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Chapter 10 Substance-Related Disorders. Perspectives on Substance-Related Disorders: An Overview. The Nature of Substance-Related Disorders Problems related to the use and abuse of psychoactive substances Produce wide-ranging physiological, psychological, and behavioral effects

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Chapter 10 substance related disorders
Chapter 10Substance-Related Disorders


Perspectives on substance related disorders an overview
Perspectives on Substance-RelatedDisorders: An Overview

  • The Nature of Substance-Related Disorders

    • Problems related to the use and abuse of psychoactive substances

    • Produce wide-ranging physiological, psychological, and behavioral effects

  • Some Important Terms and Distinctions

    • Substance use vs. substance intoxication

    • Substance abuse vs. substance dependence

    • Tolerance vs. withdrawal


Perspectives on substance related disorders an overview cont
Perspectives on Substance-RelatedDisorders: An Overview (cont.)

  • Five Main Categories of Substances

    • Depressants – Result in behavioral sedation (e.g., alcohol, sedative, anxiolytic drugs)

    • Stimulants – Increase alertness and elevate mood (e.g., cocaine, nicotine, caffeine)

    • Opiates – Primarily produce analgesia and euphoria (e.g., heroin, morphine, codeine)

    • Hallucinogens – Alter sensory perception (e.g., marijuana, LSD)

    • Other drugs of abuse – Include inhalants, anabolic steroids, medications


Perspectives on substance related disorders an overview cont1
Perspectives on Substance-RelatedDisorders: An Overview (cont.)

Figure 11.1

Ice, LSD, chocolate, TV: Is everything addictive?


Perspectives on substance related disorders an overview cont2
Perspectives on Substance-RelatedDisorders: An Overview (cont.)

Figure 11.1 (cont.)

Ice, LSD, chocolate, TV: Is everything addictive?


Perspectives on substance related disorders an overview cont3
Perspectives on Substance-RelatedDisorders: An Overview (cont.)

Figure 11.2

Easy to get hooked on, hard to get off


Perspectives on substance related disorders an overview cont4
Perspectives on Substance-RelatedDisorders: An Overview (cont.)

Figure 11.2 (cont.)

Easy to get hooked on, hard to get off


The depressants alcohol use disorders
The Depressants: Alcohol Use Disorders

  • Psychological and Physiological Effects of Alcohol

    • Central Nervous system depressant

    • Influences several neurotransmitter systems, but mainly GABA

  • Effects of Chronic Alcohol Use

    • Alcohol intoxication

    • Alcohol withdrawal

    • Associated brain conditions – Dementia and Wernicke’s disease

    • Fetal alcohol syndrome

  • DSM-IV Criteria for Disordered Alcohol Use


The depressants alcohol use disorders cont
The Depressants: Alcohol Use Disorders (cont.)

Figure 11.3

The path traveled by alcohol throughout the body


Alcohol some facts and statistics
Alcohol: Some Facts and Statistics

  • In the United States

    • Most adults consider themselves light drinkers or abstainers

    • Most alcohol is consumed by 11% of the U.S. population

    • Alcohol use is highest among Caucasian Americans

    • Males use and abuse alcohol more so than females

    • Violence is associated with alcohol, but alcohol alone does not cause aggression


Alcohol some facts and statistics cont
Alcohol: Some Facts and Statistics (cont.)

  • Facts and Statistics on Problem Drinking

    • 10% of Americans experience problems with alcohol

    • Most persons with alcoholism can moderate or cease drinking on occassion

    • 20% of those with alcohol problems experience spontaneous recovery

    • Anhedonia – Lack of pleasure, or indifference to pleasurable activities

    • Affective flattening – Show little expressed emotion, but may still feel emotion


Sedative hypnotic or anxiolytic substance use disorders an overview
Sedative, Hypnotic, or AnxiolyticSubstance use Disorders: An Overview

  • The Nature of Drugs in This Class

    • Sedatives – Calming

    • Hypnotic – Sleep inducing (e.g., barbiturates)

    • Anxiolytic – Anxiety reducing (e.g., benzodiazepines)

  • Effects of Such Drugs Are Similar to Large Doses of Alcohol

    • Combining such drugs with alcohol is synergistic

  • All Exert Their Influence Via the GABA Neurotransmitter System

  • DSM-IV Criteria for Sedative, Hypnotic, or Anxiolytic Substance Use Disorders


Stimulants an overview
Stimulants: An Overview

  • Nature of Stimulants

    • Most widely consumed drug in the United States

    • Such drugs increase alertness and increase energy

    • Examples include amphetamines, cocaine, nicotine, and caffeine


Stimulants amphetamine use disorders
Stimulants: Amphetamine Use Disorders

  • Effects of Amphetamines

    • Produce elation, vigor, reduce fatigue

    • Enhance the release of dopamine and norepinephrine, while blocking reuptake

    • Such effects are followed by a “crash” (e.g., feeling depressed and tired)

  • DSM-IV Criteria for Amphetamine Intoxication

    • Psychological symptoms

    • Physiological symptoms

  • Ecstasy and Ice

    • Produces effects similar to speed, but without the crash

    • 2% of college students report using Ecstasy

    • Both drugs can result in dependence


Stimulants cocaine use disorders
Stimulants: Cocaine Use Disorders

  • Effects of Cocaine

    • Produce short lived sensations of elation, vigor, reduce fatigue

    • Effects result from blocking the reuptake of dopamine

    • Cocaine is highly addictive, but addiction develops slowly

    • Cocaine use in the United States has declined over the last decade

  • DSM-IV Criteria for Cocaine Intoxication and Withdrawal

    • Psychological symptoms

    • Physiological symptoms

    • Most cocaine users cycle through patterns of tolerance and withdrawal


Stimulants nicotine use disorders
Stimulants: Nicotine Use Disorders

  • Effects of Nicotine

    • Stimulates the central nervous system, specifically nicotinic acetylcholine receptors

    • Results in sensations of relaxation, wellness, pleasure

    • Nicotine is highly addictive

  • DSM-IV Criteria for Nicotine Withdrawal Only

    • Psychological symptoms

    • Physiological symptoms

    • Nicotine users dose themselves to maintain a steady state of nicotine


Stimulants nicotine use disorders cont
Stimulants: Nicotine Use Disorders (cont.)

Figure 11.8

Relapse rates for nicotine compared to alcohol and heroin


Stimulants caffeine use disorders
Stimulants: Caffeine Use Disorders

  • Effects of Caffeine – The “Gentle” Stimulant

    • Found in tea, coffee, cola drinks, and cocoa products

    • Caffeine blocks the reuptake of the neurotransmitter adenosine

    • Small doses elevate mood and reduce fatigue

    • Used by over 90% of Americans

    • Regular use can result in tolerance and dependence

  • DSM-IV Criteria for Caffeine Intoxication

    • Psychological symptoms

    • Physiological symptoms


Opiods an overview
Opiods: An Overview

  • The Nature of Opiates and Opiods

    • Opiate – Natural chemical in the opium poppy with narcotic effects (i.e., pain relief)

    • Opiods – Refers to a class of nature and synthetic substances with narcotic effects

    • Such drugs are often referred to as analgesics

    • Examples include heroin, opium, codeine, and morphine

  • Effects of Opiods

    • Activate body’s enkephalins and endorphins

    • Low doses induce euphoria, drowsiness, and slowed breathing

    • High doses can result in death

    • Withdrawal symptoms can be lasting and severe


Opiods an overview cont
Opiods: An Overview (cont.)

  • DSM-IV Criteria for Opiod Intoxication and Withdrawal

    • Psychological symptoms

    • Physiological symptoms

    • Mortality rates are high for opiod addicts


Hallucinogens an overview
Hallucinogens: An Overview

  • Nature of Hallucinogens

    • Substances that change the way the user perceives the world

    • May produce delusions, paranoia, hallucinations, and altered sensory perception

    • Examples include marijuana, LSD

  • Marijuana

    • Active chemical is tetrahydrocannabinol (THC)

    • May produce several symptoms (e.g., mood swings, paranoia, hallucinations)

    • Impairment in motivation is not uncommon (i.e., amotivational syndrome)

    • Major signs of withdrawal and dependence do not typically occur


Hallucinogens an overview cont
Hallucinogens: An Overview (cont.)

  • LSD and Other Hallucinogens

    • LSD is most common form of hallucinogenic drug

    • Tolerance tends to be rapid, and withdrawal symptoms are uncommon

    • Psychotic delusional and hallucinatory symptoms can be problematic

  • DSM-IV Criteria for Marijuana and Hallucinogen Intoxication

    • Psychological and physiological symptoms are similar


Other drugs of abuse inhalants
Other Drugs of Abuse: Inhalants

  • Nature of Inhalants

    • Substances found in volatile solvents that are breathed into the lungs directly

    • Examples include spray paint, hair spray, paint thinner, gasoline, nitrous oxide

    • Such drugs are rapidly absorbed with effects similar to alcohol intoxication

    • Tolerance and prolonged symptoms of withdrawal are common

    • DSM-IV criteria for inhalant intoxication


Other drugs of abuse anabolic steroids
Other Drugs of Abuse: Anabolic Steroids

  • Nature of Anabolic-Androgenic Steroids

    • Steroids are derived or synthesized from testosterone

    • Used medicinally or to increase body mass

    • Users may engage in cycling or stacking

    • Steroids do not produce a high

    • Steroids can result in long-term mood disturbances and physical problems


Other drugs of abuse designer drugs
Other Drugs of Abuse: Designer Drugs

  • Designer Drugs

    • Drugs produced by pharmaceutical companies for diseases

    • Ecstasy, MDEA (“eve”), BDMPEA (“nexus”), ketamine (“special K”) are examples

    • Such drugs heighten auditory and visual perception, sense of taste/touch

    • Becoming popular in nightclubs, raves, or large social gatherings

    • All designer drugs can produce tolerance and dependence


Causes of substance related disorders family and genetic influences
Causes of Substance-Related Disorders: Family and Genetic Influences

  • Results of Family, Twin, and Adoption Studies

    • Substance abuse has a genetic component

    • Much of the focus has been on alcoholism

    • Genetic differences in alcohol metabolism

    • Multiple genes are involved in substance abuse


Causes of substance related disorders neurobiological influences
Causes of Substance-Related Disorders:Neurobiological Influences

  • Results of Neurobiological Research

    • Drugs affect the pleasure or reward centers in the brain

    • The pleasure center – Dopamine, midbrain, frontal cortex

    • GABA turns off reward-pleasure system

    • Neurotransmitters responsible for anxiety/negative affect may be inhibited


Causes of substance related disorders psychological dimensions
Causes of Substance-Related Disorders:Psychological Dimensions

  • Role of Positive and Negative Reinforcement

    • The self-medication and the tension reduction hypotheses

    • Most see substance abuse as a means to cope with negative affect

  • Opponent-Process Theory

    • Explains why the crash after drug use fails to keep people from using

  • Role of Expectancy Effects

    • Expectancies influence drug use and relapse


Causes of substance related disorders social and cultural dimensions
Causes of Substance-Related Disorders:Social and Cultural Dimensions

  • Exposure to Drugs is a Prerequisite for Use of Drugs

    • Media, family, peers

    • Parents and the family appear critical

  • Societal Views About Drug Abuse

    • Sign of moral weakness – Drug abuse is a failure of self-control

    • Sign of a disease – Drug abuse is caused by some underlying process

  • The Role of Cultural Factors

    • Influence the manifestation of substance abuse


An integrative model of substance related disorders
An Integrative Model of Substance-Related Disorders

  • Exposure or Access to a Drug Is Necessary, but not Sufficient

  • Drug Use Depends on Social and Cultural Expectations

  • Drugs Are Used Because of Their Pleasurable Effects

  • Drugs Are Abused for Reasons That Are More Complex

    • The premise of equifinality

    • Stress may interact with psychological, genetic, social, and learning factors


An integrative model of substance related disorders cont
An Integrative Model ofSubstance-Related Disorders (cont.)

Figure 11.11

An integrative model of substance related disorders


Biological treatment of substance related disorders
Biological Treatment of Substance-Related Disorders

  • Agonist Substitution

    • Safe drug with a similar chemical composition as the abused drug

    • Examples include methadone for heroin addiction, and nicotine gum or patch

  • Antagonistic Treatment

    • Drugs that block or counteract the positive effects of substances

    • Examples include naltrexone for opiate and alcohol problems


Biological treatment of substance related disorders cont
Biological Treatment ofSubstance-Related Disorders (cont.)

  • Aversive Treatment

    • Drugs that make the injection of abused substances extremely unpleasant

    • Examples include antabuse for alcoholism and silver nitrate for nicotine addiction

  • Efficacy of Biological Treatment

    • Such treatments are generally not effective when used alone


Psychosocial treatment of substance related disorders
Psychosocial Treatment of Substance-Related Disorders

  • Debate Over Controlled Use vs. Complete Abstinence as Treatment Goals

  • Inpatient vs. Outpatient Care

    • Data suggest little difference in terms of overall effectiveness

  • Community Support Programs

    • Alcoholics Anonymous and related groups

    • Seem helpful and are strongly encouraged


Psychosocial treatment of substance related disorders cont
Psychosocial Treatment ofSubstance-Related Disorders (cont.)

  • Components of Comprehensive Treatment and Prevention Programs

    • Individual and group therapy

    • Aversion therapy and convert sensitization

    • Contingency management

    • Community reinforcement

    • Relapse prevention

    • Preventative efforts via education


Summary of substance related disorders
Summary of Substance-Related Disorders

  • DSM-IV and DSM-IV TR Substance Related Disorders Cover Four Classes

    • Depressants, stimulants, opiates, and hallucinogens

    • Specific diagnoses include dependence, abuse, intoxication, or withdrawal

  • Most Psychotropic Drugs Activate the Dopaminergic Pleasure Pathway in the Brain

  • Psychosocial Factors Interact with Biological Influences to Produce Substance Disorders

  • Treatment of Substance Dependence Is Largely Unsuccessful

    • Highly motivated persons do best when part of combined treatment programs

  • Substance-Related Disorders Are 100% Preventable


Summary of substance related disorders cont
Summary of Substance-Related Disorders (cont.)

Figure 11.x1

Exploring substance-related disorders


Summary of substance related disorders cont1
Summary of Substance-Related Disorders (cont.)

Figure 11.x1 (cont.)

Exploring substance-related disorders


Summary of substance related disorders cont2
Summary of Substance-Related Disorders (cont.)

Figure 11.x2

Exploring substance-related disorders, treatment


Summary of substance related disorders cont3
Summary of Substance-Related Disorders (cont.)

Figure 11.x2 (cont.)

Exploring substance-related disorders, treatment


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