Psychopathology Ch.11 4/3

Abuse

• excessive use despite social, psychological, occupational, or health problems

Dependence

• more severe than abuse

• your body physiologically “needs” the substance

• you show 1+ of the following (alcohol):

  • tolerance: when you need more and more of the substance to get the same effect

  • withdrawal: when you get physical symptoms when you stop using (e.g., shaking, nausea) - can get really bad (e.g., hallucinations)

    • -delirium tremens = severe reaciton, hallucinations

Alcohol use disorder prevalence

• worlds 3rd largest contributor for disease burden

  • 5.9% of deaths annually = due to harmful use of alcohol

• WHO mental health survey → only disorder where country poverty increases risk

• US

  • lifetime prevalence = 30%

  • 12-month prevalence = 15%

  • 2:1 men:women

DSM Alcohol Use Disorder

• problematic pattern of alcohol use leading to clinically significant impairment or distress, as shown by at least 2 of these, occurring within 12 month period:

  • alcohol is taken in larger amounts than intended

  • unsuccessful efforts to cut down on use (dependence)

  • lots of time spent in activities to obtain or recover from alcohol

  • craving for alcohol

  • failure to fulfill obligations at home, work or scvhool

  • continued use despite interpersonal problems

  • occupational or recreational activities given up because of alcohol use

  • use when it’s physically dangerous

  • use despite a health or psychological problem caused by alc

  • tolerance

  • withdrawal

• past diagnosis doesn’t exist

• been sober for 3-12 months

  • “alcohol use disorder in early remission”

• been sober 12+ months

  • “alcohol use disorder in sustained remission”

Other drugs of abuse

• sedatives

  • ex.

    • alc,

    • barbituates

  • effect:

    • reduce tension

• stimulants

  • ex.

    • amphetamines (e.g., Adderall),

    • methamphetamine,

    • cocaine/crack cocaine

  • effect:

    • increase alertness/decrease fatigue

    • increase endurance

    • stimulate sex drive

• opiates

  • ex.

    • opium

    • heroin

    • morphine

    • codeine

  • effect:

    • induce relaxation

    • reduce tension

    • alleviate physical pain

• hallucinogens

  • ex.

    • LSD

    • PCP

    • Cannabis

  • effect

    • changes in mood + thought

• anti-anxiety meds (minor tranquilizers)

  • ex.

    • benzodia

    • CHECK SLIDES/ADDI TEXT

Prevalence drug abuse

• use

  • 19% of US population used one illicit drug in past year

  • 48% tried one by high school (before freshman year)

• use disorder

  • ~2-4% 12-month prevalence

  • high comorbidity with other diagnoses

    • depression and anxiety increases odds by 3-4x

    • 70% of ppl who use opioids have another diagnosis

Opioid Epidemic

• increase in opioid use since 2000

• primarily as result of being prescribe for pain (4x prescriptions from 1995 → 2010)

• CHECK SLIDES, INSERT GRAPH

• after run through prescription → illegal heroin use

Caffeine and Nicotine

• both stimulants

• DSM Nicotine disorder

• cafeine intoxication and withdrawal

• caffeine use disorder: “disorder for further study”

DSM Substance Use disorder

Same as alcohol but replace “alcohol” with substance

Behavioral Addictions

• gambling disorders (in the DSM)

• food addiction (not in the DSM)

• internet addiction (not in the DSM)

DSM Gambling Disorder

Problematic gambling, shown by at least 4 of these over 12m

1. needs to gamble/increasing amts of money to achieve desired excitement

2. Is restless or irritable when trying to cut down on gambling

3. Has made repeated unsuccessful attempts to reduce gambling

4. Often preoccupied with gambling (e.g., persistent thoughts of past gambling, thinking of ways to get money to gamble)

5. Often gambles when distressed

6. After losing money, often returns to get even

7. Lies to conceal extent of gambling

8. Has jeopardized a relationship, job, or educational/career opportunity because of gambling

9. Relies on others to provide money to relieve financial strain

Biological: Why do people keep using

• drugs/alc activate common “pleasure pathway” in brain

  • dopamine = wanting

    • all drugs of abuse increase dopamine

  • opioid and GABA = liking

  • after disorder, want and like get uncoupled

• diff systems for craving (wanting) and enjoyment (liking)

Naltrexone

• used to help treat alcohol use disorder

• Blocking the euphoric effects of these substances and helping rewire the brain to no longer be addicted

Biological: Other mechanisms drugs

• opioids: bind to opiate receptors in CNS system and pituitary gland

  • same action as endorphins (naturally produced by body) but work more quickly → euphoria

• ecstasy: release of serotonin

Biological: Reward Deficiency Syndrome hypothesis

• addiction is more likely to occur in people with genetic deviations in components of reward pathways

• blunted reactivity to non-drug pleasurable things ☹

  • evident in self-report and reduced “reward area” activity

• maintains addiction

Biolgoical Genetics

CHECK SLIDES

Personalities at Risk: Drugs

• “at risk” personality

  • impulsive

  • aggressive

  • “sensation seeking”

    • seek out novel, intense experience

Behavioral Factors

• classical conditioning

  • substance related cues → craving

  • US (naturally rewarding) e.g., alc

  • CS (originally neutral) e.g., picture of glass

  • CR e.g., crave when see pic of glass

• operant conditioning

  • positive reinforcement:

    • continue behavior bc leads to addition of positive outcome

  • negative reinforcement

    • continue behavior bc leads to removal of negative thing

Integrative Model of SUDs

CHECK SLIDES

CHECK SLIDES FOR HEALTH CONSEQUENCES

Treatment: Substance Use Disorders

• goal reduce substance use

  • difficult bc substances make us feel good

• Motivational Interviewing (MI)

  • ask questions to get patient in touch w reasons to stop using

  • “guided discovery”

    • e.g., “what’s the best thing that can come if you stop using”

  • decisional balance

    • reasons for/against change

    • reasons for/against staying the same

Biological Treatment of SUDs (substance use disorders): agonist

• agonist substitution

  • safe drug with a similar chemical composition as the abused drug

  • produces feeling of contentment w fewer negative consequences

  • examples include methadone (controversial bc is addictive) and nicotine gum or parch

  • may wean off it over many years

• partial-agonist

  • buprenorphine - produces feelings of contentment w fewer side effects, does not produce dependence

Biological Treatment of SUDs (substance use disorders): antagonist

• antagonist treatment

  • drugst that block or counteract the positive effects of substances

  • you can still take the drugs, but won’t ge tthe pleasurable feeling from them

  • ex. include naltrexone for opiat ena dlac problems

• acamprosdade to reduce craving

Biological Treatment of SUDs (substance use disorders): Aversive Treatment + Misc

• aversive

  • drugs that make use of substances extremely unpleasant (e.g., take it and drinking makes you nauseous)

    • ex. antabuse and silver nitrate

• drugs to help manage withdrawal symptoms

  • during acute detox use valium and benzodiazepines

• efficacy of biological treatment

  • naltrexone and acamprosate have good evidence for reducing drinking

  • other medications are best when accompanied by therapy

Psychosocial Treatment of SUDs

• inpatient detox to help w physical withdrawal

• inpatient → outpatient care

• community support programs

  • AA, and related gps e.g., NA may be helpful

  • minimal research on effectiveness

• blanacinng treatment goals

  • controlled use vs complete abstinence

  • research supporting controlled dirnking approaches less severe cases

Psychosocial Treatment SUDs: p

• comprehensive treatment and prevention programs

  • individ and gp psychotherapy

  • aversion therapy

  • contingency management (e.g., monetary reinforcers for negative urine test)

  • relapse prevention

    • e.g., CBT

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