Essentials of understanding abnormal behavior chapter eight
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Essentials of Understanding Abnormal Behavior Chapter Eight. Substance-Related Disorders. Substance-Related Disorders.

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Essentials of Understanding Abnormal Behavior Chapter Eight

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Essentials of Understanding Abnormal BehaviorChapter Eight

Substance-Related Disorders


Substance-Related Disorders

  • Result from the use of psychoactive substances that affect the central nervous system, cause significant social, occupational, psychological, or physical problems, and sometimes result in abuse or dependence.

  • User may become a danger to others.

  • Drug use may result in criminal activities.

  • Use of one substance may lead to use of other substances.


Figure 9.1: Percentage of Persons Who Reported Using Specific Substances at Any Time During Their Lives (Age 12 and Over)


Figure 9.2: Disorders Chart: Substance-Related Disorders


Figure 9.2: Disorders Chart: Substance-Related Disorders (cont’d)


Figure 9.2: Disorders Chart: Substance-Related Disorders (cont’d)


Substance-Related Disorders (cont’d)

  • DSM-IV-TR categories of substance-related disorders:

    • Substance-use disorders: Those involving dependence and abuse

    • Substance-induced disorders: Those involving withdrawal and substance-induced delirium

  • Substance-use disorders differentiated by:

    • Actual substance used

    • Whether disorder pattern is substance abuse or substance dependence


Substance-Related Disorders (cont’d)

  • Substance abuse: Maladaptive pattern of recurrent use that

    • Extends over a period of 12 months

    • Leads to notable impairment or distress

    • Continues despite social, occupational, psychological, physical or safety problems


Substance-Related Disorders (cont’d)

  • Substance dependence: Maladaptive pattern of use over 12-month period, characterized by:

    • Unsuccessful efforts to control use, despite knowledge of harmful effects

    • Takes more of substance than intended

    • Devotes considerable time to activities necessary to obtain the substance


Substance-Related Disorders (cont’d)

  • Tolerance: Increasing doses are necessary to achieve desired effect

  • Withdrawal: Distress/impairment in social, occupational, other areas of functioning or physical or emotional symptoms (e.g., shaking, irritability, inability to concentrate) after reducing or ceasing intake

  • Tolerance or withdrawal indicates physiological dependence.


  • Substance-Related Disorders (cont’d)

    • Intoxication: A substance affecting CNS is ingested and causes maladaptive behaviors or psychological changes

    • Progression to abuse/dependence:

      • Experimentation

      • Early regular use (actively seeking substance)

      • Plan daily activities around drug use

      • Drugs needed to avoid constant dysphoria; obvious physical and mental deterioration


    Substance-Use Disorders

    • Substance abuse, dependence, intoxication, and withdrawal can result from such substances as:

      • Prescription drugs (e.g., Valium)

      • Legal substances (e.g., alcohol)

      • Illegal substances (e.g., cocaine)


    Substance-Use Disorders (cont’d)

    • Alcohol and substance abuse: Second leading cause of disability in the U.S., Canada, and Western Europe

    • Prevalence: 8.2% of population over the age of 11 use illicit drugs (most prevalent among youths and young adults).


    Substance-Use Disorders (cont’d)

    • Nine categories of illicit drug use:

      • Marijuana (including hashish)

      • Cocaine (including crack)

      • Heroin

      • Hallucinogens (including LSD, PCP, etc.)

      • Inhalants

      • Nonmedical use of prescription drugs:

        • Pain relievers

        • Tranquilizers

        • Stimulants

        • Sedatives


    Table 9.1: Characteristics of Various Psychoactive Substances


    Figure 9.3: Past-Month Illicit Drug Use Among Persons Aged 12 and Older, by Race/Ethnicity


    Depressants or Sedatives

    • Cause generalized depression of the central nervous system and a slowing down of responses

    • Include, among other substances:

      • Alcohol

      • Narcotics

      • Barbiturates

      • Benzodiazepines


    Alcohol-Use Disorders

    • Alcoholic: Person who abuses/ is dependent on alcohol

    • Alcoholism: Characterized by abuse of, or dependency on, alcohol, which is a depressant

    • Binge drinking: Person abstains for a while, but is unable to control/moderate intake when drinking resumes


    Alcohol-Use Disorders (cont’d)

    • Pattern of problem drinking:

      • Finds taste unpleasant; swears never to drink again after first bout of drunkenness

      • Heavy drinking serves a purpose (e.g., reduces anxiety)

      • Consumption continues despite negative consequences

      • Preoccupation with alcohol consumption; deterioration of social and occupational functioning


    Alcohol Use

    • Alcohol consumption around the world:

      • 11% of U.S. adults consume 1 oz or more of alcohol per day; 55% drink more than 3 drinks per week; 35% abstain

      • In the U.S, 50% of total alcohol consumed is drunk by only 10% of drinkers, especially ages 18-25

      • Varies according to cultural traditions and gender (in U.S. men drink 2-5 times as much as women)

      • In the U.S., problems in social, medical, physical, and financial costs


    Figure 9.4: Gender, Ethnic, and Age Differences in Self-Reports of Alcohol Use During a One-Month Period


    The Effects of Alcohol

    • Short-term and long-term physiological and psychological effects:

      • Depresses CNS functioning

      • Depends on such factors as a person’s weight, amount of food in stomach, stress, etc.

      • Affects mood and behavior


    The Effects of Alcohol (cont’d)

    • Long-term: Blackouts, tolerance, destruction of brain cells, cirrhosis of liver and other lethal diseases

    • Fetal Alcohol Syndrome (FAS): Alcohol consumption during pregnancy can result in mentally retarded, physically deformed children. No amount of alcohol has been proven safe for consumption during pregnancy.


    Table 9.2: Blood Alcohol Level as a Function of Number of Drinks Consumed and Body Weight


    Other Depressants or Sedatives

    • Narcotics (opiates):

      • Drugs such as opium and its derivatives (morphine, heroin, codeine) that depress the CNS

      • Provide relief from pain, anxiety, tension

      • Tolerance builds rapidly; extreme withdrawal symptoms

      • Prevalence: 0.7% of adult population at some time in their lives; prevalence decreases with age; greater for males than females


    Other Depressants or Sedatives (cont’d)

    • Barbiturates (“downers”): Powerful depressant of CNS that are commonly used to induce relaxation and sleep

      • More lethal than heroin (accidental overdose or combined with alcohol)

    • Polysubstance dependence: Dependence on repeated use of at least 3 substances (excluding caffeine and nicotine) for a period of 12 months

    • Benzodiazepines (e.g., Valium)


    “Club Drugs”

    • Used by 70% of attendees at dance clubs and raves attended by young people

      • Stimulants: Ecstasy/MDMA, LSD, GHB, ketamine, methamphetamine (responsible for largest number of emergency room visits)

      • Benzodiazepines: Rohypnol (“Roofies” or the “date-rape” drug)

    • Ecstasy can cause cardiovascular failure, higher heart rate and blood pressure, heart wall stress, and cognitive deficits.


    Stimulants

    • Stimulant: Central nervous system energizer, inducing elation, grandiosity, hyperactivity, agitation, and appetite suppression

    • Amphetamines: Drugs that speed up CNS activity and produce increased alertness, energy, and sometimes feelings of euphoria and confidence (“uppers”)

      • Prevalence: 2% of U.S. adults at some time in their lives suffer amphetamine use/abuse; more male than female (3-4:1), more for low SES

    • Caffeine is also a stimulant.


    Stimulants (cont’d)

    • Nicotine: Most commonly associated with cigarette smoking, which accounts for 1/6 of deaths in the U.S. and is the single most preventable cause of death. 1 in 3 smokers will die from a smoking-related disease.

      • Prevalence: ~30% Americans over the age of 11 currently use tobacco products

      • Symptoms of nicotine dependence:

      • Unsuccessful attempts to stop or reduce use

      • Attempts to stop lead to withdrawal symptoms

      • Continued use despite serious physical disorder (e.g., emphysema)


    Stimulants (cont’d)

    • Cocaine: Substance extracted from coca plant that induces feelings of euphoria and self-confidence in users (followed by depression)

      • Chronic abuse: Neurophysiological changes in CNS and premature ventricular heartbeats and death

    • Crack: Purified, potent form of cocaine produced by heating cocaine with ether


    Hallucinogens

    • Hallucinogen: Produces hallucinations, vivid sensory awareness, heightened alertness, or perceptions of increased insight

    • Marijuana: The mildest and most commonly used hallucinogen

      • In the US, marijuana is not generally used in a form that is potent enough to cause hallucinations. Hash hish oil, which is 50X more potent than the marijuana usually smoked in the US, does cause hallucinations.

    • Prevalence: 40% over the age of 12 have used at some point (most commonly: ages 18-30), more common for males

    • Lysergic Acid Diethylamide (LSD)

    • Phencyclidine (PCP)


    Etiology of Substance-Use Disorders

    • Biological: Heredity and congenital factors

      • Two types of alcoholism

        • Familial: Family history of alcoholism, suggesting genetic predisposition

        • Non-familial: Suggesting environmental factors

      • Genes have been identified for certain traits in alcoholism.

      • Risk factors: Neurotransmitters, sensitivity or responsiveness to alcohol, CNS functioning


    Etiology of Substance-Use Disorders (cont’d)

    • Psychodynamic: Childhood trauma, especially in oral stage, leads to repression of painful conflicts involving dependency needs

      • Alcohol allows repressed conflicts to be expressed and offers oral gratification to satisfy dependency needs.


    Etiology of Substance-Use Disorders (cont’d)

    • Personality characteristics:

      • Associated with high activity level, emotionality, goal impersistence, sociability

      • Life transitions/maturational events

      • No evidence for “alcoholic personality,” although antisocial behavior and depression are sometimes associated with drinking problems


    Etiology of Substance-Use Disorders (cont’d)

    • Sociocultural factors:

      • More males and young adults than females and older adults

      • More Catholics than Protestants and Jews

      • Rates of alcoholism is NOT related to per capita consumption, although France has high rates of both

      • Parents, peers, and cultural values

        • Two-way street regarding peers: Users seek out other users, and users influence their friends to use


    Etiology of Substance-Use Disorders (cont’d)

    • Behavioral:

      • Anxiety reduction: Approach-avoidance conflict

      • Learned expectations

      • Cognitive influences: Tension-reducing model

        • Alcohol reduces tension and anxiety; relief of tension reinforces drinking behavior

        • Coping responses plus expectancy


    Etiology of Substance-Use Disorders (cont’d)

    • Relapse: Resume drinking after voluntary abstinence

      • Negative emotional states, negative physical states, gender differences (women: interpersonal conflict), social pressure, coping responses

      • Abstinence violation effect: Loss of personal control after drinking begins

      • Biological: Physical dependence; avoid withdrawal symptoms


    Figure 9.5: The Relapse Process


    Theories of the Addiction Process

    • Solomon’s opponent process theory: Conditions that cause drug experimentation have not been identified.

      • Best predictor: Availability

      • Addiction: An acquired motivation (opponent process theory of acquired motivation)

      • Motivation changes with repeated consumption


    Theories of the Addiction Process (cont’d)

    • Wise’s two-factor model: Positive and negative reinforcement

    • Tiffany’s theory of automatic processes: Drug-use behaviors are largely controlled by “automatic” processes, and once activated, drug-use behaviors are highly resistant to change.


    Intervention and Treatment of Substance-Use Disorders

    • Two phases:

      • Removal of abusive substance

      • Long-term maintenance without the substance

    • Detoxification: Alcohol or drug treatment phase characterized by removal of the abusive substance, after which the user is immediately or eventually prevented from consuming the substance


    Intervention and Treatment of Substance-Use Disorders (cont’d)

    • Self-help groups: Alcoholics Anonymous helps many alcoholics; Al-Anon and Alateen offer support to adults and teens living with alcoholics

    • Pharmacological: Use of chemical substances (e.g., Antabuse) to produce aversion to drug

      • Often combined with psychotherapy to develop coping skills and alternative life patterns


    Cognitive and Behavioral Interventions and Treatment

    • Aversion therapy: Response to a stimulus is decreased by pairing the stimulus with an aversive stimulus

    • Covert sensitization: Imagine a noxious stimulus occurring in the presence of a behavior

    • Skills training: Learn to resist peer pressure or temptation; resolve emotional conflicts or problems; more effective communication

    • Reinforcing abstinence: Behavioral reinforcements for abstinence; effective for opioid dependence


    Cognitive-Behavioral Interventions and Treatment (cont’d)

    • Behavioral treatment for cigarette smoking:

      • Aversive procedures have been disappointing, but “rapid smoking” has had positive outcomes.

      • Nicotine fading (gradual withdrawal) more effective

      • Scheduled-interval method more effective than “cold turkey”

      • Relapse prevention: Multicomponent programs effective for quitting smoking


    Cognitive-Behavioral Interventions and Treatment (cont’d)

    • Relaxation and systematic desensitization

    • Motivational: Important and realistic goal setting

    • Stress management and cognitive restructuring; coping with negative emotions and stress

    • Response prevention

    • Controlled drinking: Controversial


    Other Interventions and Treatments of Substance-Use Disorders

    • Multimodal treatment

    • Prevention programs

      • Discourage use before it begins

      • Education

      • Media exposure


    Effectiveness of Treatment

    • Effective, but some studies suggest outcomes have been modest

    • Some individuals recover on their own without treatment

    • No single “best” treatment: Find the best combination of treatments for particular individuals with substance use disorders


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