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Chapter 10 Substance Related Disorders. Abnormal Psychology, Eleventh Edition by Ann M. Kring, Gerald C. Davison, John M. Neale, & Sheri L. Johnson. Percentage of Indonesian Population Reporting Drug Use in 2003-2006 (Based on BNN survey). Based on areas. Based on substance.

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Chapter 10 Substance Related Disorders

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Abnormal psychology eleventh edition by ann m kring gerald c davison john m neale sheri l johnson

Chapter 10 Substance Related Disorders

Abnormal Psychology, Eleventh EditionbyAnn M. Kring, Gerald C. Davison, John M. Neale, & Sheri L. Johnson

Percentage of indonesian population reporting drug use in 2003 2006 based on bnn survey

Percentage of Indonesian Population Reporting Drug Use in 2003-2006 (Based on BNN survey)

Based on areas

Based on substance

  • Jakarta : 23%

  • Medan : 15%

  • Bandung : 14%

  • Surabaya : 6.3 %

  • Maluku utara : 4.3 %

  • Padang : 5.5 %

  • Kendari : 5%

  • Marijuana : 74.9 %

  • Anti-Depressant : 32.5 %

  • Ecstasy : 25.7 %

  • Amphetamine : 21.5 %

Substance dependence and abuse

Substance Dependence and Abuse

Dependence ( Adiction)


  • Occupational or social problems, much time trying to obtain substance, continued use despite problems, etc.

  • Involves either tolerance or withdrawal

    • Tolerance

      • Greater amounts required to produce desired effect

    • Withdrawal

      • Physiological and psychological consequences when individual discontinues or reduces substance use

        • Restlessness, anxiety, cramps, death

    • Maladaptive use of substance

    • No physiological dependence

  • In 2006, 22 million met criteria for dependence or abuse.

    • Of those 15 million involved alcohol.

  • Alcohol dependence and abuse

    Alcohol Dependence and Abuse

    • Alcohol abuse

      • Negative social and occupational effects

      • No tolerance, withdrawal, or compulsive usage

    • Alcohol Dependence

      • More severe symptoms such as tolerance and withdrawal

      • Withdrawal results in:

        • Anxiety

        • Depression

        • Weakness

        • Restlessness

        • Insomnia

        • Muscle tremors

          • Face, fingers, eyelids, other small musculature

        • Elevated BP, pulse, temperature

    Alcohol abuse and dependence

    Alcohol Abuse and Dependence

    • Delirium tremens (DTs)

      • Can occur when blood alcohol levels drop suddenly

      • Results in:

        • Deliriousness

        • Tremulousness

        • Hallucinations

          • Primarily visual; may be tactile

    • 2.5% of alcohol abusers develop dependence

    Alcohol abuse and dependence1

    Alcohol Abuse and Dependence

    • Polydrug abuse

      • Many users abuse multiple substances

        • e.g., cigarettes, cocaine, marijuana

        • 85% of alcohol are smokers

    • Synergistic

      • Some combinations of drugs produce stronger reaction

        • Alcohol and barbiturates

          • May cause death

        • Alcohol and heroin

          • Alcohol reduces amount of heroin needed to produce lethal dose

    Prevalence of alcohol abuse

    Prevalence of Alcohol Abuse

    • Lifetime prevalence (Kessler et al., 1994)

      • 20% for men

      • 8% for women

    • Lifetime prevalence:

      • Abuse - 17%

      • Dependence – 12%

    • Binge drinking

      • 5 drinks in short period

      • 43.5% prevalence among college students

    • Heavyuse drinking

      • 5 drinks, 5 or more times in a 30 day period

        • 17.6% prevalence among college students

    Short term effects of alcohol

    Short-term Effects of Alcohol

    • Enters the bloodstream through small intestine

      • metabolized by the liver

    • Effects vary by concentration

      • Concentration varies by gender, height, weight, liver efficiency

        Affects brain areas associated with error monitoring and decision making.

    • Biphasic effect

      • Initially stimulates

      • Later depresses

    Short term effects of alcohol1

    Short-term Effects of Alcohol

    • Effect of ingesting large amounts

      • Impaired speech and vision

      • Interference in complex thought processes

      • Poor coordination

      • Loss of balance

      • Depression and withdrawal

    • Interacts with several neural systems

      • Stimulates GABA receptors

      • Increases dopamine and serotonin

      • Inhibits glutamate receptors

    Long term effects of alcohol

    Long-term Effects of Alcohol

    • Malnutrition

      • Alcohol interferes with digestion and absorption of vitamins from food

    • Deficiency of B-complex vitamins

      • Amnestic syndrome

        • Severe loss of memory for both long and short term information

    • Cirrhosis of the liver

      • Liver cells engorged with fat and protein impeding functioning

      • Cells die triggering scar tissue which obstructs blood flow

    • Damage to endocrine glands and pancreas

    • Heart failure

    • Erectile dysfunction

    • Hypertension

    • Stroke

    • Capillary hemorrhages

      • Facial swelling and redness, especially in nose

    • Destruction of brain cells

      • Especially areas important to memory

    Fetal alcohol syndrome

    Fetal Alcohol Syndrome

    • Heavy alcohol intake during pregnancy

      • Fetal growth slowed

        • Cranial, facial and limb anomalies occur

    • Moderate alcohol intake

      • 1 drink per day

      • Learning and memory impairments

      • Growth deficits

    • Total abstinence recommended by NIAAA

    Nicotine and cigarette smoking

    Nicotine and Cigarette Smoking

    • Nicotine

      • Addicting agent of tobacco

      • Principal alkaloid

        • Active chemicals that give drugs their physiological and psychological altering properties

      • Stimulates dopamine neurons in mesolimbic area

        • Involved in reinforcing effect

    Prevalence and health consequences

    Prevalence and Health Consequences

    • Prevalence decreased since mid 1960s although use increased through the 1990s, among white adolescents

    • More prevalent among white & Hispanic youth than African Americans

      • African Americans less likely to quit and more likely to get lung cancer

        • Metabolize nicotine more slowly

    • Chinese Americans have lower lung cancer rates

      • Metabolize less nicotine

    • More prevalent among men than women

      • Exception: 12 to 17 year olds

    • Secondhand smoke (ETS, environmental tobacco smoke)

      • Higher levels of ammonia, carbon monoxide nicotine and tar

      • Causes 40,000 deaths per year in US



    • Drug derived from dried and ground leaves and stems of the female hemp plant (Cannibis sativa)

    • Hashish

      • Stronger than marijuana

      • Produced by drying the resin exudate of the tops of plants



    • Most frequently used illicit drug in US

      • 15,000,000 reported using it in 2006

    • Peaked in 1979 then began to decline

      • Rose again in 90s

    • Greater use by men than women although rates among women increased faster in 1990s

    Effects of marijuana

    Effects of Marijuana

    • Major active ingredient

      • THC (delta-9-tetrahydrocannabinol)

    • Psychological

      • Feelings of relaxation and sociability

      • Rapid shifts of emotion

      • Interferes with attention, memory, and thinking

        • Decline in IQ over time

      • Heavy doses can induce hallucinations and panic

      • Impairment of skills needed for driving

        • Impairment present for several hours after ‘high’ has worn off

    • Physiological

      • Bloodshot & itchy eyes

      • Dry mouth and throat

      • Increased appetite

      • Reduced pressure within the eye

      • Increased BP

      • Abnormal heart rate

        • May exacerbate preexisting cardiovascular problems

      • Damage to lung structure and function in long term users

    Therapeutic effects of marijuana

    Therapeutic Effects of Marijuana

    • Reduces nausea and loss of appetite caused by chemotherapy (Salan et al., 1975)

    • Relieves discomfort of AIDS (Sussman et al., 1996)

    • Analgesic effects due to ability of THC to block pain signals from reaching the brain.

    • Supreme Court rulings:

      • Federal law prohibits dispensing marijuana for medicinal purposes

      • Medical use can be prohibited by federal government even if states approve



    • Group of addictive sedatives that in moderate doses relieve pain and induce sleep

      • Opium

      • Morphine

      • Heroin

      • Codeine

    • Synthetic sedatives

      • Seconal and valium

    • Opiates legally prescribed as pain medications include:

      • Hydrocodone combined with other substances yields Vicodin, Zydone, and Lortab

      • Oxycodone the basis for OxyContin, Percodan, & Tylox.

    Prevalence of opiate use

    Prevalence of Opiate Use

    • Heroin

      • Estimated1,000,000 individuals addicted to heroin in US

        • 300,000 in 2006 alone

      • From 1995 to 2002, rates of use among adults 18 to 25 increased from 0.8% to 1.6%

      • Accounted for 62 to 82% of drug-related hospital admissions in Baltimore, Boston, & Newark.

    • Heroin is more pure (25 to 50%) than in the past

      • Increases likelihood of overdose

    • OxyContin prescriptions jumped 1800% between 1996 and 2000 (DEA, 2001)

      • 2.8 million users (SAMSHA, 2004)

        • Can be dissolved for injection or snorting

        • Street price from $25 to $40 per pill

    Psychological and physical effects of opiates

    Psychological and Physical Effects of Opiates

    • Euphoria, drowsiness, reverie, and lack of coordination

      • Loss of inhibition, increased self-confidence

      • Severe letdown after about 4 to 6 hours

    • Heroin and OxyContin

      • Rush

        • Intense feelings of warmth and ecstasy following injection

    • Stimulate receptors of the body’s opioid system

      • Endorphins and enkephalins

    • Tolerance develops and withdrawal occurs

      • Muscle soreness and twitching, tearfulness, yawning

      • Become more severe and also include cramps, chills/sweating, increase in HR and BP, insomnia, & vomiting

        • Withdrawal lasts about 72 hours

    Psychological and physical effects of opiates1

    Psychological and Physical Effects of Opiates

    • 29 year follow up of 500 heroin addicts (Hser, et al., 1993)

      • 28% dead by age 40

        • Half by suicide, homicide, or accident

        • One-third by overdose

    • Many users resort to illegal activities to obtain money for drugs

      • Theft, prostitution, dealing drugs

    • Exposure to infectious diseases via shared needles

      • e.g. HIV

      • Evidence suggests that free needles reduces infectious diseases associated with IV drug use

    Synthetic sedatives

    Synthetic Sedatives

    • Barbituates

      • Induce muscle relaxation, reduce anxiety, produce mild euphoria

      • In 1940s prescribed to aid sleep

      • Usage declined from 1975 thru 1990s but increased recently

    • Other synthetic sedatives

      • Benzodiazepines

        • e.g., Valium, Ketamine

    • Stimulate GABA system

    • Heavy dosages

      • Slurred speech

      • Unsteady gait

      • Impaired judgment & concentration

      • Irritability & combativeness

      • Accidental suffocation due to excessive relaxation of diaphragm muscles

    • Alcohol magnifies depressant effects

    • Tolerance & withdrawal

      • Delirium, convulsions & other symptoms

    Stimulants amphetamines

    Stimulants: Amphetamines

    • Increase alertness and motor activity

    • Reduce fatigue

    • Amphetamines

      • Synthetic stimulants

        • Benzedrine, Dexedrine, Methedrine

      • Trigger release of and block reuptake of norepinephrine and dopamine

      • Produce high levels of energy, sleeplessness

      • Reduce appetite, increase HR, constrict blood vessels in skin and mucous membranes

      • High doses can lead to:

        • Nervousness, agitation, irritability confusion, paranoia, hostility

      • Tolerance can develop after only 6 days use (Comer et al., 2001)

    Stimulants methamphetamine

    Stimulants: Methamphetamine

    • Amphetamine derivative (aka crystal meth)

      • Can be taken orally, intravenously, or intranasally (snorting)

      • In 2006, over 700,000 people used methamphetamine (SAMHSA, 2007).

    • Chronic use damages brain

      • Reduction in hippocampus volume (see figure 10.4; abusers represented by yellow bars)

    Stimulants cocaine

    Stimulants: Cocaine

    • Alkaloid obtained from coca leaves

      • Reduces pain

      • Produces euphoria

      • Heightens sexual desire

      • Increases self-confidence and indefatigability

    • Blocks reuptake of dopamine in mesolimbic areas of brain

    • Overdose

      • Chills, nausea, insomnia, paranoia, hallucinations; possibly heart attack & death

    • Not all users develop tolerance

      • Some become more sensitive

        • May increase risk of OD

    • In 2006, 2.4 million people over the age of 12 reported using cocaine, and 700,000 reported using crack (SAMHSA, 2007).

    Stimulants cocaine1

    Stimulants: Cocaine

    • Crack

      • Form of cocaine that quickly become popular in the 80s

      • Rock crystal that is heated, melted, & smoked

      • Cheaper than cocaine

    Hallucinogens ecstasy and pcp

    Hallucinogens, Ecstasy, and PCP

    • Hallucinogeneffects include:

      • Colorful visual hallucinations

      • Synestesias

        • Overflow from one sensory modality to another

      • Alterations in time perception

      • Lability of mood

      • Anxiety & paranoia

    • LSD

      • d-lysergic acid diethylamide

    • Psilocybin

      • Extracted from mushroom psylocube mexicana

    • Mescaline

      • Active ingredient of peyote

    • Ecstasy

      • Increase feelings of intimacy and enhances mood

      • Chemically similar to mescaline and amphetamines

    • PCP (phencyclidine)

      • Angel dust

      • Animal tranquilizer

      • Causes severe paranoia and violence

    Figure 10 5 process of becoming a drug abuser

    Figure 10.5 Process of Becoming a Drug Abuser

    Etiology of substance related disorders developmental approach

    Etiology of Substance-Related Disorders: Developmental approach

    • Li et al. (2001) Two paths to alcohol abuse

      • First group began drinking in early adolescence, increased drinking throughout high school

      • Second group drank lesser amounts in early adolescence, increased drinking in middle school and again in high school.

        • Boys more likely to be in the first group, girls in the second group

    • Developmental studies do not account for all cases

      • Not an inevitable progression through stages

    Etiology of substance related disorders genetic factors

    Etiology of Substance-Related Disorders:Genetic Factors

    • Relatives and children of problem drinkers have higher-than-expected rates of alcohol abuse or dependence

    • Greater concordance in MZ than DZ twins

      • In men

        • Alcohol, caffeine, smoking, marijuana, & drug abuse in general

      • In women

        • Role of genetics less clear

        • Fewer available studies

        • Findings are mixed

    • Genetic and shared environmental risk factors for illicit drug abuse and dependence appear to be nonspecific

    • Ability to tolerate large quantities of alcohol may be an inherited diathesis

      • Asians have low rates of alcohol abuse

    • CYP2A6

      • Gene associated with metabolism of nicotine

      • Smokers with defect in this gene less likely to become dependent (Rao et al., 2000)

    Etiology of substance related disorders neurobiological factors

    Etiology of Substance-Related Disorders: Neurobiological Factors

    • Nearly all drugs, including alcohol, stimulate the dopamine system in the brain

    • Some evidence that people dependent on drugs or alcohol have a deficiency in the dopamine receptor DRD2

    • People take drugs to avoid the bad feelings associated with withdrawal

      • Explains frequency of relapse

    • Incentive-sensitization theory (Robinson & Berridge, 19983, 2003)

      • Distinguish

        • Wanting (craving for drug)

        • Liking (pleasure obtained by taking the drug)

      • Dopamine system becomes sensitive to the drug and the cues associated with drug (e.g., needles, rolling papers, etc.)

      • Sensitivity to cues induces & strengthens wanting

    • Brain imaging studies show that cues for a drug (needle or a cigarette) activate the reward and pleasure areas of the brain involved in drug use.

    Etiology of substance related disorders psychological factors

    Etiology of Substance-Related Disorders: Psychological factors

    • Mood alteration

      • Tension reduction may be due to “alcohol myopia” (Steele & Joseph, 1990)

        • User focuses reduced cognitive capacity on immediate distractions

        • Less attention focused on tension-producing thoughts

      • Effect similar for smoking

      • Cognitive distraction also reduces aggressive behavior in intoxicated individuals

      • However, alcohol and nicotine may increase tension when no distractions are present.

    • Expectancies about drugs effects influence behavior

      • People who expect alcohol to reduce stress & anxiety are most likely to drink

      • The greater perceived risk, the less likely it is to be used

    Etiology of substance related disorders psychopathology and personality

    Etiology of Substance-Related Disorders: Psychopathology and Personality

    • Personality factors that predict onset of substance related disorders:

      • Negative emotionality

      • Desire for increased arousal and positive affect

      • Constraint

        • Harm avoidance, conservative moral values, & cautious behavior

    • Kindergarten children who were rated high in anxiety and novelty seeking more likely to get drunk, smoke, and use drugs in adolescence.

    Etiology of substance related disorders sociocultural factors

    Etiology of Substance-Related Disorders: Sociocultural factors

    • Alcohol is the most common abused substance worldwide (Smart & Ogborne, 2000)

    • Men consume more alcohol than women but differences vary by country

      • Israel

        • Men drank 3x as much as women

      • Netherlands

        • Men drank 1½x as much as women

    • Availability

      • Usage is higher when alcohol and drugs are easily available

    Etiology of substance related disorders sociocultural factors1

    Etiology of Substance-Related Disorders: Sociocultural factors

    • Family factors

      • Parental alcohol use (Hawkins et al., 1997)

      • Psychiatric, marital, or legal problems in the family linked to drug abuse

      • Lack of emotional support from parents increases use of cigarettes, marijuana, and alcohol (Cadoret et la., 1995a)

      • Lack of parental monitoring linked to higher drug usage (Chassin et al., 1996; Thomas et al., 2000)

    Etiology of substance related disorders sociocultural factors2

    Etiology of Substance-Related Disorders: Sociocultural factors

    • Social network

      • Social influence or social selection?

      • Bullers et al.(2001) found evidence for both

        • Having peers who drink influences drinking behavior (social influence) but individuals also choose friends with drinking patterns similar to their own (social selection)

    • Advertising and Media

      • Countries that ban ads have 16% less consumption than those that don’t (Saffer, 1991)

    Treatment of substance related disorders alcohol abuse and dependence

    Treatment of Substance Related Disorders: Alcohol Abuse and Dependence

    • Inpatient hospital treatment

      • Detoxification

        • Withdrawal from alcohol under medical supervision

        • The therapeutic results of hospital treatment are not superior to those of outpatient treatment

    • Alcoholics Anonymous (AA)

      • Largest self-help group for problem drinkers

      • Regular meetings provide support, understanding, and acceptance

      • Promotes complete abstinence

      • Although some studies have shown AA participation predicts better outcome, recent studies suggest AA no more effective than other forms of therapy.

    Treatment of substance related disorders alcohol abuse and dependence1

    Treatment of Substance Related Disorders: Alcohol Abuse and Dependence

    • Couples and Family Therapy

      • Emphasizes support from problem drinker’s partner

      • Reduced problem drinking maintained1 year after therapy ended

      • Also reduced couples’ overall level of distress

    Treatment of substance related disorders alcohol abuse and dependence2

    Treatment of Substance Related Disorders: Alcohol Abuse and Dependence

    • Cognitive and Behavioral Treatments

      • Contingency-Management Therapy

        • Patient and family reinforce behaviors inconsistent with drinking

          • e.g., avoiding places associated with drinking

        • Teach problem drinker how to deal with uncomfortable situations

          • e.g., refusing the offer of a drink

        • AKA Community-reinforcement approach

      • Relapse Prevention

        • Strategies to prevent relapse

      • Brief motivational interventions

        • Designed to curb heavy drinking in college

    Treatment of substance related disorders alcohol abuse and dependence3

    Treatment of Substance Related Disorders: Alcohol Abuse and Dependence

    • Controlled drinking

      • Belief that problem drinkers can consume alcohol in moderation

      • Avoid total abstinence and inebriation

      • Guided self-change

    • Medications

      • Antabuse (disulfiram)

        • Produces nausea and vomiting if alcohol is consumed

      • Other medications include naltrexone, naloxone, & acamprosate

        • Most effective when combined with CBT

    Treatment of substance related disorders nicotine dependence

    Treatment of Substance Related Disorders: Nicotine Dependence

    • Peer behavior important

      • If others in social network stop smoking, increases likelihood that individual will also stop

    • Rapid smoking treatment

      • Rapid puffing, focused smoking, & smoke holding

    • Scheduled smoking

      • Reduce nicotine intake gradually over a few weeks

    • Physician’s advice

      • By age 65, most smokers have quit (USDHHS, 1998b)

    • Nicotine replacement treatments

      • Gum, patches, or inhalers

      • Reduce craving for nicotine

      • Combining patch with antidepressants improved success rate

    Treatment of substance related disorders illegal drug abuse and dependence

    Treatment of Substance Related Disorders: Illegal Drug Abuse and Dependence

    • Detoxification central to treatment

    • Psychological treatments

      • Desipramine and CBT showed effectiveness for cocaine use

        • CBT especially helpful for users with high dependence levels (Carroll et al., 1994, 1995)

      • Operant conditioning

        • Tokens that can be traded for desirable goods are given to users who abstain (Dallery et al., 2001)

      • Motivational interviewing or enhancement thereapy

        • CBT plus Rogerian therapy effective for alcohol and drug use (Burke et al., 2003)

      • Self-help residential homes for heroin users

        • Non-drug environment

        • Group therapy

        • Guidance and support from former users

    Treatment of substance related disorders illegal drug abuse and dependence1

    Treatment of Substance Related Disorders: Illegal Drug Abuse and Dependence

    • Drug replacement treatments and medications

    • A meta-analysis of stimulant medication as a treatment for cocaine abuse revealed little evidence that this type of medication is effective

    • Heroin replacements

      • Synthetic narcotics

        • Methadone, levomethadyl acetate, bupreophine

        • Used to wean heroin users from dependence

      • More effective if combined with psychological support & treatment (Lilley et al., 2000)

    Prevention of substance related disorders

    Prevention of Substance-Related Disorders

    • Often aimed at adolescents

    • Utilize some or all of the following elements:

      • Enhancing self-esteem

      • Social skills training

      • Peer pressure resistance training

      • Parental involvement in school programs

      • Warning labels on alcohol bottles

      • Education regarding alcohol impairment

      • Testing for drugs and alcohol at school or work

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