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: Substances that slow the activity of the central nervous system
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
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
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: 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: 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: 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
Caused by regular use of either cocaine or amphetamines
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: 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
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
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
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
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
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
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
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
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
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
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
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
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
People may become addicted to behaviors and activities beyond substance use
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 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
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: Substances that slow the activity of the central nervous system
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
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
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: 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: 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: 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
Caused by regular use of either cocaine or amphetamines
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: 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
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
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
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
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
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
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
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
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
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
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
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
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
People may become addicted to behaviors and activities beyond substance use
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 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