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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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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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