Substance Use and Gambling Disorders Study Notes

Chapter 14: Substance Use and Gambling Disorders

Overview

• Description: Chronic difficulties involving substance use or gambling behavior leading to significant distress and/or impairment in functioning.

  • Substance: Any natural or synthesized product that has psychoactive effects.

  • Effects: Changes in perceptions, thoughts, emotions, and behaviors.

  • Diagnosis of substance use disorders does not require evidence of physical dependence.

Definitions and Concepts

Definition of Substance Use Disorders

1. Substance Intoxication:

   • Behavioral and psychological changes due to physiological effects of a substance on the central nervous system.

   • Factors Affecting Effects:

     • Type and amount of substance ingested.

     • User’s biochemistry and tolerance.

     • The context or setting in which it is used.

2. Substance Withdrawal:

   • Symptoms that manifest upon discontinuing a substance after extended heavy use.

   • Symptoms are typically the opposite of intoxication effects.

3. Tolerance:

   • Diminished effects from the same dose or need for a higher dose to achieve intoxication.

Diagnosis of Substance Use Disorder

• Criteria for diagnosis involves significant harmful consequences from substance use, including:

  • Impaired Control (Addiction): Loss of control over substance use.

  • Continued Use Despite Consequences: Ongoing use despite negative impact on social, occupational, and health domains.

  • Risky Use: Engaging in hazardous activities while using substances.

  • Evidence of Tolerance or Withdrawal: Signs of physical dependence and adverse physiological reactions upon withdrawal.

Table of Criteria for Substance Use Disorder

1. Impaired Control Criteria:

   • Taking the substance in larger amounts or over longer periods than intended.

   • Craving the substance persistently.

   • Unsuccessful attempts to cut down or control use.

   • Spending excessive time in obtaining, using, or recovering from the substance.

2. Social Impairment Criteria:

   • Inability to fulfill responsibilities at home, work, or school due to substance use.

   • Abandonment of important activities because of substance use.

   • Continued use despite social or relationship problems exacerbated by substance use.

3. Risky Use Criteria:

   • Using substances in dangerous situations (e.g., driving).

   • Continued use despite awareness of physical or psychological issues caused or worsened by substances.

4. Pharmacological Criteria:

   • Tolerance: Needing more of the substance for the same effects or diminished effects with continued use.

   • Withdrawal: Experiencing withdrawal syndrome or using the same/similar substance to alleviate withdrawal symptoms.

Types of Substances and Their Effects

Depressants

• General Effects: Slow the central nervous system leading to relaxation and sedation.

  • Moderate doses may induce sleepiness and reduce concentration; heavy doses can result in stupor or death.

Alcohol

• Effects on the Brain:

  • Low doses: Increased self-confidence, relaxation, euphoria, decreased inhibitions.

  • High doses: Fatigue, lethargy, sleep disturbances, depressed mood, confusion.

• Factors Influencing Effects: Alcohol's impacts vary based on whether consumed on a full or empty stomach.

Symptoms of Alcohol Withdrawal

1. Stage 1:

   • Initiates a few hours after cessation, includes tremors, weakness, anxiety, headache, nausea, abdominal cramps.

2. Stage 2:

   • Begins days 2-3, characterized by convulsive seizures.

3. Stage 3:

   • Delirium Tremens: Symptoms include hallucinations, delusions, sleep disturbance, fever, and irregular heartbeat.

Long-Term Effects of Alcohol Abuse

• Toxic damage to organs (stomach, esophagus, pancreas, liver).

• Low-grade hypertension, increased cancer risk, brain development impact especially during adolescence, potentially leading to dementia.

Benzodiazepines and Barbiturates

• Effects and withdrawal symptoms are similar to alcohol.

• Legally prescribed as sedatives; common misuse may lead to dangerous overdose and death.

Stimulants

• Activate the central nervous system, induce energy, happiness, and reduce appetite.

Cocaine

• Highly addictive white powder derived from coca plants; forms include crack (smoked cocaine).

• Effect induced includes intense euphoria and, at high doses, grandiosity, impulsiveness, hypersexuality, compulsive behavior, anxiety, and paranoia.

Amphetamines

• Stimulants used to treat ADHD and narcolepsy; release dopamine and norepinephrine and block their reuptake.

• Rapid development of tolerance and physical dependence; associated with cardiovascular issues and abuse potential.

Nicotine

• Psychoactive compound found primarily in tobacco products, mimics fight-or-flight response.

• Associated health risks include serious respiratory diseases.

Nicotine Withdrawal Symptoms

• Symptoms include depressed mood, irritability, anxiety, restlessness, insomnia, and increased appetite.

Caffeine

• Widely used central nervous system stimulant, enhances dopamine, norepinephrine, and serotonin release.

Opioids

• Derived from opium poppy for pain relief; includes morphine, heroin, codeine.

  • Toxic effects, risk of respiratory and cardiovascular depression leading to death.

  • Rising misuse of prescription opioids and synthetic opioids like fentanyl.

Psychedelics (Hallucinogens)

• Altered perceptions even at small doses; includes LSD, magic mushrooms, peyote.

• Associated with spiritual and cognitive changes; less addiction potential compared to other substances.

Cannabis

• Commonly impaired functioning seen due to regular use; may increase psychosis risk and varies in effects.

Inhalants

• Produce vapors inhaled to achieve psychoactive effects; chronic use can cause severe CNS damage and possible death.

Other Drugs

• MDMA (Molly): Often combined with amphetamines, inducing euphoria and connection.

• GHB: CNS depressant with potential misuse as a date-rape drug.

Theories of Substance Use Disorders

Biological Factors

• Chronic psychoactive substance use alters reward centers, leading to craving.

  • Genetic predisposition influences rewarding substance effects.

Psychological Factors

• Learning through modeling, expectations regarding substance effects, and beliefs about coping with stress influence substance use behavior.

  • Tendency of individuals with lower behavioral control to engage in substance use more early and extensively.

Gender Differences

• Societal acceptability varies between genders; women tend to display lower rates of risk factors and experience adverse effects sooner.

Treatments for Substance Use Disorders

Biological Treatments

• Utilize antianxiety drugs, antidepressants, and drug antagonists to manage addiction symptoms.

  • Methadone Maintenance Programs: Used for treating opioid withdrawal without inducing intoxication.

Psychosocial Treatments

• Motivational Interviewing: Elicits client motivation for change.

• Behavioral Treatments: Utilize aversive classical conditioning.

• Cognitive Treatments: Identify situations leading to alcohol abuse and misbeliefs about alcohol's effects.

Relapse Preventative Strategies

• Address the Abstinence Violation Effect—guilt from relapse contributing to future relapse behaviors.

• Teach individuals to contextualize slips as situational rather than personal failures.

Comparing Treatment Efficiency

• Project MATCH evaluated cognitive-behavioral therapy, motivational interviewing, and 12-step programs; all showed similar effectiveness in managing drinking behavior and preventing relapse.

Prevention Programs

• Colleges implement harm reduction models educating about immediate risks and alternate coping mechanisms to excess drinking.

Gambling Disorder

• Involves persistent gambling behavior resulting in significant distress; often co-occurs with substance use disorders, anxiety, and depression.

• More prevalent among men; linked to similar brain areas activated by substance abuse.

Treatment for Gambling Disorder

• Cognitive-Behavioral Therapy (CBT): Focuses on changing beliefs about gambling control, overconfidence, and superstitions, alongside developing alternative activities.

  • Consideration of serotonin reuptake inhibitors as potential pharmacological management.

Internet Gaming Disorder

• Recognized in DSM for further study, associated with excessive preoccupation with gaming leading to significant impairment or distress.