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Substance Use and Addictive Disorders

Substance Use and Addictive Disorders. Chapter 12. Slides & Handouts by Karen Clay Rhines, Ph.D. American Public University System. Substance Use Disorders. Many drugs are available in our society

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Substance Use and Addictive Disorders

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  1. Substance Use and Addictive Disorders Chapter 12 Slides & Handouts by Karen Clay Rhines, Ph.D. American Public University System

  2. Substance Use Disorders • Many drugs are available in our society • Some are harvested from nature, others derived from natural substances, and still others are produced in a laboratory • Some require a physician’s prescription for legal use; others, like alcohol and nicotine, are legally available to adults • Still others, like heroin, are illegal under all circumstances Comer, Abnormal Psychology, 8e DSM-5 Update

  3. Substance Use Disorders • Recent statistics suggest that drug use is a significant social problem • 22 million people in the U.S. have used an illegal substance within the past month • Almost 24% of all high school seniors have used an illegal drug within the past month Comer, Abnormal Psychology, 8e DSM-5 Update

  4. Substance Use Disorders • What is a drug? • Any substance other than food that affects our bodies or minds • Need not be a medicine or illegal • Current language uses the term “substance” rather than “drug” to overtly include alcohol, tobacco, and caffeine Comer, Abnormal Psychology, 8e DSM-5 Update

  5. Substance Use Disorders • Substances may cause temporary changes in behavior, emotion, or thought • May result in substance intoxication (literally, “poisoning”), a temporary state of poor judgment, mood changes irritability, slurred speech, and poor coordination • Some substances such as LSD may produce a particular form of intoxication, sometimes called hallucinosis, which consists of perceptual distortions and hallucinations Comer, Abnormal Psychology, 8e DSM-5 Update

  6. Substance Use Disorders • Substances can also lead to long-term problems: • Substance use disorder: a pattern of maladaptive behaviors and reactions brought about by repeated use of substances • In many cases, people become physically dependent on the substances, developing a tolerance for it (needing increasing doses to get an effect) and experiencing withdrawal reactions (unpleasant and dangerous symptoms when substance use is stopped or cut down) Comer, Abnormal Psychology, 8e DSM-5 Update

  7. Substance Use Disorders • About 9% of all teens and adults in the U.S. display substance use disorders • The highest rate in the U.S. is found among American Indians (15.5%), while the lowest is among Asian Americans (3.5%) • White Americans, Hispanic Americans, and African Americans display rates between 9 and 10% • Only 11% receive treatment from a mental health professional Comer, Abnormal Psychology, 8e DSM-5 Update

  8. Substance Use Disorders • The substances people misuse fall into several categories: • Depressants • Stimulants • Hallucinogens • Cannabis Comer, Abnormal Psychology, 8e DSM-5 Update

  9. Depressants • Depressants slow the activity of the central nervous system (CNS) • Reduce tension and inhibitions • May interfere with judgment, motor activity, and concentration • Three most widely used depressants: • Alcohol • Sedative-hypnotic drugs • Opioids Comer, Abnormal Psychology, 8e DSM-5 Update

  10. Depressants: Alcohol • The World Health Organization estimates that 2 billion people worldwide consume alcohol • In the U.S., more than half of all residents drink alcoholic beverages from time to time Comer, Abnormal Psychology, 8e DSM-5 Update

  11. Depressants: Alcohol • When people consume 5 or more drinks in a single occasion, it is called a binge-drinking episode • 24% of all people in the U.S. over the age of 11, most of them male, binge-drink each month • Nearly 7% of people over age the age of 11 binge-drink at least 5 times each month • Considered heavy drinkers, males outnumber females by more than 2:1 (around 8% to 4%) Comer, Abnormal Psychology, 8e DSM-5 Update

  12. Depressants: Alcohol • All alcoholic beverages contain ethyl alcohol • It is absorbed into the blood through the stomach lining and takes effect in the bloodstream and CNS • Short-term: alcohol binds to certain neurons • Alcohol helps GABA (an inhibitory messenger) shut down neurons and relax the drinker Comer, Abnormal Psychology, 8e DSM-5 Update

  13. Depressants: Alcohol • The first brain area affected is that which controls judgment and inhibition • Next affected are additional areas in the CNS, leaving the drinker even less able to make sound judgments, speak clearly, and remember well • Motor difficulties increase as drinking continues, and reaction times slow Comer, Abnormal Psychology, 8e DSM-5 Update

  14. Depressants: Alcohol • The extent of the effect of ethyl alcohol is determined by its concentration (proportion) in the blood • A given amount of alcohol has a lesser effect on a large person than on a small one • Gender also affects blood alcohol concentration • Women have less alcohol dehydrogenase, an enzyme in the stomach that metabolizes alcohol before it enters the blood • Women become more intoxicated than men on equal doses of alcohol Comer, Abnormal Psychology, 8e DSM-5 Update

  15. Depressants: Alcohol • Levels of impairment are closely tied to the concentration of ethyl alcohol in the blood: • BAC = 0.06: Relaxation and comfort • BAC = 0.09: Intoxication • BAC > 0.55: Death • Most people lose consciousness before they can drink this much Comer, Abnormal Psychology, 8e DSM-5 Update

  16. Depressants: Alcohol • The effects of alcohol subside only after alcohol is metabolized by the liver • The average rate of this metabolism is 25% of an ounce per hour • You can’t increase the speed of this process! Comer, Abnormal Psychology, 8e DSM-5 Update

  17. Alcohol Use Disorder • Though legal, alcohol is one of the most dangerous recreational drugs • Its effects can extend across the life span • Alcohol use is a major problem on college campuses Comer, Abnormal Psychology, 8e DSM-5 Update

  18. Alcohol Use Disorder • Surveys indicate that 7.4% of all adults in the U.S. display alcohol use disorder over a one-year period while over 13% display it at some point in their lives • Men outnumber women 2:1 • Many teenagers also experience the disorder Comer, Abnormal Psychology, 8e DSM-5 Update

  19. Alcohol Use Disorder • The prevalence of alcoholism in a given year is about the same (7% to 9%) for White Americans, African Americans and Hispanic Americans • The men in these groups show strikingly different age patterns • American Indians, particularly men, tend to display a higher rate of alcohol use disorders than any of these groups • Overall 15% of them have the disorder Comer, Abnormal Psychology, 8e DSM-5 Update

  20. Alcohol Use Disorder • Generally, Asians have lower rates of alcohol disorders than do people from other cultures • As many as one-half of these individuals have a deficiency of alcohol dehydrogenase; thus, they have a negative reaction to even modest alcohol intake Comer, Abnormal Psychology, 8e DSM-5 Update

  21. Alcohol Use Disorder • Clinical Picture • In general, people with alcohol use disorder drink large amounts regularly and rely on it to enable them to do things that would otherwise make them anxious • Eventually the drinking interferes with social behavior and the ability to think and work • Individual patterns of alcoholism abuse vary Comer, Abnormal Psychology, 8e DSM-5 Update

  22. Alcohol Use Disorder • Tolerance and Withdrawal • For many individuals, alcohol use disorder includes the symptoms of tolerance and withdrawal reactions • As their bodies build up a tolerance for alcohol, they need to drink greater amounts to feel its effects • They may experience withdrawal symptoms, including nausea and vomiting, when they stop drinking • A small percentage of these people experience a dramatic and dangerous withdrawal syndrome known as delirium tremens (“the DTs”) • Alcohol withdrawal can be fatal Comer, Abnormal Psychology, 8e DSM-5 Update

  23. Depressants: Alcohol • What is the personal and social impact of alcoholism? • Alcoholism destroys families, social relationships, and careers • Losses to society total many billions of dollars annually • Plays a role in suicides, homicides, assaults, rapes, and accidents • Has serious effects on the children (some 30 million) of persons with this disorder Comer, Abnormal Psychology, 8e DSM-5 Update

  24. Depressants: Alcohol • What is the personal and social impact of alcoholism? • Long-term excessive drinking can seriously damage physical health • Especially damaged is the liver (cirrhosis) • Long-term excessive drinking can cause major nutritional problems • Example: Korsakoff’s syndrome • Women who drink alcohol during pregnancy place their fetuses at risk from fetal alcohol syndrome (FAS) and increased risk of miscarriage Comer, Abnormal Psychology, 8e DSM-5 Update

  25. Depressants: Sedative-Hypnotic Drugs • Sedative-hypnotic (anxiolytic) drugs produce feelings of relaxation and drowsiness • At low doses, they have a calming or sedative effect • At high doses, they function as sleep inducers or hypnotics • Sedative-hypnotic drugs include barbiturates and benzodiazepines Comer, Abnormal Psychology, 8e DSM-5 Update

  26. Depressants: Barbiturates • First discovered more than 100 years ago, barbiturates were widely prescribed in the first half of the 20th century to fight anxiety and to help people sleep • Although still prescribed, they have been largely replaced by benzodiazepines • They can cause many problems, not the least of which is misuse Comer, Abnormal Psychology, 8e DSM-5 Update

  27. Depressants: Barbiturates • Barbiturates are usually taken in pill or capsule form • At low doses, they reduce excitement in a manner similar to alcohol by attaching to the GABA receptors and helping GABA operate • Also similar to alcohol, barbiturates are metabolized by the liver Comer, Abnormal Psychology, 8e DSM-5 Update

  28. Depressants: Barbiturates • At too high a level, they can halt breathing, lower blood pressure, and can lead to coma and death Comer, Abnormal Psychology, 8e DSM-5 Update

  29. Depressants: Barbiturates • Repeated use of barbiturates can quickly result in sedative-hypnotic use disorder • A great danger of barbiturate tolerance is that the lethal dose of the drug remains the same, even while the body is building a tolerance for the sedative effects • Barbiturate withdrawal is particularly dangerous because it can cause convulsions Comer, Abnormal Psychology, 8e DSM-5 Update

  30. Depressants: Benzodiazepines • Benzodiazepines are often prescribed to relieve anxiety • Most popular sedative-hypnotics available • Class includes Xanax, Ativan, and Valium Comer, Abnormal Psychology, 8e DSM-5 Update

  31. Depressants: Benzodiazepines • Benzodiazepines have a depressant effect on the CNS by binding to GABA receptors and increasing GABA activity • Unlike barbiturates and alcohol, however, benzodiazepines relieve anxiety without causing drowsiness • They are also less likely to slow breathing and lead to death by overdose Comer, Abnormal Psychology, 8e DSM-5 Update

  32. Depressants: Benzodiazepines • Once thought to be a safe alternative to other sedative-hypnotic drugs, benzodiazepines can cause intoxication and lead to an addictive pattern of use • As many as 1% of U.S. adults display a sedative-hypnotic use disorder that centers on benzodiazepines at some point in their lives Comer, Abnormal Psychology, 8e DSM-5 Update

  33. Depressants: Opioids • This class of drug includes both natural (opium, heroin, morphine, codeine) and synthetic (methadone) compounds and is known collectively as “narcotics” • Each drug has a different strength, speed of action, and tolerance level Comer, Abnormal Psychology, 8e DSM-5 Update

  34. Depressants: Opioids • Narcotics are smoked, inhaled, injected by needle just under the skin (“skin popped”), or injected directly into the bloodstream (“mainlined”) • Injection seems to be the most common method of use, although other techniques have been increasing in recent years • An injection quickly brings on a “rush” – a spasm of warmth and ecstasy that is sometimes compared with orgasm • This spasm is followed by several hours of pleasurable feelings (called a “high” or “nod”) Comer, Abnormal Psychology, 8e DSM-5 Update

  35. Depressants: Opioids • Opioids create these effects by depressing the CNS • Opioids bind to the receptors in the brain that ordinarily receive endorphins (NTs that naturally help relieve pain and decrease emotional tension) • When these sites receive opioids, they produce pleasurable and calming feelings, just as endorphins do • In addition to reducing pain and tension, opioids can cause nausea, narrowing of the pupils, and constipation Comer, Abnormal Psychology, 8e DSM-5 Update

  36. Depressants: Opioids • Heroin use exemplifies the problems posed by opioids: • After just a few weeks, users may become caught in a pattern of abuse (and often dependence) • Users quickly build a tolerance for the drug and experience withdrawal when they stop taking it • Early withdrawal symptoms include anxiety and restlessness; later symptoms include twitching, aches, fever, vomiting, diarrhea, and weight loss from dehydration Comer, Abnormal Psychology, 8e DSM-5 Update

  37. Depressants: Opioids • Such individuals soon need the drug just to avoid experiencing withdrawal, and they must continually increase their doses in order to achieve even that relief • Many users must turn to criminal activity to support their “habit” and avoid withdrawal symptoms Comer, Abnormal Psychology, 8e DSM-5 Update

  38. Depressants: Opioids • Surveys suggest that close to 1% of adults in the U.S. display opioid use disorder at some time in their lives Comer, Abnormal Psychology, 8e DSM-5 Update

  39. Depressants: Opioids • What are the dangers of opioid use ? • Once again, heroin provides a good example: • The most immediate danger is overdose • The drug closes down the respiratory center in the brain, paralyzing breathing and causing death • Death is particularly likely during sleep • Ignorance of tolerance is also a problem • People who resume use after having avoided it for some time often make the fatal mistake of taking the same dose they had built up to before Comer, Abnormal Psychology, 8e DSM-5 Update

  40. Depressants: Opioids • What are the dangers of opioid use? • Each year approximately 2% of persons addicted to heroin and other opioids die under the drug’s influence • In addition, users run the risk of getting impure drugs • Opioids are often “cut” with noxious chemicals • Dirty needles and other equipment can spread infection Comer, Abnormal Psychology, 8e DSM-5 Update

  41. Stimulants • Stimulants are substances that increase the activity of the central nervous system (CNS) • Cause increases in blood pressure, heart rate, and alertness • Cause rapid behavior and thinking • The four most common stimulants are: • Cocaine • Amphetamines • Caffeine • Nicotine Comer, Abnormal Psychology, 8e DSM-5 Update

  42. Stimulants: Cocaine • Derived from the leaves of the coca plant, cocaine is the most powerful natural stimulant known • 28 million people in the U.S. have tried cocaine • 1.6 million people are currently using it Comer, Abnormal Psychology, 8e DSM-5 Update

  43. Stimulants: Cocaine • Cocaine produces a euphoric rush of well-being • It seems to work by increasing dopamine at key receptors in the brain and overstimulating them • Also appears to increase norepinephrine and serotonin Comer, Abnormal Psychology, 8e DSM-5 Update

  44. Stimulants: Cocaine • High doses of cocaine can produce cocaine intoxication, whose symptoms include mania, paranoia, and impaired judgment • Some people also experience hallucinations and/or delusions, a condition known as cocaine-induced psychosis • As the stimulant effects of the drug subside, the user experiences a depression-like letdown, popularly called “crashing” Comer, Abnormal Psychology, 8e DSM-5 Update

  45. Stimulants: Cocaine • Cocaine use in the past was limited by the drug’s high cost • Since 1984, newer, more powerful, and sometimes cheaper versions of the drug have become available, including: • A “freebase” form where the drug is heated and inhaled with a pipe • “Crack,” a powerful form of freebase that has been boiled down for smoking in a pipe Comer, Abnormal Psychology, 8e DSM-5 Update

  46. Stimulants: Cocaine • What are the dangers of cocaine? • Aside from its behavioral effects, cocaine poses significant physical danger • The greatest danger of use is the risk of overdose • Excessive doses depress the brain’s respiratory function, and stop breathing • Cocaine use can also cause heart failure • Pregnant women who use cocaine have an increased likelihood of miscarriage and of having children with abnormalities Comer, Abnormal Psychology, 8e DSM-5 Update

  47. Stimulants: Amphetamines • Amphetamines are stimulant drugs that are manufactured in the laboratory • Most often taken in pill or capsule form • Some people inject the drugs intravenously or smoke them for a quicker, more powerful effect Comer, Abnormal Psychology, 8e DSM-5 Update

  48. Stimulants: Amphetamines • Like cocaine, amphetamines: • 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 dopamine, norepinephrine, and serotonin Comer, Abnormal Psychology, 8e DSM-5 Update

  49. Stimulants: Amphetamines • One kind of amphetamine, methamphetamine, has had a major surge in popularity in recent years • Almost 6% of all persons over the age of 11 in the US have used this stimulant at least once • Most of the nonmedical meth is made in “stovetop laboratories” • Meth is about as likely to be used by women as men and has gained popularity as a “club drug” Comer, Abnormal Psychology, 8e DSM-5 Update

  50. Stimulant Use Disorder • Regular use of either cocaine or amphetamine may lead to stimulant use disorder • The stimulant comes to dominate the individual’s life • Tolerance and withdrawal reactions may also develop • In a given year, 0.5% of all people over the age of 11 display stimulant use disorder centered on cocaine and 0.25 display it centered on amphetamines Comer, Abnormal Psychology, 8e DSM-5 Update

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