Substance Dependence

1. Substance Dependence Definition and Etiology

2. DSM-IV Substance Abuse Criteria Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period: • Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household) • Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use) • Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct) • Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights). Alternatively, the symptoms have never met the criteria for substance dependence for this class of substance.

3. DSM-IV Substance Dependence Maladaptive pattern of substance use, leading to clinical impairment or distress, occurring over 12 month period. Three or more of the following: • Tolerence • Need for amounts of substance to achieve intoxication • Markedly diminished effect with continued use of same amount • Withdrawal • Characteristic withdrawal (w/d) syndrome (substance dependent) • Substance or substitute taken to relieve or avoid w/d symptoms • Substance taken in larger amounts or for longer period that was intended

4. Substance Dependence • Persistent desire or unsuccessful efforts to cut down or control substance use • Great deal of time spent in activities related to acquiring, using, or recovering from the substance • Important social, occupational, or recreational activities are given up or reduced because of substance use • Continued substance use despite knowledge of having persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance use

5. Developmental Perspectives Hesselbrock & Hesselbrock, 2006

6. Personal Factors • Temperament • Behavioral undercontrol • Negative affectivity • Five factor model • Neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness • Child Psychopathology • Conduct/behavioral problems • ADHD? • Early use significant risk factor for later dependence

7. Personal Factors • Expectancies • Social facilitation • Enhanced sexual performance and pleasure • Power and aggression • Social assertiveness • Relaxation and tension reduction • Positive expectancies predict: • Initiation of drinking, intention to drink, and drinking rates among middle school students • Role of negative expectancies? • Plays large role in reducing heavy drinking episodes

8. Personal Factors • Poor cognitive functioning • Neuropsychological tests • Memory, attention span, abstract thinking, verbal reasoning, visual-spatial skills • Behavioral inhibition • EEP and ERP brainwaves • Reduced P300 ERP amplitude • Mediators?

9. Environmental Influences • Risk factor vs Causation • Family Violence • Findings inconsistent b/c substances are clustered, sampling bias, no comparison group • Family Interaction • Disease model • Substance dependence or codependency • Systems model • Homeostasis achieved through organization around substance • Behavioral family approach • Behaviors serve as antecedence and reinforcers

10. Environmental Influences • Peer Influences • Close vs distal friends • Same age peers • Deviant peers – which comes first? • Social Support • Social network • Perception • Secular Trends/Birth Cohort • Gender Differences • Ethnicity

11. Deviance proneness model of risk