Clinical chapter 10

Chapter 10: 

1. Substance Abuse: Depressants

Depressants slow the central nervous system's activity, leading to relaxation and reduced inhibitions. This class of drugs can significantly affect judgment and coordination, and long-term use can lead to dependence. The three primary groups of depressants include:

• Alcohol: Widely consumed worldwide with over 2 billion users; over half of U.S. adults drink occasionally. Sales in the U.S. exceed billions annually.

• Sedative-hypnotic drugs: Initially barbiturates, now largely replaced by benzodiazepines due to their safety profile.

• Opioids: Medications utilized for pain relief but carry a high risk of addiction.

2. Alcohol

Statistics and Drinking Patterns

• Binge Drinking: Defined as consuming 5 or more drinks during a single occasion. Approximately 25% of U.S. adults binge drink at least monthly, while 6.5% are classified as heavy drinkers (5 or more times a month).

  • Demographics: heavy drinking is significantly more common in males versus females at a ratio of 2:1.

• Effects of Ethyl Alcohol: Ethanol is quickly absorbed into the bloodstream, leading to its immediate effects on the central nervous system, particularly regarding the neurotransmitter GABA, which inhibits neural activity and induces relaxation.

  • Concentration Effects:

  • 0.06%: Relaxed and comfortable

  • 0.09%: Intoxication begins

  • 0.55%: Risk of death

• Metabolism: Alcohol can only be deactivated through metabolic processes, an average rate of approximately 25% of an ounce per hour.

3. Alcohol Use Disorder (AUD)

Prevalence and Demographics

• Alcohol Use Disorder affects various demographics differently:

  • White Americans: 5.7%

  • Hispanic Americans: 5.3%

  • Black Americans: 4.5%

  • American Indians: 7.1% (highest prevalence)

  • Asians: 3.8% (many have a genetic aversion to alcohol due to a deficiency in alcohol dehydrogenase).

Treatment Strategies

• Treatment Options:

  • Aversion Therapy: Creates negative associations with alcohol consumption.

  • Cognitive Behavioral Therapy (CBT): Emphasizes planning and self-regulation to prevent relapses and patterns of drinking.

4. Biological and Cognitive Impacts of Alcoholism

Cognitive and Psychological Effects

• Alcoholism can lead to impairments in various cognitive functions, namely:

  • Memory and attention deficits

  • Speed of cognitive processing and reaction time.

Withdrawal Symptoms

• Withdrawal from alcohol may yield severe psychological and physical symptoms:

  • Physical: Tremors, sweating, nausea, rapid heart rate.

  • Psychological: Increased anxiety and depressive symptoms may occur, leading to serious complications.

  • Delirium Tremens (DTs): A severe form of withdrawal that includes confusion, hallucinations, and seizures.

Social Impacts

• Alcoholism is implicated in 1/3rd of all suicides, homicides, assaults, and fatal accidents in the U.S.

• It highly affects children of individuals with alcoholism, often leading to long-term issues of low self-esteem and marital problems.

5. Sedative-Hypnotic Drugs

• Mechanism of Action: These drugs, also known as anxiolytics, produce calming effects, with low doses yielding relaxation and higher doses leading to sleep induction.

  • Historical Context: While barbiturates were once the go-to sedative, they have largely been replaced by benzodiazepines (e.g., Xanax, Ativan) due to a better safety profile.

• Effects of Long-term Use: Chronic consumption can lead to dependence, impaired cognitive function, anxiety, and withdrawal symptoms upon cessation.

6. Opioids

• Opium Derivatives: Key drugs include heroin, morphine, and codeine, widely used for pain relief but consequently leading to high addiction potential.

• Psychological Effects: Opioids attach to brain receptors for endorphins, producing significant pleasure and relaxation, which can lead users to prioritize drug use over basic needs.

• Withdrawal Symptoms: Withdrawal can result in severe anxiety, muscle aches, nausea, and blood pressure spikes, severely impacting quality of life.

• Epidemic Statistics: Opioid misuse has increased significantly, with recent data showing a rise in overdose deaths since COVID-19.

7. Stimulants

• Main Types: Cocaine, amphetamines, and nicotine are primary stimulants, with widely varying effects and addiction potential.

• Consequences of Misuse: Regular use may lead to stimulant use disorder, which dominates an individual's lifestyle and health.

8. Overview of Substance Use Disorders

• Definition: Includes alcohol, cocaine, and gambling as significant focus areas in mental health and addiction discourse.

  • Identifying Characteristics: Involve problematic substance use leading to consequences across physical and mental health spectrums.

• Consequences of Abuse: Relationships, employment, and day-to-day functioning become increasingly difficult due to substance-related behaviors.

9. Treatment Approaches for Substance Use Disorders

• CBT and Integrated Treatment: Incorporates both psychological and pharmacological strategies to treat substance use disorders effectively.

• Importance of Community Support: Coordination among healthcare providers and community resources can significantly improve treatment outcomes.