• 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