Oct 21 D&B

Alcohol Use Disorders

Pharmacological Tools for Treatment

  • Discussed medications: disulfiram, naltrexone, acamprosate.

Treatment Goals

  • Importance of defining the goal of treatment in psychological conditions.

  • Contrast of Treatment Approaches:

    • Disease Concept of Alcoholism: Dominant view that alcoholism is a chronic disease and can only be managed through abstinence.

      • Authors like Emejelenik in 1960 popularized this concept.

      • Gamma Drinkers: A classification identified by Jelinek that describes individuals who experience loss of control when drinking.

        • Addiction as a progressive disease leading to dire consequences if untreated.

        • Loss of control suggests that addiction leads to inevitable relapse post any drinking.

    • Harm Reduction Approach: Treatment is more flexible, allowing for controlled drinking as a goal.

      • Aims to address personal readiness for treatment without the fear of total abstinence.

      • Suggests that learning to control drinking can be feasible.

Characteristics of Gamma Alcoholics (Jelinek)

  • Progressive and irreversible disease.

  • Loss of control post first drink leading to potential bingeing.

  • Treatment goal focused solely on abstinence leads to limited success.

Controlled Drinking

  • Advocated as a viable alternative to abstinence-only models.

    • Provides a way for engaged individuals, especially youth, to seek help.

  • Suggests that learning to control drinking is itself a conditioned behavior.

    • Example scenarios:

      • Drinking to cope with bullying.

      • Drinking to escape depression.

Cognitive Expectancies in Drinking

  • Expectancies influence behaviors surrounding drinking.

  • Research indicates that perceived loss of control may be psychologically instigated rather than purely physiological.

  • Balanced Placebo Design: Used to discern effects of expectancy versus pharmacological actions in alcohol and controlled drinking studies.

Research by Marlott & Sobel

  • Studies comparing harm reduction strategies with traditional abstinence-focused therapies.

  • Findings indicate that teaching controlled drinking techniques can lead to better overall functioning in post-treatment life compared to strict abstinence goals.

    • Many with controlled drinking approaches maintained more stability in life circumstances.

  • Treatment as a dual approach—control drinking while addressing underlying reasons for drinking.

Cannabis

Overview of Cannabis Use

  • Cannabis has been used for thousands of years, with both psychoactive and fibrous applications.

  • Key cannabinoids: Delta 9 THC and Cannabidiol (CBD).

Historical Context

  • Marijuana’s introduction in North America primarily as a fiber source, not for psychoactive effects.

  • Mid to late 1800s saw a rise in hashish use post-French campaigns in Africa.

  • Marijuana gained popularity during U.S. Prohibition, leading to a rise in clandestine smoking venues (tea rooms).

Criminalization of Cannabis

  • Harry Anslinger’s pivotal role in the criminalization of marijuana, linking usage predominantly to ethnic minorities.

  • Classifying cannabis as a narcotic in legislation under the influence of societal prejudices.

Modern Cannabis Use Statistics

  • As of 2022, around 25% of Canadians reported cannabis use, peaking at 50% in the 20-24 age group.

  • Strong correlation between heavy use and frequency of use—25% of cannabis users partaking five or more times daily.

Cannabis Products and Methods of Use

  • Marijuana: Mixture of dried leaves and flower tops, while potency has substantially increased in recent years to an average of 15% THC today.

  • Hashish: Compressed trichomes extracted from cannabis for a higher THC concentration, around 40%.

  • Dabs/Shatter: Further refined cannabis products that feature extremely high THC concentrations (over 60%).

Effects of Cannabis

  • Varying psychoactive effects based on dosage; ranges from euphoria to hallucinations.

  • Low doses might enhance sexual arousal but higher doses often suppress libido.

Cognitive and Physical Effects

  • THC influences cognitive abilities, particularly motor performance, impairing activities like driving.

  • The comparison between THC and alcohol in impairment levels remains significant.

Medical Uses of Cannabis

  • THC shown to alleviate nausea (antiemetic) and enhance appetite; systemic use noted for chemotherapy patients.

  • Cannabidiol (CBD) emerging as a superior option for many pain-relieving effects without psychoactive symptoms of THC.

Conclusion

  • The chapter will continue with further discussion on cannabis, focusing on its effects and medical usage, building on the knowledge accumulated about alcohol previously.