Chapter 11 Substance Use and Addictive Disorders

Substance Use and Addictive Disorders

• Definition of Drugs: Any substance (excluding food) that affects the body or mind.

  • The term "substance" includes alcohol, tobacco, and caffeine.

Substance Intoxication

• Substance Intoxication: A temporary state of poor judgment and mood changes, irritability, slurred speech, and poor coordination.

  • Hallucinosis: A specific type of intoxication characterized by perceptual distortions and hallucinations.

Substance-Use Disorder

• Definition: A chronic pattern of behavior where a person excessively relies on a drug.

  • Substance Dependence: A more severe form where a person's life revolves around the drug.

  • Key features: tolerance (increasing doses needed) and withdrawal (unpleasant symptoms upon cessation).

• Prevalence: 7.4% of U.S. teens and adults experience substance use disorder, with the highest rates in Native Americans (10.1%) and lowest in Asian Americans (4.8%).

  • Only 18.4% seek treatment.

Categories of Substances

1. Depressants: Slow CNS activity, reducing tension and inhibitions.

   • Common Depressants: Alcohol, sedative-hypnotic drugs, opioids.

2. Stimulants: Increase CNS activity, heart rate, and alertness.

   • Common Stimulants: Cocaine, amphetamines, caffeine, nicotine.

3. Hallucinogens: Cause sensory changes and delusions.

4. Cannabis: Both depressant and stimulant effects.

5. Polysubstance Use: The concurrent use of multiple substances.

Depressants

Alcohol

• Over 2 billion people consume alcohol; prevalent in the U.S.

• Binge Drinking: Consuming 5 or more drinks in a single occasion, with 25% of U.S. adults partaking monthly.

• Alcohol acts by enhancing GABA, an inhibitory neurotransmitter.

Alcohol Impairment

• BAC Levels:

  • 0.06: Relaxation

  • 0.09: Intoxication

  • >0.55: Risk of death

• Factors: Body size, gender (women metabolize slower), and race (e.g., many Asians have alcohol dehydrogenase deficiency).

Alcohol Dependence

• Develops tolerance and withdrawal, which can include severe symptoms like delirium tremens (the DTs).

• Long-term effects: liver damage, cancer, nutritional issues, fetal alcohol syndrome risk.

Opioids

• Types: Natural (e.g., opium, heroin) and synthetic (e.g., methadone). Known as narcotics.

• Provide pain relief but can lead to dependence and serious dangers like overdose.

Stimulants

• Definition: Increase CNS activity, leading to increased alertness and energy.

• Cocaine: A powerful natural stimulant that increases dopamine and produces euphoria.

  • Risks: Overdose, heart issues, and “crashing” post-use.

• Amphetamines: Increase alertness; high doses can lead to psychosis.

• Caffeine: Widely used stimulant; withdrawal can cause headaches and fatigue.

Hallucinogens

• Cause powerful sensory and perceptual changes; examples include LSD and Psilocybin.

• Risks: Bad trips and potential for persistent changes in perception (flashbacks).

Cannabis

• Comprised of marijuana and hashish; THC is the active component.

• Potency increases over time, leading to higher levels of abuse and dependence.

Combinations of Substances

• Polysubstance Use: Taking multiple drugs simultaneously, sometimes leading to enhanced effects (synergistic effects) or dangerous interactions (cross-tolerance).

Treatment Approaches for Substance-Related Disorders

• Behavioral Therapies: Contingency management that incentivizes drug-free living; works best combined with other approaches.

• Cognitive-Behavioral Therapies: Focus on self-control and coping strategies to prevent relapse.

• Biological Treatments: Include detoxification and the use of antagonist drugs to block effects of substances (e.g., disulfiram for alcohol).

• Sociocultural Therapies: Peer support groups (e.g., Alcoholics Anonymous), community prevention programs, and gender/culture-sensitive approaches.

Other Addictive Disorders

• Gambling Disorder is characterized by a persistent and recurrent problematic gambling behavior, which leads to significant impairment or distress. Individuals with this disorder often experience a preoccupation with gambling, a need to gamble with increasing amounts of money to achieve the desired excitement, and unsuccessful efforts to control or stop gambling.

Treatment Approaches:

1. Cognitive Behavioral Therapy (CBT):

   • Focuses on identifying and changing distorted beliefs about gambling, enhancing coping skills, and developing strategies to manage triggers and urges.

   • High efficacy in addressing the cognitive distortions that contribute to gambling behavior.

2. Biological Treatments:

   • Utilization of medications such as opioid antagonists (e.g., naltrexone) which have shown promise in reducing cravings and gambling behaviors.

   • Other medications, like SSRIs, may be explored for their mood-stabilizing effects to aid in treatment.

3. Self-Help Groups:

   • Groups like Gamblers Anonymous provide a supportive community for individuals to share experiences and strategies for recovery, following the twelve-step approach.

   • These groups emphasize accountability and support while fostering a sense of community, which can be crucial for individuals in recovery from addiction to gambling.

4. Motivational Interviewing:

   • This counseling approach can enhance motivation to change by exploring ambivalence and encouraging individuals to make positive behavioral changes.

5. Family Therapy:

   • Involves the family in the treatment process, addressing family dynamics that may contribute to gambling behavior and supporting the individual’s recovery journey.

6. Financial Counseling:

   • Assists individuals in creating a budget and managing finances effectively to mitigate the financial consequences of gambling and prevent relapse.

• Internet Gaming Disorder: Currently under consideration for DSM inclusion.