chapter 11

Chapter 11: SUBSTANCE USE AND ADDICTIVE DISORDERS

Define substance intoxication—a temporary state of poor judgment, mood changes, irritability, slurred speech, and poor coordination; hallucinosis—particular form of intoxication that consists of perceptual distortion and hallucinations.

Define substance use disorder: a pattern of maladaptive behaviors and reactions brought about by repeated use of substances.

Physical dependence—develop tolerance=needing increasing doses to get an effect, and experience withdrawal=unpleasant and sometimes dangerous symptoms when substance use is stopped or cut down.

Be able to categorize various drugs based on their general effects on the body:
1) Depressants (e.g., alcohol, sedative-hypnotics, opioids)—slow the activity of the
central nervous system (CNS), reduce tension and inhibitions, may interfere with judgment, motor activity, and concentration.

2) Stimulants (e.g., cocaine, amphetamines, caffeine, nicotine)—increase activity of the CNS—increase in blood pressure, heart rate, alertness, rapid behavior and thinking.

3) Hallucinogens (e.g., LSD, mescaline, PCP)--Produce delusions, hallucinations, and other
sensory changes.

4) Cannabis—Produce sensory changes, but have both depressant and stimulant effects.

DEPRESSANTS

Alcohol -
Know how ethyl alcohol is absorbed and metabolized in the body.
It is absorbed into the blood through the stomach lining and takes effect in the
bloodstream and CNS. Alcohol is a GABA agonist (facilitates GABA), an inhibitory
neurotransmitter.
Level of intoxication and impairment are tied to concentration of ethyl alcohol
in the blood (BAC): BAC = 0.06—relaxation, BAC = 0.09—intoxication, BAC > 0.55—death (most will lose consciousness before they can drink this amount).
Effects subside after alcohol is metabolized by the liver.
Alcohol dehydrogenase (an enzyme in the stomach that metabolizes alcohol
before it enters the blood) can also influence the sensitivity of individuals to alcohol’s
effects (less of this enzyme, the more sensitive you will be).
Be able to identify symptoms of withdrawal (e.g., shakiness, nausea, anxiety,
headaches, possibly blackouts). Delirium tremens (“DTs”) is a dangerous severe
withdrawal syndrome which can be fatal. DTs symptoms can include hallucinations,
shivering, and sweating, and in more extreme cases seizures, loss of consciousness, and
stroke.
Disorders related to the long-term abuse of alcohol (e.g., Wernicke’s
encephalopathy—confusion, loss of motor control, Korsakoff’s syndrome—memory
disorder, cirrhosis of the liver—scarred/damaged liver).

Section on sedative-hypnotic drugs, barbiturates, benzodiazepines--will not be covered on
the final exam.

Opioids – also known as “narcotics”
Heroin - know its effects when injected (i.e., initial “rush” leads to longer-term
“high”/“nod”).
Know how opioids produce their effects (i.e., by depressing the CNS, particularly centers
that control emotion. These drugs attach to the receptors stimulated by endorphins).
They naturally help relieve pain and reduce emotional tension.
Side-effects: nausea, narrowing of pupils, and constipation.
May develop opioid use disorder in just a few weeks.
Symptoms of withdrawal (e.g., anxiety, restlessness, craving, tension, flu-like
symptoms, diarrhea, cramps, weight loss from dehydration, loss of motor control, etc.)
Danger of overdose—closes down the respiratory center of the brain, paralyzing
breathing and causing death. Risk of overdose is heightened after abstinence followed by
resumption of the drug at the same dose they had used before.

STIMULANTS

Cocaine
Know how cocaine produces its effects (i.e., by stimulating the activity of
neurotransmitters, dopamine as well as norepinephrine and serotonin)
Produces euphoric rush of well-being and confidence. High doses can produce
intoxication: mania, paranoia, and impaired judgement. Some also experience
hallucinations and/or delusions, a condition known as “cocaine-induced psychotic
disorder.”
Symptoms of withdrawal (e.g., depression-like letdown—“crashing”, fatigue).
Physical risks associated with cocaine use: heart arrythmias & brain seizures that can lead
to cardiac arrest. Biggest risk--overdose, excessive doses depress the respiratory center of
the brain and stop breathing.
Amphetamines—with attention to methamphetamine’s surge in popularity over recent years
and associated risks.

HALLUCINOGENS

Know how these drugs are proposed to produce their effects (e.g., by binding to serotonin
receptors).
Risk of physical addiction relative to other addictive drugs
Risks associated with the use of various hallucinogens, especially bad “trips” and
flashbacks.

CANNABIS

Know the major active ingredient in cannabis is tetrahydrocannabinol (THC).
The greater the THC content, the more powerful the drug. Marijuana available today is
significantly more potent than decades ago due to higher THC content.

POLYSUBSTANCE USE

Effects of combining drugs--People often take more than one drug at a time, a pattern called
polysubstance use.
Synergistic effect—drugs act to potentiate--strengthen their effects in combination, e.g.,
alcohol and barbiturates combined can lead to an overdose by severely depressing the CNS).
Antagonistic effect—a drug can block or change the effects of another drug.
Cross-tolerance (tolerance for one substance can lead to tolerance for similar
substance…can help to reduce withdrawal symptoms, e.g., under medical supervision,
benzodiazepines can assist in modulating severe withdrawal from alcohol).
There could be a small number of questions that address various psychological (e.g., self-help
and residential treatment programs, behavioral self-control training, contingency management,
relapse-prevention) and biological treatments (maintenance approach, e.g., methadone, and
blocking approach, e.g., antagonist drugs such as Antabuse for alcohol, naltrexone for narcotics
and alcohol), and their relative effectiveness.
Other addictive disorders, e.g., gambling disorder, will not be emphasized on the exam.