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Chapter Twelve: Substance Use and Addictive Disorders (copy)

  • Drug: Any substance other than food that affects our bodies or minds

    • Also called a substance

  • Substance Intoxication: When substances cause temporary changes in behavior, emotion, or thought

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

  • Hallucinogen Intoxication / Hallucinosis: Perceptual distortions and hallucinations

  • Substance Use Disorders: Patterns of maladaptive behaviors and reactions brought about by the repeated use of substances

    • Crave a particular substance and rely on it excessively

    • Results in

      • Damage to their family and social relationships

      • Poor functioning at work

      • Danger to themselves or others

    • Become physically dependent on the substance

  • Tolerance: A person needs increasing doses of the substance to produce the desired effect

  • Withdrawal: Unpleasant and sometimes dangerous symptoms that occur when the person suddenly stops taking or cuts back on the substance

  • 7.8 % of all teens and adults in the US have a substance use disorder

Depressants

  • Depressants: Substances that slow the activity of the central nervous system

Alcohol

  • 2 billion people worldwide consume alcohol

  • Binge Drinking Episode: When people consume five or more drinks on a single occasion

  • Heavy drinkers: People who binge drink at least five times a month

  • Ethyl Alcohol: A chemical that is quickly absorbed into the blood through the lining of the stomach and the intestine

    • Carried into the central nervous system

    • Acts to depress (slow) functioning by binding to various neurons

      • Depresses the areas of the brain that control judgment and inhibition

        • People become looser, more talkative, and more friendly

        • Feel relaxed, confident, and happy

    • Slows down additional areas in the central nervous system

      • Less able to make sound judgments

      • Speech becomes less careful and less coherent

      • Memory becomes weaker

      • Motor difficulties increase

      • Reaction times slow

  • When alcohol binds to receptors on GABA neurons, it helps GABA to shut down the neurons, helping to relax the drinker

  • Concentration

    • A given amount of alcohol has less effect on a large person than on a small one

    • Women have less of the stomach enzyme that breaks down alcohol

    • 0.06 percent of blood volume - person feels relaxed and comfortable

    • 0.09 percent - drinker becomes intoxicated

    • 0.55 percent - drinker will likely die

  • Most of the alcohol is broken down (metabolized) by the liver into carbon dioxide and water, which can be exhaled and excreted

  • Alcohol Use Disorder / Alcoholism

    • Clinical Picture

      • Those with alcohol use disorder drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious

      • Drinking interferes with their social behavior and ability to think and work

      • Impairments in memory, speed of thinking, attention skills, and balance patterns of alcoholism vary

    • Tolerance and Withdrawal

      • As their bodies build up a tolerance for alcohol, they need to drink larger amounts to feel the effects

      • They have withdrawal symptoms when they stop drinking (within hours)

      • Small percentage of ppl with alcohol use disorder go through this withdrawal reaction: delirium tremens

        • Terrifying visual hallucinations that begin within three days after they stop or reduce their drinking

        • May cause seizures and strokes

        • Can die

  • Personal and Social Impacts of Alcoholism

    • Alcoholism plays a role in ⅓ of all suicides, homicides, assaults, rapes, and accidental deaths, including in car accidents

    • Intoxicated drivers are responsible for more than 10,000 deaths each year

    • Home life for children of alcoholics

      • Much conflict

      • May have sexual / other forms of abuse

      • Higher rates of psychological problems

      • Low self-esteem, poor communication skills, poor sociability, maritial problems

    • Physical health

      • Cirrhosis: Liver becomes scarred and dysfunctional

      • Damage the heart

      • Lowers the immune system’s ability to fight off cancer, bacterial infections, and AIDS

    • Nutritional problems

      • Makes people feel full and lowers their desire for food, but has no nutritional value

        • Chronic drinkers become malnourished, weak, and prone to disease

      • Korsakoff’s syndrome: An alcohol related disorder caused by a deficiency of vitamin B

        • Marked by extreme confusion, memory loss, and other neurological symptoms

        • Confabulating: Reciting made-up events to fill in the gaps

        • Cannot remember the past or learn new info

    • Fetal Alcohol Syndrome: A pattern of abnormalities that can include intellectual disability disorder, hyperactivity, head and face deformities, heart defects, and slow growth

      • Caused by excessive alcohol use during pregnancy

    • Heavy drinking early in pregnancy often leads to a miscarriage

Sedative-Hypnotic Drugs

  • Also called anxiolytic (anxiety-reducing) drugs

  • Produces feelings of relaxation and drowsiness

  • Low doses: drugs have a calming or sedative effect

  • Higher doses: sleep inducers / hypnotics

  • Most widely prescribed sedative-hypnotic drugs

    • In the past: barbiturates

    • Now: benzodiazepines

  • ex: xanax, ativan, valium

  • These drugs calm people by binding to receptors on the neurons that receive GABA and by increasing GABA’s activity at those neurons

  • Benzodiazepines

    • Generally safer

    • Less likely to lead to intoxication, tolerance effects, and withdrawal reactions

    • Relieve anxiety without making people as drowsy as other kinds of sedative-hypnotics

    • Less likely to slow a person’s breathing - less likely to cause death in the event of an overdose

  • In high enough doses, these drugs can cause intoxication and lead to sedative-hypnotic use disorder

  • Sedative-hypnotic Use Disorder: A pattern marked by craving for the drugs, tolerance effects, and withdrawal reactions

    • 0.4% of all adults in the US display this disorder in a year

Opioids

  • Opioid: Opium, drugs derived from opium, and other synthetic drugs

    • Heroin, morphine, codeine

  • Opium: A highly addictive substance made from the sap of the opium poppy

  • Widely used in the past because of its ability to reduce both physical and emotional pain

  • Morphine: A highly addictive substance derived from opium that is particularly effective in relieving pain

    • Can lead to addiction

    • Morphine addiction became known as soldier’s disease

  • Heroin: One of the most addictive substances derived from opium

  • 1917: US Congress concluded that all drugs derived from opium were addictive and passed a law making opioids illegal except for medical purposes

  • Opioid Use Disorder

    • Heroin use interferes significantly with their social and occupational functioning, and their lives center around the drug

    • Build a tolerance for heroin and experience a withdrawal reaction when they stop taking it

      • Symptoms peak by the third day, gradually subside, and disappear by the eighth day

      • Person in withdrawal can either wait out the symptoms or end withdrawal by taking the drug again

    • People need heroin just to avoid going into withdrawal

    • Must continually increase their doses to achieve relief

    • 1% of adults in the US display an opioid use disorder within a given year

  • Dangers of Opioid Use

    • Overdose: Closes down the respiratory center in the brain, almost paralyzing breathing and in many cases causing death

    • Heroin can be mixed with other drugs / deadly substances

    • Dirty needles and other unsterilized equipment spreads infections

Stimulants

  • Stimulants: Substances that increase the activity of the central nervous system, resulting in increased blood pressure and heart rate, more alertness, and sped-up behavior and thinking

Cocaine

  • Cocaine: An addictive stimulant obtained from the coco plant and the most powerful natural stimulant known

  • Brings on a euphoric rush of well-being and confidence

  • Increases the supplies of dopamine at key neurons throughout the brain

  • Increases the activity of norepinephrine and serotonin in some areas of the brain

  • Cocaine Intoxication: Symptoms are poor muscle coordination, grandiosity, bad judgment, anger, aggression, compulsive behavior, anxiety, and confusion

  • Cocaine-induced Psychosis: Some people have hallucinations, delusions, or both

  • Crashing: As the stimulant effects of cocaine subside, the user goes through a depression-like letdown, causing a pattern that may also include headaches, dizziness, and fainting

  • Ingesting Cocaine

    • In the past, it was usually snorted

    • Freebasing: A technique in which the pure cocaine basic alkaloid is chemically separated (freed) from processed cocaine, vaporized by heat from a flame, and inhaled through a pipe

    • Crack: A powerful, ready-to-smoke freebase cocaine

  • Dangers

    • Linked to many suicides

    • Overdose

    • Major heart irregularities or brain seizures that bring breathing or heart functioning to a sudden stop

    • Pregnant women who use cocaine run the risk of having a miscarriage and of having children with predispositions to drug use and other abnormalities

Amphetamines

  • Amphetamines: Stimulant drugs that are manufactured in the laboratory

  • Benzedrine, dexedrine, methedrine

  • First produced to help treat asthma

  • Most often taken in pill or capsule form

  • Increase energy and alertness and reduce appetite when taken in small doses

  • Produce a rush, intoxication, and psychosis in high doses

  • Cause an emotional letdown as they leave the body

  • Stimulate the CNS by increasing the release of the neurotransmitters dopamine, norepinephrine, and serotonin through the brain

  • Methamphetamine: A kind of amphetamine that has surged in popularity in recent years, posing major health and law enforcement problems

    • Most is made in small “stovetop laboratories” which can expel dangerous fumes and residue

    • About as likely to be used by women as men

    • Increases activity of the neurotransmitters dopamine, serotonin, and norepinephrine, producing increased arousal, attention, and related effects

    • Neurotoxicity: Damages nerve endings

Stimulant Use Disorder

  • Caused by regular use of either cocaine or amphetamines

Caffeine

  • World’s most widely used stimulant

  • Coffee, tea, energy drinks, chocolate, numerous prescription/over-the-counter meds

  • Acts as a stimulant of the cns

  • Raises a person’s arousal and motor activity, enhances physical stamina, reduces fatigue

  • Disrupt mood, fine motor movement, and reaction time

  • May interfere with sleep

  • High doses: Increases gastric acid secretions in the stomach and the rate of breathing

  • 250+ milligrams of caffeine can produce caffeine intoxication

    • 2-3 cups of coffee

    • 6 cans of soda

    • 3 cans of energy drinks

  • Doses larger than 10 grams of caffeine can cause grand mal seizures and fatal respiratory failure

    • 100 cups of coffee

  • People who suddenly stop or cut back on their usual intake have withdrawal symptoms

Hallucinogens, Cannabis, and Combinations of Substances

Hallucinogens

  • Hallucinogens: Substances that cause powerful changes in sensory perception

  • Produce delusions, hallucinations, and other sensory changes also called psychedelic drugs

  • LSD, mescaline, psilocybin, MDMA (ecstacy)

  • LSD

    • Brings on a state of hallucinogen intoxication / hallucinosis

      • Strengthening of perceptions, psychological changes, and physical symptoms

      • Cause one to hear sounds more clearly, feel tingling or numbness in the limbs, or confuse the sensations of hot and cold

      • Synesthesia

    • Can induce strong emotions

    • Perception of time may slow dramatically

    • Physical symptoms

    • Binds to some of the neurons that normally receive serotonin, changing the neurotransmitter’s activity at those sites

    • 15+% of all ppl in the US have used LSD or another hallucinogen at some point in their lives

    • People don’t develop tolerance to LSD or have withdrawal symptoms when they stop taking it

    • Any dose, no matter how small, is likely to produce an enormous reaction

    • Users eventually develop psychosis or a mood or anxiety disorder

    • Flashbacks: A recurrence of the sensory and emotional changes after the LSD has left the body

      • May occur days or months after the last LSD experience

Cannabis

  • produces sensory changes and has depressant and stimulant effects

  • The higher the THC content, the more powerful the cannabis

  • Produces a mixture of hallucinogenic, depressant, and stimulant effects

  • High is called Cannabis Intoxication

  • Cannabis Use Disorder

  • Dangers

    • Occasionally causes panic reactions similar to the ones caused by hallucinogens

    • Can interfere with the performance of complex sensorimotor tasks and with cognitive functioning

      • Caused many automobile accidents

    • Fail to remember information no matter how hard they try to concentrate

    • Chronic users have higher blood flow

    • Long-term health problems

      • Reduces the ability to expel air from the lungs

      • Lower sperm counts and abnormal ovulation

  • Cannabis and Society

    • Used to play a respected role in medicine

    • Began to be used as a recreational drug

    • Assumed to be highly dangerous and was outlawed

    • Campaigned for the medical legalization of marijuana

    • Moved to legalize the recreational use of marijuana

Combinations of Substances

  • Polysubstance Use: People often take more than one drug at a time

  • Cross-tolerance: Tolerance for a substance one has not taken before as a result of using another substance similar to it

  • Synergistic Effect: In pharmacology, an increase of effects that occurs when more than one substance is acting on the body at the same time

    • Two or more drugs have similar actions

      • Combining them, even in small doses, can lead to extreme intoxication, coma, and even death

      • ex: alcohol and opioids

    • Two or more drugs have opposite / antagonistic actions

      • Build up toxic, even lethal, levels of the depressant drugs in their systems

      • Cory Monteith

What Causes Substance Use Disorders?

Sociocultural Views

  • People are most likely to develop substance use disorders when they live under stressful socioeconomic conditions

    • Unemployment, low socioeconomic classes

  • People confronted regularly by other kinds of stress have a heightened risk of developing substance use disorder

  • People are more likely to develop substance use disorders if they’re part of a family or social environment in which substance use is valued or at least accepted

Psychodynamic Views

  • People with substance use disorders have powerful dependency needs that can be traced to their early years

    • When parents fail to satisfy a young child’s need for nurturance, the child is likely to grow up depending excessively on others for help and comfort

    • Develop a dependent relationship with a substance

  • Certain people respond to their early deprivations by developing a substance abuse personality that leaves them particularly prone to drug abuse

    • Individuals who abuse drugs tend to be more dependent, antisocial, impulsive, and depressive than other individuals

    • Cannot presently conclude any one personality trait or group of traits that stands out in the development of the disorders

Cognitive-Behavioral Views

  • Operant conditioning may play a key role in substance use disorders

  • Temporary reduction of tension / raising of spirits produced by the drug has a rewarding effect

    • Increases the likelihood that the user will seek that reaction again

    • Lead users to try higher dosages or more powerful methods of ingestion

    • Produce an expectancy that substances will be rewarding, which helps motivate people to increase drug use at times of tension

  • Many people do drink more alcohol or seek heroin when they feel tense

  • Many people take drugs to medicate themselves when they feel tense

  • Classical conditioning may also play a role in these disorders

  • Cues or objects present at the time a person takes a drug may come to produce some of the same pleasure brought on by the drugs themselves

Biological Views

  • Genetic Predisposition - People may inherit a predisposition to misuse substances

    • Alcohol concordance rate of around 50% in identical twins

  • Neurotransmitters

    • When a particular drug is ingested, it increases the activity of certain neurotransmitters whose normal purpose is to calm, reduce pain, lift mood, or increase alertness

    • Drug takers build tolerance for a drug, becoming more and more reliant on it rather than on their own biological processes

    • If they suddenly stop taking the drug, their natural supply of neurotransmitters will be low for a time, producing the symptoms of withdrawal

    • The abused substance dictates which neurotransmitters will be affected

      • Alcohol/benzos: GABA

      • Opioids: Endorphins

      • Cocaine/Amphetamines: Dopamine

      • Marijuana: Anandamide (neurotransmitter that operates like THC)

  • Reward Circuit: A dopamine-rich circuit in the brain that produces feelings of pleasure when activated

    • When a person ingests a substance, the substance eventually activates the brain’s reward circuit

    • When dopamine is activated throughout this circuit, a person feels pleasure

    • Certain drugs stimulate the structures in the reward circuit, others stimulate it in roundabout ways

      • Leads to increased dopamine in the reward circuit and excessive communications between the structures in the reward circuit

    • Incentive-sensitization Theory of Addiction: As substances repeatedly stimulate this reward circuit, the circuit develops a hypersensitivity to the substances, contributing to future desires for them

    • Reward Deficiency Syndrome: People who chronically use drugs have a reward circuit that is not readily activated by the usual events in their lives, so they turn to drugs to stimulate the pleasure pathway, particularly in times of stress

      • Abnormal D2 receptor gene is a possible contributor

The Developmental Psychopathology View

  • Genetically inherited predispositions

    • Less-than-optimal reward circuit in the brain

    • Problematic temperament

  • Will eventually result in a substance use disorder if the individual further experiences numerous stressors

    • Ppl who experience manageable adversities can develop a level of resilience

  • Temperaments that can set the stage for later substance abuse

    • Disinhibited / Externalizing Temperament

      • Impulsivity, aggressiveness, overactivity, limited persistence, low frustration tolerance, inattention

      • Great difficulty controlling their behaviors

    • Internalizing Temperament

      • Temperament of inhibition and negative affectivity

      • Multiple fears, depression, negative thinking, and dependence

      • Turn to substances to reduce their emotional pain, quiet their troublesome thoughts, and help them through interpersonal difficulties

  • Equifinality: The principle that different developmental pathways can lead to the same psychological disorder

How Are Substance Use Disorders Treated?

  • Motivational Interviewing: Therapists help motivate the clients to make constructive choices and behavioral changes

  • Effectiveness of treatment for substance use disorders can be difficult to determine

    • Different substance use disorders pose different problems

    • Many people with such disorders drop out of treatment very early

    • Some people recover without any intervention while others recover and then relapse

    • Different criteria are used by different clinical researchers

Psychodynamic Therapies

  • Guide clients to uncover and work through the underlying needs and conflicts that led to the substance use disorder

  • Try to help the clients change their substance-related styles of living

  • Tends to be of more help when combined with other approaches in a multidimensional treatment program

Cognitive-Behavioral Therapies

  • Help clients identify and change the behaviors and cognitions that keep contributing to their patterns of substance misuse

  • Aversion Therapy: Clients are repeatedly presented with an unpleasant stimulus at the very moment that they are taking a drug

    • Expected to react negatively to the substance itself and lose their craving for it

    • Used to treat alcoholism most

    • Limited success when its the sole form of treatment

    • Approach can only be effective if people are motivated to subject themselves to multiple sessions

  • Contingency Management: Offers clients incentives that are contingent on the submission of drug-free urine specimens

    • Rewards clients from abstaining from substance use

    • Clients in these programs maintain a higher attendance record than those in other kinds of programs

    • Moderately effective

    • Can be effective only when people are motivated to continue despite its demands

    • Most useful in the treatment of stimulant use disorder and opioid use disorder

    • The larger the rewards offered, the greater the client’s improvement

  • Relapse-Prevention Training

    • Goal: For clients to gain control over their substance-related behaviors

    • Taught to identify high risk situations, look at the range of decisions they can make, change their dysfunctional lifestyles, and learn from their mistakes

    • Strategies for alcoholism

    • Therapists have clients keep track of their drinking

      • Helps them become aware of the situations that place them at risk for excessive drinking

    • Therapists teach clients coping situations to use when such situations arise

    • Therapists teach clients to plan ahead of time

      • Determine beforehand how many drinks are appropriate, etc.

  • Acceptance and Commitment Therapy

    • Use a mindfulness based approach to help clients become aware of their streams of thoughts as they’re occurring and to accept them as mere thoughts of mind

    • Increasing their awareness and acceptance of their drug cravings, worries, and depressive thoughts

Biological Treatments

  • Detoxification: Systematic and medically supervised withdrawal from a drug

    • Clients take smaller and smaller doses until they’re off the drug completely

    • Give clients other drugs that reduce the symptoms of withdrawal (like anti anxiety meds)

    • Relapse rates tend to be high for those who don’t receive a follow-up treatment after successfully detoxifying

  • Antagonist Drugs: Drugs that block or change the effects of the addictive drug as an aid to resisting temptation

    • Disulfiram - increases negative effects of alcohol

    • Opioid antagonist drugs like naloxone

      • Attach to endorphin receptor sites throughout the brain and make it impossible for the opioids to have their usual effect

        • Reduces cravings for alcohol as well

      • Continued drug use becomes pointless

      • Can reverse the deadly effect of respiratory depression

    • Partial Antagonists: Opioid antagonists that produce less severe withdrawal symptoms

      • Causes rapid detoxification - helps speed things along

  • Drug Maintenance Therapy

    • Methadone Maintenance Programs: A treatment approach in which clients are given legally and medically supervised doses of methadone - a heroin substitute - to treat various opioid use disorders

      • Developed in the 1960s to treat heroin addiction

      • Ppl with an addiction were given methadone as a substitute for heroin

      • They then became addicted to methadone, but this addiction was maintained under safe medical supervision

      • Methadone produces a moderate high, can be taken by mouth, and only needs to taken once a day

      • Was very effective at first, now less possible bc substituting one addiction for another isn’t very acceptable

      • Methadone is sometimes harder to withdraw from - symptoms can last longer

      • Methadone treatment is safer than street opioid use

      • Most effective when combined with education, psychotherapy, family therapy, and employment counseling

    • Buprenorphine: An opioid substitute drug being used as a form of maintenance therapy

      • Opioid that is administered to patients as a safer alternative to heroin, painkillers, etc.

      • Permitted by law to be prescribed by physicians in their offices rather than as part of a highly structured clinic program

Sociocultural Therapies

  • Psychological problems emerge in a social setting and are best treated in a social context

  • Self-Help and Residential Treatment Programs

    • Alcoholics Anonymous: A self-help organization that provides support and guidance for people with alcohol use disorder

      • Promotes abstinence instead of controlled drinking

    • Abstinence is a more appropriate goal for ppl who have a long-standing alcohol use disorder

    • Controlled drinking is a helpful goal for younger drinkers whose pattern doesn’t include tolerance and withdrawal reactions

    • Residential Treatment Centers / Therapeutic Communities: A place where people formerly addicted to drugs live, work, and socialize in a drug-free environment while undergoing therapy and making a transition back to community life

  • Culture and Gender-Sensitive Programs

    • Therapists should be sensitive to their clients’ life challenges - the special sociocultural pressures and problems faced by drug abusers who are poor, homeless, or members of minority groups

    • Women often require different treatment methods than those designed for men

  • Community Prevention Programs

    • Prevention Program Model

      • Total abstinence

      • Responsible use

      • Interrupt drug use

      • Delay the age of onset for drug use

    • Programs can

      • Offer drug education

      • Teach alternatives to drug use

      • Try to change the psychological state of the potential user

      • Help people change their peer relationships

    • Program Focus

      • Individual: Providing education about unpleasant drug effects

      • Family: Teaching parenting skills

      • Peer group: Teaching resistance to peer pressure

      • School: Setting up firm enforcement of drug policies community

    • Not always effective

Other Addictive Disorders

  • People may become addicted to behaviors and activities beyond substance use

Gambling Disorder

  • Preoccupied with gambling and cannot walk away from a bet

  • Continue gambling even in the face of financial, social, occupational, and health problems

  • Gamble more when feeling distressed

  • Lie to cover up the extent of their gambling

  • Have symptoms that are similar to the tolerance and withdrawal reactions often associated with substance use disorder

  • People with gambling disorder may

    • Inherit a genetic predisposition to develop the disorder

    • Experience heightened dopamine activity and dysfunction of the brain’s reward circuit when they gamble

    • Have impulsive, novelty-seeking, and other personality styles that leave them prone to gambling disorder

    • Make repeated and cognitive mistakes such as inaccurate expectations and misinterpretations of their emotions and bodily states

  • Gamblers Anonymous: A self-help group problem for gamblers modeled after Alcoholics Anonymous

Internet Gaming Disorder: Awaiting Official Status

  • Internet Use Disorder: An uncontrollable need to be online

  • Ppl spend all their waking moments online

  • Parallels symptoms found in substance use disorders and gambling disorder

  • Possible withdrawal reactions when internet use is not possible

  • Not included in the DSM-5

Chapter Twelve: Substance Use and Addictive Disorders (copy)

  • Drug: Any substance other than food that affects our bodies or minds

    • Also called a substance

  • Substance Intoxication: When substances cause temporary changes in behavior, emotion, or thought

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

  • Hallucinogen Intoxication / Hallucinosis: Perceptual distortions and hallucinations

  • Substance Use Disorders: Patterns of maladaptive behaviors and reactions brought about by the repeated use of substances

    • Crave a particular substance and rely on it excessively

    • Results in

      • Damage to their family and social relationships

      • Poor functioning at work

      • Danger to themselves or others

    • Become physically dependent on the substance

  • Tolerance: A person needs increasing doses of the substance to produce the desired effect

  • Withdrawal: Unpleasant and sometimes dangerous symptoms that occur when the person suddenly stops taking or cuts back on the substance

  • 7.8 % of all teens and adults in the US have a substance use disorder

Depressants

  • Depressants: Substances that slow the activity of the central nervous system

Alcohol

  • 2 billion people worldwide consume alcohol

  • Binge Drinking Episode: When people consume five or more drinks on a single occasion

  • Heavy drinkers: People who binge drink at least five times a month

  • Ethyl Alcohol: A chemical that is quickly absorbed into the blood through the lining of the stomach and the intestine

    • Carried into the central nervous system

    • Acts to depress (slow) functioning by binding to various neurons

      • Depresses the areas of the brain that control judgment and inhibition

        • People become looser, more talkative, and more friendly

        • Feel relaxed, confident, and happy

    • Slows down additional areas in the central nervous system

      • Less able to make sound judgments

      • Speech becomes less careful and less coherent

      • Memory becomes weaker

      • Motor difficulties increase

      • Reaction times slow

  • When alcohol binds to receptors on GABA neurons, it helps GABA to shut down the neurons, helping to relax the drinker

  • Concentration

    • A given amount of alcohol has less effect on a large person than on a small one

    • Women have less of the stomach enzyme that breaks down alcohol

    • 0.06 percent of blood volume - person feels relaxed and comfortable

    • 0.09 percent - drinker becomes intoxicated

    • 0.55 percent - drinker will likely die

  • Most of the alcohol is broken down (metabolized) by the liver into carbon dioxide and water, which can be exhaled and excreted

  • Alcohol Use Disorder / Alcoholism

    • Clinical Picture

      • Those with alcohol use disorder drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious

      • Drinking interferes with their social behavior and ability to think and work

      • Impairments in memory, speed of thinking, attention skills, and balance patterns of alcoholism vary

    • Tolerance and Withdrawal

      • As their bodies build up a tolerance for alcohol, they need to drink larger amounts to feel the effects

      • They have withdrawal symptoms when they stop drinking (within hours)

      • Small percentage of ppl with alcohol use disorder go through this withdrawal reaction: delirium tremens

        • Terrifying visual hallucinations that begin within three days after they stop or reduce their drinking

        • May cause seizures and strokes

        • Can die

  • Personal and Social Impacts of Alcoholism

    • Alcoholism plays a role in ⅓ of all suicides, homicides, assaults, rapes, and accidental deaths, including in car accidents

    • Intoxicated drivers are responsible for more than 10,000 deaths each year

    • Home life for children of alcoholics

      • Much conflict

      • May have sexual / other forms of abuse

      • Higher rates of psychological problems

      • Low self-esteem, poor communication skills, poor sociability, maritial problems

    • Physical health

      • Cirrhosis: Liver becomes scarred and dysfunctional

      • Damage the heart

      • Lowers the immune system’s ability to fight off cancer, bacterial infections, and AIDS

    • Nutritional problems

      • Makes people feel full and lowers their desire for food, but has no nutritional value

        • Chronic drinkers become malnourished, weak, and prone to disease

      • Korsakoff’s syndrome: An alcohol related disorder caused by a deficiency of vitamin B

        • Marked by extreme confusion, memory loss, and other neurological symptoms

        • Confabulating: Reciting made-up events to fill in the gaps

        • Cannot remember the past or learn new info

    • Fetal Alcohol Syndrome: A pattern of abnormalities that can include intellectual disability disorder, hyperactivity, head and face deformities, heart defects, and slow growth

      • Caused by excessive alcohol use during pregnancy

    • Heavy drinking early in pregnancy often leads to a miscarriage

Sedative-Hypnotic Drugs

  • Also called anxiolytic (anxiety-reducing) drugs

  • Produces feelings of relaxation and drowsiness

  • Low doses: drugs have a calming or sedative effect

  • Higher doses: sleep inducers / hypnotics

  • Most widely prescribed sedative-hypnotic drugs

    • In the past: barbiturates

    • Now: benzodiazepines

  • ex: xanax, ativan, valium

  • These drugs calm people by binding to receptors on the neurons that receive GABA and by increasing GABA’s activity at those neurons

  • Benzodiazepines

    • Generally safer

    • Less likely to lead to intoxication, tolerance effects, and withdrawal reactions

    • Relieve anxiety without making people as drowsy as other kinds of sedative-hypnotics

    • Less likely to slow a person’s breathing - less likely to cause death in the event of an overdose

  • In high enough doses, these drugs can cause intoxication and lead to sedative-hypnotic use disorder

  • Sedative-hypnotic Use Disorder: A pattern marked by craving for the drugs, tolerance effects, and withdrawal reactions

    • 0.4% of all adults in the US display this disorder in a year

Opioids

  • Opioid: Opium, drugs derived from opium, and other synthetic drugs

    • Heroin, morphine, codeine

  • Opium: A highly addictive substance made from the sap of the opium poppy

  • Widely used in the past because of its ability to reduce both physical and emotional pain

  • Morphine: A highly addictive substance derived from opium that is particularly effective in relieving pain

    • Can lead to addiction

    • Morphine addiction became known as soldier’s disease

  • Heroin: One of the most addictive substances derived from opium

  • 1917: US Congress concluded that all drugs derived from opium were addictive and passed a law making opioids illegal except for medical purposes

  • Opioid Use Disorder

    • Heroin use interferes significantly with their social and occupational functioning, and their lives center around the drug

    • Build a tolerance for heroin and experience a withdrawal reaction when they stop taking it

      • Symptoms peak by the third day, gradually subside, and disappear by the eighth day

      • Person in withdrawal can either wait out the symptoms or end withdrawal by taking the drug again

    • People need heroin just to avoid going into withdrawal

    • Must continually increase their doses to achieve relief

    • 1% of adults in the US display an opioid use disorder within a given year

  • Dangers of Opioid Use

    • Overdose: Closes down the respiratory center in the brain, almost paralyzing breathing and in many cases causing death

    • Heroin can be mixed with other drugs / deadly substances

    • Dirty needles and other unsterilized equipment spreads infections

Stimulants

  • Stimulants: Substances that increase the activity of the central nervous system, resulting in increased blood pressure and heart rate, more alertness, and sped-up behavior and thinking

Cocaine

  • Cocaine: An addictive stimulant obtained from the coco plant and the most powerful natural stimulant known

  • Brings on a euphoric rush of well-being and confidence

  • Increases the supplies of dopamine at key neurons throughout the brain

  • Increases the activity of norepinephrine and serotonin in some areas of the brain

  • Cocaine Intoxication: Symptoms are poor muscle coordination, grandiosity, bad judgment, anger, aggression, compulsive behavior, anxiety, and confusion

  • Cocaine-induced Psychosis: Some people have hallucinations, delusions, or both

  • Crashing: As the stimulant effects of cocaine subside, the user goes through a depression-like letdown, causing a pattern that may also include headaches, dizziness, and fainting

  • Ingesting Cocaine

    • In the past, it was usually snorted

    • Freebasing: A technique in which the pure cocaine basic alkaloid is chemically separated (freed) from processed cocaine, vaporized by heat from a flame, and inhaled through a pipe

    • Crack: A powerful, ready-to-smoke freebase cocaine

  • Dangers

    • Linked to many suicides

    • Overdose

    • Major heart irregularities or brain seizures that bring breathing or heart functioning to a sudden stop

    • Pregnant women who use cocaine run the risk of having a miscarriage and of having children with predispositions to drug use and other abnormalities

Amphetamines

  • Amphetamines: Stimulant drugs that are manufactured in the laboratory

  • Benzedrine, dexedrine, methedrine

  • First produced to help treat asthma

  • Most often taken in pill or capsule form

  • Increase energy and alertness and reduce appetite when taken in small doses

  • Produce a rush, intoxication, and psychosis in high doses

  • Cause an emotional letdown as they leave the body

  • Stimulate the CNS by increasing the release of the neurotransmitters dopamine, norepinephrine, and serotonin through the brain

  • Methamphetamine: A kind of amphetamine that has surged in popularity in recent years, posing major health and law enforcement problems

    • Most is made in small “stovetop laboratories” which can expel dangerous fumes and residue

    • About as likely to be used by women as men

    • Increases activity of the neurotransmitters dopamine, serotonin, and norepinephrine, producing increased arousal, attention, and related effects

    • Neurotoxicity: Damages nerve endings

Stimulant Use Disorder

  • Caused by regular use of either cocaine or amphetamines

Caffeine

  • World’s most widely used stimulant

  • Coffee, tea, energy drinks, chocolate, numerous prescription/over-the-counter meds

  • Acts as a stimulant of the cns

  • Raises a person’s arousal and motor activity, enhances physical stamina, reduces fatigue

  • Disrupt mood, fine motor movement, and reaction time

  • May interfere with sleep

  • High doses: Increases gastric acid secretions in the stomach and the rate of breathing

  • 250+ milligrams of caffeine can produce caffeine intoxication

    • 2-3 cups of coffee

    • 6 cans of soda

    • 3 cans of energy drinks

  • Doses larger than 10 grams of caffeine can cause grand mal seizures and fatal respiratory failure

    • 100 cups of coffee

  • People who suddenly stop or cut back on their usual intake have withdrawal symptoms

Hallucinogens, Cannabis, and Combinations of Substances

Hallucinogens

  • Hallucinogens: Substances that cause powerful changes in sensory perception

  • Produce delusions, hallucinations, and other sensory changes also called psychedelic drugs

  • LSD, mescaline, psilocybin, MDMA (ecstacy)

  • LSD

    • Brings on a state of hallucinogen intoxication / hallucinosis

      • Strengthening of perceptions, psychological changes, and physical symptoms

      • Cause one to hear sounds more clearly, feel tingling or numbness in the limbs, or confuse the sensations of hot and cold

      • Synesthesia

    • Can induce strong emotions

    • Perception of time may slow dramatically

    • Physical symptoms

    • Binds to some of the neurons that normally receive serotonin, changing the neurotransmitter’s activity at those sites

    • 15+% of all ppl in the US have used LSD or another hallucinogen at some point in their lives

    • People don’t develop tolerance to LSD or have withdrawal symptoms when they stop taking it

    • Any dose, no matter how small, is likely to produce an enormous reaction

    • Users eventually develop psychosis or a mood or anxiety disorder

    • Flashbacks: A recurrence of the sensory and emotional changes after the LSD has left the body

      • May occur days or months after the last LSD experience

Cannabis

  • produces sensory changes and has depressant and stimulant effects

  • The higher the THC content, the more powerful the cannabis

  • Produces a mixture of hallucinogenic, depressant, and stimulant effects

  • High is called Cannabis Intoxication

  • Cannabis Use Disorder

  • Dangers

    • Occasionally causes panic reactions similar to the ones caused by hallucinogens

    • Can interfere with the performance of complex sensorimotor tasks and with cognitive functioning

      • Caused many automobile accidents

    • Fail to remember information no matter how hard they try to concentrate

    • Chronic users have higher blood flow

    • Long-term health problems

      • Reduces the ability to expel air from the lungs

      • Lower sperm counts and abnormal ovulation

  • Cannabis and Society

    • Used to play a respected role in medicine

    • Began to be used as a recreational drug

    • Assumed to be highly dangerous and was outlawed

    • Campaigned for the medical legalization of marijuana

    • Moved to legalize the recreational use of marijuana

Combinations of Substances

  • Polysubstance Use: People often take more than one drug at a time

  • Cross-tolerance: Tolerance for a substance one has not taken before as a result of using another substance similar to it

  • Synergistic Effect: In pharmacology, an increase of effects that occurs when more than one substance is acting on the body at the same time

    • Two or more drugs have similar actions

      • Combining them, even in small doses, can lead to extreme intoxication, coma, and even death

      • ex: alcohol and opioids

    • Two or more drugs have opposite / antagonistic actions

      • Build up toxic, even lethal, levels of the depressant drugs in their systems

      • Cory Monteith

What Causes Substance Use Disorders?

Sociocultural Views

  • People are most likely to develop substance use disorders when they live under stressful socioeconomic conditions

    • Unemployment, low socioeconomic classes

  • People confronted regularly by other kinds of stress have a heightened risk of developing substance use disorder

  • People are more likely to develop substance use disorders if they’re part of a family or social environment in which substance use is valued or at least accepted

Psychodynamic Views

  • People with substance use disorders have powerful dependency needs that can be traced to their early years

    • When parents fail to satisfy a young child’s need for nurturance, the child is likely to grow up depending excessively on others for help and comfort

    • Develop a dependent relationship with a substance

  • Certain people respond to their early deprivations by developing a substance abuse personality that leaves them particularly prone to drug abuse

    • Individuals who abuse drugs tend to be more dependent, antisocial, impulsive, and depressive than other individuals

    • Cannot presently conclude any one personality trait or group of traits that stands out in the development of the disorders

Cognitive-Behavioral Views

  • Operant conditioning may play a key role in substance use disorders

  • Temporary reduction of tension / raising of spirits produced by the drug has a rewarding effect

    • Increases the likelihood that the user will seek that reaction again

    • Lead users to try higher dosages or more powerful methods of ingestion

    • Produce an expectancy that substances will be rewarding, which helps motivate people to increase drug use at times of tension

  • Many people do drink more alcohol or seek heroin when they feel tense

  • Many people take drugs to medicate themselves when they feel tense

  • Classical conditioning may also play a role in these disorders

  • Cues or objects present at the time a person takes a drug may come to produce some of the same pleasure brought on by the drugs themselves

Biological Views

  • Genetic Predisposition - People may inherit a predisposition to misuse substances

    • Alcohol concordance rate of around 50% in identical twins

  • Neurotransmitters

    • When a particular drug is ingested, it increases the activity of certain neurotransmitters whose normal purpose is to calm, reduce pain, lift mood, or increase alertness

    • Drug takers build tolerance for a drug, becoming more and more reliant on it rather than on their own biological processes

    • If they suddenly stop taking the drug, their natural supply of neurotransmitters will be low for a time, producing the symptoms of withdrawal

    • The abused substance dictates which neurotransmitters will be affected

      • Alcohol/benzos: GABA

      • Opioids: Endorphins

      • Cocaine/Amphetamines: Dopamine

      • Marijuana: Anandamide (neurotransmitter that operates like THC)

  • Reward Circuit: A dopamine-rich circuit in the brain that produces feelings of pleasure when activated

    • When a person ingests a substance, the substance eventually activates the brain’s reward circuit

    • When dopamine is activated throughout this circuit, a person feels pleasure

    • Certain drugs stimulate the structures in the reward circuit, others stimulate it in roundabout ways

      • Leads to increased dopamine in the reward circuit and excessive communications between the structures in the reward circuit

    • Incentive-sensitization Theory of Addiction: As substances repeatedly stimulate this reward circuit, the circuit develops a hypersensitivity to the substances, contributing to future desires for them

    • Reward Deficiency Syndrome: People who chronically use drugs have a reward circuit that is not readily activated by the usual events in their lives, so they turn to drugs to stimulate the pleasure pathway, particularly in times of stress

      • Abnormal D2 receptor gene is a possible contributor

The Developmental Psychopathology View

  • Genetically inherited predispositions

    • Less-than-optimal reward circuit in the brain

    • Problematic temperament

  • Will eventually result in a substance use disorder if the individual further experiences numerous stressors

    • Ppl who experience manageable adversities can develop a level of resilience

  • Temperaments that can set the stage for later substance abuse

    • Disinhibited / Externalizing Temperament

      • Impulsivity, aggressiveness, overactivity, limited persistence, low frustration tolerance, inattention

      • Great difficulty controlling their behaviors

    • Internalizing Temperament

      • Temperament of inhibition and negative affectivity

      • Multiple fears, depression, negative thinking, and dependence

      • Turn to substances to reduce their emotional pain, quiet their troublesome thoughts, and help them through interpersonal difficulties

  • Equifinality: The principle that different developmental pathways can lead to the same psychological disorder

How Are Substance Use Disorders Treated?

  • Motivational Interviewing: Therapists help motivate the clients to make constructive choices and behavioral changes

  • Effectiveness of treatment for substance use disorders can be difficult to determine

    • Different substance use disorders pose different problems

    • Many people with such disorders drop out of treatment very early

    • Some people recover without any intervention while others recover and then relapse

    • Different criteria are used by different clinical researchers

Psychodynamic Therapies

  • Guide clients to uncover and work through the underlying needs and conflicts that led to the substance use disorder

  • Try to help the clients change their substance-related styles of living

  • Tends to be of more help when combined with other approaches in a multidimensional treatment program

Cognitive-Behavioral Therapies

  • Help clients identify and change the behaviors and cognitions that keep contributing to their patterns of substance misuse

  • Aversion Therapy: Clients are repeatedly presented with an unpleasant stimulus at the very moment that they are taking a drug

    • Expected to react negatively to the substance itself and lose their craving for it

    • Used to treat alcoholism most

    • Limited success when its the sole form of treatment

    • Approach can only be effective if people are motivated to subject themselves to multiple sessions

  • Contingency Management: Offers clients incentives that are contingent on the submission of drug-free urine specimens

    • Rewards clients from abstaining from substance use

    • Clients in these programs maintain a higher attendance record than those in other kinds of programs

    • Moderately effective

    • Can be effective only when people are motivated to continue despite its demands

    • Most useful in the treatment of stimulant use disorder and opioid use disorder

    • The larger the rewards offered, the greater the client’s improvement

  • Relapse-Prevention Training

    • Goal: For clients to gain control over their substance-related behaviors

    • Taught to identify high risk situations, look at the range of decisions they can make, change their dysfunctional lifestyles, and learn from their mistakes

    • Strategies for alcoholism

    • Therapists have clients keep track of their drinking

      • Helps them become aware of the situations that place them at risk for excessive drinking

    • Therapists teach clients coping situations to use when such situations arise

    • Therapists teach clients to plan ahead of time

      • Determine beforehand how many drinks are appropriate, etc.

  • Acceptance and Commitment Therapy

    • Use a mindfulness based approach to help clients become aware of their streams of thoughts as they’re occurring and to accept them as mere thoughts of mind

    • Increasing their awareness and acceptance of their drug cravings, worries, and depressive thoughts

Biological Treatments

  • Detoxification: Systematic and medically supervised withdrawal from a drug

    • Clients take smaller and smaller doses until they’re off the drug completely

    • Give clients other drugs that reduce the symptoms of withdrawal (like anti anxiety meds)

    • Relapse rates tend to be high for those who don’t receive a follow-up treatment after successfully detoxifying

  • Antagonist Drugs: Drugs that block or change the effects of the addictive drug as an aid to resisting temptation

    • Disulfiram - increases negative effects of alcohol

    • Opioid antagonist drugs like naloxone

      • Attach to endorphin receptor sites throughout the brain and make it impossible for the opioids to have their usual effect

        • Reduces cravings for alcohol as well

      • Continued drug use becomes pointless

      • Can reverse the deadly effect of respiratory depression

    • Partial Antagonists: Opioid antagonists that produce less severe withdrawal symptoms

      • Causes rapid detoxification - helps speed things along

  • Drug Maintenance Therapy

    • Methadone Maintenance Programs: A treatment approach in which clients are given legally and medically supervised doses of methadone - a heroin substitute - to treat various opioid use disorders

      • Developed in the 1960s to treat heroin addiction

      • Ppl with an addiction were given methadone as a substitute for heroin

      • They then became addicted to methadone, but this addiction was maintained under safe medical supervision

      • Methadone produces a moderate high, can be taken by mouth, and only needs to taken once a day

      • Was very effective at first, now less possible bc substituting one addiction for another isn’t very acceptable

      • Methadone is sometimes harder to withdraw from - symptoms can last longer

      • Methadone treatment is safer than street opioid use

      • Most effective when combined with education, psychotherapy, family therapy, and employment counseling

    • Buprenorphine: An opioid substitute drug being used as a form of maintenance therapy

      • Opioid that is administered to patients as a safer alternative to heroin, painkillers, etc.

      • Permitted by law to be prescribed by physicians in their offices rather than as part of a highly structured clinic program

Sociocultural Therapies

  • Psychological problems emerge in a social setting and are best treated in a social context

  • Self-Help and Residential Treatment Programs

    • Alcoholics Anonymous: A self-help organization that provides support and guidance for people with alcohol use disorder

      • Promotes abstinence instead of controlled drinking

    • Abstinence is a more appropriate goal for ppl who have a long-standing alcohol use disorder

    • Controlled drinking is a helpful goal for younger drinkers whose pattern doesn’t include tolerance and withdrawal reactions

    • Residential Treatment Centers / Therapeutic Communities: A place where people formerly addicted to drugs live, work, and socialize in a drug-free environment while undergoing therapy and making a transition back to community life

  • Culture and Gender-Sensitive Programs

    • Therapists should be sensitive to their clients’ life challenges - the special sociocultural pressures and problems faced by drug abusers who are poor, homeless, or members of minority groups

    • Women often require different treatment methods than those designed for men

  • Community Prevention Programs

    • Prevention Program Model

      • Total abstinence

      • Responsible use

      • Interrupt drug use

      • Delay the age of onset for drug use

    • Programs can

      • Offer drug education

      • Teach alternatives to drug use

      • Try to change the psychological state of the potential user

      • Help people change their peer relationships

    • Program Focus

      • Individual: Providing education about unpleasant drug effects

      • Family: Teaching parenting skills

      • Peer group: Teaching resistance to peer pressure

      • School: Setting up firm enforcement of drug policies community

    • Not always effective

Other Addictive Disorders

  • People may become addicted to behaviors and activities beyond substance use

Gambling Disorder

  • Preoccupied with gambling and cannot walk away from a bet

  • Continue gambling even in the face of financial, social, occupational, and health problems

  • Gamble more when feeling distressed

  • Lie to cover up the extent of their gambling

  • Have symptoms that are similar to the tolerance and withdrawal reactions often associated with substance use disorder

  • People with gambling disorder may

    • Inherit a genetic predisposition to develop the disorder

    • Experience heightened dopamine activity and dysfunction of the brain’s reward circuit when they gamble

    • Have impulsive, novelty-seeking, and other personality styles that leave them prone to gambling disorder

    • Make repeated and cognitive mistakes such as inaccurate expectations and misinterpretations of their emotions and bodily states

  • Gamblers Anonymous: A self-help group problem for gamblers modeled after Alcoholics Anonymous

Internet Gaming Disorder: Awaiting Official Status

  • Internet Use Disorder: An uncontrollable need to be online

  • Ppl spend all their waking moments online

  • Parallels symptoms found in substance use disorders and gambling disorder

  • Possible withdrawal reactions when internet use is not possible

  • Not included in the DSM-5