substance abuse disorders- Psychology

what does substance abuse disorders do to the United States?

costs hundreds of billions of dollars each year to citizens, kills 500000 Americans anually, and is implicated in street crime, homelessness and gang violence

What are substance related and addictive disorders?

range of problems assoxiated with the use and abuse of drugs such as alcohol, cocaine, heroin, and other substances people use to alter the way they think, feel, and behave. These are extremely costly in human and financial terms

• newly added disorder is gambling disorder

What are impulse control disorders?

Disorders in which a person acts in an irresistible but potentially harmful impulse

• reflect inability to resist acting on a drive or temptation

• within this group are impulse to steal or to set fires

Why does controversy surround substance related addictive and impulse control disorders?

because our soxiety sometimes believes that these problems simply result from a lack of “will” and if you wanted to stop you would just stop

What percent of people are believed to use illegal drugs?

9.7 percent of the general population 12 years or older

• many presidents have declared the “war on drugs” but problem remains

What did the Roman Catholic Church issue in 1992?

a universal catachism that officially declared drug ab use and drunk driving to be sins

What celebs died of substance abuse?

Jimi Hendrix and Janis Joplin in 1970

michael Jackson, Whitney Houston and Amy Winehouse

What is alcohol use disorder?

Cognitive, biological, behavioral and social problems associated with alcohol use and abuse

What does the term substance refer to? what is a psychoactive substance?

Substance: chemical compounds that are ingested to alter mood or behavior

psychoactive substances: alter mood, behavior, or both

• include cocaine, heroin, alcohol, nicotine, caffeine, soft drinks, and chocolate

  • these “safe drugs” can affect mood and behavior, can be addictive and account for more health problems and a greater mortality rate than all illegal drugs combined

What is substance use? Also the definition for substance use disorders

the ingestion of psychoactive substances in moderate amounts that does not significantly interfere with social, educational, or occupational functioning

• Ie drinking coffee occasionally or smoking a cig and drinking occasionally with friiends or occasional use of harder drugs

What is substance intoxication?

our physiological reaction to ingested substances

• for a person to become initoxicated many variables interact including the type of drug, amount, and the persons individual biological reaction

• for many substances intoxication is experienced as Impaired Judgment, Mood Changes, and Lowered Motor Ability

Why is defining substance use disorders by how much of a substance is ingested problematic? what does DSM-5 define it as?

is it one drink, two glasses of fine an hour, three, 6 or one shot of heroin?? not sure

DSM-5 defines in terms of how significantly the use interferes with the user’s life

• if substances disrupt your education, job, or relationships with others and put you in a physically dangerous situation you would be considered to have a disorder

What does some evidence suggest that drug use can predict?

later job outcomes

• found that repeated hard drug use predicted poor job outcomes after college

What is substance use disorder usually descibed as?

an addiction

• although we use addiction when we describe people who seem to be under the control of drugs there is some disagreement on how to define

In order to meet criteria for a disorder what must a person meet?

They must meet criteria for at least two symptoms in the past year that interfered with his/her life or bothered him/ her a great deal

• when they have 4-5 symptoms they fall into a moderate range

• with 6 or more symptoms falls into the severe substance use disorder range

What can symptoms for a substance used disorder include?

a physiological dependence on the drug or drugs meaning the use of increasingly greater amounts of the drug to experience the samfe effect and a negative physical response when the substance is no longer ingested

• tolerance and withdrawal

What are the definitions for tolerance and withdrawal?

Tolerance: Need for increased amounts of a substance to achieve the desired effect and a diminished effect with continued use of the same amount

Withdrawal: severely negative physiological reaction to removal of a psychoactive substance which can be alleviated by the same or a similar substance

• they are physiological reactions to chemicals being ingested

What can happen with alcohol withdrawal?

delirium: a person can experience frightening hallucinations and body tremors

What does withdrawal from many substances bring?

• chills

• fever

• diarrhea

• nausea

• vomiting

• aches

• pains

Not all substances are physiologically addicting

• IE: LSD you don’t go through severe withdrawal

• cocaine has patterns of anxiety, sleep changes, lack of motivation, boredom

• cannabis: irritability, nervousness, appetite change, and sleep disturbance

What is another symptom that makes up a substance use disorder? what are behaviors that define the extent of a substance use disorder?

Drug seeking behaviors

• the repeated use of a drug, a desperate need to ingest more of the substance, and the likelihood that use will resume after a period of abstinence are behaviors that define the extent of substance use disorders

  • these behaviors are different from the physiological responses to drugs and are sometimes referred to in terms of psychological dependence

What did the previous version of the DSM consider substance abuse and substance dependence? what is substance dependence?

Separate diagnoses

• substance dependence: maladaptive pattern of substance use characterized by the need for increased amount to get desired effect, negative physixal effects when the substance is withdrawn, unsuccessful efforts to control its use, and substantial effort expended to seek it or recover from its effects

  • also known as addiction

The DSM-5 combines the two into the general definition of substance-related disorders based on research that suggests they co-occur

Can you use drugs and not abuse them? can you abuse drugs and not become addicted to them?

1. yes: some people drink without drinking in excess and some people use drugs (like coke or crack or heroin) without abusing them

   1. problem is that we do not know who might be likely to lose control and abuse these drugs and who is likely to become dependent with even a passing use of a substance

2. dependence can be present without abuse

   1. IE someone with cancer may take morphine for pain and become dependent building up a tolerance and go through withdrawal if stopped without abusing it

In early editions of the DSM what weren’t treated as separate disorders?

Alcoholism and drug abuse

• instead they were categorized as “sociopathic personality disturbances,” a forerunner of the current antisoxcal personality disorder because substance use was seen as a symptom of other problems

  • considered a sign of moral weakness and influence of genetics was hardly recognized

    • a separate category was greated for substance abuse disorders in the DSM-3 in 1980 and since then we have acknowledged the complex biological and psychological nature of the problem

The DSM-5 term substance-related disorders include what?

11 symptoms that range from mild to more severe

• the DSM-5 removed the previous symptom that indicates the presence of craving or a strong desire to use the substance

  • these distinctions help clarify the problem and focus treatment on the appropriate aspect of the disorder

What is substance abuse?

Pattern of psychoactive substance use leading to significant distress or impairment in social and occupational roles and in hazardous situations

What can symptoms of other disorders do to substance use disorder?

They can complicate the substance use disorder picuture significantly

• IE do some people take drugs in excess because they are depressed or does drug use and its consequences create depression

What do researchers estimate the number of people in addiction treatment who have additional psychiatric disorder?

almost ¾ of people

• mood disorders observed in more than 40 percent and anxiety disorders and PTSD seen in more than 25 percent of cases

Why might substance use occur with other disorders?

1. Substance-related disorders and anxiety and mood disorders are highly prevalent in our society and may occur together so often just by chance

2. drug intoxication and withdrawal can cause symptoms of anxiety, depression, and psychosis

3. Disorders such as schizophrenia and antisocial personality disorder are highly likely to include a secondary problem of substance abuse

Because substance related disorders can be so complicated, the DSM-5 tries to define when a symptom is a result of what?

substance use and when it is not

• if symptoms seen in schizophrenia or extreme state of anxiety appear during intoxication or within 6 weeks after withdrawal they are not considered signs of a separate psychiatric disorder

  • IE if someone severely depressed before they used stimulants and those whose symptoms persist more than 6 weeks after they stop might have a separate disorder

What are the 6 general categories of substances themselves?

1. depressants

2. stimulants

3. opiates

4. hallucinogens

5. other drugs of abuse

6. gambling disorder

What are depressants?

These substances result in behavioral sedation and can induce relaxation

• include alcohol and the sedative and hypnotic drugs in the families of barbiturates and benzodiazepines (valium and xanax)

What are stimulants?

These cause us to be more active and alert and can elevate mood

• amphetamine, cocaine, nicotine, and caffeine

What are opiates?

Effects produce analgesia temporarily (reduce pain) and euphoria

• heroin, opium, codeine, and morphine

What are hallucinogens?

• alter sensory perception and can produce delusions, paranoia, and hallucinations

  • cannabis and LSD and included

What are other drugs of abuse?

inhalants (airplane glue), anabolic steroids and other over-the-counter prescriptions and medications (nitrous oxide)

• produce a variety of psychoactive effects that are characteristic of substances described in other categories

What is gambling disorder?

Individuals who display a gambling disorder are unable to resist the urge to gamble, which results in negative personal consequences

What are depressants and what do they do?

They decrease CNS activity

• principle effect is to reduce our levels of physiological arousal and help us relax

  • alcohol and the sedative hypnotic and anxiolytic drugs such as those prescribed for insomnia

  • are among the most likely to produce symptoms of physical dependence, tolerance and withdrawal

What is the most commonly used depressant?

Alcohol

How long has alcohol been around?

has been widely used throughout history

• evidnece of wine or beer in pottery jars at the site of a Sumerian trading post in western Iran and the country of Georgia that date back 7000 years

• Egyptian drank large amounts of beer, wine, and hard liquor and brought to North America in the early 1600s

In the US during the early 1800s how much alcohol was consumed?

more than 7 gallons per year for every person older than 15 which is more than three times the current rate of US alcohol use

• mostly whiskey

What is the initial effect of alcohol and what is the description of the experience?

Apparent stimulation is the intial effect of alcohol, although it is a depressant

• generally experience a feeling of well-being, inhibitions are reduced, and we become more outgoing because the inhibitory centers in the brain are initially depressed or slowed

• with continued drinking more areas of the brain are depressed which impedes ability to function properly

  • motor coordination impaired

  • reaction time slowed

  • confusion

  • reduced ability to make judgments

  • vision and hearing can be negatively affected

What is alcohol broking into as it passes through the liver?

carbon dioxide and water

What does alcohol effect as it is absorbed?

infleunces a number of neuroreceptor systems which makes it difficult to study

• Gamma-aminobutyric acid (GABA) system seems to be particularly sensitive to alcohol

  • GABA: inhibitory neurotransmitter and interferes with the firing of the neuron it attaches to

  • when it attaches to receptor chloride ions enter the cell and make it less sensitive to effects of other neurotransmitters

    • alcohol reinforces the movement of these chloride ions and the neurons have difficulty firing meaning that although alcohol seems to make us more sociable it makes it difficult for neurons to communicate with one another

• Gaba is why alcohol seems to produce antianxiety properties

What does some research suggest about communication between neurons and alcohol?

That genes responsible for communication between neurons may also be responsible for individual differences in response to alcohol

How is the glutamate system affected by alcohol?

Glutamate system is excitatory helping fire neurons and suspected to involve learning and memory and may be the avenue through with alcohol affects our cognitive abilities

• blackouts and loss of memory may result from interaction of alcohol iwth the glutamate system

How is the serotonin system affected by alcohol?

Serotonin system affects mood, sleep, and eating behavior and is thought to be responsible for alcohol cravings

What does withdrawal symptoms from chronic alcohol use produce?

hand tremors and within several hourse nausea or comiting, anxiety, transient hallucinations, agitation, insomnia and at its most extreme

• Withdrawal delirium or delirium tremens (DT): frightening hallucinations and body tremors that result when a heavy drinker withdraws from alcohol

What does whether alcohol will cause organic damage depend on?

genetic culnerability, the frequency of use, the length of drinking binges, the blood alcohol levels attained during the drinking periods and whether the body is given time to recover between binges

What are consequences of long-term excessive drinking?

liver disease, pancreatitis, cardiovascular disorders, and brain damage

What is a folklore concerning alcohol?

That is permanently kills brain cells

• may not be true

• some evidence comes from the experiences of people who are alcohol dependent and experience blackouts, seizures, and hallucinations and have trouple with memory and ability to perform tasks.

What are two types of organic brain syndromes that may result from long term heavy alcohol use?

dementia (neurocognitive disorder): general loss of intellectual abilities and can be a direct result of neurotoxicity or poisoning of the brain by excessive amounts of alcohol

• the dementia caused by this disease does not go away once the brain is damaged but important to note that mild to moderate intake of alcohol especially wine may actually serve a protective role in cognitive decline as we age

wernicke- Korsakoff syndrome: organic brain syndrome resulting from prolonged heavy alcohol use involving confusion, unintelligible speech, and loss of motor coordination

• may be caused by a deficiency of thiamine, a vitamin metabolized poorly by heavy drinkers

What is fetal alcohol syndrome (FAS)

patten of problems including learning difficulties, behavior deficits, and characteristic physical flaws resulting from heavy drinking by the victims mother when she was pregnant with the victim

How is alcohol metabolized? how does this play a role in FAS

by ADH

• three forms include beta-1, beta-2, and beta-3

• among children with FAS beta-3 may be prevalent and Beta 3 is also found most often in African Americans

In addition to the drinking habits of the mother the likelihood of a child having FAS may depend on whether there is a genetic tendency to have certain enzymes

• thus children from certain racial groups may be more susceptible to FAS than are others

What are statistics related to alcohol use in the US?

most adults in the US characterize themselves as light drinkers or abstainers

• half of all Americans over the age of 12 report being current drinkers and there are differences among people from different backgrounds

  • caucasians report highest frequency of drinking 56.8 percent and drinking is lowest among Asian- Americans 40 percent

63 million Americans 24.6 percent over the age of 18 report binge drinking on 4 or more drinks for women and 5 or more for men in 2 hours in the past month

• Asians report the lowest level of binge drinking 12.4 percent

• caucasians 24 percent

• hispanics or latinos 24.1 percent

When does peak alcohol use happen?

around late teens to early adolescence

• of a college survey

  • 36 percent said they had gone on a binge drinking once in the last 2 weeks

  • binging has increased in college students along with drunk driving and alcohol related deaths

men are more likely to report several binges in the 2 week period

• those with an A GPA had no more than 3 drinks a week whereas D and F students averaged 11 drinks per week

How many people meet the criteria for an alcohol use disorder?

16.6 million adults ages 18 and older and the same is true of 697000 adolescents age 12-17

• lifetime prevalence rates of alcohol use disorders is 29 percent

  • 1/3 people in their entire lives

What are alcohol use prevalence outside of the US

according to the WHO

• highest in eastern European countries (russian 19 percent), Colombia 13 percent, South Korea 13.5 percent and Thialand 11 percent

• prevalence lowest in Northern Africa and the Middle East

  • cultural differences can be accounted for by different attitudes toward drinking, the availability of alcohol, physiological reaciotns, and family norms and patterns

Who do many people with alcohol use disorder fluctuate between?

drining heavily, drinking socially without negative effects and being abstinent

• 20 percent of people with severe alcohol dependence have a spontaneous remission and do not reexperience problems with drinking

• used to be thought that once problems arose they would get worse following a downward pattern as long as the person kept drinking

  • First Championed by Jullinek more than 50 years ago this view continues to influence the way people view and treat the disorder

    • based his model on a faulty study

What faulty study did Jullinek base his ideas on what what did it say?

in 1945 Alcoholics Anonymus sent out about 1600 surveys to its members askign to descibe symptoms related to drinking and only 98 of the surveys were returned

• small group of people

• responses were retrospective

despite this Jellinek still analyzed the data and developed a four-stage model for the pregression of alcoholism based on limited information

What was the four stage model created by Jellinek on the progression of alcoholism?

1. prealcoholic stage: drink occasionally with few serious consequences

2. prodromal stage: drinking heavily but with few outward signs of a problem

3. Crucial stage: loss of control with occasional binges

4. Chronic Stage: the primary daily acitivities involve getting and drinking alcohol

Attempts but other researchs to confirm this has not been successful

What does it appear about the course of severe alcohol use disorder?

That it may be progressive for most people

• early use of alcohol may predict later abuse

• study of 6000 lifetime drinkers

  • found that drinking at an early age (11-14) was predictive of later alcohol related disorders

• Study following 636 male inpatients in an alcohol rebailitation center

  • chronically alcohol dependent men a general progression of alcohol related life problems did emerge though not in the specific pattern proposed by Jellinek

  • ¾ men reported moderate consequences of their drinking like demotions at work in 20s and by 30s and 40s these med demonstrated long-term serious consequences of their drinking which included hallucinations, withdrawal convulsions, and hepatitis or pancreatitis

    • suggests a common pattern among people with chronic alcohol abuse and dependence with increasingly severe consequences

    • progressive pattern not inevitable for everyone who abuses alcohol though we do not unerstand what distinguishes those who are and those who are not susceptible

What does research on the mechanism responsible for the differences in early alcohol use suggest?

That one’s response to the sedative effects of the substance affects later use

• Ie those individuals who do not tend to develop the slurred speech, staggering, and other sedative effects of alcohol use are more likely to abuse it in the future

  • this is of particular concern with the mis of highly caffeinated drinks with alcohol

    • this combination can reduce the sedative effects of alcohol which may increase the likelihood of later abuse

What is often linked with alcohol statistically?

violent behavior

• many studies found that people who commit such violent acts as murder, rape and assault are intoxicated at the time of the crime

  • just because they overlap does not mean that alcohol will make everyone violent

• some studies show that alcohol may increase participants aggression and whether a person behaves aggressively outside of the lab probably involves a number of interrelated factors such as quantity and timing of alcohol consumed, the persons history of violence, expectations about drinking and what happens to the individual while intoxicated

• alcohol does not CAUSE aggression but may increase a person’s likelihood of engaging in impulsive acs and it may impair the ability to consider the consequences of acting impulsively

  • such impaired rational thinking may increases a persons risk of behaving aggressively

What does the general group of depression also include?

sedatives (calming), hypnotic (sleep inducing), and anxiolytic (anxiety reducing) drugs

• these drugs include barbiturates and benzodiazepines

What are Barbiturates?

sedative and addictive drugs including Amytal, Seconal, and Nembutal that are used as sleep aids

• first synthesized in Germany in 1882

• prescribed to help people sleep and replace alcohol and opium

• widely prescribed in 1930s and 40s before their addictive properties were understood

• by the 1950s they are the drugs most abused by adults in the US

What are Benzodiazepines?

Antianxiety drugs including valium, Xanax, Dalmane, and Halcion used to treat insomnia. Effective against anxiety and at high potency panic disorder

they show some side effects such as some cognitive and motor impairment and may result in substance dependence. Relapse rates are very high when the drug is discontinued

• used since the 1960 for anxiety

• in 1980 with FDA ruled that they are not appropriate for reducing the tension and anxiety resulting from everyday stresses and starins

• 85 million prescriptions were wrote in the US each year

• considered much safer than barbiturates with less risk of abuse and dependence

• misuse of Rohypnol show how dangerous even some benzodiazepine drugs can be: roofies

  • popular in the 90s because it has the same effect as alcohol and used as a date rape drug

What do barbiturates do clinically?

relax the muscles and can produce a mild feeling of well-being

larger doses can have similar results to heavy drinking such as slurred speech and problems walking, concentrating, and working

• highe doses the diaphragm muscles can relax so much that they cause death by suffocation

  • common means of suicide

What are benzodiazepines used for clinically?

used to calm an individual and induce sleep

• prescibed as muscle relaxants and anticonvulsants

non medical use report fellings of a pleasant high and a reduction of inhibition similar to effects of alcohol

with continued use tolerance and dependence can develop and users who try to stop taking experience symptoms like alcohol withdrawal

• anxiety, insomnia, tremors, and delirium

How does DSM-5 criteria for sedative, hypnotic, and anxiolytic related disorders differ from those for alcohol disorders

Do not differ much at all

• both include maladaptive behavioral changes such as inappropriate sexual or agressive behavior, variable moods, impaired judgement, impaired social or occupational functioning, slurred speech, motor coordination problems and unsteady gait

Hw do sedative, hypnotic, and anxiolytic drugs affect the brain?

By influencing GABA neurotransmitter system, although mechanisms differ from those of alcohol

• when people use alcohol with any of these drugs or combine multiple types there can be synergistic effects

  • IE effects can reach dangerous levels

  • Marilyn Monroe in 1962 theory is that she combined barbiturates with alcohol and accidentally killed herself

  • Heath Ledger in 2008 oxycodone and a variety of barbiturates and benzos

What are statistics on Barbiturate and Benzo use?

They have increased since 1960 and of those seeking treatment for substance related problems, less than 1 percent presenting problems with benzos compared with other drugs of abuse

• those who do seek help with these drug addictions tend to be female, caucasian and over the age of 35

of all of the psychoactive drugs used in the US, which are the most commonly consumed?

Stimulants: make your more alert and energetic

• caffeine, nicotine, amphetamines, and cocaine

What did chinese physicians prescribe?

an amphetamine compound called Ma-huang (Ephedra Sinica) for more than 5000 years for illnesses such as headaches, asthma, and the common cold

What are amphetamines and what do they do?

Stimulant medication used to treat hypersomnia by keeping the person awake during the day and to treat narcolepsy including sudden onset episodes by supressing REM sleep

• induce feeling of elation and vigor and reduce fatigue

• you feel up and then after a period of elevation you come back down and “crash”feeling depressed or tired

What was the origin of Amphetamines ? What are their uses?

• manufactured in labs and first synthesized in 1887 and later used as a treatment for asthma and as a nasal decongestant

• also used for weight loss

• Adloph became addicted to amphetamines and some truck drivers will use for an energy boost

• Uses

  • amphetamines are prescribed for people with narcolepsy

  • some like Ritalin and Adderall are given to children with ADHD

  • misused for their psychostimulant effects

What did one study find with college students and being offered illegal substances

that almost 2/3 of college students in their 4th year had been offered illegal prescription stimulants and 31 percent of the used them, usually to improve studying

What are Amphetamine use disorders and what is the DSM-5 criteria for intoxication?

Amphetamine use disorders: stimulent medication same definition as the med

• criteria

  • significant behavioral symptoms such as euphoria or affective blunting (lack of emotional expression)

  • changes in sociability

  • interpersonal sensitivity

  • anxiety

  • tension

  • anger

  • stereotyped behaviors

  • impaired judgment

  • impaired social or occupational functioning

• in addition physiological symptoms occur during or shortly after amphetamine or related substances are ingested and can include heart rate or BP changes, perspiration or chills, nausea or comiting, weight loss, muscular weakness, respiratory depression, chest pain, seizures, or coma

What can severe intoxication or overdose cause with amphetamines? What about amphetamine tolerance? what are withdrawal symptoms

hallucinations, panic, agitation and paranoid delusions

• amphetamine tolerance builds quickly making it doubly dangerous

withdrawal often results in apathy, prolonged periods of sleep, irritability, and depression

What is the designer drug Methylene dioxymethamphetamine (MDMA)

first made in 1912 in Germany and was used as an appetitie suppressant now commonly called Ecstasy and rose in popularity in the 1980s

• after meth and coke MDMA is the club drug most often bringing people into ER and has passed LSD in frequency of use

• effects

  • makes you “feel happy” and “love everyone and everything” “music feels better” and more fun to dance

  • can say what is on your mind without worrying

• Variation of MDMA

  • Molly marketed as a purified powder in capsules instead of pressed pills

What is the purified crystallized form of amphetamine?

methamphetamine or crystal meth or ice which is ingested through smoking

• causes marked agressive tendencies

• stays in system longer than cocaine

• gained and dropped in populatiry since invented in 1930 but use spread very wide now

Potential for users to become dependent on them is high with great risk for long-term difficulties

What can repeated use of MDMA cause?

lasting memory problems

How do Amphetamines stimulate the CNS?

By enhancing the activity of norepinephrine and dopamine

• specifically amphetamines help release these neurotransmitters and block their reuptake making more of them available throughout the system

What can too much amphetamine lead to?

too much dopamine and norepinephrine and lead to hallucinations and delusions

What does the use and misuse of drugs wax and wane according to?

societal fashion, moods, and sanctions

What replaced amphetamines as the stimulant of choice when? What is it?

Cocaine in the 1970s

• derived from the leaves of the coca plant which is indigenous to South America

• Sigmund Freud wrote “On Coca” talking of the properties stating that it wards off hunger, sleep, and fatigue and steels one to intellectual effort

How long had latin America used Coca leaves and for what? When was it introduced in the US

Used for centuries for relief from hunger and fatigue

introduced in the US in the late 19th century and widely used until the 1920s

• in 1885 Parke Davis and Co manufactured Coca and cocaine in 15 forms

  • coca-leaf cigarettes and cigars, inhalants, and crystals

• for people who could not afford this the cheap way was to get in Coca-Cola

  • until 1903 contained a small amount 60 mg per 8 oz

What does cocaine do medically?

in small amounts increases alertness, produces euphoria, increases BP and pulse, and causes insomnia and loss of appetite

makes the heart beat more rapidly and irregularly and can have fatal consequences depending on the persons physical condition and the amount of drug ingested

• effects are short lived

• can lead to cocaine induced paranoia: experience exaggerated fears

  • common among people with cocaine use disorder occurin in 2/3 or more

What is cocaine?

Derivative of Coca leaves used medically as a local anesthetic and narcotic

What can Cocain do to a fetus?

suspected that use of cocaine especially crack can have adverse effects on babies

• crack babies affear more irritable than normal babies and have long bouts of high-pitched crying

  • originally thought to have brain damage although recent research suggests that effects are less dramatic

• some suggest decreased birth weight and decreased head circumference and are at increased risk for later behavior problems

• mothers almost always use other substances as well including alcohol and nicotine and many children are raised in disrupted home environments which furhter complicated the picture

What percent of adults worldwide report using cocaine and what are some other statistics?

5 pecent of adults reported using at some point in their lives and in the US 0.6 percent of the population or 1.5 million report using coke including crack each year

• 18-25 are twice as likely to use cocaine compared with other age groups

• men twice as likely to use compared to women

• black individuals account for close to half of admissions to ER for Cocaine related problems (47 percent)

• caucasian individuals account for 37 percent in ER and hispanic 10 percent

• Men are twice as likely to be in the ER

• 17 percent of users have also used Crack (crystalized form that is smoked)

• 0.1 percent of people in the US have tried crack and that an increasing proportion of the abusers seeking treatment are young unemployed adults in urban areas

Why is cocaine in the same group of stimulants as amphetamines?

Because it had similar effects on the brain

• the up comes primarily from the effect of cocaine of the dopamine system

• cocain enters the bloodstream and is carried to the brain where the cocaine molecules block the reuptake of dopamine

• cocaine seems to bind to places where dopamine neurotransmitters reenter their home neuron and block reuptake causing repeated stimuation of the next neuron

• this stimulation of the dopamine neurons in the “pleasure pathway” causes the high

What is the pleasure pathway?

The site in the brain that seems to be involved in the experience of pleasure

What did the Comprehensive Textbook of psychiatry in 1980 indicate about coke?

That if taken no more than 2-3 times per week it creates no sereous problem and many people in this time though that is produced feelings of euphoria without being addictive

• cocaine actually is addictive

  • does not resemble that of many other drugs early on and typically people find that they have a growing inability to resist taking more

  • few negative effects reported first but continued use leads to

    • sleep disruption, increased tolerance causes a need for higher doses

    • paranoia

    • and cocaine user gradually becomes socially isolted

    • chronic use may result in premature aging of the brain

What does withrawal from cocaine produce?

Pronounced feelings of apathy and boredom

• viscious cycle of cocaine being abused, withdrawal causes apathy, and cocain abuse resumes

  • cocaine abusers go through patterns of tolerance and withdrawal comparable to those experienced bu abusers to other psychoactive drugs

What are tobacco related disorders?

cognitive, biological, behavioral, and social problems associated with the use and abuse of nicotine

What did Scottish physician Lennox Johnson find in 1942?

they shot up nicotine extract and found after 80 injections that he liked it more than cigarettes and felt super deprived without it

• named nicotine after Jean Nico who introduced tobacco to french court in the 16th century

Where is the tobacco plant indiginous to? what percent of people smoke

North American and Native Americans cultivated and smoked the leaves centuries ago

• today 20 percent of all people in the US smoke which is down from the 42.4 percent who were smokers in 1965

Does the DSM-5 descibe an intoxication pattern for tobacco related disorders? what does it do instead?

No.

instead it lists withdrawal symptoms

• depressed mood

• insomnia

• irritability

• anxiety

• difficulty concentrating

• restlessness

• increased appetite and weight gian

What does nicotine do for the body?

in small doses stimulates the CNS and can relieve stress and improve mood

• can cause high BP and increase the risk for heart disease and cancer

High doses

• can blur your vision

• cause confusion

• lead to convulsions

• or death

The rate of relapse among people trying to givev up drugs is equivalent among those using alcohol, heroin, and cigarettes

How is nicotine taken in? What is the pathway it takes?

It is inhaled into the lungs where it enters the bloodstream

• 17-19 seconds after inhaling the nicotine reaches the brain

nicotine stimulates specific receptors

• nicotinic acetylcholine receptors nAChRs in the midbrain reticular formation and the limbic system, the site of the brain’s pleasure pathway (dopamine system responsible for feelings of euphoria)

Smokers dose throughout the day to keep nicotine at a steady level