

it binds to mu-opioid receptors in the brain and spinal cord, where it blocks the transmission of pain signals and triggers the release of dopamine, producing both pain relief and a sense of euphoria. This interaction dampens the nervous system's response to pain while also slowing breathing, heart rate, and gastrointestinal activity. Because it mimics the body's natural endorphins but with much stronger and longer-lasting effects, repeated use can lead to tolerance, physical dependence, and addiction.

dopamine theory of addiction

theory suggesting that addiction is the result of a dysfunction of the dopamine reward pathway

reward deficiency syndrome

a genetically disposed deficiency in the natural brain systems for pleasure and well-being that leads people to crave whatever provides that missing pleasure or relieves negative feelings

addiction associated with psychopathology

- 50% have other forms of substance abuse

- 36% have a history of trauma

- depression

- anxiety

treatment for opiate addiction

methadone

activates opiate receptors, but acts more slowly, so it dampens the high. Reduces cravings, eases withdrawal, and can't experience the high because receptors are already filled

stimulant examples

caffeine, nicotine, cocaine, amphetamines

Sigmund Freud described that cocaine was

a wonderful treatment for depression

effects of cocaine abuse

Cardiovascular System: Increased heart rate and blood pressure Risk of heart attack, stroke, and arrhythmias—even after a single use

Neurological Effects: Seizures, headaches, paranoia, hallucinations Long-term use may impair memory, decision-making, and motor skills

Respiratory and Gastrointestinal Systems: Snorting damages nasal tissues; smoking harms lungs Can cause bowel gangrene due to reduced blood flow

Mental Health:

Anxiety, depression, irritability, and psychosis

High addiction potential due to rapid dopamine spikes and tolerance buildup

Cocaine crosses the placenta, directly affecting fetal development and maternal health:

Risks to the Baby: Premature birth, low birth weight, and small head circumference Increased risk of miscarriage and stillbirth Long-term cognitive and behavioral issues, including attention deficits and learning delays

Risks to the Mother: Placental abruption—a life-threatening condition where the placenta detaches prematurely Hypertensive crises and seizures due to cardiovascular strain

Neonatal Abstinence Syndrome (NAS):

Babies may experience withdrawal symptoms like tremors, irritability, poor feeding, and sleep problems

effects of amphetamine abuse

•Not an energy source—pushes users toward greater expenditures of their own energy; can cause hazardous fatigue

•Side effects include excitability, profuse sweating, rapid/unclear speech, sleeplessness, tremors, loss of appetite, confusion

amphetamine treatment and outcomes

methylphenidate can reduce addiction. With abstinence, depression usually peaks in 48-72 hours, lessen gradually over a period of several days.

methamphetamine

a powerfully addictive drug that stimulates the central nervous system, with speeded-up body functions and associated energy and mood changes; over time, appears to reduce baseline dopamine levels

caffeine

a mild stimulant found in coffee, tea, and several other plant-based substances

nicotine

a stimulating and highly addictive psychoactive drug in tobacco

nicotine effects

Insomnia, anxiety, arrhythmias; withdrawal: weight-gain, irritability, anxiety, craving

caffeine effects

stimulant; increased alertness and wakefulness; anxiety, restlessness, and insomnia in high doses, uncomfortable withdrawal

effects of sedatives

Drowsiness, impaired judgment, and diminished motor skills

Excessive use can lead to accidental overdose and death

Combining alcohol with sedatives increases danger

High potential for tolerance and physiological dependence

Withdrawal symptoms

effects of barbiturates

Nonreversable

Protein binding (dosing consideration for hypoproteinemic patients)

Variable degrees of lipid solubility (affects recovery time)

Eliminated through liver metabolism and excreted in urine

barbiturates

drugs that depress the activity of the central nervous system, reducing anxiety but impairing memory and judgment

causal factors in barbiturate abuse and dependence

most young people do not become dependent. middle aged and older people use them as sleeping pills. They are often used with alcohol.

treatments and outcomes for barbiturate abuse and dependence

withdrawal includes tremors in the hands and face

LSD

a powerful hallucinogenic drug; also known as acid (lysergic acid diethylamide)

hallucinogens

psychedelic ("mind-manifesting") drugs, such as LSD, that distort perceptions and evoke sensory images in the absence of sensory input

types of hallucinogens

LSD

Peyote (Mescaline)

Psilocybin

MDMA (ecstasy)

Marijuana

flashback

an involuntary recurrence of perceptual distortions or hallucinations weeks or even months after an individual has taken a drug