CHAPTER 14: SUBSTANCE-RELATED DISORDERS

SUBSTANCE USE DISORDERS:

• Chronic difficulties in resisting the desire to use substances 

• Substance

  • Any natural or synthesized product with psychoactive effects

DEFINING SUBSTANCE USE DISORDERS

• Substance use

  • Ingestion of substance

• Substance intoxication

  • Behavioral and psychological changes from substance use

• Substance abuse

  • Excessive use of a substance resulting in

    • Impairment and hazardous behavior 

    • Continue use despite problems 

• Substance dependence 

  • Physiological need for a substance

  • Indicators 

    • Tolerance

      • Diminished effects of a substance 

    • Withdrawal

      • Physiological and behavioral symptoms when people stop using a substance 

• DSM-5: substance abuse and dependence = 1 diagnosis

• Criteria:

  • 2 or more symptoms in 1 year 

• Prevalence: 10.8%

• Categories

  • Central nervous system depressants 

  • Central nervous system stimulants 

  • Opioids

  • Hallucinogens and phencyclidine (PCP)

  • Cannabis

DEPRESSANTS:

• Slow the central nervous system

• 2 types 

  • Alcohol 

  • Benzodiazepines and barbiturates 

ALCOHOL’S EFFECTS ON THE BRAIN:

• Low doses

  • Activate the brain’s pleasure areas

• Higher doses

  • Depress brain functioning; inhibits glutamate 

• Intoxication = blood alcohol level 0.08%

• Blood alcohol level 0.5%

  • The entire neural balance is upset 

  • Loss of consciousness

ALCOHOL ABUSE ASSOCIATED WITH:

• 40% of deaths suffered in automobile accidents 

• 40-50% of all murders 

• 40% of all assaults 

• 50% of all sexual assaults 

• 43% of violent encounters with police 

• 66% of domestic violence incidents 

SYMPTOMS OF ALCOHOL WITHDRAWAL:

• Stage 1: few hours 

  • Tremulousness, weakness, and profuse perspiration

  • Anxiety, headache, nausea, and abdominal cramps  

  • EEG pattern may be mildly abnormal

• Stage 2: 2nd or 3rd day

  • Convulsive seizures 

• Stage 3

  • Delirium tremens: auditory, visual, and tactile hallucinations

  • Death from hyperthermia or collapse of the peripheral vascular system (10%)

MORE STATS:

• More prevalent in men 

• Onset: any age 

• Declines with age

• 37% of alcohol abusers have one coexisting disorder

  • Mood disorders

  • Eating disorders

  • Personality disorders

LONG-TERM EFFECTS OF ALCOHOL MISUSE:

• Hypertension

• Cirrhosis of the liver 

• Malnutrition

• Vitamin B (thiamine) deficiency 

• Dementia 

BENZODIAZEPINES AND BARBITURATES:

• Treat anxiety and insomnia

• Cause decrease in blood pressure, respiratory rate, and heart rate

• Overdose

  • Death from respiratory arrest or cardiovascular collapse 

STIMULANTS:

• Activate the central nervous system 

  • Feelings of energy, happiness, and power

  • Decreased sleep and appetite 

COCAINE:

• White powder from the coca plant 

• Instant rush of intense euphoria 

• High doses 

  • Grandiosity, impulsiveness, agitation

  • Panic and paranoia 

• Activates the brain’s reward system 

  • Dopamine 

• Effects wear off quickly 

  • Tolerance 

EFFECTS OF COCAINE ON DOPAMINE SYSTEMS:

AMPHETAMINES: 

• Appetite suppression, treat narcolepsy and ADHD

• Release and block reuptake of dopamine and norepinephrine

  • Euphoria, self-confidence, alertness, paranoia

• Tolerance and dependence develop fast 

• Abuse = cardiovascular problems

  • Same damage as small blood vessels in the brain (aka stroke)

WITHDRAWAL FROM COCAINE AND AMPHETAMINES:

• Withdrawal symptoms

  • Depression 

  • Fatigue 

  • Vivid, unpleasant dreams 

  • Insomnia or hypersomnia 

NICOTINE: 

• Alkaloids found in tobacco 

  • Cigarettes 

• Operates on the central and peripheral nervous system 

  • Causes fight or flight response?

    • Doesn’t actually calm them down 

• Lung cancer, bronchitis, and coronary heart disease

NICOTINE: WITHDRAWAL SYMPTOMS:

• Depression

• Insomnia

• Anxiety

• Decreased heart rate 

• Increased appetite 

CAFFEINE:

• Most heavily used stimulant 

• Stimulates central nervous system

  • Increases dopamine, norepinephrine, and serotonin

• Increases metabolism, body temperature, and blood pressure

• DSM-5

  • Caffeine intoxication

  • Caffeine use disorder 

CAFFEINE: WITHDRAWAL SYMPTOMS:

• Fatigue or drowsiness

• Dysphoric mood or irritability 

• Flulike symptoms

OPIOIDS:

• Sap of the opium poppy

  • Morphine heroin, codeine, and methadone

• Smoked, snorted, or “mainlined”

• Euphoria leads to drowsiness, lethargy

• Death 

  • Suppress respiratory and cardiovascular systems 

OPIOIDS: WITHDRAWAL SYMPTOMS:

• Long list…

HALLUCINOGENS:

• Produce perceptual changes 

• Lysergic acid diethylamide (LSD)

  • Severe anxiety, paranoia, loss of control

• Phencyclidine (PCP)

  • Powder: snorted or smoked

  • Intoxication symptoms of PCP:

    • Involuntary rapid eyeball movement

    • Hypertension

    • Numbness

    • Loss of muscle coordination 

    • Problems speaking due to poor muscle control

    • Muscle rigidity 

    • Seizures or coma

    • Exceptionally acute hearing

    • Perceptual disturbances 

CANNABIS:

• Leaves are cut, dried, and rolled into cigarettes or inserted into food and drinks

• The most commonly used illegal drug

• Impairs cognitive and motor functioning

• Increases the risk of chronic cough, sinusitis, bronchitis, and emphysema

INHALANTS:

• Produce chemical vapors that are inhaled

• Rapidly reach the lungs, bloodstream, and brain and depress the central nervous system

• Chronic use:

  • Permanent damage to the central nervous system

  • Degeneration and lesions of the brain 

  • Death

    • Depression of the respiratory or cardiovascular system 

OTHER DRUGS OF ABUSE:

• Ecstasy

  • Stimulant and hallucinogenic effects

  • Causes variation in serotonin levels 

• GHB

  • central nervous system

  • Treats anxiety

  • Treats narcolepsy 

• Ketamine

  • Rapid-acting anethetic that produces hallucinogenic effects 

• Rohypnol

  • Benzodiazepine; has sedative and hypnotic effects 

THEORIES OF SUBSTANCE USE DISORDERS: BIOLOGICAL FACTORS:

• Amphetamines and cocaine

  • Chronic use alters the reward pathway 

    • The brain produces less dopamine

    • Dopamine receptors become less sensitive

    • Creates craving 

• Adverse effects on biochemical and brain systems

• Genetic factors 

THEORIES OF SUBSTANCE USE DISORDERS: PSYCHOLOGICAL FACTORS:

• Social learning theory

  • Model parents and important others

• Cognitive theory: expectations

  • Expectation that alcohol will reduce distress (combined with poor coping)

• Personality theory:

  • Behavioral under control

  • Genetic influence 

THEORIES OF SUBSTANCE USE DISORDERS: SOCIOCULTURAL FACTORS:

• Rates of substance use higher:

  • People living in poverty

  • Women in abusive relationships

  • Adolescents witness interpersonal conflict

• Cultural beliefs and expectations are important 

• Gender gap

  • More prevalent in men 

  • Women who drank were deemed unladylike

BIOLOGICAL TREATMENTS FOR SUBSTANCE USE DISORDERS:

• Antianxiety drugs 

  • Manage withdrawal symptoms from alcohol

  • Very slowly so they don’t become dependent on the drug 

  • Don’t know a lot about effectiveness

• Antagonist drugs 

  • Reduce desire

  • Form of aversive conditioning 

  • Ex: nail biting (that gross sour thing on your nails to stop biting)

• Methadone maintenance programs

  • Synthetic opioid

    • Blocks receptors for heroin

    • Help withdrawal safely from opioids 

  • Gradual withdrawal from heroin

  • Controversial 

    • Some people say that it is just making them dependent on something else

    • Some believe this is the only way to keep them off of heroin

PSYCHOSOCIAL TREATMENTS FOR SUBSTANCE USE DISORDERS:

• Behavioral treatments:

  • Aversive classical conditioning 

    • Drug antagonists 

    • Covert sensitization therapy 

    • Contingency management programs 

• Cognitive treats help clients identify

  • Situations in which they are most likely to drink and lose control over drinking

  • Expectations that alcohol will help them cope in those situations 

• Motivational interviewing 

  • Assesses client's motivation and commitment to changing their substance use 

RELAPSE PREVENTION FOR SUBSTANCE USE DISORDERS:

• Abstinence violation effect:

  • Conflict and guilt when violating abstinence

  • Attribute a violation to a lack of willpower and self-control

• Relapse prevention programs:

  • View slips as temporary and situationally caused 

• Alcoholics Anonymous (AA)

  • An organization created by and for people with alcohol-related problems 

SUBSTANCE USE TREATMENT FOR OLDER ADULTS:

• Characteristics of psychotherapy used

  • Elders are treated along with people their same age in a supportive, nonconfrontational approach

  • Negative emotional states and their relationship to substance abuse are the focus of the intervention

  • Social skills and social networks are rebuilt

  • Staff members are respectful and are interested in working with older adults

  • Linkages are made with medical facilities and community resources

PREVENTION PROGRAMS:

• Solution?

  • Focus on immediate risks of excess and the payoffs of moderation

• Harm reduction model:

  • Alcohol skills training program (ASTP)

    • Promotes safe drinking 

    • Self-monitoring

    • Challenges effects of drinking on social skills and sexual prowess