substance use disorders iv chapter 11 april 9 2014 psyc 2340 abnormal psychology brett deacon ph d n.
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Substance Use Disorders IV (Chapter 11) April 9 , 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D. From Last Class. Disease model of alcoholism Twelve step treatment. Twelve Steps of Alcoholics Anonymous. Twelve Step treatment critical analysis:

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substance use disorders iv chapter 11 april 9 2014 psyc 2340 abnormal psychology brett deacon ph d
Substance Use Disorders IV(Chapter 11)April 9, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.
from last class
From Last Class
  • Disease model of alcoholism
  • Twelve step treatment
twelve steps of alcoholics anonymous
Twelve Steps of Alcoholics Anonymous
  • Twelve Step treatment critical analysis:
exam review
Exam Review
  • Chapter 7 (Mood Disorders)
  • Major depressive and manic episodes
  • Nature, causes, and treatment of:
    • Major depressive disorder
    • Bipolar disorder
  • Suicide
  • 15 questions from this section
exam review1
Exam Review
  • Chapter 8 (Eating Disorders)
  • No questions on Sleep Disorders
  • Anorexia
  • Bulimia
  • Causes
  • Treatment
  • 9 questions form this section
exam review2
Exam Review
  • Chapter 11 (Substance-Related Disorders)
  • No questions on Impulse Control Disorders
  • Substance abuse and dependence
  • Alcohol: effects, cultural patterns, disease model
  • Addictive properties of different substances
  • Properties and effects of different substances
  • Treatments
  • 16 questions from this section
drug addictiveness
Drug Addictiveness
  • Which of the following drugs is most addictive?
    • 1. Nicotine
    • 2. Heroin
    • 3. Cocaine
    • 4. Alcohol
    • 5. Caffeine
    • 6. Marijuana
brief review of different substances
Brief Review of Different Substances
  • Sedative, Hypnotics, & Anxiolytics
  • Stimulants
  • Opioids
  • Hallucinogens
  • Other Drugs of Abuse
sedative hypnotic or anxiolytic substance use disorders
Sedative, Hypnotic, or AnxiolyticSubstance use Disorders
  • Drugs in this class
    • Sedatives – calming (e.g., barbiturates)
    • Hypnotic – sleep inducing
    • Anxiolytic – anxiety reducing (e.g., benzodiazepines)
sedative hypnotic or anxiolytic substance use disorders1
Sedative, Hypnotic, or AnxiolyticSubstance use Disorders
  • Effects similar to large doses of alcohol
    • Synergistic effect when combined with alcohol
  • Adverse effects
    • Dependence, tolerance, withdrawal, overdose
  • Nature of stimulants
    • Most widely consumed class of drug in the US
    • Drugs increase alertness and increase energy
    • Examples include amphetamines, cocaine, nicotine, and caffeine
stimulants amphetamines
Stimulants: Amphetamines
  • Used for all-nighters, weight control, and high
  • Effects:
    • Elation, vigor, reduce fatigue
    • Followed by extreme fatigue and depression
  • Prescription stimulants (for ADHD) increasing becoming drugs of abuse
  • The NY Times: When Stimulants Are Bad
stimulants nicotine
Stimulants: Nicotine
  • Approximately 25% of Americans smoke
  • Effects:
    • Stress relief, relaxation, wellness, pleasure
    • Withdrawal: depression, insomnia, irritability, anxiety, increased appetite
  • Highly addictive and extremely difficult to quit
  • Cues that elicit urges to smoke are ubiquitous
  • Users dose themselves frequently
stimulants caffeine
Stimulants: Caffeine
  • Used regularly by 90% of Americans
  • Effects of the “gentle” stimulant
    • Found in tea, coffee, cola drinks, and cocoa products
    • Small doses elevate mood and reduce fatigue
    • Regular use can result in tolerance and dependence
opioids an overview
Opioids: An Overview
  • Opiate – narcotic-like chemical in opium poppy
  • Examples: heroin, opium, codeine, and morphine
  • Effects:
    • Pain relief, euphoria, drowsiness, slowed breathing
    • High doses can be fatal
    • Withdrawal symptoms can be lasting and severe
    • Elevates risk for HIV
    • High mortality rates for addicts
hallucinogens an overview
Hallucinogens: An Overview
  • Substances that alter perceptions of the world
  • Examples: Marijuana, LSD
  • Effects:
    • Delusions, paranoia, hallucinations, and/or altered sensory perception
hallucinogens marijuana
Hallucinogens: Marijuana
  • Active chemical is tetrahydrocannabinol (THC)
  • Effects:
    • Heightened sensory experiences, mood swings, paranoia, hallucinations
    • Varies greatly from person to person
    • Minimal tolerance, withdrawal, dependence
    • Medicinal uses and controversies
hallucinogens lsd
Hallucinogens: LSD
  • Derivative of ergot fungus
  • Effects:
    • Perceptual changes, depersonalization, hallucinations
    • Very rapid tolerance
    • Withdrawal symptoms are rare
    • Can produce psychotic reactions
  • Interesting historical note: LSD and the Salem Witch Trials of 1692
other drugs of abuse steroids
Other Drugs of Abuse: Steroids

“My lawyers have advised me that I cannot answer these questions without jeopardizing my friends, my family and myself.”-Mark McGwire

other drugs of abuse steroids1
Other Drugs of Abuse: Steroids

"I did take a banned substance. And for that, I am very sorry and deeply regretful.“

-Alex Rodriguez

other drugs of abuse steroids2
Other Drugs of Abuse: Steroids
  • Synthesized from testosterone
  • Legitimate medical uses: asthma, anemia, breast cancer, men with inadequate sexual development
  • Used illegally to increase body mass
  • Do not produce a high
  • Long-term mood disturbances and physical problems
causes of substance related disorders
Causes of Substance-Related Disorders
  • Exposure/access to drug is necessary, but not sufficient, for abuse and addiction
  • Use depends on social and cultural expectations
  • Drugs are used because of pleasurable and/or reinforcing effects
  • Reasons for drug abuse are complex
biological influences
Biological Influences
  • Drugs affect the pleasure or reward centers in the brain
  • Biological changes occur with repeated drug use
  • Unlike substance use, substance abuse and dependence has a genetic component
psychological influences
Psychological Influences
  • Positive and negative reinforcement
    • Pleasurable effects
    • Self-medication (cope with negative affect)
  • Expectancy effects
    • Expectancies influence drug use and relapse
social and cultural influences
Social and Cultural Influences
  • Exposure to drugs is a prerequisite for use
    • Media, family, peers
    • Parents and the family appear critical
  • Cultural factors
    • Influence the manifestation of substance use and abuse
social and cultural influences1
Social and Cultural Influences
  • The importance of context
  • 42% of Vietnam war soldiers used heroin
    • Half became dependent in Vietnam
  • Three years after returning home, only 12% were still using heroin
social and cultural influences2
Social and Cultural Influences
  • Societal views about drug abuse
    • Moral weakness
    • Biological disease model (Twelve Steps)
    • “War on drugs”
american culture and drug use
American Culture and Drug Use
  • Assumptions of America’s “War on Drugs”
  • 1. Illicit drug use is bad. How bad?

Criminal Offense Average Prison Sentence

Murder/manslaughter 153 months

Drugs 78 months

Rape 67 months

Burglary 51 months

Aggravated Assault 50 months

Source: U.S. Bureau of Justice Statistics

war on drugs
War on Drugs
  • 2. Illicit drug use is unhealthy, uncontrollable, and addictive
  • 3. Prevention and treatment programs work
    • Project DARE
    • Lynam et al. (1999)
      • 10-year follow-up of 1,000+ 10-year olds
      • Received either DARE or standard drug ed
      • Long-term outcomes
american cultural and drug use
American Cultural and Drug Use
  • 4. People are unable to choose whether or not to take drugs or to regulate their use
    • Thus, prohibition is necessary
  • 5. There is an end to the drug war
    • When is it over exactly?
biological treatments
Biological Treatments
  • Agonist substitution
    • Substitute safer drug with similar chemical composition
    • Examples – methadone, nicotine gum/ patch
  • Antagonistic treatment
    • Blocks or counteracts pleasurable drug effects
    • Examples - naltrexone for opiate and alcohol problems
biological treatments1
Biological Treatments
  • Aversive treatment
    • Makes drug use extremely unpleasant
    • Examples - Antabuse for alcoholism
  • Efficacy of biological treatment
    • Largely ineffective when used alone
psychosocial treatment
Psychosocial Treatment
  • Inpatient vs. outpatient care
    • Comparable efficacy, not cost
  • Controlled use (Sobell study)
  • Project MATCH
    • Compared 12 sessions of twelve step facilitation and CBT, and 4 sessions of motivational enhancement
    • No differences in outcome
    • No control group
psychosocial treatment1
Psychosocial Treatment
  • Community support programs
    • Alcoholics Anonymous and related groups
    • Extremely popular but little evidence of benefits
    • From a 2006 literature review: “No experimental studies unequivocally demonstrated the effectiveness of Alcoholics Anonymous or 12-Step approaches for reducing alcohol dependence or problems.”
  • Confrontation by family and friends
  • Element of surprise, often humiliating
  • Intended to break down “denial” and persuade client to enter treatment
  • Confronts individuals with “cataclysmic consequences” if they do not enter treatment
  • Miller and Sovereign (1989)
    • Two groups: 1) confrontational strategies 2) client-centered motivational interviewing
    • Clients in confrontational group exhibited MORE resistance to treatment than in client-centered group and were more likely to be drinking a year later
  • G. Alan Marlatt, Ph.D: “Once you have the person on board and involved and you have a good continued care program, things will happen in a good way. But if you say, ‘Do this or else,’ you take away a person’s choice and the consequences are negative.”
analysis of intervention programs
Analysis of Intervention Programs
  • Not empirically supported
  • Studies show high rate of entry into treatment following an Intervention, but:
    • High rate of dropout
    • Higher relapse following treatment (Loneck, Garrett, & Banks 1996)